NIOSH EXTRAMURAL RESEARCH

AND TRAINING PROGRAM 

ANNUAL REPORT OF FISCAL YEAR 2020

Prepared by the Office of Extramural Programs

National Institute for Occupational Safety and Health

Centers for Disease Control

and Prevention

National Institute for Occupational 

Safety and Health
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NIOSH EXTRAMURAL RESEARCH 

AND TRAINING PROGRAM

ANNUAL REPORT OF FISCAL YEAR 2020

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 2020

This document is in the public domain and may be freely copied or reprinted.

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for Occupational Safety and Health, Centers for Disease Control and Prevention. In addition, 

citations to websites external to NIOSH do not constitute NIOSH endorsement of the sponsoring 

organizations or their programs or products. Furthermore, NIOSH is not responsible for the 

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 [2022]. NIOSH extramural research and training program: annual report of fiscal year 

2020. By Robison WA, Williams DF, Grandillo P. Atlanta, GA: 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. 2022-120.

DOI: https://doi.org/10.26616/NIOSHPUB2022120

DHHS (NIOSH) Publication No. 2022-120

June 2022
NIOSH Extramural Research and Training Program ■ Annual Report of Fiscal Year 2020 iii

FOREWORD

I am pleased to share with you the fiscal year (FY) 2020 annual 

report on the National Institute for Occupational Safety and 

Health (NIOSH) Extramural Research and Training Program. 

NIOSH aims to lead and support national occupational safety 

and health research and training programs and reduce workrelated injuries and illnesses through a diversified portfolio of 

high-quality extramural research, education, and training. The 

data in this report reflect the achievements of the extramural 

community of researchers supported by NIOSH and the Office 

of Extramural Programs (OEP).

In Section II of 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 highlights how the NIOSH OEP and extramural researchers responded to the coronavirus 

disease 2019 (COVID-19) pandemic.

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

multidisciplinary portfolios with program highlights from FY 2020. In addition, this report now 

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

agreements, which are shown in Section V.

I would like to acknowledge the work of NIOSH OEP 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, M.D.

Director, National Institute for

 Occupational Safety and Health,

Centers for Disease Control and Prevention

“The data in this report 

reflect the achievements of 

the extramural community 

of researchers supported 

by NIOSH and the Office of 

Extramural Programs.”
 

 

AT-A-GLANCE: FY 2020 EXTRAMURAL AWARDS 

In FY 2020, which spanned from October 1, 2019, 

through September 30, 2020, the National Institute 

for Occupational Safety and Health (NIOSH) funded 

153 extramural awards totaling $93,808,025 for 

extramural research and training. This compares with 

66%

Multidisciplinary 

centers 

16%

Investigator-initiated 

research 

9%

Cooperative research 

agreements 

7%

Specialty training 

programs 

2%

Small business 

innovation research 

the FY 2019 figure of $94,896,043 for 167 awards. You

can find more information on annual extramural

funding and awards since 2012 at Extramural

Research and Training Program Annual Reports. 

This year’s funding includes the following: 

iv NIOSH Extramural Research and Training Program ■ Annual Report of Fiscal Year 2020
NIOSH Extramural Research and Training Program ■ Annual Report of Fiscal Year 2020 v

In addition to extramural research and training, the NIOSH Office of Extramural Programs (OEP) 

manages the extramural activities of the World Trade Center (WTC) Health Program. This 

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

Health Program for 2011–2020 are in Section V of this report, separate from all other extramural 

data. The total research funding for the WTC Health Registry and the 84 research projects was $195 

million for 2011–2020. Specifically, for FY 2020, that figure was $23.7 million for the WTC Health 

Registry and 29 research projects. This compares to FY 2019 figures of $24.1 million for the WTC 

Health Registry and 29 research projects.

In FY 2020, NIOSH extramural researchers wrote 

460 peer-reviewed articles in 211 journals. 

Education and Research Centers published the 

most articles (215), followed by investigatorinitiated (R01) research (90). These articles 

appeared most often in the Journal of Occupational 

and Environmental Medicine. Altmetrics data—which 

measure the extent that the public is influenced 

by, exposed to, promotes, and engages with 

research online, in the media and beyond—show 

the following:

■ 9% (41) of the FY 2020 articles ranked in the top 5% of more than 32.9 million research 

outputs scored by altmetric.com

■ 310 (67%) of the articles were mentioned or cited in various ways, including in online research 

forums, blogs, social media sites, and mainstream media

See Extramural Research Impact: Top Articles by Altmetric Score for additional information on 

altmetrics data for extramural publications over more than a decade.

Section IV has more information on publications and program successes from extramural research 

and training during FY 2020, including the following:

■ U.S. Surgeon General highlighting the NIOSH Total Worker Health® approach and Centers of 

Excellence for Total Worker Health (TWH)

■ First National Stand-Down to Prevent Struck-by Incidents in Construction

■ Study predicting wear on shoes to prevent slips, trips, and falls widely shared with footwear 

companies and standards organization

The above highlights do not include those from the WTC Health Program. For information on 

peer-reviewed publications and other outputs or products from the WTC Health Program, see 

Section V of this report.

During the coronavirus disease 2019 (COVID-19) pandemic, NIOSH extramural grantees 

contributed in various ways. Staff from 28 extramurally funded institutions provided their expertise 

to help NIOSH in the COVID-19 response effort through Interagency Personnel Agreements (IPAs). 

Additionally, some state surveillance programs requested to redirect their funding and staff 

towards COVID-19 activities. For more details, see Section III of this report.
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NIOSH Extramural Research and Training Program ■ Annual Report of Fiscal Year 2020 vii

TABLE OF CONTENTS

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

AT-A-GLANCE: FY 2020 EXTRAMURAL AWARDS  . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  IV

LIST OF ABBREVIATIONS  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  VIII

LIST OF FIGURES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . VIII

LIST OF TABLES  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  IX

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 2020  ..........................................  3

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

Extramural Research Portfolio FY 2020 ..................................  5

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

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

Cooperative Agreements  ..........................................  9

Specialty Training Programs ........................................  11

Small Business Innovation Research  ................................  12

Extramural Research Trend Data  .......................................  13

Extramural Research and Training Funding and Awards, FY 2015–2020  ..  13

Success Rates for Research Project Grants, FY 2010–2020  ..............  14

III. COVID-19  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  17

IV. FY 2020 EXTRAMURAL RESEARCH PROGRAM HIGHLIGHTS  . . . . . . . . . . . . . . . .  18

Multidisciplinary Centers .............................................. 19

Investigator-initiated Research ......................................... 37

Cooperative Research Agreements...................................... 43

Specialty Training Programs ........................................... 48

V. WORLD TRADE CENTER (WTC) HEALTH PROGRAM  . . . . . . . . . . . . . . . . . . . . . . . .  56

WTC Health Program 

Research Portfolio Overview ........................................... 57

WTC Health Registry .................................................. 60

APPENDIX  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  62
viii NIOSH Extramural Research and Training Program ■ Annual Report of Fiscal Year 2020

LIST OF ABBREVIATIONS

SECTOR PROGRAMS

ALL All Sectors or Multiple Sectors

AFF Agriculture, Forestry, and Fishing

CON Construction

HSA Healthcare and Social Assistance

MNF Manufacturing

MIN Mining

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 2020 . .

Figure 2. Multidisciplinary center awards, FY 2020 . .

Figure 3. Research funding by sector program, FY 2020 . .

Figure 4. Cooperative agreements, FY 2020 . .

Figure 5. NIOSH extramural funding and awards, FY 2015–2020 . . 

Figure 6. Overall success rates for research project grants, FY 2010–2020 . . 

Figure 7. Success rates for R01 applications, FY 2010–2020 . . 

Figure 8. Success rates for R03 applications, FY 2010–2020 . . 

Figure 9. Success rates for R21 applications, FY 2010–2020 . . 

Figure 10. Research funding for 2011–2020 research cooperative agreements, 

WTC Health Registry, and research contracts . . 

Figure 11. Research studies and publications by primary focus area . . 

Figure 12. WTC Health Registry key scientific outputs including 

publications and presentations, 2004–2020 . . 
NIOSH Extramural Research and Training Program ■ Annual Report of Fiscal Year 2020 ix

LIST OF TABLES

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

Table 2. Summary of all awards by type of funding in FY 2020  . . . . . . . . . . . . . . . . . . . . . . . .   

Table 3. Investigator-initiated research and conference grant funding, FY 2020  . . . . . . . . .   

Table 4. ERC trainees, graduates, and employment, FY 2020  . . . . . . . . . . . . . . . . . . . . . . . . . .   3

Table 5. ERC graduate employment by work setting, FY 2020  . . . . . . . . . . . . . . . . . . . . . . . . .   3

Table 6. Continuing education courses by discipline, FY 2020  . . . . . . . . . . . . . . . . . . . . . . . . .   3

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

discipline, FY 2020  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .   5

Table 8. Emergency responder training classes, FY 2020  . . . . . . . . . . . . . . . . . . . . . . . . . . . . .   5

Table 9. World Trade Center Health Program funding, FY 2020  . . . . . . . . . . . . . . . . . . . . . . .   5
NIOSH Extramural Research and Training Program ■ Annual Report of Fiscal Year 2020 1

I. NIOSH EXTRAMURAL RESEARCH AND 

TRAINING PROGRAM

The National Institute for Occupational Safety and Health (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, the 

Commercial Fishing Occupational Safety Research and Training Program, and new funding for 

the National Robotics Initiative, in collaboration with the National Science Foundation, enhance 

the breadth and depth of extramural research and training at NIOSH. The NIOSH Extramural 

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 V 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 2020.

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 evidence-based 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. Research priorities are organized by 

program area and outlined in the NIOSH Strategic Plan for FY 2019–2024. These goals are used 

for extramural program and projects by researchers outside of NIOSH, except for those under 

the WTC Health Program.

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 2020

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 Health Hazard Evaluations

Center for Direct Reading and Sensor Technologies Nanotechnology

Center for Maritime Safety and Health Studies National Center for Productive Aging and Work

Center for Motor Vehicle Safety Occupational Health Equity

Center for Occupational Robotics Research Personal Protective Technology

Center for Work and Fatigue Research 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
NIOSH Extramural Research and Training Program ■ Annual Report of Fiscal Year 2020 3

II. NIOSH EXTRAMURAL RESEARCH

FUNDING DISTRIBUTION FY 2020

In FY 2020, NIOSH awarded $93,808,025 in extramural funding for 153 projects. Data for the 

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

awards by activity for FY 2020. The majority (66%) of extramural funding went to multidisciplinary 

centers, followed by 16% for investigator-initiated and career development research grants. Other 

cooperative research agreements made up 9% of the FY 2020 grant distributions, followed by 

specialty training programs (7%), and small business innovation research projects (2%).

Figure 1. NIOSH extramural grant distribution, FY 2020

In FY 2020, NIOSH presented 153 awards: 40 (26%) for new projects and 113 (74%) for continuing 

awards. Table 2 summarizes all NIOSH extramural awards for FY 2020. Of these awards,

■ 49 (32%) funded investigator-initiated research and career development;

■ 36 (24%) 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®;

■ 32 (21%) funded specialty training programs;

■ 30 (20%) funded cooperative research agreements; and

■ 6 (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 2020

SUMMARY OF ALL AWARDS BY TYPE OF FUNDING

Table 2. Summary of all awards by type of funding in FY 2020

Award Category Award Mechanism

Number 

of Awards Funding

Multidisciplinary Centers 36 $62,115,975

Education and Research Centers* Training Grant (T42) 18 $29,333,381

Centers for Agricultural Safety and Health Cooperative Research 

Agreement (U54)

11 $19,028,001

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 $8,004,593

Investigator-initiated Research Grants 49 $15,174,357

Research Grants Investigator-initiated 

(R01, R03, R21, 

R13, U13)

34 $13,290,265 

Career Developmental Research Mentored Career 

Scientist (K01)

13 $1,384,166

National Robotics Initiative Interagency Research 

Grant Agreements

2 $499,926

Cooperative Research Agreements 30 $8,202,123

State Surveillance Program Cooperative Research 

Agreement (U60)

26 $6,536,879

Occupational Safety & Health Surveillance 

Collaboration, Education & Translation

Cooperative Research 

Agreement (U24)

1 $225,000

National Mesothelioma Virtual Bank Cooperative Research 

Agreement (U24)

1 $1,068,089

Commercial Fishing Occupational 

Safety Research

Cooperative Research 

Agreement (U01)

2 $372,155

Specialty Training Programs 32 $6,465,790

Training Project Grants Training Grant (T03) 28 $5,076,944

Miner Safety and Health Training Program Cooperative Research 

Agreement (U60)

2 $970,154

Commercial Fishing Occupational 

Safety Training†

Training Grant (T03) 2 $418,692
NIOSH Extramural Research and Training Program ■ Annual Report of Fiscal Year 2020 5

Award Category Award Mechanism

Number 

of Awards Funding

Small Business Innovation Research 6 $1,849,780

Small Business Innovation Research Phase I (R43) & Phase 

II (R44)

6 $1,849,780

Total Extramural Funding 153 $93,808,025

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

These data are shown in Section V of this report.

*$20,000 of ERC funds were obligated using Total Worker Health program funds during FY 2020. However, as the grant 

operated out of the ERC, the entirety of the grant is reported under the ERC total.

†

During FY 2020, no financial obligations were made towards four Commercial Fishing Research Occupational Safety Research cooperative agreements and five Commercial Fishing Occupational Safety Training grants. These projects received 

all funding in FY 2019 and remained active in FY 2020 using FY 2019 funds.

EXTRAMURAL RESEARCH PORTFOLIO FY 2020

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 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 $62.1 million to 36 multidisciplinary centers in FY 2020 (see 

Figure 2).

Section IV describes each of these center portfolios and lists individual center grants.
6 NIOSH Extramural Research and Training Program ■ Annual Report of Fiscal Year 2020

Figure 2. Multidisciplinary center awards, FY 2020

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)

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

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

National Robotics Initiative

In FY 2020, NIOSH awarded $1.5 million to fund studies of collaborative robots, or co-robots, in 

the workplace through a partnership with the National Science Foundation (NSF) and its National 

Robotics Initiative 2.0. The Initiative supports research in the United States that will accelerate 

the development and use of co-robots, an emerging robotic technology that complements, not 

replaces, human workers.
NIOSH Extramural Research and Training Program ■ Annual Report of Fiscal Year 2020 7

Through this funding mechanism, two academic institutions—University of Illinois at Chicago 

and Worcester Polytechnic Institute—will receive $1.5 million over a 3-year funding period. Their 

projects aim to reduce workers’ exposures to hazards through the development and use of 

co-robots and are described below:

■ University of Illinois at Chicago

Project Title: Customizable Lower-limb Wearable Robot Using Soft-wearable Sensor to Assist 

Occupational Workers

In manufacturing, lifting heavy objects can lead to costly and disabling work-related 

musculoskeletal disorders. Wearable robots, which provide mechanical assistance to the user’s 

joints, have the potential to reduce injuries from heavy lifting. Researchers at the University of 

Illinois Chicago will develop and investigate the effectiveness of a personalized wearable robot 

worn on the lower body that senses the wearer’s physical effort and responds accordingly using 

soft-wearable electronics. Research objectives include improving customization, enhancing softwearable electronics with the goal of improving on and replacing conventional sensors, and 

integrating and evaluating the personalized assistance achieved using soft-wearable sensor 

measurements in a physically intensive activity, such as lifting using an ankle exoskeleton. More 

information on this project can be found on the NSF webpage.

■ Worcester Polytechnic Institute

Project Title: Transparent and Intuitive Teleoperation Interfaces for the Future Nursing Robots 

and Workers

In healthcare, remote-controlled nursing robots have the potential to reduce workload and risk 

of infection, especially in quarantine and intensive care environments. Researchers at Worcester 

Polytechnic Institute will develop and evaluate a more intuitive interface to make it easier for 

nurses to operate robots from a distance. Researchers also will investigate the psychological and 

social impacts on workers in the nursing field, educators, and students as well as best practices 

for integrating robots into current nursing education. More information on this project can be 

found on the NSF webpage.

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 2020, NIOSH funded one R13 conference 

grant and three U13 cooperative agreement conference grants (see Table 3).
8 NIOSH Extramural Research and Training Program ■ Annual Report of Fiscal Year 2020

Table 3. Investigator-initiated research and conference grant funding, FY 2020

Grant 

Type

New 

Awards New Funding

Continuing 

Awards

Continuing 

Funding Total Funding

R01 4 $2,012,228 18 $9,558,404 $11,570,632

R21 6 $1,322,626 4 $722,589 $2,045,215

K01 3 $323,991 10 $1,060,175 $1,384,166

R03 0 $0 0 $0 $0

R13 0 $0 1 $19,438 $19,438

U13 0 $0 3 $154,906 $154,906

Total 13 $3,658,845 36 $11,515,512 $15,174,357

NIOSH awarded $15.2 million to new and continuing research projects, mentored scientist 

grants, and conference grants in FY 2020 (see Table 3). Section IV describes investigator-initiated 

research outputs.

Extramural Research Activity by Industry Sector

NIOSH has research programs for each of the ten industry sectors of NORA. Figure 3 shows FY 2020 

funding for investigator-initiated research and career development research across the sectors. 

Extramural research in FY 2020 took place across most of the NIOSH sector program areas except 

Oil and Gas Extraction (OGE). Agriculture, Forestry and Fishing (AFF), Healthcare and Social Assistance 

(HSA), and Manufacturing (MNF) received the most funding, followed by All Sectors* (ALL). 

*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 3. Research funding by sector program, FY 2020
NIOSH Extramural Research and Training Program ■ Annual Report of Fiscal Year 2020 9

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 2020 totaled $8.2 million and included longstanding state surveillance programs and funding for Occupational Safety and Health Surveillance 

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

Commercial Fishing Occupational Safety Research and Training Program also received funding. 

Figure 4 shows how NIOSH distributed funds and how many cooperative research agreements 

received funding.

Figure 4. Cooperative agreements, FY 2020
10 NIOSH Extramural Research and Training Program ■ Annual Report of Fiscal Year 2020

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 2020.

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 and nongovernmental organizations are also able to leverage current relationships 

and new partnerships to use and promote surveillance data for action. For example, these 

nongovernmental organizations 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 2020, 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 (NMVB) for Translational Research advances translational 

research for the scientific community by collecting quality data and biospecimens, or human body 

materials, for mesothelioma research. Participating institutions share independent collections 

of tissues and other relevant information through this virtual registry and tissue bank, and the 

research community uses these resources as a network of collaborators in the registry. Developed 

in 2006, NMVB continues advancing biomedical research for malignant mesothelioma by expanding 

the collection of biospecimens, related data, and other information. NMVB gives researchers access 

to clinical data associated with a multitude of biospecimens and provides associated demographic 

data such as age, sex, race, occupational history, and other epidemiologic information. It also 

serves as a repository, providing a library of information on substances, chemical compounds, 

and other data related to mesothelioma that can be shared among investigators. NMVB supports 

scientific discovery, identifies and develops early markers of the disease, 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. NMVB may ultimately help improve the quality of life of current and former workers 

who have malignant mesothelioma.
NIOSH Extramural Research and Training Program ■ Annual Report of Fiscal Year 2020 11

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. In FY 

2019–2020, the Commercial Fishing Occupational Safety Research and Training Program paid 

up to 50% of an organization’s costs. Each award ranged from $150 thousand to $650 thousand 

over a 2-year funding period. In FY 2020, NIOSH and the U.S. Coast Guard had six active research 

cooperative agreements and seven training projects. We note that no financial obligations were 

made towards four of the cooperative agreements and five training grants during FY 2020. These 

projects received all funding in FY 2019 and remained active in FY 2020 using FY 2019 funds. 

You can find a list of all commercial fishing research projects below and the training projects are 

discussed at the end of the next section under Specialty Training Programs.

■ Fishing Partnership Health Plan (Burlington, MA)

Project Title: A Feasibility Study to Inform a Multi-year Comprehensive Health and Safety 

Initiative for Commercial Fishermen in the Northeastern United States

Project Title: Evaluating the Benefits and Costs of Broadband VMS+ IoT Solutions for Fishing 

Vessel Performance, Diagnostics, and Safety at Sea in New England

■ Northeast Center for Occupational Health and Safety in Agriculture, Forestry, and Fishing 

(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

■ 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). The majority of TPGs are academic programs that support undergraduate, graduate, and 
12 NIOSH Extramural Research and Training Program ■ Annual Report of Fiscal Year 2020

postgraduate training, including the Association of Occupational and Environmental Clinics, which 

has a unique TPG through its Occupational Health Internship Program. Other TPGs reach targeted 

worker populations to meet their education needs. For example, the Alaska Marine Education 

Association has a grant focused on training a national network of fishing safety instructors in a 

Marine Safety Instructor-training course to address high fatality rates in commercial fishing. The 

Emergency Responder Training Program is another TPG through the International Association of 

Fire Fighters (IAFF). 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. It aims to address the significant 

challenges of the mining industry. 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.

The following seven training projects are funded under the partnership between NIOSH and the 

U.S. Coast Guard through the Commercial Fishing Occupational Safety Research and Training 

Program. 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

Project Title: Commercial Fishing Safety Training and Materials Development

■ Fishing Partnership Health Plan (Burlington, MA)

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

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

Project Title: Improving Monthly Drills and Instruction in East Coast Fisheries by Developing 

Relevant Training Aids

■ 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 2020.

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 
NIOSH Extramural Research and Training Program ■ Annual Report of Fiscal Year 2020 13

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 2020 SBIR grants.

EXTRAMURAL RESEARCH TREND DATA

Extramural Research and Training Funding and Awards,

FY 2015–2020

Figure 5 shows the total amount of extramural funding for each fiscal year from FY 2015 through 

FY 2020, along with the number of funded projects per year. These data include funding for all 

grants and cooperative agreements in the NIOSH extramural portfolio, including multidisciplinary 

centers, other cooperative agreements, investigator-initiated and career development research 

grants, and training grants. This information shows how NIOSH invested in its extramural research 

and training over time. You can find more information on annual extramural funding and awards 

at Extramural Research and Training Program Annual Reports. 

Figure 5. NIOSH extramural funding and awards, FY 2015–2020
14 NIOSH Extramural Research and Training Program ■ Annual Report of Fiscal Year 2020

Success Rates for Research Project Grants, FY 2010–2020

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 6 shows that throughout FY 2010–2020, the success rate remained stable until FY 2013, 

when it decreased from 23% to 1% in FY 2017 due to funding shortages. However, in FY 2018, the 

success rate increased to 10% and remained stable before slightly declining to 4% this year. For 

FY 2010–2020, the mean annual number of applications was 170, the mean number of awards 

was 20, and the mean annual success rate was 12%. Figures 7–9 show the success rates for each 

research mechanism. 

Figure 6. Overall success rates for research project grants, FY 2010–2020
NIOSH Extramural Research and Training Program ■ Annual Report of Fiscal Year 2020 15

Figure 7. Success rates for R01 applications, FY 2010–2020

Figure 8. Success rates for R03 applications, FY 2010–2020
16 NIOSH Extramural Research and Training Program ■ Annual Report of Fiscal Year 2020

Figure 9. Success rates for R21 applications, FY 2010–2020
NIOSH Extramural Research and Training Program ■ Annual Report of Fiscal Year 2020 17

III. COVID-19

In FY 2020, the world faced the global coronavirus disease 2019 (COVID-19) 

pandemic. For the Centers for Disease Control and Prevention (CDC), this was 

the largest emergency response in its 74-year history. Along with many NIOSH 

employees, nearly one third of OEP staff contributed to CDC’s COVID-19 response 

through varied roles.

Additionally, early in the COVID-19 response effort, NIOSH identified a need to increase the national 

capacity for occupational technical assistance to employers, workers, and public health officials 

for workplaces. To address this need, NIOSH utilized existing extramural partnerships to obtain 

Interagency Personnel Agreements (IPAs) with occupational safety and health experts across 

the United States as a mechanism to increase the national capacity for occupational technical 

assistance. NIOSH grantees responded to requests to contribute their expertise in various 

areas, including return-to-work, to help NIOSH with various activities that support industries as 

employees return to the workplace. NIOSH used the IPA mechanism to partner with 47 individuals 

from 28 academic institutions. These included staff from NIOSH-funded multidisciplinary centers 

and state surveillance programs and extramural scientists with investigator-initiated research 

projects. Established in August 2020, the NIOSH IPA program is highly successfully at providing 

occupational technical assistance in a wide variety of workplaces and has significant impact at 

national and local levels.

Two of the 26 NIOSH-funded state surveillance programs also requested permission from Health 

and Human Services (HHS)/CDC to redirect their extramural funding towards COVID-19 activities. 

They reassigned staff to support varied COVID-19 related roles within their states, including 

activities such as contact tracing; COVID-19 surveillance and epidemiology; infection control and 

mitigation; COVID-19 communication initiatives; food and medical delivery; management of COVID19 hotlines; support of healthcare systems with data, guidance, education, personal protective 

equipment, medical personnel, and ventilators; and education and training for government 

leadership, media, and the public.
18 NIOSH Extramural Research and Training Program ■ Annual Report of Fiscal Year 2020

IV. FY 2020 EXTRAMURAL RESEARCH

PROGRAM HIGHLIGHTS

Selected outputs, outcomes, and accomplishments 

of NIOSH-funded extramural research and training 

during FY 2020 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, 2019, through September 30, 2020, NIOSH-funded extramural research led to 

460 peer-reviewed publications in 211 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=37), followed by the American Journal 

of Industrial Medicine (n=26), the Journal of Agromedicine (n=23), 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 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. Of the 460 

extramural articles, 310 (67%) were mentioned or cited in the 

ways described 5,826 times, most often on Twitter and in the 

news media. There was an average of 19 mentions per article, 

and 41 (9%) of the articles ranked in the top 5% of more than 

32.9 million research outputs (journal articles, white papers, 

reports, etc.) scored by altmetric.com. Data from altmetric 

were obtained July 21, 2021.

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 2020.
NIOSH Extramural Research and Training Program ■ Annual Report of Fiscal Year 2020 19

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

 Overview

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 more than 30 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.

The Ag Centers made significant contributions 

to public health in FY 2020:

■ Integrating skill and know-how from 

multiple disciplines, institutions, 

and community partners to solve 

complex problems.
20 NIOSH Extramural Research and Training Program ■ Annual Report of Fiscal Year 2020

■ 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.

 Research Outputs: 

Publications in FY 2020

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, 2019, through September 30, 2020, Ag 

Centers published 59 articles in peer-reviewed 

journals. Find a searchable database of 
NIOSH Extramural Research and Training Program ■ Annual Report of Fiscal Year 2020 21

NIOSH publications, which includes grantee 

final reports and publications, by using the 

NIOSHTIC-2 publications search.

 Program Highlights in FY 2020

Cross-center Collaborations to 

Protect the Safety and Health of 

Workers

The NIOSH-supported Ag Centers have a 

long history of cross-center collaboration, 

including outreach, educational, evaluation, 

and research activities. These partnerships 

among the centers have created a strong, 

nationwide network of academic and medical 

research institutions devoted to addressing 

morbidity and mortality among AFF workers, 

and their families. While housed in 11 

institutions across the country, this network 

is driven and maintained by a large group of 

interconnected researchers, communicators, 

educators, evaluators, and other contributors. 

Many of these individuals train and work at 

other institutions in the network outside of 

their own. The camaraderie created through 

the shared histories and experiences of those 

in the network strengthens their collective 

approach and impact while improving the lives 

of people working in AFF.

Additionally, many of the collaborations and 

connections between the Ag Centers develop 

through their outreach efforts. The Centers have 

numerous long-standing collaborative initiatives. 

Evaluation, coordination, and outreach staff 

at the centers network through regular 

meetings and support each other in various 

aspects of their center’s outreach activities. 

These meetings and connections improve 

efficiency and create synergies in areas where 

centers are working on the same topic or with 

similar target populations. Examples include 

fact sheets created by one center and used 

by others, and the coordination and sharing 

of multilingual materials and educational 

campaigns. Next are examples how the Ag 

Centers work together to respond to particular 

workforce needs.

Using YouTube for Widespread Reach 

and Awareness in Agriculture, Forestry, 

and Fishing

In 2013, the Ag Centers partnered to start 

a YouTube channel that uses videos to 

raise awareness of hazards and provides 

information to prevent injuries and illnesses 

in AFF. The videos are posted in multiple 

languages including English, Spanish, and 

K’iche. Through YouTube, the centers also 

aim to increase their visibility and sphere of 

influence and create a model of collaborative 

work that can be used by other organizations. 

The centers set up policies, procedures, 

and a standard review process for videos 

posted on its YouTube page to ensure 

high scientific standards. They have a joint 

marketing plan to promote the channel to 

agricultural cooperative extension agents, 

educators, producers, owners, operators, 

first responders, families, and community 

organizations. The centers disseminate 

this information through email, social 

media, conference presentations, and 

outreach exhibits.

The YouTube channel currently features 167 

videos, which are the total number that have 

been posted since 2013. People watched the 

videos 426,764 times from 2013 through 2020. 

The videos with the most views are on safe 

use of chain saws and grain bin safety. In FY 

2020, people viewed the videos 108,050 times. 

You can find more information on this project 

at the links below.

Details:

■ U.S. Agricultural Safety and Health Centers

■ Development of an Educational YouTube 

Channel: A Collaboration Between U.S. 

Agricultural Safety and Health Centers

Preventing Injuries and Death Through 

the Rollover Protective Structures 

Program

Tractor overturns, a long-standing concern 

in agriculture, are the leading cause of farmrelated fatalities. Recognizing this problem, 
22 NIOSH Extramural Research and Training Program ■ Annual Report of Fiscal Year 2020

the Ag Centers have been active since their 

beginning to try to lessen the circumstances 

that lead to these tragic incidents. Rollover 

protective structures, or ROPS, which became 

standard tractor equipment in 1985, help 

prevent injuries from tractor overturns. 

However, many tractors made before that 

time are still in use. The Ag Centers proposed 

the National Agricultural Tractor Safety 

Initiative in 2004, a broad plan of action to 

bolster ROPS efforts. Since this time, the 

centers have worked individually on specific 

research or technical ROPS issues while 

also cooperating and supporting each other 

collectively on varied ROPS-related projects 

including education and outreach. Notably, 

the Northeast Center for Occupational 

Health and Safety created a successful 

ROPS Rebate Program in New York State, 

addressing barriers that farmers face related 

to retrofitting or adding ROPS on tractors. The

program relies on state funding to provide 

incentives, such as a rebate of approximately 

70% of the cost to retrofit a tractor (including 

purchase of the ROPS kit, shipping, and 

installation). A cost-inclusive evaluation of 

the program showed ROPS saved more than 

$4 million in prevented deaths and injuries 

among New York State farm workers from 

2007 through 2017.

In 2017, the Northeast Center started building 

on National Tractor Safety Coalition (NTSC) 

efforts to launch a National ROPS Rebate 

Program. The center collaborates with NTSC 

partners to address manufacturing design 

and supply concerns related to ROPS. They 

also work together to increase interest among 

agricultural partners related to expanding the 

National ROPS Rebate Program. To support 

this effort, Northeast Center researchers 

recently conducted a study on how interested 

groups in agriculture perceive the expansion 

of the ROPS Rebate Program and the use 

of media as an implementation strategy for 

agricultural safety. In FY 2020, the research 

team analyzed their results and developed 

recommendations, published in BMC Public 

Health. The study showed the importance 

of using media before, during, and after 

implementation of a ROPS program to get 

and sustain support. Scientists also received a 

NIOSH-funded investigator-initiated research 

grant (R01) in FY 2020 to put strategies into 

place from the study to create a ROPS Rebate 

Program in states at high risk for overturn 

fatalities. This new project will focus on three 

high-risk states—Kansas, Iowa, and Missouri.

The previously mentioned ROPS efforts show 

how coordination and collaboration among 

the Ag Centers can be topic focused. These 

also illustrate how each center’s involvement 

can fall on varied points of the research to 

practice (r2p) spectrum.

Details:

■ Northeast Center for Occupational Health 

and Safety Agriculture, Forestry, and Fishing: 

Summary Annual Report Fiscal Year 2020

■ Stakeholder Experiences Implementing 

a National ROPS Rebate Program: A 

Grounded Theory Situational Analysis

■ An Exploration of Rollover Protective 

Structures (ROPS) Rebate Program Media 

Coverage: Strategies for Implementation 

and Sustainment

■ Outside NIOSH: Costs From Injuries and 

Deaths Decrease After State Program 

Promotes Rollover Protective Structures for 

Tractors

■ NIOSH Agricultural Safety and Health 

Centers: National Agricultural Tractor Safety 

Initiative January 2004

National Farm Safety and Health Week

In 1944, the National Safety Council began 

recognizing National Farm Safety and 

Health Week (NFSHW). The same year, U.S. 

President Franklin D. Roosevelt proclaimed 

it as a nationally recognized week, and every 

president since then has done the same. 

During this third week in September, the goal 

is to widely promote messages and resources 

on a range of farm safety and health topics. 
NIOSH Extramural Research and Training Program ■ Annual Report of Fiscal Year 2020 23

Each day of the week has a different theme, 

and the weekly theme changes annually. 

Because agriculture ranks among the most 

hazardous industries, with farmers remaining 

at very high risk for fatal and nonfatal injuries, 

NFSHW continues to remain relevant in the 

AFF sector. Since 2014, the Ag Centers have 

collaborated on an annual NFSHW campaign, 

partnering to create and disseminate a 

campaign communication toolkit that includes 

resources aligned with the NFSHW daily 

themes that amplify useful communication 

tools, like the National YouTube Channel. 

The toolkit also highlights best practices and 

offers guidance and other critical information 

related to agricultural safety and health. 

The centers designed the toolkit for users to 

share via multiple communication channels, 

including social media, websites, and print and 

broadcast media.

NFSHW 2020 featured the overall theme of 

Every Farmer Counts, and the Ag Centers 

shared their toolkit resources, which fit with 

each daily theme during the week, via social 

media channels. Data collected from 9 of 

11 centers on Twitter and Facebook (FB) 

metrics showed that people viewed their FB 

posts more than 11,000 times. More than 

1,500 FB users engaged with these posts 

by either liking, sharing, or commenting on 

them. Centers estimate that all Twitter posts 

combined reached more than 12,000 users.

Details:

■ Upper Midwest Agricultural Safety and 

Health Center – National Farm Safety and 

Health Week 2020

Saving Lives Through Telling the Story

“We don’t want this to happen to anyone 

else” is the basic message of the Telling 

The Story Project. It uses personal stories 

and first-hand experiences from farmers 

and other agricultural workers, along with 

their families and community members, to 

reach at-risk populations in the agricultural 

industry. This project is based on research

from public health, psychology, sociology, 

and organizational development that 

supports the use of storytelling as an effective 

communication and marketing approach.

Through storytelling, the individuals featured 

in the Telling The Story Project discuss ways 

they have been impacted by injuries, fatalities, 

and close calls or circumstances where they 

could have been hurt. Their narratives are 

told in their own words and provide valuable 

information and insight to help prevent 

others from having similar incidents in the 

future. The Telling The Story Project started 

in 2016 and is a collaborative outreach and 

educational campaign between four centers 

in the Midwest—the Central States Center for 

Agricultural Safety and Health, Great Plains 

Center for Agricultural Health, Upper Midwest 

Agricultural Safety and Health Center, and 

National Farm Medicine Center.

More information about this project is 

available at the website shown below, which 

has over 18,000 views. Created by the Telling 

The Story team, the website highlights the 

personal narratives, along with videos, 

educational resources, safety vignettes, and 

study or discussion guides related to safety 

and health in AFF. Web visitors downloaded 

the study guides more than 300 times since 

their creation in 2018. These resources 

provide additional information on the hazards 

outlined in each featured story. Multiple 

news outlets in the agricultural industry have 

featured stories from the Telling The Story 

Project. These include the Angus Beef Bulletin, 

Wisconsin State Farmer, Morning Ag Clips, and 

AgNet West.

Details:

■ Telling The Story: Tell a Story, Save a Life

■ Being in a Hurry Is No Excuse for an 

Unsafe Act

■ New Project Helps Farmers Share 

Safety Messages

■ Telling The Story Project Saving Lives
24 NIOSH Extramural Research and Training Program ■ Annual Report of Fiscal Year 2020

Developing a National Model of 

Agricultural Safety and Health 

Education

In 1987, the Agricultural Health and Safety 

Course started at the University of Iowa (UI) 

College of Public Health. Originally focused on 

medical professionals, the course expanded 

to include safety professionals and others 

working with agricultural communities. This 

educational program focuses on key health 

and safety issues for rural and agricultural 

workers and includes presentations relevant 

to those working in occupational safety 

and health, health care, public health, and 

education. In 2007, the NIOSH-funded Great 

Plains Center for Agricultural Health (GPCAH) 

at UI started disseminating the course 

nationally and internationally. GPCAH later 

partnered with two other Ag Centers on 

the project—the Central States Center for 

Agricultural Safety and Health and Southwest 

Center for Agricultural Health, Injury 

Prevention, and Education.

Other organizations across the United States 

have also adopted the course, as shown on 

the Agricultural Safety and Health: The Core 

Course webpage. A consensus process with 

national and international experts guides the 

development and continuous revisions of the 

content for this week-long course. The course 

focuses on prevention and the hierarchy of 

controls for occupational hazards. It includes 

live lectures, small-group discussions, online 

modules, podcasts, case studies, homework 

assignments, and interactive exercises.

Course topics include safety and industrial 

hygiene, respiratory diseases, children and 

aging workers on farms, traumatic injury, 

zoonotic diseases, livestock handling, 

behavioral health, pesticides, ergonomics 

and musculoskeletal disorders, and personal 

protective equipment. The course provides 

the information and skills to help individuals 

anticipate, identify, and prevent workplace 

injuries and illnesses in the agricultural 

industry. Individuals completing the course 

can receive academic credit, continuing 

education, and a certificate of completion.

Since 2011, 1,391 trainees from the United 

States and Australia participated in 39 

courses. In FY 2020, the course occurred five 

times, and a total of 285 people participated. 

A survey completed by course participants 

six months later showed 80% of them 

believed their ability to anticipate, diagnose, 

treat, or prevent agricultural injuries and 

illnesses improved. Almost 90% indicated 

the course information helped them address 

occupational hazards, and 70% felt confident 

when recommending personal protective 

equipment for the farming population.

GPCAH also created separate online education 

from the Agricultural Health and Safety Course 

that includes some of its course topics. These 

online modules are freely available and offer 

a certificate of completion. The Agricultural 

Health and Safety Course has become a 

national model of effective agricultural safety 

and health education.

Details:

■ Agricultural Health and Safety Course for 

Medical and Safety Professionals

■ Annual Report September 2019–August 

2020: Central States Center for Agricultural 

Safety and Health

■ Online Training Agricultural Safety and Health

Building Capacity for 

Effective Evaluation

In FY 2020, the Ag Centers collaborated with 

NIOSH to start building evaluation capacity 

across the AFF Program. NIOSH recently 

developed an Evaluation Capacity-Building 

Plan (2021–2025) outlining institute evaluation 

needs and steps to address those needs 

over a five-year period. As a part of the plan, 

NIOSH staff collaborated with Ag Centers to 

develop a shared understanding of evaluation 

concepts, definitions, and frameworks 

which we can apply to our programs and 

research projects. This includes definitions for 

common evaluative terms such as outputs, 
NIOSH Extramural Research and Training Program ■ Annual Report of Fiscal Year 2020 25

intermediate outcomes, and end outcomes, 

as well as an introduction to the framework 

that NIOSH uses to guide its program reviews. 

This has allowed the centers to work together 

with NIOSH to develop shared logic models 

on common AFF health and safety topics, 

including heat-related illness and rollover 

protective equipment. These models will 

enable Ag Centers and NIOSH AFF Program 

leaders to assess the progress made to date, 

identify gaps that may still exist, and make 

informed decisions about the future direction 

of the program.

NATIONAL CENTER FOR 

CONSTRUCTION SAFETY AND 

HEALTH RESEARCH AND 

TRANSLATION

 Overview

CPWR—The Center for Construction 

Research and Training received a 

NIOSH cooperative agreement to be the 

National Center for Construction Safety 

and Health Research and Translation for 

2019–2024. CPWR received this funding 

through an extramural competition 

and has received NIOSH funding for 

the past 30 years through a series of 

competitive funding announcements. 

The center, with its diverse construction 

community, leads in the field of 

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. The 

center has cultivated and optimized external 

partnerships for prevention, protections, 

research, and research translation for 

protecting U.S. construction workers. A 

recent evaluation of the NIOSH Construction 

Program recognized CPWR for the value 

of its research translation focused efforts 

in construction.

 Research Outputs: 

Publications in FY 2020

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, 

2019, through September 30, 2020, CPWR 

published 13 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 2020

National Stand-Down to Prevent 

Struck-by Incidents

In the construction industry, struck-by 

incidents are a leading cause of death and 

have topped the leading cause of nonfatal 

injuries since 1992. Most workers are 

struck by flying, swinging, or rolling objects, 

according to the Occupational Safety and 

Health Administration. In FY 2020, CPWR 

joined the NORA Construction Sector Council

in launching the first-ever National StandDown to Prevent Struck-by Incidents.
26 NIOSH Extramural Research and Training Program ■ Annual Report of Fiscal Year 2020

This inaugural event aimed to increase 

awareness of both struck-by hazards, as well 

as approaches for preventing these incidents. 

Held during National Zone Awareness Week 

in April, the event featured a virtual question 

and answer (Q&A) panel with experts who 

talked about struck-by hazards in work zones 

and ways to prevent these from occurring 

on job sites. A variety of resources for the 

National Stand-Down to Prevent Struck-by 

Incidents were also available, including 

training materials, toolbox talks, and webpage. 

Almost 700 people attended the virtual event, 

and 1,708 people viewed the virtual Q&A from 

April 22, 2020, through August 31, 2020. In 

addition, 386 people accessed CPWR’s Struckby-Injuries webpage and additional materials 

from September 1, 2019, through August 31, 

2020.

Details:

■ Struck-by Hazards

New Tool to Support Construction 

Companies in Improving Safety 

Climate

A key leading indicator of a company’s jobsite 

safety is having a strong positive safety 

climate—defined as employees’ shared 

perceptions that a company’s stated safety 

policies and procedures are consistent 

with actual jobsite practices. In 2016, CPWR 

developed the Safety Climate Assessment 

Tool (S-CAT) to help construction companies 

evaluate their jobsite safety climate 

maturity across eight leading safety climate 

indicators. In 2018, they also developed the 

Safety Climate Assessment Tool for Small 

Contractors (S-CATsc), which is a simple needs 

assessment based on the S-CAT’s eight leading 

indicators. While both provide guidance on 

how to strengthen jobsite safety climate, 

neither offer actual safety management 

resources companies can use to improve their 

climate scores.

To fill this gap, CPWR is creating a new 

interactive online tool called the Safety 

Climate-Safety Management Information 

System (SC-SMIS). SC-SMIS users will be 

able to (1) conduct jobsite safety climate 

assessments using the S-CAT and/or S-CATsc, 

(2) select from over 80 evidence-based 

safety management resources to target and 

improve low-scoring safety climate indicators, 

(3) develop plans to put the resources into 

action, (4) schedule reminders to conduct 

periodic assessments, and (5) implement 

new resources for continuous safety climate 

improvement. CPWR expects to finalize and 

begin offering the SC-SMIS by the end of FY 

2021. To complement the SC-SMIS, CPWR is 

developing a new Confidence to Implement 

scale to measure a safety professional’s 

confidence to identify, implement, and 

evaluate the effectiveness of safety 

management resources. The center believes 

this tool will help these safety professionals 

better understand their strengths and 

needs in terms of safety climate and safety 

management improvement activities.

Details:

■ Safety Climate-Safety Management 

Information System (SC-SMIS)

■ Outside NIOSH: Tool Helps Construction 

Companies Evaluate Jobsite Safety Climate

Advancing Women in the Trades: 

New Mentoring Program to Improve 

Safety, Health, and Well-being

Women working in the trade industry face 

many challenges, including a higher likelihood 

of discrimination and harassment compared 

with men, and their skills are often underutilized, according to research. More so in 

the construction industry, women represent 

a small portion of the workforce and leave 

construction apprenticeship programs at 

high rates, possibly due to these challenges. 

Researchers funded by CPWR at the University 

of Washington are now developing and 

testing a mentoring program for women in 

construction, promoting safety, health wellbeing. They are partnering with a labor union 
NIOSH Extramural Research and Training Program ■ Annual Report of Fiscal Year 2020 27

on this project—the International Association 

of Sheet Metal, Air, Rail, and Transportation 

Workers (SMART).

The goal of the program is to increase these 

construction workers’ self-knowledge, selfefficacy, and skills related to advocating for 

safety, ultimately reducing injury risks and 

psychological stressors at work. Journey-level, 

or skilled, construction workers from local 

SMART unions in the study will mentor female 

apprentices. The mentors will get training on 

effective mentoring techniques and program 

content. A group of 100 women will receive 

mentoring while another group of 100 female 

apprentices will not during a two-year period. 

Throughout the study, researchers will assess 

both groups to measure the program’s impact, 

with a focus on changes in their stress levels, 

coping mechanisms, safety climate at work, 

and job retention.

Details:

■ Women in the Trades

CENTERS OF EXCELLENCE FOR 

TOTAL WORKER HEALTH®

 Overview

In FY 2020, NIOSH funded six Centers of 

Excellence for TWH, located throughout 

the United States, to explore and 

research TWH-related concepts. 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-related research and practice:

■ Pilot testing of promising workplace policies 

and programs.

■ Developing and distributing best practices 

and tool kits.

■ Creating strategies to overcome barriers 

for adoption of work-based 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
28 NIOSH Extramural Research and Training Program ■ Annual Report of Fiscal Year 2020

■ Evaluation of results to determine the 

impact on occupational safety and health 

and reduction in burden.

 Research Outputs: 

Publications in FY 2020

The centers’ outputs are the products of 

research activities and include publications. 

We collected publications by NIOSHfunded extramural researchers from 

principal investigator reports to NIOSH, the 

NIH Reporter database, the NIOSHTIC-2 

database, and the PubMed database. From 

October 1, 2019, through September 30, 

2020, the Centers of Excellence published 

50 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 FY 2020

U.S. Surgeon General Highlights 

NIOSH TWH Approach

In an article in Public Health Reports, the U.S. 

Surgeon General, Vice Admiral (VADM) Jerome 

Adams, MD, MPH, highlighted the Centers 

of Excellence for TWH, along with the NIOSH 

Office of TWH and NIOSH TWH affiliates. The 

article focused on the important relationship 

between employment and health. The 

U.S. Surgeon General recommended that 

employers and companies ensure that worker 

well-being programs are implemented more 

broadly and meet the needs of workers—an 

approach that can lead to better health and 

business outcomes. He mentioned successful 

research and practice for worker well-being 

from the NIOSH Office of TWH and the 

Centers of Excellence for TWH. One center 

project he mentioned included the Health 
NIOSH Extramural Research and Training Program ■ Annual Report of Fiscal Year 2020 29

Improvement Through Training & Employee 

Control Program from the Center for the 

Promotion of Health in the New England 

Workplace (CPH-NEW). However, while the 

article acknowledged the centers’ work and 

NIOSH, it noted that more research is needed 

on workplace well-being interventions across 

varied settings that shows the positive 

impacts on multiple health, human capital, 

and financial outcomes. Through partnerships 

among public health leaders, academia, 

employers, and other interested parties—like 

the one between NIOSH and the Centers of 

Excellence for TWH—the U.S. Surgeon General 

believes we can help workers achieve their 

highest potential.

Details:

■ The Value of Worker Well-being

■ U.S. Surgeon General Highlights the Value 

of Worker Well-being and the NIOSH Total 

Worker Health® Approach

Connecticut Department of 

Corrections Adopts TWH-Oriented 

Training Programs

Based on past studies, CPH-NEW found that 

correctional officers developed high risks 

factors for chronic disease within the first 

five years of working. They often experienced 

obesity, hypertension, physical inactivity, 

and high levels of depression, along with 

poor sleep and nutritional habits. To address 

this issue, CPH-NEW researchers conducted 

a study focused on peer health mentoring 

for new cadet correctional officers known 

as “Health Improvement through Training 

& Employee Control (HITEC II).” HITEC II 

researchers and the Connecticut Department 

of Corrections developed design teams 

combining a Kaizen design approach and CPHNEW’s IDEAS process. Correctional officers 

and supervisors on the teams created TWH 

interventions for workplace safety and health 

concerns. The teams created intervention 

programs, including educational trainings on 

mental health, prevention of substance use 

and misuse, and nutrition.

The supervisors involved are also a part of 

the Correction Supervisors Unit (NP-8) of the 

Service Employees International Union, Local 

2001. In FY 2020, the Connecticut Department 

of Corrections started permanently funding 

and offering the trainings to employees 

as part of a union collective bargaining 

agreement. Employees now have formal 

training days to participate in the programs, 

but their involvement is voluntary. So far, 

more than 40% of all corrections supervisors 

have participated in the trainings.

Details:

■ History of Health Improvement Through 

Training & Employee Control (HITEC) I & II

You OK? Center Develops National 

Suicide Prevention Campaign for 

Construction Trade Association

In the United States, suicide is the 10th 

leading cause of death, claiming the lives 

of nearly 48,000 people in 2019, according 

to the National Institute of Mental Health. 

More so, the construction industry has one 

of the highest suicide rates compared with 

other industries. To address this issue, the 

Association of General Contractors (AGC),

a construction industry trade association, 

developed a suicide prevention campaign 

with the Healthier Workforce Center of the 

Midwest. Before the campaign, the center 

worked with the AGC chapter in Missouri and 

center-funded researchers at Washington 

University at St. Louis on projects to 

improve the safety, health, and well-being of 

construction apprentices. The collaboration 

led national AGC leadership to recruit this 

group to work on its suicide prevention 

campaign for construction workers. 

They joined a small team of union safety 

professionals and representatives from large 

contractors for the project.
30 NIOSH Extramural Research and Training Program ■ Annual Report of Fiscal Year 2020

The suicide prevention campaign called “You 

OK?” launched in September 2019 during 

National Suicide Prevention Week. This 

ongoing campaign includes freely accessible 

materials including medallions, hard hat 

stickers, posters, and toolbox talk handouts. 

Throughout FY 2020, 185 individuals 

requested campaign materials and several 

large Missouri construction companies have 

shared this information with hundreds of 

employees during Safety Stand-Down events. 

The Healthier Workforce Center of the 

Midwest now has plans to nationally expand 

the campaign.

Details:

■ Suicide Prevention Campaign for the 

Workplace

■ Partnering to Prevent Suicide in the 

Construction Industry—Building Hope and a 

Road to Recovery

The Oregon Healthy Workforce 

Center Dissemination Workgroup

The Dissemination Workgroup at the 

Oregon Healthy Workforce Center focuses 

on the center’s use of best practices for 

disseminating, or sharing, its intervention 

research. The Workgroup developed multiple 

products including the Health Impacts Safety 

toolbox and safety meeting guides, which are 

given out at conferences and available online. 

Through these resources, organizations can 

learn more about the center’s TWH-related 

work and use this information to integrate 

workplace safety, health, and well-being. In 

FY 2020, more than 400 people downloaded 

the Health Impacts Safety materials online. 

The workgroup also created a webpage, 

YourWorkpath.com, to share all the center’s 

toolkits and TWH-related resources in one 

space. In FY 2020, 1,264 individuals visited 

the page.

Two organizations, the State Accident 

Insurance Fund Corporation (SAIF) in Oregon 

and Eskenazi Health in Indiana, developed 

partnerships with the center after their staff 

visited the page and will adopt or use the 

center’s Safety and Health Improvement 

Program (SHIP). Eskenazi has plans to roll 

out the SHIP training program throughout its 

hospital system, and SAIF will include SHIP 

in its series of manager-focused training 

programs, called “Leadership Project.” 

The Dissemination Workgroup also built a 

collaboration between the Oregon Healthy 

Workforce Center and a community college 

in the Midwest, focused on the Promoting U 

through Safety & Health toolkit. The college 

plans to first distribute the toolkit to workers 

and students from ages 18 through 45 years 

on two of its four campuses. After this, it 

will eventually roll out the toolkit to more 

than 3,000 individuals across all four of its 

campuses and satellite locations.

Details:

■ Health Impacts Safety

■ YourWorkpath.com

■ Celebrating the Relaunch of Our Safety and 

Health Improvement Program (SHIP) Toolkit

■ Total Worker Health in Young Workers

Study Identifies Policy 

Recommendations and Gaps From 

TWH Research

The Center for Work, Health, and Well-being 

has conducted the first literature review of 

TWH research articles, focused on identifying 

policy implications. As a part of its Policy 

Working Group, the center’s researchers 

analyzed its peer-reviewed publications 

over 71⁄2 years that focused on links between 

work conditions and health outcomes. They 

looked at the literature for scientific findings 

addressing organizational or public policies 

and identified common themes or topics. The 

scientists reviewed 32 of 57 peer-reviewed 

articles published from 2011 through mid2019 that fit the study’s inclusion criteria 

and found 12 cross-cutting or broad themes 

focused on policies. These included (1) 

ergonomic practices, (2) harassment and 

abuse, (3) safety practices, (4) social support, 

(5) staffing levels, (6) work-family conflict, 

(7) work schedules, (8) work stress, job 
NIOSH Extramural Research and Training Program ■ Annual Report of Fiscal Year 2020 31

demands and decision-making, (9) injuries 

and injury reporting, (10) mental health, (11) 

physical activity, and (12) sleep deficiency. 

The themes were grouped and reported 

in two categories—working conditions and 

related health outcomes—categories that 

researchers report influence each other. This 

finding supports a core component of the 

TWH concept that multiple working conditions 

can interact and influence one another and 

health outcomes.

Beyond being the first of its kind, this study 

is significant because policies are key to the 

integration of TWH practices in the workplace 

and its influence on worker well-being. 

The research identified themes for policy 

recommendations from TWH research, as well 

as gaps where future research is needed on 

policies. In FY 2020, the Journal of Occupational 

and Environmental Medicine published 

these findings.

Details:

■ Literature Review of Policy Implications 

From Findings of the Center for Work, 

Health, and Well-being

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

Center for Work, Health & Well-being

Launch of the Get Outdoors 

Employer Toolkit

In FY 2020, the Center for Health, Work & 

Environment created the Get Outdoors 

Employer Toolkit, in partnership with the 

Office of Outdoor Recreation at the Colorado 

Office of Economic Development and 

International Trade. The toolkit includes 

free resources for businesses to support 

a healthier employee lifestyle through 

integrating and promoting nature experiences 

and outdoor recreation into workplace 

initiatives. A workplace focused wellness 

and health survey is included in the toolkit. 

Those who complete this assessment receive 

a set of recommendations on ways their 

company can improve health and wellness 

programs through outdoor activities. Through 

the assessment and resources, the Center 

for Health, Work & Environment expects to 

improve the health and well-being of diverse 

Colorado workforces. The toolkit also aligns 

with the Colorado Governor’s Health Initiative 

to lower healthcare cost by encouraging state 

residents to get outside.

The center promoted the toolkit to leading 

Colorado employers in the manufacturing, 

healthcare, construction, and retail industries, 

and the media also widely promoted it. 

So far, 51 companies of varied sizes and 

industries have completed the assessment 

in the toolkit and received guidance on how 

to support employee well-being. The center 

plans to launch the first Get Outdoors Healthy 

Workplace Award in October 2020, recognizing 

companies based on their assessment results.

Details:

■ Outdoor Recreation Industry Office 

Launches Get Outdoors Employer Toolkit—

Employers Encouraged to Take the Get 

Outdoors Survey

Community Interventions for Safer 

and Healthier Work

Building on data from a past assessment of 

two Chicago neighborhoods with high levels of 

unemployment and/or residents in precarious 

work, the University of Illinois at Chicago 

(UIC) Center for Healthy Work is developing 

community interventions. The center is using 

the assessment results, and a theory of 

change and strategic road map resulting from 

it, to create a healthy work culture within the 

community. The four interventions are a part 

of the Greater Lawndale Healthy Work (GLHW) 

Project and focus on community perceptions 

and strong community infrastructure that 

support healthy work, along with fair work 

opportunities within neighborhoods.

Members of the GLHW Council are creating 

and will pilot test the following interventions 

within Chicago’s Greater Lawndale area:
32 NIOSH Extramural Research and Training Program ■ Annual Report of Fiscal Year 2020

■ An educational campaign that includes an 

interactive bingo/lotería game, art, and 

events focused on changing beliefs on work 

and health among community members, 

workers, employers, and policy makers 

through highlighting work as a human 

rights and social justice priority.

■ Training and outreach materials on workers’ 

rights that will be distributed to temporary 

staffing agencies and then customized and 

widely shared by these companies.

■ Education and advocacy for policies that 

increase opportunities to build community 

wealth and spending through more support 

of local entrepreneurship, small businesses, 

and cooperative businesses.

■ Characterization of COVID-19 impact on 

communities and related resident needs 

and use of this information to modify 

GLHW interventions.

Through the GLHW Project, UIC Center for 

Healthy Work continues to explore ways to 

implement safer and healthier approaches to 

work that extend into the community.

Details:

■ Greater Lawndale Healthy Work Project

■ NIOSH Extramural Research and Training 

Program Annual Report of Fiscal Year 2019

EDUCATION AND

RESEARCH CENTERS

 Overview

NIOSH is mandated to provide an 

adequate supply of qualified personnel 

to carry out the purposes of the 

Occupational Safety and Health Act 

(Public Law 91-596), and the ERCs 

are one of the principal means for 

meeting this mandate. ERCs are 

academic institutions that provide 

high-quality interdisciplinary graduate 

and post-graduate training, research 

training, education, and outreach in the 

core occupational safety and health 

disciplines of industrial hygiene, 

occupational health nursing, 

occupational medicine residency, and 

occupational safety, as well as allied 

disciplines. Research and research 

training are integral components of 

ERCs, with ERC faculty and NIOSH 

trainees conducting research on issues 

related to the NIOSH Strategic Plan: FYs 

2019−2024 and emerging issues. ERCs 

serve as regional resources for industry, 

labor, government, and the public 

through training, research to practice, 

education, and outreach.

 Public Health Relevance

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 2030—to promote the health and 

well-being of the workforce—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.
NIOSH Extramural Research and Training Program ■ Annual Report of Fiscal Year 2020 33

■ Serving as the primary knowledge source 

for public and government leaders for jobrelated safety issues without duplicating 

other government programs.

 Research Outputs: 

Publications in FY 2020

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, 2019, through September 30, 2020, the 

ERCs published 215 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 FY 2020

Trainees, Graduates, and 

Employment of Graduates

In academic year 2019–2020, more than 300 

students graduated from ERC programs with 

specialized training in disciplines including 

industrial hygiene, occupational health 

nursing, occupational medicine, occupational 
34 NIOSH Extramural Research and Training Program ■ Annual Report of Fiscal Year 2020

safety, and other closely related occupational 

safety and health fields. The number of 

students enrolled increased from 978 in 

FY 2019 to 997 in FY 2020. Table 4 shows the 

number of students enrolled, graduates, and 

employment status during FY 2020.

Table 5 shows the placement of FY 2020 

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.

Table 4. ERC trainees, graduates, and employment, FY 2020

Program Area Enrolled Graduates

Employed or seeking 

occupational safety and health 

employment (%)

Industrial Hygiene 292 115 108 (94)

Occupational Health Nursing 137 30 28 (93)

Occupational Medicine 129 34 33 (97)

Occupational Safety 161 53 53 (100)

Other Related Disciplines 278 71 63 (89)

Total 997 303 285 (94)

Table 5. ERC graduate employment by work setting, FY 2020

Work Setting/

Program Area

Industrial 

Hygiene 

Occupational 

Health 

Nursing 

Occupational 

Medicine 

Occupational 

Safety Other Total 

Private Industry 48 0 2 34 21 105

Federal/State/

Local Government

22 3 3 1 13 42

Academic 

Institution

13 4 1 5 13 36

Clinic/Hospital 3 14 23 4 1 45

Other OSH 

Employment

1 0 2 1 2 6

Seeking Advanced

OSH Degree

5 2 0 5 12 24

Seeking OSH 

Employment

16 5 2 3 1 27

Total 108 28 33 53 63 285
NIOSH Extramural Research and Training Program ■ Annual Report of Fiscal Year 2020 35

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 2020, ERCs provided 306,952 person 

hours of training to 73,695 occupational safety 

and health professionals who took 1,543 

courses. This compares with FY 2019 when the 

ERCs offered more courses (1,562) and more 

hours of training (348,390) but had a lower 

number of trainees (51,153).

Table 6. Continuing education courses by discipline, FY 2020

Discipline

Number of 

Courses

Number of 

Trainees

Person-Hours

of Training

Industrial Hygiene 159 4,928 32,331

Occupational Health Nursing 129 8,176 34,254

Occupational Medicine 209 28,270 40,342

Occupational Safety 805 20,837 143,954

Other 241 11,484 56,071

Total 1,543 73,695 306,952

ERC Program Achievements

Center Focuses on Work Ability Among 

Older Nurses

Many older nurses in the United States are 

working in direct care and facing safety 

and health hazards, but research is limited 

on their ability to safely perform at work. 

Researchers at the New York and New Jersey 

ERCs recently looked at the factors influencing 

aging nurses’ work ability. They interviewed 

17 female registered nurses, with an average 

age of 59 years, by phone or in person at a 

large academic medical center. Guided by 

a NIOSH Organization of Work Framework, 

the questions focused on the framework’s 

principles that include work context, or 

characteristics of the job like work tasks 

and roles, and organizational context, like 

workplace practices and policies.

The participants’ main motivations were 

internal factors like experiencing joy from 

nursing and feeling connected to patients at 

their bedside. Other aspects that increased 

their ability to work included having a 

preferred work schedule that supported 

work-life balance, a work environment 

filled with camaraderie and teamwork, and 

organizational leaders who valued workers’ 

input. These nurses also identified health 

issues, including knee replacement surgery, as 

one barrier to work performance—especially 

related to their desire to work future. Most 

expected to continue working for 5–10 

more years.

While researchers say future research needs 

to reflect a wider population and range of 

healthcare systems, these findings support the 

need for managers of aging nurses to focus 

on schedules, workload, and enhancement of 

overall health. The Western Journal of Nursing 

Research featured this study, as did a NIOSH 

Science Blog in FY 2020 commemorating 

nurses during the Year of the Nurse. So 

far, more than 400 people have read about 

the study.
36 NIOSH Extramural Research and Training Program ■ Annual Report of Fiscal Year 2020

Details:

■ NIOSHTIC-2 Publications Search: 

Organization of Work Factors Associated 

With Work Ability Among Aging Nurses

■ New York-New Jersey Occupational Safety & 

Health Center

■ Work Ability Among Older Nurses

The Widespread Reach and Influence 

of Harvard’s Continuing 

Professional Education

Continuing professional education and 

outreach at the Harvard ERC offers a varied 

slate of courses that meet regional, national, 

and global occupational safety and health 

needs. These Executive and Continuing 

Professional Education Courses (ECPE) are 

short classes, ranging from two to five days, 

taught by staff in the Harvard T.H. Chan 

School of Public Health. Course participants 

include current and aspiring global leaders in 

healthcare and public health, with up to 55 

individuals participating in each class.

Topics can range from leading in healthcare 

systems and organizations to applied risk 

communication to health outcomes research. 

These four topics are typically included each 

year and were the only classes offered in-person 

in FY 2020 due to the COVID-19 pandemic:

■ Comprehensive Industrial Hygiene

■ In-place Filter Testing Workshop

■ Ergonomics and Human Work Factors

■ Radiological Emergency Planning

The Harvard ERC offered 46 courses attended 

by 1,763 people in FY 2020. Participants 

included state police, firefighters, and 

first responders, along with hospital and 

university staff. Representatives from the 

U.S. Air Force, U.S. Navy, Federal Emergency 

Management Agency, and U.S. Nuclear 

Regulatory Commission also participated. 

Class evaluations showed most participants 

thought the courses would improve their 

job performance. When asked to rate the 

overall quality, participants gave the courses 

an average score of high quality. Looking 

forward to FY 2021, ECPE courses will be held 

online. The Harvard ERC hopes this approach 

will make the program more accessible to 

new participants.

Details:

■ Harvard Education and Research Center

■ About ECPE

Symposium Highlights Key Topics 

Related to Wildfires

The Southern California ERC, located jointly 

at University of California Los Angeles and 

University of California Irvine, hosted a 

symposium on wildfires—an issue that 

continues to increase in severity and length 

in the Western United States. This event, 

entitled “Hot Topics in Wildfires: Present 

and Future Health Risk,” focused on varied 

topics such as health effects from wildfires, 

regulations for worker protection from 

wildfire smoke, and the impact of climate 

change on wildfires. Presentations also 

highlighted past and current NIOSH research 

on wildland firefighters. Additionally, sessions 

focused on exposure assessment in wildfire 

research including biomonitoring, exposure 

monitoring, and computer modeling. 

Presenters represented universities, state 

health departments, and other organizations, 

including the University of California San 

Francisco, University of Arizona, and California 

Department of Public Health. Symposium 

attendees included local government officials 

from Los Angeles and Irvine, along with staff 

at the Irvine Police Department and Orange 

County Fire Authority.

This February 2020 event aligned with the 

Southern California ERC’s efforts to provide 

professional education, research, and 

outreach that positively impacts regional 

and national occupational health and 

safety practice.

Details:

■ Hot Topics in Wildfires: Present and Future 

Health Risks

■ UCLA-UCI: Southern California NIOSH 

Education and Research Center
NIOSH Extramural Research and Training Program ■ Annual Report of Fiscal Year 2020 37

INVESTIGATOR-INITIATED RESEARCH

The NIOSH extramural research program supports relevant, 

high-quality scientific investigations that help reduce workrelated 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

 Overview

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 work-related 

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 

and 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.

 Research Outputs: 

Publications in FY 2020

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 
38 NIOSH Extramural Research and Training Program ■ Annual Report of Fiscal Year 2020

NIH Reporter database, the NIOSHTIC-2 

database, and the PubMed database. From 

October 1, 2019, through September 30, 2020, 

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 3 (R03), 1 (U13), 8 (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 2020

Preventing Slips, Trips, and Falls by 

Predicting Wear on Shoes

Project Title: Impact of Worn Shoes on 

Slipping (R01 Grant).

Principal Investigator: Kurt Beschorner

Slip and fall accidents are a leading and 

quickly growing cause of U.S work-related 

injuries. According to the NIOSH Traumatic 

Occupational Injuries webpage, 27% of 

nonfatal work injuries resulting in lost 

workdays in 2018 were linked to slips, trips, 

and falls. An important part of preventing slips 

and falls is the shoes’ tread, which provides 

friction with the floor. However, not all treads 

are the same. Some treads have patterns that 

create strong traction with the floor surface. 

Other tread designs have difficulty gripping 

the floor during walking, especially around 

water and other liquids, due to reduced 

coefficient of friction. Heavily worn shoes 

increase the risk of slipping. Worn shoes lose 

traction when they come into contact with 

fluids and can no longer release these liquids. 

The fluid becomes trapped in the shoe and 

pressurized, decreasing the shoe’s coefficient 

of friction and increasing the risk of slipping.

Before this study, limited knowledge existed 

about the rate at which shoe tread becomes 

worn and how shoe wear causes a reduced 

coefficient of friction. To address this issue, 

investigators at the University of Pittsburgh 

looked at key causes of worn shoe tread 

and the tread thresholds or points where 

shoes become unsafe. Looking at the size 

of the shoes’ treads and the worn regions, 

researchers determined how friction or 

traction are linked to the size of the worn 

regions—a finding not previously reported in 

studies. Using this information, they created 

the battery test that indicates the threshold 

when the friction of shoes has deteriorated 

and can be used for inspecting shoes. They 

also developed virtual computer models that 

predict the wear patterns over time and the 

deterioration in friction of shoe treads as 

a shoe became worn. Scientists calculated 

the impact of worn regions on friction. They 

validated one of these computer models by 

comparing its results with real-life workers 

wearing different shoes on the job, as well 

as tested workers’ shoes on flooring covered 

in liquid. The studies’ findings highlight the 

usefulness of this type of computer model 

in designing slip-resistant shoes to decrease 

work-related slips and falls.

Information about this project has been 

widely shared with varied footwear 

companies, Grainger industrial supply 

company, and a committee within the 

ASTM International standards organization 

focused on pedestrian/walkway safety and 

footwear. Researchers also highlighted their 

findings via 12 journal articles, 22 conference 

presentations, and a keynote speech at the 

Slips, Trips & Falls Conference Madrid 2020. 

The NORA Traumatic Injury Cross-Sector 

Council also partnered with researchers to 

create posters for restaurant and healthcare 

workers on using the battery test for shoe 

inspections to determine slipping risk.

Details:

■ Impact of Worn Shoes on Slipping

■ How to Inspect Your Shoes: A Guide for 

When to Replace Slip-resistant Shoes Using 

a AA battery

■ Influence of Averaging Time-interval 

on Shoe-floor-contaminant Available 

Coefficient of Friction Measurements
NIOSH Extramural Research and Training Program ■ Annual Report of Fiscal Year 2020 39

■ Changes in Under-shoe Traction and Fluid 

Drainage for Progressively Worn Shoe Tread

■ Predicting Slips Based on the STM 603 

Whole-footwear Tribometer Under Different 

Coefficient of Friction Testing Conditions

■ Outside NIOSH: Computer Model Predicts 

Wear on Shoes

■ NORA Traumatic Injury Prevention CrossSector Council, Posters: Slip Resistant Shoe 

Tread Wear

Study Examines Effects of Work-hour 

Restrictions on Physician Safety 

and Health

Project Title: Impact of Lifting Work Hour 

Restrictions on First-year Resident Safety, 

Health, and Well-Being (R01 Grant).

Principal Investigator: Laura Barger

Some of the leading occupational hazards that 

resident physicians face are associated with 

extended work shifts, according to research. 

These include motor vehicle crashes, which 

can occur as these workers commute to 

and from work, and percutaneous injuries, 

such as injuries from a needlestick or other 

sharp objects. The Accreditation Council 

for Graduate Medical Education (ACGME) 

changed its policy on work hour restrictions 

for resident physicians in 2011 from 24–28 

hours to 16 hours. In this study, researchers 

at Brigham and Women’s Hospital found 

a link between this work-hour limit and 

improvements in physician safety and health.

These scientists examined the effect of 

ACGME’s work-hour regulations on the safety 

of first-year resident physicians, focusing on 

varied outcomes, including motor vehicle 

crashes, near crashes, and percutaneous 

injuries. They collected and analyzed safety 

outcome data from 15,276 first-year resident 

physicians, which included reported work 

hours, extended shifts, and hours of sleep. 

Participants in the study included physicians 

in a residency program from 2002 through 

2007, and another group who were resident 

physicians from 2014 through 2017 after the 

ACGME restriction.

Researchers found that, following the 

ACGME regulation, resident physicians 

had a considerably lower risk of motor 

vehicle crashes, percutaneous injuries, 

and attentional failures, or injuries caused 

by lack of attention. The average hours of 

nightly sleep also increased for this group 

of workers. In contrast, extended shifts and 

prolonged or long weekly work hours were 

linked to negative safety outcomes. These 

findings are important because ACGME lifted 

the 16-hour work limit in 2017, and first-year 

resident physicians can now work 24–28 

consecutive hours. The American Journal of 

Medicine featured this study in FY 2020, and it 

was highlighted in several news outlets in the 

healthcare field including Becker’s Hospital 

Review and Medical Xpress. Researchers 

at Brigham and Women’s Hospital plan to 

continue examining changes in resident 

physicians’ health outcomes, following the 

latest ACGME policy change.

Details:

■ The Association Between Resident Physician 

Work-hour Regulations and Physician Safety 

and Health

■ Impact of Lifting Work Hour Restrictions 

on First-year Resident Safety, Health, and 

Well-Being

Factors Linked to Low Back Pain for 

Manufacturing and Warehousing 

Workers

Project Title: Exposure Response 

Relationships for Low Back Pain From Pooled 

Data (R01 Grant).

Principal Investigator: Jay Kapellusch

Low back pain (LBP) is a leading cause of 

global disability and a frequent cause of 

limited activity and lost workdays. Research 

shows that risk factors for LBP may vary 

across many studies due to lack of a standard 

case definition for LBP. Past studies use 
40 NIOSH Extramural Research and Training Program ■ Annual Report of Fiscal Year 2020

different definitions, resulting in varying risk 

factors. Many studies also have limited or 

imprecise measures of exposures for LBP in 

the workplace, especially related to health 

outcomes. Because of these challenges and 

other limited research methods, there is not a 

clear link between biomechanical risk factors 

related to physical movement and LPB.

Researchers at the University of Wisconsin 

Milwaukee aimed to understand the 

occurrence, risk factors, and health effects 

of LBP among workers. In this study, 

scientists combined and analyzed data 

from multiple past studies, looking at 

differences in their prevalence or frequency 

of LBP and risk factors for this health issue. 

They also examined connections between 

biomechanical or physical stressors for 

various work tasks, personal factors like 

demographics, psychosocial factors, LBP 

prevalence, and LBP incidence or rate of new 

cases. This project focused on LBP cases, in 

general, and those that resulted in workers 

seeking medical treatment and having lost 

workdays. Scientists analyzed data for 1,650 

workers from 82 facilities, mostly in the 

manufacturing and warehousing industries. 

They measured biomechanical stressors 

related to workers’ limits on lifting objects, 

including maximum weight, reach, and 

twisting. Researchers used the Revised NIOSH 

Lifting Equation (RNLE), a common tool to 

assess risk of lifting and lowering tasks at 

work. The RNLE focuses on an object’s weight, 

the hand location, travel distance, angle of 

body twisting, lifting frequency, and length 

and type of grasp; measurements on these 

factors are combined for a single metric. 

For a comprehensive analysis, researchers 

compared the RNLE data to other identified 

physical exposure variables at work, including 

load moment and trunk posture.

Participants in this study had an average age 

of 35 years, and 75% were male and 68% 

non-Hispanic White. According to researchers, 

prevalence and incidence of LBP, along with 

health outcomes like seeking medical care 

and having lost work time, were linked to 

biomechanical stressors measured via the 

RNLE and other physical exposure variables. 

Scientists also linked factors like advanced 

age, history of LBP, and psychosocial factors 

to either prevalence and/or incidence of LBP, 

health outcomes, or both. However, these 

factors did not impact the relationship found 

between biomechanical stressors, LBP, and 

health effects.

Researchers say these findings demonstrate 

biomechanical exposures are independent 

risk factors for LBP and health outcomes. 

This study, previously featured in Journal 

of Occupational and Environmental Medicine

and Human Factors and other publications, 

is significant because it could potentially 

influence organizational and governmental 

policies on workplace physical exposures.

Details:

■ Exposure-Response Relationships for Low 

Back Pain From Pooled Data

■ Prevalence of Low Back Pain, Seeking 

Medical Care, and Lost Time Due to Low 

Back Pain Among Manual Material Handling 

Workers in the United States

■ Psychosocial Factors and Low Back Pain 

Outcomes in a Pooled Analysis of Low Back 

Pain Studies

■ Evaluating Different Measures of Low Back 

Pain Among U.S. Manual Materials Handling 

Workers: Comparisons of Demographic, 

Psychosocial, and Job Physical Exposure

Interventions for Vietnamese Nail 

Salon Workers

Project Title: A Feasibility Study to Develop a 

Multilevel Occupational Health Intervention 

Program for Nail Salon Employees and 

Owners (R21 Grant).

Principal Investigator: Tran Huynh

In the United States, more than half of 

nail salon workers identify as Vietnamese, 

and according to research, they face 

various hazards. These include exposure to 
NIOSH Extramural Research and Training Program ■ Annual Report of Fiscal Year 2020 41

dangerous chemicals from nail products, 

ergonomic hazards, and clients potentially 

spreading infectious diseases. The 

challenges facing Vietnamese nail salon 

workers are linked to barriers caused by 

social marginalization, a lack of health and 

safety training, gaps in policy, and economic 

pressures. The long-term exposure of 

chemicals from nail products puts nail 

salon workers at risk of health problems 

that include reproductive and cognitive 

developmental issues; cancer; allergies; 

irritation to the respiratory, dermatological, 

and central nervous systems; and 

musculoskeletal pain impacting the bones, 

muscles, tendons, ligaments, and soft tissues.

Research is lacking on evidenced-based 

interventions for Vietnamese nail salon 

workers, as well as studies on facilitators and 

barriers to their workplace settings adopting 

occupational health best practices. Building 

on a past NIOSH-funded K01 project, Drexel 

University researchers are using theorybased information to create a toolkit for salon 

owners and will test the effectiveness of this 

intervention in Philadelphia area Vietnamese 

nail salons. The toolkit will include trainings 

and self-assessment checklists, which allow 

salon owners to measure their work settings 

for chemical safety, infection control, and 

ergonomics. The toolkit will also include 

educational materials for salon owners, 

managers, and nail technicians on effective 

occupational safety and health practices and 

workers’ rights.

So far, scientists have developed and pilot 

tested four online training modules with a 

small sample of seven salon owners and 

workers. The courses focus on infection 

control, chemical safety, ergonomics, and 

labor rights. Lessons learned from this effort 

will be used to improve training for the next 

cohort in the study. The principal investigator 

on this study also wrote an opinion article 

in the metro Philadelphia newspaper, The 

Philadelphia Inquirer, on workplace safety 

and health issues facing immigrant nail 

salon workers.

Details:

■ An Immigrant Daughter’s Call to Help 

Philadelphia’s Nail Salons | Opinion

■ A Feasibility Study to Develop a Multilevel 

Occupational Health Intervention Program 

for Nail Salon Employees and Owners

Reducing the Impact of Client Death 

on Home Care Aides

Project Title: Exploring the Role of Client 

Death Support in Home Care Workers’ Grief, 

Stress, and Job Satisfaction (K01 Grant).

Principal Investigator: Emma Tsui

Prior research shows that home care aides 

experience grief, burnout, and job insecurity 

following the death of a client. Because these 

workers typically help older clients with daily 

living activities and healthcare needs, the 

death of a client can be a harsh reality and 

work-associated stressor. When this occurs, 

studies found home care aides experience 

emotional strain and short-term job loss until 

they are reassigned to a new case. However, 

there is limited research focused on home 

care agencies’ perspectives on this topic and 

how they address it and support their aides.

Scientists at The City University of New York 

Graduate School of Public Health and Health 

Policy studied this issue, interviewing leaders 

from a sample of eight New York City home 

care agencies on facilitators and barriers to 

how they handle client death. According to 

the study, the agencies mainly had a range of 

informal practices in reaction to a client dying 

and very few preventive efforts to help home 

care aides deal with the issue. In particular, 

after clients die, the organizations did not 

provide paid leave and lacked appropriate 

emotional support such as counseling or 

responsive case reassignment. They also 

provided limited to no training on end-oflife care and the emotional experiences 

surrounding client death. Rather, agencies 
42 NIOSH Extramural Research and Training Program ■ Annual Report of Fiscal Year 2020

relied on their coordinators to informally 

handle home care aides’ needs; however past 

studies have shown they often emphasize 

staffing priorities over the needs of aides.

While most leaders in this study recognized 

that home care aides need more support, 

they mentioned one major barrier to this 

happening is the lack of funding and available 

resources related to employment and 

healthcare policy. Nevertheless, researchers 

note that policy changes leading to increased 

wages, paid time off, and emotional support 

services for aides can increase well-being and 

retention among this critical workforce. Their 

findings have been reported in the Journal of 

Applied Gerontology.

Details:

■ Interventions to Reduce the Impact of Client 

Death on Home Care Aides: Employers’ 

Perspectives
NIOSH Extramural Research and Training Program ■ Annual Report of Fiscal Year 2020 43

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 2020, NIOSH funded the state 

surveillance program to support states in 

monitoring occupational injuries, diseases, 

exposures, and deaths. Other cooperative 

agreements awarded in FY 2020 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

 Overview

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 2020

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, 2019, through September 30, 2020, the 

state surveillance program published 14 

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.
44 NIOSH Extramural Research and Training Program ■ Annual Report of Fiscal Year 2020

 Program Highlights FY 2020

Occupational Injury Added to 

Syndromic Surveillance System

EpiCenter—the New Jersey syndromic 

surveillance system that alerts local and 

state health officials of potential community 

outbreaks in near real time based on data 

from emergency department visits—now 

includes occupational injury classifiers. 

These classifiers allow cases of workplace 

injuries and illnesses to be identified through 

keywords entered in the chief complaint 

field. This new addition to EpiCenter 

occurred through a partnership between 

the Occupational Health Surveillance (OHS) 

Unit and the Communicable Disease Service, 

Infectious, and Zoonotic Disease Program 

within the State of New Jersey Department of 

Health. Through the new classifiers, the OHS 

Unit receives alerts on potential occupational 

hazards, like chemical exposures, when three 
NIOSH Extramural Research and Training Program ■ Annual Report of Fiscal Year 2020 45

or more cases are reported in 24 hours. The 

OHS Unit also notifies the appropriate groups 

when these alerts are received, including 

the health department’s Public Employees 

Occupational Safety and Health, along with 

regional Occupational Safety and Health 

Administration (OSHA) offices, so immediate 

public health action can be taken.

Building on this milestone, staff in the 

health department’s OHS Unit chaired 

an occupational Syndromic Surveillance 

Workgroup for the Council of State and 

Territorial Epidemiologists (CSTE). CSTE 

invited this state surveillance program to lead 

the workgroup, which eventually created a 

guidance document for other states to use to 

implement their own syndromic surveillance 

for occupational health. The guidance includes 

information on how states can use syndromic 

surveillance and develop their occupational 

health syndrome definitions. The report also 

describes some states’ current syndromic 

surveillance systems, including details on 

their types of systems and what variables are 

collected. CSTE posted the guidance document 

on its website and featured it during its 

December 2019 Occupational Health 

Surveillance Subcommittee Meeting.

Details:

■ NJ Health: Syndromic Surveillance

■ NJ Health: Workplace Health and Safety 

Occupational Health Surveillance 

■ Syndromic Surveillance for Occupational 

Health Surveillance: Guidance Document 

and Examples

Effort to Prevent Opioid Exposure 

Reaches Thousands of Georgia First 

Responders

Carfentanil and other similar substances 

designed to mimic fentanyl—a synthetic, 

or manmade, opioid—can be harmful to 

public safety, first responder, and medical 

treatment and laboratory workers. Emergency 

responders are likely to come into contact 

with illicit drugs on the job, including opioids 

such as fentanyl and fentanyl-related 

compounds like Carfentanil. These substances 

are increasingly linked to opioid overdose 

deaths. Fentanyl and substances that are 

compounds from its drug class have many 

forms, like powder or liquid, and exposed 

workers can accidentally inhale or absorb 

it through the skin. In 2018, emergency 

medical services (EMS) and law enforcement 

personnel completed a survey on opioid 

exposure, given by the Georgia Department 

of Public Health Occupational Health & Safety 

Surveillance Program (GA-OHS). Less than 

half of the workers knew about CDC/NIOSH 

recommendations for preventing opioid 

exposures among first responders, according 

to survey findings.

Based on these data, GA-OHS determined a 

need for more education and outreach on 

preventing opioid exposure. The program 

created a fact sheet in FY 2020 summarizing 

CDC/NIOSH recommendations entitled 

“First Responder Safety Precautions for 

Dealing With Unknown Opioids,” and widely 

distributed the document. All licensed EMS 

personnel in Georgia received the fact sheet 

via email, totaling more than 20,000 workers. 

The program also hosted a booth at the 

2019 Georgia EMS Association Providers 

and Educators Conference in October 2019, 

where GA-OHS staff talked with hundreds 

of EMS personnel. They handed out the fact 

sheets, along with information on the NIOSH 

illicit drug toolkit, and provided education on 

preventing opioid exposures, including use of 

personal protective equipment. The Georgia 

Association of Chiefs of Police also featured 

the fact sheet in its quarterly newsletter.

Details:

■ Opioid Epidemic: First Responders and EMS

■ Preventing Emergency Responders’ 

Exposures to Illicit Drugs

■ Fentanyl

■ Georgia Association of Chiefs of Police 

Online Quarterly News
46 NIOSH Extramural Research and Training Program ■ Annual Report of Fiscal Year 2020

Identification of Top Occupational 

Injury Claims in Massachusetts

In a study examining workers’ compensation 

claims from 2014 through 2016, the 

Massachusetts Department of Public Health, 

in collaboration with the Massachusetts 

Department of Industrial Accidents and 

the Massachusetts Department of Labor 

Standards, found state workers filed 

claims most often for strains and sprains. 

Investigators used previously unavailable 

data from the Massachusetts Department of 

Industrial Accidents and looked at trends of 

occupational injuries and illnesses for private 

sector workers. Analyzing 93,123 workers’ 

compensation lost-wage claims, they identified 

common types of incidents leading to injuries 

and illnesses and reported demographics like 

gender, age, and industry. The claims were 

filed during 2014–2016 for employees working 

at least 40 hours weekly, equaling to an 

average of 31,041 claims per year.

The occupational sectors with the highest 

claim rates included Transportation and 

Warehousing, Construction, Healthcare and 

Social Assistance, and Wholesale and Retail 

Trade. Other key findings included that injuries 

accounted for 95% of all claims, with most of 

the workers experiencing strains and sprains 

(51%); contusions, crushings, bruises (12%); 

fractures (9%); and cuts, lacerations, and 

punctures (8%). Overexertion due to lifting and 

pushing marked the top cause of all injuries 

(38%), followed by slips, trips, and falls (29%), 

contact with an object or equipment (19%), 

and violence and transportation incidents (5%). 

Males filed the majority of claims, along with 

workers aged 55–64 years who mostly reported 

being injured from a fall on the same level. 

These findings can help guide research and 

prevention efforts—full results are available in 

a report released in November 2019.

Details:

■ Outside NIOSH: Strains and Sprains Lead 

Work-related Injury Claims in Massachusetts

■ Occupational Health Surveillance Program

Surveillance Uncovers Hazardous 

Lead Exposure at Small Business

The New York State Department of Health 

(NYSDOH) uses its Heavy Metals Registry 

(HMR) to collect surveillance data on adult 

exposures to lead, mercury, cadmium, and 

arsenic. The registry helped the NYSDOH 

surveillance program identify 27 workers at a 

small business who had the highest blood lead 

levels (BLLs) ever recorded in the HMR. They 

were subcontractor field technicians hired by 

a specialty company to remove and refurbish 

older windows in a commercial building under 

renovation. After looking into the situation, the 

program found the commercial building was 

older with lead paint on its interior and exterior 

surfaces, as well as its windows and doors. The 

investigation also revealed the company did 

not test the facility for lead, and employees 

reported safety rules were not enforced onsite, 

along with a lack of respiratory protection and 

guidance on sanitation and hygiene practices 

for lead exposure.

The business responded to the incident with 

several actions including putting their workers 

on a medical monitoring plan based on 

OSHA guidelines and setting up a Respiratory 

Protection Program. The workers must now 

wear personal protective equipment, including 

respirators, which they are fit tested for, when 

around lead or other harmful materials. The 

company also developed standard operating 

procedures (SOPs) that include the new 

safety and health changes. They trained all 

employees on the SOPs and now offer an 

annual lead training that includes a review of 

OSHA standards and lead hazards.

The NYSDOH surveillance program continues 

to monitor the workers’ BLLs and tracks the 

company’s progress in implementing the new 

safety and health changes. The program also 

offers follow-up medical care to the workers, 

when needed, through its Occupational Health 

Clinic Network, which assists thousands of 

patients annually for occupational illness 

and injuries.
NIOSH Extramural Research and Training Program ■ Annual Report of Fiscal Year 2020 47

Details:

■ Heavy Metals Surveillance: New York State 

Heavy Metals Registry

■ Occupational Health Clinic Network—

Prevention and Protection for the NYS 

Workforce

Identification of Injury Risks 

Associated With Motor Vehicle 

Towing

Past data show that deaths related to 

managing the scene after motor vehicle 

crashes most likely involve commercial tow 

truck operators. Following roadway incidents, 

these workers coordinate with traffic incident 

managers in multiple ways to remove 

disabled or nonworking vehicles, clearing 

debris and cleaning up fallen cargo. Research 

shows these workers have a high likelihood 

of being struck by roadway traffic, also 

called pedestrian struck-by incidents, when 

performing these traffic incident management 

(TIM) activities. In fact, commercial tow truck 

operators are at greater risk than other first 

responders with TIM functions like fire, police, 

and emergency medical personnel.

Limited research exists on hazards related 

to motor vehicle towing (MVT) and effective 

safety strategies for this industry. To address 

this issue, the Kentucky Occupational Health 

and Safety Surveillance Program used OSHA 

data to describe factors linked to injuries 

among commercial tow truck operators as 

they provided roadside assistance. They 

analyzed information from OSHA investigation 

files from 2002–2017, specifically the written 

descriptions of each injury event. They 

also examined separate data on weather 

conditions for each case.

In total, there were 106 cases where tow 

truck operators died or were severely hurt, 

but researchers could only get detailed 

descriptions for 41 cases. They focused on 

types of injury incidents and related causes. 

Most of the incidents were either struck-by 

incidents or caught-in or -between’ incidents, 

where workers were pinned beneath 

or between vehicles or caught in their 

moving parts.

According to researchers, these findings 

demonstrate the need for first-time and 

refresher safety trainings in the MVT industry 

on loading and unloading vehicles and 

defensive techniques while around roadway 

traffic. Researchers also recommended 

trainings on proper wheel chocking and 

braking procedures, advocating for states to 

add tow trucks to the list of first responder 

vehicles in “Move Over” laws. The Journal 

of Safety Research published this study in 

December 2019, and the Kentucky surveillance 

program shared its findings with the Towing 

and Recovery Association of America and 

Emergency Road Service Coalition of America.

Details:

■ Motor Vehicle Towing: An Analysis of 

Injuries in a High-risk yet Understudied 

Industry

■ Kentucky Occupational Safety and Health 

Surveillance Program
48 NIOSH Extramural Research and Training Program ■ Annual Report of Fiscal Year 2020

SPECIALTY TRAINING PROGRAMS

NIOSH funds the TPGs, the 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

 Overview

NIOSH supports training in occupational 

safety and health through TPGs. Most 

TPGs are academic training programs 

that support undergraduate, graduate, 

and post-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 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 2030—

to promote the health and well-being of the 

workforce. TPGs also serve as important 

resources on job-related safety and health 

issues for business, labor, government, and 

the public.

 Research Outputs: 

Publications in FY 2020

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 
NIOSH Extramural Research and Training Program ■ Annual Report of Fiscal Year 2020 49
50 NIOSH Extramural Research and Training Program ■ Annual Report of Fiscal Year 2020

Reporter database, the NIOSHTIC-2 database, 

and the PubMed database. From October 1, 

2019, through September 30, 2020, the TPG 

researchers published 21 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 2020

Training Project Grant Trainees, 

Graduates, and Employment by 

Discipline

In academic year 2019–2020, the TPG 

academic training programs had 859 trainees, 

of which 259 graduated 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. These current figures reflect an 

increase from the FY 2019 number of trainees 

(787) and graduates (256).

Training Project Grant (TPG) Program 

Achievements

Study on Indoor Portable Air Cleaners 

and Wildfire Safety

In the United States, the wildfire season 

continues to intensify in severity and duration, 

particularly out west. Wildfire smoke contains 

dangerous chemicals—mostly fine particulate 

matter or PM2.5—a harmful substance that 

can stay in the air for long periods. People 

can inhale it deep into their lungs, and studies 

show PM2.5 is linked to systemic inflammation 

and disorders affecting the heart and lungs; it 

is linked to increased fatalities.

Public health recommendations for wildfires 

include using an indoor portable air cleaner 

that removes particulate matter from rooms 

by moving air through a filter. According to 

research, this type of device can decrease 

PM2.5 levels in homes caused by wildfire 

smoke. However, data are limited on exposure 

to wildfire-sourced PM2.5 in office settings. 

Led by one of its trainees, the Montana 

Technological University TPG studied the 

effectiveness of an indoor portable air cleaner 

in decreasing PM2.5 in offices and explored 

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

discipline, FY 2020

Program Area Trainees Graduates

Employed in occupational safety and 

health field or seeking advanced training 

(%)

Industrial Hygiene 286 78 78 (100)

Occupational Safety 233 83 79 (95)

Occupational Medicine 42 22 22 (100)

Allied Disciplines 298 76 73 (96)

Total 859 259 252 (97)
NIOSH Extramural Research and Training Program ■ Annual Report of Fiscal Year 2020 51

connections between outdoor and indoor 

PM2.5 levels during wildfires. Researchers 

found concentrations of PM2.5 in offices were 

like those reported outside by a local National 

Ambient Air Quality Standards monitoring 

station during a Pacific Northwest wildfire. 

Scientists compared two identical offices—one 

with the device and one without it—during 

wildfire season. The portable air cleaner 

reduced the amount of PM2.5 inside the office 

by 73% during working hours and 92% during 

nonworking hours.

These findings show that indoor work areas, 

like offices, can have high PM2.5 levels during 

wildfires, but a portable air cleaner can lessen 

the problem and protect health. Researchers 

also created a method to improve their 

measuring instruments by correcting for 

overestimated PM2.5 levels. The Journal of 

Occupational and Environmental Hygiene

featured this study in FY 2020, and more than 

500 people have read about the project.

Details:

■ Control of Wildfire-sourced PM2.5 in an 

Office Setting Using a Commercially 

Available Portable Air Cleaner

■ Outside NIOSH: Portable Air Cleaners: 

Making Indoor Work Safer During Wildfires

Training Successes from Texas

A&M University

The Occupational Safety and Health Training 

Program at the Texas A&M University Health 

Science Center School of Public Health is a TPG, 

offering graduate training with concentrations 

in worker safety, health, and ergonomics. 

Trainees gain knowledge and skills in varied 

occupational safety and health areas including 

workplace wellness, occupational disease, 

ergonomics, user-computer interaction, 

industrial hygiene, industrial process safety, 

epidemiology, and other areas.

In FY 2020, TPG trainees completed research 

and developed new tools related to the safety, 

design, and human factors of the workplace. 

They worked with the Texas A&M Ergo Center 

and provided ergonomics task analysis and 

job description information, which allowed the 

center to examine university workers’ varied 

postures on the job. Trainees also provided 

ergonomic evaluations at a local area hospital 

and for university employees who requested 

these to identify risks like repetitive tasks that 

can cause strains or other issues that cause 

musculoskeletal disorders. These types of 

professional practice experiences provide 

invaluable training and leads to employment 

opportunities. In FY 2020, all 21 TPG graduates 

from Texas A&M were hired in OSH positions 

at the time they obtained their degrees or 

shortly after. These graduates are also eligible 

to apply for the Certified Safety Professional® 

credential because the Occupational 

Safety and Health Training Program is 

accredited through the Board of Certified 

Safety Professionals.

Increasing Diversity in Occupational 

Safety and Environmental Health

Recruitment of minority students marks a key 

focus for the Western Kentucky University TPG. 

This grant helps to support undergraduate 

and graduate students in the university’s 

Environmental and Occupational Health 

Science (EOHS) Program. These trainees gain 

knowledge and experience in public health, 

environmental health, occupational safety and 

health, environmental science and compliance, 

and injury and illness prevention. The Western 

Kentucky University TPG carried out strategies 

in FY 2020 to recruit, train, and retain minority 

trainees in the program, with the goal of 

increasing diversity in both occupational 

safety and health and environmental 

health. Key strategies for recruiting minority 

undergraduate students included participating 

in college recruitment fairs and promoting 

the program’s scholarships and professional 

opportunities. The TPG targeted high school 

students taking college courses and college 

students taking general EOHS courses. To 

recruit minority graduate students, TPG staff 

gave presentations during EOHS upper-level 
52 NIOSH Extramural Research and Training Program ■ Annual Report of Fiscal Year 2020

courses, promoted the program through the 

university’s graduate school, and participated 

in the graduate school’s recruitment events. 

Information that the Western Kentucky 

University TPG recently obtained from 

interested parties, including environmental and 

occupational health managers, revealed an 

ongoing regional need for EOHS professionals. 

Its past graduates are currently working in 

these types of positions and impacting worker 

health in Kentucky and beyond.

EMERGENCY RESPONDER 

TRAINING PROGRAM

 Overview

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 first 

responders training program. 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 lifethreatening events, including the administration 

of naloxone (NARCAN). In response, IAFF 

developed an Opioid Crisis Toolkit, which uses 

the protocols, state-of-the-art responses, and 

resources available to firefighters.

 Program Highlights FY 2020

In FY 2020, IAFF delivered 63 classes to 1,231 

students, totaling 21,608 contact hours.

Table 8. Emergency responder training classes, FY 2020

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 34 678 16,272

Illicit Drug Labs 8 hours 13 230 1,840
NIOSH Extramural Research and Training Program ■ Annual Report of Fiscal Year 2020 53

MINER SAFETY AND HEALTH 

TRAINING PROGRAM

 Overview

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 2020, 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 

occupational illnesses, injuries, and fatalities 

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

Recent research shows that 24 mining 

workers died in 2019—the lowest number of 

fatalities in MSHA’s 43-year history. In 2020, 

there were 29 mining deaths, making it the 

sixth consecutive year in the agency’s history 

that mining industry fatality numbers were 

below 30. While this improvement cannot be 

solely attributed to effective safety training, 

such interventions likely contribute to these 

outcomes. In a recent evaluation of the 

NIOSH Mining Program, it is noted that MSHA 

takes advantage of knowledge and products 

provided by the NIOSH-funded Miner Safety 

and Health Training Program—Western 

United States.

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, 
54 NIOSH Extramural Research and Training Program ■ Annual Report of Fiscal Year 2020

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. During FY 

2020, the program trained 984 mine workers 

through 84 courses. Due to challenges related 

to COVID-19, training numbers were lower 

than in FY 2019 when 1,538 mine workers 

received training 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 2020

New Online Courses for Professionals 

in Mining Safety and Health

The Colorado School of Mines (CSM) offers a 

broad Professional Development Curriculum 

that aims to increase trainers’ and safety and 

health professionals’ capacity to train mining 

workers. The curriculum achieves this goal by 

increasing the technical skills and knowledge 

of trainers and other professionals and has 

been offered through the following ways 

since 2018:

■ Train-the-Trainer Presentations on 

varied topics including engineering 

controls, exposure assessment and hazard 

recognition, instructor coaching, training 

methodologies, and adult education.

■ Short Courses on topics required by 

MSHA to be taught during its 30 CFR Part 

48 trainings.

■ Joint Industry Training that links 

management and labor to participate 

in productive discussions on safety 

and health issues pertinent to their 

individual operations.

■ Safety and Health Training Courses

to improve the effectiveness of safety 

and health programs and/or safety 

management systems.

■ Webinar Series that focuses on current 

relevant safety and health topics.

In FY 2020, CSM created four online courses 

under the Professional Development 

Curriculum and offers them on the CSM 

website. These classes are called (1) Hazardous 

Particulates, (2) Safety Management Systems 

[Part 1 and 2], (3) MSHA 101 [Part 1 and 2], and 

(4) Sleep: The Most Important Component of 

Safe Behavior. CSM also held other training 

activities that included some of these course 

topics, such as two presentations at the 15th 

Annual Mine Safety & Health Conference in 

October, 2019, in Reno, Nevada. More than 

90 people attended the two presentations: 

“Sleep: The Most Important Component of 

Safe Behavior” and “Energy, Mining, and 

Construction Industry Safety (EMCIS) Training: 

Fun—Not Funny.” CSM staff offered ”EMCIS 

Training: Fun—Not Funny” and another 

presentation, “Your Brain on Stress and 

Fatigue,” to nearly 50 members of the Society 

for Mining, Metallurgy & Exploration via a 

webinar. The CSM program reports many 

conference and webinar attendees requested 

slides following the events.

Details:

■ Online Training Modules & Presentations
NIOSH Extramural Research and Training Program ■ Annual Report of Fiscal Year 2020 55

New Gaming Software Features 

Enhance Training and Evaluation of 

Performance

The University of Arizona added a new 

feature to its computer-based serious gaming 

software such as “Harry’s Hard Choices” and 

“Harry’s Hazardous Day” during FY 2020. This 

software is used to provide engaging training 

in miner safety and health through games 

that lead to increased knowledge transfer. The 

new feature is a series of game mechanics 

or computerized rules that guide trainees’ 

actions and tasks they are given while using 

the game, along with game advancement 

strategies. These mechanics provide a 

competency-based evaluation or assessment 

of trainees’ performance during the game, 

using this assessment to improve the training.

The gaming software is based on the 

university’s Mine Health and Safety 

Competency Model—a five-tiered approach 

to occupational safety. The mechanics 

assess trainees’ performance on gaming 

tasks, providing measures in the areas of 

(1) skills and abilities, (2) derived attributes 

based on personality assessments, (3) core 

attributes based on behavioral tendencies 

and talents, and (4) class or knowledge of 

certain jobs or professions. University staff 

created these mechanics using methodology 

proven successful in the genre of role playing 

games, which includes the university’s serious 

games that train workers through avatars in 

simulated scenarios. Through this new feature, 

trainees’ choices and behaviors in the game 

determine their avatars’ assigned knowledge, 

skills, abilities, and other attributes, along with 

specific tasks they are asked to complete, and 

guide the feedback, rewards and penalties 

received during the game.

Details:

■ Harry’s Hazardous Day Game Mechanics
56 NIOSH Extramural Research and Training Program ■ Annual Report of Fiscal Year 2020

V. 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 400,000 people are 

believed to be at an 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 people. 

Illnesses related to the 9/11 attacks persisted in many survivors 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 responders, 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 (Zadroga Act). 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 (Public Law 111–347, as amended 

by Public Laws 114–113 and 116–59), 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.
NIOSH Extramural Research and Training Program ■ Annual Report of Fiscal Year 2020 57

WTC HEALTH PROGRAM 

RESEARCH PORTFOLIO OVERVIEW

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 

2020, the WTC Health Program reviewed a 

total of 300 research proposals (including 

contracts but excluding the initial and 

renewal awards of the WTC Health Registry) 

and selected 84 (28%) projects in addition to 

the WTC Health Registry for funding. 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.

During FY 2011–2020, the WTC Health 

Program funded 84 research projects 

(excluding the WTC Health Registry) for a total 

of $127.4 million. During FY 2011–2020, the 

WTC Health Program continued to fund the 

WTC Health Registry project for a total of $67.6 

million. Total research funding from 2011 

through 2020 for the 84 research projects and 

the WTC Health Registry is shown in Figure 

10. Additionally, see Table 9 for FY 2020 data. 

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.

Table 9. World Trade Center Health Program funding, FY 2020

Award Category Award Mechanism

Number 

of Awards Funding

World Trade Center Health Program — 30 $23,717,253

World Trade Center Research Cooperative Agreements (U01) 29 $15,822,253

World Trade Center Health Registry Health Registry 1 $7,895,000

*The data in Table 9 do not include active projects funded with prior year funding through no cost extensions.
58 NIOSH Extramural Research and Training Program ■ Annual Report of Fiscal Year 2020

Figure 10. Research funding for 2011–2020 research cooperative agreements, 

WTC Health Registry, and research contracts

Of the 84 projects awarded since 2011, 38 

(45%) are active and 46 (55%) are completed 

(closed). Thirteen of the active projects 

and 33 of the closed projects produced 

144 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 partners, 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 11 for data on the publications 

resulting from WTC cooperative research 

agreements.
NIOSH Extramural Research and Training Program ■ Annual Report of Fiscal Year 2020 59

Note: Some projects involve more than one focus area, but publications are counted only toward the main 

area of focus.

*Emerging conditions: autoimmune disease, assessment of bias in WTC studies, cognitive function, 

neuropathic symptoms, kidney disease, general responder mortality, WTC exposure assessment-global 

DNA methylation, trace elements in autopsy tissues from WTC decedents, development of a comparison 

WTC occupational cohort, and hepatitis C.

Figure 11. Research studies and publications by primary focus area
60 NIOSH Extramural Research and Training Program ■ Annual Report of Fiscal Year 2020

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, 2001, terrorist attacks 

and in its aftermath. It is one of the longest running postdisaster 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, 2001, terrorist attacks.

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 meetings with 

interested parties/groups.

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 partners 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 

adults 18 years of age or older. Approximately 

1,684 child registrants who have aged into 

adulthood have consented to remain in the 

Registry as young adults, including 152 in 

2020. WTC Health Registry staff are conducting 

outreach to the remaining unconsented 

young adults.
NIOSH Extramural Research and Training Program ■ Annual Report of Fiscal Year 2020 61

SCIENTIFIC OUTPUTS

From 2004 through 2020, the WTC Health 

Registry had a total of 592 scientific outputs 

(publications, presentations, published 

guidelines, etc.). The distribution of outputs by 

type is presented in Figure 12.

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. For summaries 

of the Registry’s 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.

*Number of registry outputs for 2004–2020; publications resulting from registry-facilitated recruitment into 

external research studies or registry provided de-identified data.

Figure 12. WTC Health Registry key scientific outputs including publications* and 

presentations, 2004–2020
62 NIOSH Extramural Research and Training Program ■ Annual Report of Fiscal Year 2020

APPENDIX

FY 2020 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

NSF-20-522 Interagency 

Agreement 

National Robotics Initiative 2.0

Training Programs and Centers

PAR-15-352 T03 Occupational Safety and Health Training Project Grants

RFA-OH-20-003 T03 Commercial Fishing Occupational Safety Training Project Grants 

PAR-15-303 T42 Occupational Safety and Health Education and Research Centers

Cooperative Agreements

RFA-OH-20-002 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
NIOSH Extramural Research and Training Program ■ Annual Report of Fiscal Year 2020 63

Funding 

Opportunity Mechanism Title

RFA-OH-20-007 U54 National Center of Excellence for the Prevention of Childhood 

Agricultural Injury

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

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

Research and Translation

RFA-OH-20-001 U60 Miner Safety and Health Training Program—Western United States

Cosponsored Research With the National Institutes of Health 

PA-19-272 R43, R44 PHS 2019-02 Omnibus Solicitation of the NIH, CDC, and FDA for 

Small Business Innovation Research Grant Applications 
Promoting productive workplaces through safety and health research

DHHS (NIOSH) Publication No. 2022-120

DOI: https://doi.org/10.26616/NIOSHPUB2022120