ationa/Sa fety and Health 

cia/ Hazard 

Review 

Child Labor Research Needs 

Re~ommendations from the 

NIO5H Child Labor 

US. DEPARTMENT OF HEALTH AND HUMAN SERVICES 

Public Health Service 

Centers for Disease Control and Prevention 

National Institute for Occupational Safety and Health 

CDC 

crll,/sr so1 0 IE/SE GO*TROL 

"*O sltlluol 
E 

SPECIAL HAZARD REVIEW 

CHILD LABOR RESEARCH NEEDS 

Recommendations from the NIOSH 

Child Labor Working Team 

US. DEPARTMENT OF HEALTH AND HUMAN SERVICES 

Public Health Service 

Centers for Disease Control and Prevention 

National Institute for Occupational Safety and Health 

August 1997 
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DHHS (NIOSH) Publication No. 97-143 
PREFACE 

The Occupational Safety and Health Act of 1970 emphasizes the need for standards to protect the 

safety and health of American workers. To fulfill this need, the National Institute for Occupational 

Safety and Health (NIOSH) has developed a strategy for disseminating information that will help 

employers protect their workers from workplace hazards. This strategy includes the development 

of NIOSH Special Hazard Reviews, which support and complement the major standards development and hazard documentation activities of the Institute. These documents deal with hazards that 

merit research and concern from the scientific community even though they are not currently suitable for comprehensive review in a criteria document or a Current Intelligence Bulletin. NIOSH 

Special Hazard Reviews are distributed to the occupational health community at large-industries, 

trade associations, unions, and members of the academic and scientific communities. 
ABSTRACT 

The Child Labor Working Team of the National Institute for Occupational Safety and Health 

(NIOSH) presents child labor research needs identified as of July 1996 and recommends interagency collaborations. In addition, the Team supplies information about youth employment, occupational injury and illness in young workers, Federal and State regulation of child labor, and 

national objectives for the occupational safety and health of youths. The Team also describes 10 

NIOSH projects focused on young workers in 1996. 

i" 
CONTENTS 

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

.................................. Preface iii 

Abstract iv 

Abbreviations xii 

ExecutiveSummary ............................. ix 

Acknowledgments .............................. xiii 

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

1 INTRODUCTION ........................ 1 

Scope ................................ 

Approach .............................. 1 

1 

2 BACKGROUND ......................... 3 

Historical issues ............................ 3 

Data on youth employment ........................ Occupational injury and illness data for youths ................ Fatalinjuries ........................... 5 

National-level analyses ...................... State-level analyses ....................... 6 

Nonfatal injuries and illnesses ..................... National-level analyses ...................... 11 

State-level analyses ....................... 12 

Limitations ofthe surveillance systems and the data 

Gaps in surveillance systems .................... Unreliable identification of work-relatedness ............. 21 

Inadequate documentation of agricultural injuries in children ....... Occupational illnesses in young workers ............... Inadequate knowledge about the relative risks ofjobs .......... Lack of data on the number and cost of disabling injuries ......... 

Risk factors unique to children and adolescents ................ Physical and physiological risk factors ................. 22 

Sleep requirements ....................... 23 

Susceptibility to injuries and illnesses 

Psychosocial risk factors ....................... 24 

Psychological factors ...................... 24 

Lack ofwork experience ..................... 25 

Lack of training and supervision Inappropriate work assignments .................. 25 

3 

5 

5 

11 

............ 21 

21 

21 

22 

22 

22 

22 

Size 22 

Growth ............................ 23 

23 

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

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

.................. 25 
summary ............... 

Psychosocial effects of youth employment .... 

Positiveeffectsofpart-timework ..... Negativeeffectsofpart-timework ..... 

Needs and opportunities for education and training 

Educating and training primary stakeholders . Using community groups ....... Reaching industry and labor groups ... Tapping into the educational system ... Educating and training secondary stakeholders 

Health education at the community level ... 

.............. 25 

.............. 25 

.............. 26 

.............. 26 

.............. 21 

.............. 21 

.............. 21 

.............. 21 

.............. 21 

.............. 21 

.............. 29 

3 APPLICABLE RECUlATlONS .................... 30 

OSHA regulations ........................... 30 

Federal child labor laws ......................... 30 

State child labor laws .......................... 31 

State workers' compensation laws ..................... 31 

4 NATIONAL OBJECTIVES FOR THE OCCUPATIONAL 

SAFETYAND HEALTH OFYOUTHS ................. 33 

Federal objectives ........................... 33 

Private sector objectives ......................... 33 

5 NlOSH PROJECTS FOCUSED ON CHILDREN AND ADOLESCENTS ..... 35 

Occupational injuries in children and adolescents ............... 35 

35 

Hazard control evaluation of the safety device technology for cardboard paper balers . 36 

Hazards ofyouth work ......................... 36 

MassachusettsSENSOR-seriousoccupationalinjuriestoyouths ......... 37 

Missouri agricultural safety promotion system ................ 31 

Promoting safety and health in vocational. technical. and industrial programs: 

guidelines and curricula ....................... 38 

Enhancing young workers' safety and health through community 

education efforts .......................... 38 

Adverse neurobehavioral effects in children of farm workers ........... 39 

Support of Farm Safety 4 Just Kids ..................... 39 

Hazard surveillance and injury investigation of paper baling machinery ...... 

6 RESEARCHNEEDS ........................ 40 

adolescents ............................ 40 

and adolescents ........................... 40 

Improved surveillance for work-related injuries and illnesses of children and 

Research to identify risk factors for work injuries and illnesses of children 

"I 
Research to assess the age-appropriateness of work tasks ............ 40 

Intervention research .......................... 41 

Costhenefit analyses of models for the healthful employment of children 

and adolescents ........................... 41 

Research to promote occupational safety and health education for adolescents 

inschool-basedor-facilitatedworkexperienceprograms .......... 41 

Refinement and expansion of community-level interventions to promote 

safe and healthhl work experiences for children and adolescents ........ 41 

7 RECOMMENDATIONS FOR COORDINATION. COLIABORATION. 

AND PARTNERSHIPS ....................... 42 

hteragency coordination and collaboration ................. 42 

State partnerships ........................... 43 

Private organization partnerships ..................... 43 

References ............................... 44 

Appendices 

A . Charge to the NIOSH Child Labor Working Team ............. 50 

B . NIOSH Child Labor Working Teammembership ............. 51 

C . Expert presentations to NIOSH Child Labor Working Team ......... 53 

D . National objectives for the occupational safety and health of youths ...... 55 
EXECUTIVE SUMMARY 

The National Institute for Occupational Safety 

and Health (NIOSH) Child Labor Working 

Team was formed in April 1994 to identify research, surveillance, and intervention actions 

to prevent injuries and illnesses among working children and adolescents. This Special 

Hazard Review presents the research needs 

identified by the Team and their recommendations for interagency collaborations as of July 

1996. The document uses available data to 

identify research needs and opportunities for 

prevention. 

Research needs were identified through the diverse expertise and research of Team members 

and presentations by outside experts. The recommendations in this report were shaped by 

the following complementary goals: 

To reduce injuries and illnesses resulting 

from childhood exposures to hazardous 

work environments 

To promote positive, encouraging, successful, and healthy introductions to 

working life 

To foster knowledge and skills in safety 

and health that will remain with youths 

throughout their working lives and enable them to be active participants in 

shaping their work environments 

Concerns about the employment of children 

are not new. Child labor laws enacted in the 

early 1900s resulted in substantial improvements in working conditions and in the number 

of children receiving an education. Recent research by NIOSH and others has demonstrated 

that concerns about child labor cannot be restricted to the past. Although numerous gaps 

exist in our information, it is clear that 

employment and occupational injuries and illnesses among children and adolescents are 

common in the United States. In 1995, an estimated 2.6 million adolescents aged 16 and 17 

were employed. Each year, approximately 70 

youths die from injuries at work; hundreds are 

hospitalized; and tens of thousands require 

treatment in hospital emergency rooms. Children and adolescents have a relatively high risk 

for occupational injury compared with adults. 

Characteristics of youths that differentiate 

them from older workers (and may increase 

their risk for occupational injuries and illnesses) include minimal work experience, factors associated with physical and psychosocial 

development, and the need to balance the demands of school and work. Research on the 

psychosocial aspects of youth employment 

have found both positive and negative outcomes. Positive outcomes include the acquisition of basic job skills and enhanced 

self-confidence and self-esteem. Negative effects include decreased school performance, 

increased use of alcohol, decreased participation in extracurricular activities, and a consistent pattern of inadequate sleep. 

Stakeholders concerned with the occupational 

safety and health of youths include employers, 

parents, youths, educators, medical providers, 

and others interested in the well-being of 

youths. Efforts are needed to increase awareness of occupational safety and health issues 

among stakeholders and encourage efforts to 

prevent occupational injuries and illnesses 

among children and adolescents. Efforts to 

promote the safe and healthfid employment of 

these workers can benefit from the broad perspective of community health education. 

ix 
Children and adolescents are protected by a 

patchwork of regulations. The Occupational 

Safety and Health Administration (OSHA) 

regulations apply to children and adolescents 

as well as to older workers. Except for exposure to ionizing radiation, OSHA regulations 

do not differentiate on the basis of age. However, Federal child labor laws provide specific 

protection for children under age 18. Federal 

child labor regulations include restrictions on 

both occupations and hours of work for children under age 16. In addition, the Secretary of 

Labor declares certain jobs to be too hazardous 

for minors to perform (Hazardous OccupaGons 

Orders). The minimum age for performing 

work that has been declared hazardous by the 

Secretary is 16 years in agriculture and 18 

years in nonagricultural industries. NIOSH 

submitted comments when the US. Department of Labor (DOL) published an Advance 

Notice of Proposed Rulemaking in 1994. Several bills have been considered by Congress 

this year to limit enforcement of or modify 

specific Hazardous Occupations Orders. Sates 

also have child labor laws, which may be 

stricter than Federal laws. State workers’ compensation laws affect data that are collected in 

each State. In addition, some State workers’ 

compensation laws provide for increased rates 

or fines with child labor law violations, and 

many States limit legal remedies that may be 

pursued when children are injured or killed at 

work. 

Multiple national objectives, both inside and 

outside the Federal government, intersect with 

the mission of the Team. The Secretary of the 

U.S. Depahent of Health and Human Services (DHHS), Healthy People 2000, the 

School-to-Work Opportunities Act, the Goals 

2OOO-Educate America Act, and the American 

Public Health Association (APHA) all call for 

providing students with an education that will 

prepare them for work. Healthy People 2000 

includes a specific objective to reduce workrelated injury rates among adolescent workers. 

Youths are a priority area at the Centers for 

Disease Control and Prevention (CDC), and 

“special populations at risk,” which explicitly 

includes young workers, is a priority research 

area in the National Occupational Research 

Agenda. Other groups calling for research into 

the occupational safety and health of youths include the National Committee for Childhood 

Agricultural Injury Prevention, the National 

Safety Council Agricultural Division, APHA, 

and the Child Labor Coalition. AF’HA and the 

Child Labor Coalition have both urged coordination of efforts across multiple government 

agencies. 

Most NIOSH research and activities have implications for workers of all ages-with the exception of research focused on industries or 

occupations in which children and adolescents 

have minimal employment, or special populations excluding children and adolescents. As 

of July 1996, NIOSH had 10 research projects 

that take into account the unique characteristics and needs of working children and adolescents. These projects range from the collection 

and analysis of data on exposures or outcomes 

to community-based demonstration projects. 

The impacts of these projects will not be restricted to working children and adolescents: 

they will affect the general workforce as well 

as the future workforce. 

When identifying occupational safety and 

health research needs for children and adolescents, the Team considered existing knowledge, current research efforts, and needs 

expressed by stakeholders. The following are 

research needs identified by the Team: 

* Improved surveillance of work-related 

injuries and illnesses in children and 

adolescents 
Etiologic research to identify risk factors 

leading to work injuries and illnesses of 

children and adolescents, with particular 

attention to risk factors that may be specific to youths 

Research to support assessments of the 

age-appropriateness of specific work 

tasks 

Intervention research to identify effective prevention strategies 

A model for the healthful employment of 

children and adolescents, with rigorous 

assessment of diverse benefits for employers 

" Research to promote occupational safety 

and health education for adolescents and 

a safe environment in school-based or 

-facilitated work experience programs 

* Refinement and expansion of communitylevel interventions to promote safe and 

healthful work experiences for children 

and adolescents 

Because child labor involves multiple stakeholders, we need routine communication, collaboration, and coordination among Federal 

agencies such as DOL, the U.S. Department of 

Agriculture, the U.S. Department of Education, and other agencies within DHHS. Funding by multiple agencies for some projects 

should be considered. NIOSH should seek 

partnerships with stakeholders in the private 

sector as well. 
ABBREVIATIONS 

APHA 

BLS 

CDC 

CFOI 

CPS 

CSREES 

DHHS 

DOL 

DRDS 

DSHEFS 

DSR 

EID 

EPA 

FACE 

FLSA 

HOs 

IMIS 

NCHS 

NEISS 

NIOSH 

NTOF 

OD 

OSHA 

SENSOR 

so11 

American Public Health Association 

Bureau of Labor Statistics 

Centers for Disease Control and Prevention 

Census of Fatal Occupational Injuries 

Current Population Survey 

Cooperative State Research, Education, and Extension Service 

US. Department of Health and Human Services 

U.S. Department of Labor 

Division of Respiratory Disease Studies 

Division of Surveillance, Hazard Evaluations, and Field Studies 

Division of Safety Research 

Education and Information Division 

U.S. Environmental Protection Agency 

Fatality Assessment and Control Evaluation Program 

Fair Labor Standards Act 

Hazardous Occupations Orders 

Integrated Management Information System 

National Center for Health Statistics 

National Electronic Injury Surveillance System 

National Institute for Occupational Safety and Health 

National Traumatic Occupational Fatalities Surveillance System 

Office of the Director 

Occupational Safety and Health Administration 

Sentinel Event Notification System for Occupational Risks 

Survey of Occupational Injuries and Illnesses 

xii 
ACKNOWLEDGMENTS 

The Team thanks all those who attended and gave expert presentations at Team meetings (Appendix C). The presentations and input from these experts greatly increased Team knowledge and appreciation of the complex issues surrounding youth employment. Special thanks go to several 

individuals who provided expertise on occupational safety and health concerns for children and 

adolescents on a regular basis: Letitia Davis, Sc.D., Massachusetts Department of Public Health; 

David Parker, M.D., M.P.H., Minnesota Department of Health; Suzanne Mager, J.D., and Mary 

Miller, Washington Department of Labor and Industries; and Chaya Piotrkowski, Fordham University. These individuals are all actively involved in the occupational safety and health of adolescents 

and were.extremely generous in sharing their expertise with the Team. The Team also thanks our supervisors and the National Institute for Occupational Safety and Health (NIOSH) Leadership Team 

for their support and commitment to our efforts at providing an informed response to the occupational safety and health research needs of working children and adolescents. 
1 INTRODUCTION 

HE National Institute for Occupational T Safety and Health (NIOSH) Child Labor 

Working Team was formed in April 1994 by 

Dr. Richard Lemen, the former Deputy Director of NIOSH. In his Charge to the Team (Appendix A), Dr. Lemen stated that “NIOSH 

must take an active role in the prevention of 

work-related injuries and illnesses among our 

Nation’s youth.” The mandate for the Team 

was to assess cuqent research and prevention 

activities “with the goal of identifying research, 

surveillance, and intervention actions to be undertaken for the prevention of injuries and illnesses that limit the health, well-being, or potential of our working youth in this country.” 

This Special Hazard Review identifies the research needs identified by the Team as of July 

1996. The document synthesizes available data 

and identifies research needs and opportunities 

for prevention. 

Scope 

The research recommendations in this Special 

Hazard Review cover the full research spectrum-from surveillance through etiologic and 

intervention research. Considerations of the 

occupational safety and health of children and 

adolescents cannot be restricted to the work 

environment. School, family, and extracurricular activities all influence the safety and health 

of working children and adolescents. Furthermore, many nonworking children are routinely 

exposed to hazardous work environments. 

Consequently, the foci for research and intervention must be diverse. 

In identifying research needs, the Team addressed both the formal and informal employment of children-for example, children 

employed informally in family farming and 

fishing operations. The Team also addressed 

school-based or -facilitated work programs 

(such as vocational and school-to-work programs) and children exposed to occupational 

hazards in their living environments or in their 

parents’ workplaces (some children accompany their parents at work). The Team identified special populations that have specific 

research or intervention needs: youths with 

learning disabilities, minority and disadvantaged youths, school drop-outs, and children 

who accompany their parents at work (e.g., migrant and nonmigrant children on farms, and 

children of immigrants working in sweatshops). Two areas of child labor that the Team 

acknowledges to be important are not addressed in this report: international child labor 

and the illicit employment of children in operations such as drug sales, prostitution, and 

door-to-door sales. 

Approach 

The identification of research needs was 

shaped by the following complementary goals: 

To reduce injuries and illnesses resulting 

from childhood exposures to hazardous 

work environments 

To promote positive, encouraging, successful, and healthy introductions to 

working life 

To foster knowledge and skills in 

safety and health that will remain with 

youths throughout their working lives 

Child Labor Reseorch Needs 
1 INTRODUCTION 

and enable them to be active participants 

in shaping their work environments 

The Team identified research needs by drawing on (I) the diverse expertise of Team members (Appendix B), (2) research conducted by 

Team members, and (3) presentations and input from outside experts (Appendix C). The 

Team explored the following issues: available 

data, regulatory approaches, school-based and 

-facilitated work experience and education, 

psychosocial aspects of youth employment, issues in agriculture, and perceived research 

needs of various stakeholders actively involved in youth occupational safety and health 

issues. All potential stakeholders should be involved to ensure innovative, comprehensive, 

coordinated approaches to the occupational 

safety and health of young workers. Future 

Team efforts will maintain stakeholder involvement as a goal. 

2 Child Labor Research Needs 
Historical Issues 

ISTORICALLY, regulation of child lanomic issues and concerns for the safety, 

health, and normal development of children. In 

the early part of this century, children were 

viewed as a potential source of cheap labor 

who competed with adults for jobs at the cost 

of their health and education. Early efforts to 

regulate child labor were made at the State and 

national levels, but early Federal legislation 

was challenged in the courts and ruled to be 

unconstitutional. In 1938, passage of the Fair 

Labor Standards Act (FLSA) provided the basis for regulating child labor at the Federal 

level. The FLSA, as amended [29 USC’ Ch. 8 

$201-219], is still the basic Federal statute 

dealing with child labor. 

H bor has been motivated by both ecoThe growth of child labor in recent decades 

again threatens to interfere with education and 

poses threats to the safety and health of children. Before 1945, it was unusual for children 

to work while attending school; but by the 

1980s, about one third of students held jobs 

during the academic year. The workplace has 

become an important factor in adolescent development. 

Data on Youth Employment 

Limited information is available at the national 

level for characterizing youth employment and 

calculating rates of injuries and illnesses. The 

Current Population Survey (CPS) conducted 

‘United States Code. 

for the Bureau of Labor Statistics (BLS) is a 

monthly survey of U.S. households selected 

from a probability sample of the civilian noninstitutionalized population. In 1995, an estimated 2.6 million (35%) of the Nation’s 

adolescents aged 16 and 17 were employed 

[BLS 19961. Comparisons of employment data 

from the CPS and longitudinal surveys suggest 

that the CPS underestimates youth employment [GAO 19911. One reason may be their 

use of proxy respondents. Because data are not 

routinely collected for youths aged 14 and 

younger, it is not possible to estimate the 

number of the Nation’s youngest workers and, 

consequently, their rates of injury and illness. 

High school surveys suggest that about 80% of 

students are employed at some time during 

their high school years [Steinberg and Cauffman 19951. Data suggest that in 1975, the 

United States had twice the proportion of children under age 15 in the workforce as other industrial countries [Richter and Jacobs 19911. 

Data from the 1990 Census indicate that most 

youths worked in the retail trades-especially 

restaurants and grocery stores [Children’s 

Safety Network 19951 (see Figure 1). CPS data 

indicate that 87% of employed adolescents 

aged 16 and 17 worked part time (34 hr or less 

per week) in 1995. Data from the 1990 Census 

showed that adolescents aged 16 and 17 

worked an average of 24 hr per week for 25 

weeks of the year in 1989 [Children’s Safety 

Network 19951. Longitudinal surveys demonstrate that brief periods of employment are 

common among young workers [BLS 19921. 

Steinberg and Caufian [ 19951 confirmed this 

observation for workers under age 18. 

Child Labor Reseorch Needs 3 
Restaurants 

25% 5% 5% 

Figure 1. Types ofjobs held by youths in 1990. (Data from Children's Safety Network [1995].) 

4 Child Labor Research Needs 
2 BACKGKOUND 

Because youth employment data are frequently difficult to access at the State level, research within States and comparisons across 

States are hampered. State-specific employment data from the CPS are published using 

the group aged 16 to19 [BLS 1995a1, though 

analyses for youths under age 18 are possible 

within individual States [Belville et al. 19931. 

Decennial census data can be analyzed at the 

State level [Brooks and Davis 1996; Miller 

1995; Banco et al. 19921; but they may not correspond with the years of injury and illness 

data, and they may require the assumption that 

youth employment is stable over time. A survey of teens was used to estimate employment 

in one State [Parker et al. 1994al. One group 

Occupational Injury and Illness 

Data for Youths 

Fatal Injuries 

National-Level Analyses 

Several national-level sources of data exist 

for fatal work injuries among children under 

age 18: 

The Integrated Management Information System (IMIS), which includes data 

from fatality investigations by the Occupational Safety and Health Administration (OSHA) 

calculated injury and illness rates based on issued child labor documents [State of Wyoming 

19841, and another reported rates per capita 

[Brooks et al. 19931. Others have reported 

State-specific injury and illness data Without 

* The National Traumatic Occupational 

Fatalities (NTOF) Surveillance System, 

based on death certificates for workers 

aged 16 and older 

calculating rate; based on employment data 

[Cooper and Rothstein 1995; Bush and Baker 

1994; Heyer et al. 19921. 

The Census of Fatal Occupational Injuries (CFOI), a national multisource database 

When examining employment patterns of children under age 18, it is important to recognize 

that work is frequently in addition to school attendance. Thus working 20 hr per week during 

the school year approximates a 50-hr workweek, not considering homework or extracurricular activities. Youth employment is 

clustered in occupations that mirror the emerging workforce. Service workers are projected 

to become the largest group of workers in the 

near future [Silvestri 19941, and temporary or 

part-time jobs are increasingly common 

@IOSH 1996bl. Most youths work part time, 

and many work in service occupations. Occupational safety and health issues in working 

children may highlight issues that will arise as 

the Nation’s workforce is transformed. 

The Fatality Assessment and Control 

Evaluation (FACE) Program, which investigates causes of work-related deaths 

in participating States 

The IMIS database included 104 deaths of 

children under age 18 for the years 1984-87 

[Suruda and Halperin 19911. Citations for 

safety violations were issued in 70% of these 

deaths, and 41% of the deaths involved work 

prohibited by Federal child labor laws. Fourteen of the 104 deaths were of children under 

age 15. These figures do not represent all 

work-related deaths of children during this period, since OSHA fatality investigations are 

concentrated in construction and manufacturing, and OSHA does not investigate transportation- or violence-related deaths. 

5 Child Labor Research Needs 
2 BACKGROUND 

The NTOF Surveillance System reports 784 

deaths of adolescents aged 16 and 17 for the 

period 1980-92 [NIOSH 19971. This figure is 

a conservative count of work-related fatalities 

of children during this period because death 

certificates alone identify only about 80% of 

work-related deaths, and the NTOF Surveillance System does not include workers under 

age 16 [Castillo et al. 19941. The leading 

causes of death were incidents involving motor 

vehicles, machines, electrocution, and homicide. The fatality rate for adolescents aged 16 

and 17 was 5.1 per 100,000 full-time equivalent workers for the 10-year period 1980-89 

[Castillo et al. 19941. The rate for adults aged 

18 and older was 6.1. This relatively small difference in rates is cause for concern because 

youths under age 18 are employed less frequently in especially hazardous jobs. 

The CFOI identified 67 to 68 work-related 

deaths of children under age 18 each year from 

1992 to 1994 [Toscano and Windau 1994, 

1995; Derstine 19941. In 1994, 25 deaths of 

workers under age 16 and 42 deaths ofworkers 

aged 16 and 17 occurred [Toscano and Windau 

19951. Agricultural business and retail trades 

accounted for the most deaths [NIOSH 1995; 

Derstine 19941. Many of the deaths of adolescents occurred in family businesses. Highway 

events accounted for the most deaths: 20% of 

the deaths of youths under age 16 and 26% of 

the deaths of adolescents aged 16 and 17. 

CFOI data suggest that homicide accounts for 

a larger proportion of the deaths of working 

adolescents than indicated by NTOF for the 

1980s. Homicide accounted for 10% of the occupational injury deaths of adolescents aged 

16 and 17 during 1980-89 [Castillo etal. 19941 

compared with 28% in 1993 [Toscano and 

Windau 19941. Because of differences between the NTOF and CFOI systems, it is not 

possible to determine whether the incidence of 

homicide has increased in the 1990s or 

whether homicides of youths were underreported in NTOF during the 1980s. 

State-Level Analyses 

The NTOF Surveillance System includes occupational injury deaths for adolescents by 

State (see Table I). The FACE Program has 

two components: an in-house component (in 

which NIOSH staff investigate certain causes 

of death in West Virginia and five surrounding 

States) and a program in which 14 cooperating 

States enumerate all work-related fatalities in 

their States and investigate certain causes of 

death. The in-house FACE program investigated three electrocutions of children under 

age 18 between 1986 and 1989 [NIOSH 

1986a,b; 19881. The State FACE Program has 

identified 67 work-related deaths of children 

under age 18 since 1989 [NIOSH 1996al. Because States entered the FACE Program at 

varying times since 1989, these figures do not 

represent all work-related deaths of youths in 

FACE States during this period. Investigations 

have been conducted for 12 deaths, including 

events related to machinery, motor vehicles, 

and falls. 

Comprehensive information from FACE investigations has been very informative. An investigation by the Iowa FACE Program is a 

good example [Iowa FACE Program 19951. A 

12-year-old boy, who was working part time 

for a farmer, died after he lost control and overturned atractor in aroadside ditch. The investigation identified two factors that may have 

contributed to the incident: the distance from 

the seat to the brakes (which was too long for 

the boy) and the loader frame on the tractor 

(which may have obstructed the boy’s view of 

the front wheels, making it difficult to see the 

exact position of the front wheel and the edge 

of the road). The farmer reported that the boy 

had read books on tractor safety and was a 

good student. 

6 Child Lobor Research Needs 
2 BACKGROUND 

Table 1. Occupational injury deaths of U.S. adolescents aged 16 and 17,1980-92, by State 

Total 

State number 

Leading causes of death 

Type Number 

Alabama 

Alaska 

Arizona 

Arkansas 

California 

Colorado 

Connecticut' 

Delaware 

District of Columbia 

Florida 

Georgia 

Hawaii 

Idaho 

Illinois 

See footnotes at end of table. 

Child Lobor Research Needs 

12 

I 

8 

11 

81 

15 

3 

t 

t 

38 

30 

t 

9 

38 

Electrocution 

Motor-vehicle-related 

Electrocution 

Motor-vehicle-related 

Motor-vehicle-related 

Homicide 

Machine-related 

Motor-vehicle-related . 

- 

- 

Motor-vehicle-related 

Machine-related 

Electrocution 

Motor-vehicle-related 

Falls 

Suffocation 

- 

Motor-vehicle-related 

Motor-vehicle-related 

Homicide 

3 

- 

3 

5 

3 

24 

21 

13 

7 

- 

- 

- 

9 

6 

5 

8 

5 

4 

- 

5 

8 

6 

(continued) 

7 
Table 1 (continued). Occupational injury deaths of U.S. Adolescents 

aged 16 and 17,1980-92, by State 

Total Leading causes of death 

State number Type Number 

Indiana 

Iowa 

Kansas 

Kentucky 

Louisiana 

Maine 

Maryland 

Massachusetts 

Michigan 

Minnesota 

Mississippi 

Missouri 

Montana 

Nebraska 

Nevada 

See footnotes at end of table. 

14 

13 

10 

9 

14 

5 

6 

11 

17 

13 

19 

13 

3 

8 

t 

Motor-vehicle-related 

Motor-vehicle-related 

Suffocation 

Motor-vehicle-related . Water-transport -related 

Machine-related 

Motor-vehicle-related 

Machine-related 

Machine-related 

Drowning 

Electrocution 

Falls 

Homicide 

Machine-related 

Machine-related 

- 

6 

5 

3 

3 

- 

5 

3 

- 

3 

7 

4 

3 

3 

3 

4 

3 

- 

3 

(continued) 

Child tobor Research Needs 
2 BACKGRCNND 

Table 1 (continued). Occupational injury deaths of U.S. Adolescents 

aged 16 and 17,1980-92, by State 

Total Leading causes of death 

State number Number 

New Hampshire 

New Jersey 

New Mexico 

New Yorkt 

North Carolina 

North Dakota 

Ohio 

Oklahoma 

Oregon 

Pennsylvania 

Rhode Island 

South Carolina 

3 

9 

5 

24 

20 

t 

22 

21 

19 

36 

t 

8 

Machine-related 

Motor-vehicle-related 

Motor-vehicle-related 

Homicide 

Machine-related 

- 

Motor-vehicle-related 

Machine-related 

Electrocution 

Machine-related 

Electrocution 

Motor-ve hicle-related 

Machine-related 

Electrocution 

Motor-vehicle-related 

Machine-related 

- 

I 

4 

6 

4 

3 

- 

7 

4 

3 

6 

4 

8 

4 

3 

12 

7 

See footnotes at end of table 

Child Labor Rereorch Needs 

(continued) 

I 
2 BACKGROUND 

Table 1 (continued). Occupational injury deaths of U.S. Adolescents 

aged 16 and 17,1980-92, by State 

Total 

State number 

Leading causes of death 

Type Number 

South Dakota 

Tennessee 

Texas 

Utah 

Vermont 

Virginia 

Washington 

West Virginia 

Wisconsin 

Wyoming 

TOTAL 

10 

12 

100 

13 

t 

25 

7 

9 

18 

4 

784 

Machine-related 

Electrocution 

Falls 

Motor-vehicle-related 

Motor-vehicle-related 

Homicide 

Machine-related 

Motor-vehicle-related 

Electrocution 

Motor-vehicle-related 

Motor-vehicle-related 

Machine-related 

6 

4 

3 

3 

23 

15 

14 

- 

8 

3 

3 

5 

4 

Source: NTOF Surveillance System PIOSH 19971. 

'No single cause accounted for more than two deaths. 

'Death certificates were not available from Connecticut and New York City, New York, for 1992. 

;NIOSH does not report data for States with fewer than three deaths. 

10 Child Labor Research Needs 
2 BACKGROUND 

Work-related fatalities of children have been 

examined in four States using workers’ compensation data, death certificates, and medical 

examiner records [Cooper and Rothstein 1995; 

Miller 1995; Dunn and Runyan 1993; Belville 

et al. 19931. In at least one of these States 

(North Carolina), the analyses spawned additional research and were considered in the 

promulgation of new State child labor regulations [university of North Carolina Injury Prevention Research Center 19951. 

Nonfatal injuries and illnesses 

National-Level Analyses 

Nonfatal work-related injuries among children 

and adolescents have been analyzed at the national level using data from the Survey of Occupational Injuries and Illnesses (SOII) [CDC 

1996bl and the National Electronic Injury Surveillance System (NEISS) [Layne et al. 19941. 

The SO11 is a BLS survey of approximately 

250,000 private industry establishments in the 

United States [BLS 1995bl. Demographic and 

case information is available only for the most 

serious injuries (those resulting in at least 1 day 

away from work). The SO11 excludes selfemployed workers, farmers with fewer than 11 

employees, private households, and govemment employees [BLS 1995bl. Employment 

data for workers aged 16 and 17 suggest that at 

least 11% of working children under age 18 are 

not represented by the SO11 [CDC 1996bl. 

Nevertheless, the working children included in 

the 1993 SO11 suffered an estimated 21,620 injuries and illnesses involving days away from 

work [CDC 1996bl. The median number of 

days away from work was 3. Injured and ill 

children under age 18 were most frequently 

employed in the following types of workplaces: 

% total cases 

Eatinganddrinkingplaces . . . . . . 39 

Grocery stores . . . . . . . . . . . 14 

Nursingandpersonalcare facilities. . . . 6 

Department stores . . . . . . . . . . 5 

The most common events resulting in injury 

were as follows: 

% totalcases 

Falls on the same level (includes 

falls to floors and falls onto or 

against objects) . . . . . . . . . . . 21 

Injuries from overexertion 

(includes injuries from lifting, 

pulling, pushing, turning, 

wielding, holding, carrying, 

or throwing objects) . . . . . . . . . 17 

Striking against objects 

(includes bumping into, 

stepping on, kicking, and 

being pushed or thrown into 

or against objects) . . . . . . . . . . 10 

Contact with hot objects . . . . . . . . 9 

Beingstruckby fallingobjects . . . . . 7 

Being struck by a slipping 

handheld object (such as a 

knife, razor, or tool). . . . . . . . . . 6 

NEISS is a probability sample of 91 hospital 

emergency departments in the United States 

[Layne et al. 19941. Previous research indicates that only one-third of work-related injuries are seen in emergency rooms [Ries 19781. 

An estimated 64,000 adolescents aged 14 to 17 

required treatment in hospital emergency 

rooms for work-related injuries in 1992 [Layne 

et al. 19941. The rate of injury for workers 

aged 15 to 17 was estimated to be 5.8 per 100 

Child lobor Research Needs I! 
i, ,,,',, ,.: :, ,r> 

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

full-time equivalent employees. Because the 

NEISS was limited to young workers in 1992, 

it was not possible to contrast the rates for adolescents to those of adults. In a previous surveillance effort in which data were collected 

for workers of all ages, rates for workers aged 

16 and 17 were exceeded only by the rate for 

workers aged 18 and 19 [Coleman and Sanderson 19831. Based on emergency department 

data, a study of all iniuries to children in MasTelephone interviews were conducted with 

adolescents aged 14 to 16 who were identified 

in the surveillance system within the first 3 

months of surveillance [Knight et al. 19951. 

Sixty-eight percent of these youths experienced limitations in their normal activities (including work, school, and play) for at least 1 

day, and 25% experienced limitation in their 

normal activities for more than a week. 

.I 

sachusetts during the early 1980s suggests that 

work contributes substantially to adolescent Analyses 

injuries prooks et al. 1993J.Among adolescents aged 14 to 17, 7% to 13% of all injuries 

seen in the emergency department were attributed to work. Among adolescents aged 17, 

work injuries constituted 14% to 26% ofall injuries seen in the emergency department. 

Retail trades had both the highest frequency 

and rate of adolescent injuries treated in the 

emergency department [Layne et al. 19941. 

Fifty-four percent of adolescent occupational 

injuries were attributed to work in retail trades, 

with a rate of 6.3 injuries per 100 full-time 

equivalent employees. Restaurants accounted 

for nearly three-fourths of these injuries in the 

retail trades. 

The service industry sector had the next highest frequency of adolescent occupational injuries: nearly two-thirds of the injuries in the 

service industry occurred in health services, 

amusement and recreation, and educational 

services [Layne et al. 19941. The most frequent 

types of injuries in adolescent workers were as 

follows: 

% total cases 

Lacerations ............ 35 

Contusions ............ 18 

Sprains .............. 16 

Bums.. ............. 12 

Fractures and dislocations ....... 4 

Allother ............. 15 

Workers' compensation claims reported to the 

BLS Supplementary Data System were analyzed for injuries to children under age 18 in 24 

States for the years 198G83 [Schober et al. 

19881. Ofthe 23,823 claims reported, approximately 10% occurred in children under age 16. 

Workers' compensation data have also been 

reported for workers under age 18 in 8 States: 

Massachusetts [Brooks and Davis 19961, 

Texas [Cooper and Rothstein 19951, Washington [Miller 1995; Heyer et al. 19921, California 

[Bush and Baker 19941, Minnesota [Parker et 

al. 1994a1, New York [Belville et al. 19931, 

Connecticut [Banco et al. 19921, and Wyoming 

[State of Wyoming 19841. State-specific data 

from the SO11 have been reported for the 42 

States participating in the FederaUState cooperative agreement for 1993 [CDC 1996b] 

(Table 2), and analyses have been done using 

emergency department data [Brooks et al. 

19931 and survey methodology [Parker et al. 

1994bl in individual States. 

Many State-specific studies duplicate the findings of national-level studies. Numerous studies have demonstrated that the number of 

work-related injuries increases with age 

through adolescence, with the greatest incidence among workers aged 17 [Brooks and 

Davis 1996; Cooper and Rothstein 1995; Toscan0 and Windau 1995; Miller 1995; Layne et 

al. 1994; Castillo et al. 1994; Belville et al. 

1993; Brooks et al. 1993; Banco et al. 1992; 

Heyer et al. 1992; Suruda and Halperin 1991; 

li Child Labor Rarearch Needs 
Table 2. Work injuries and illnesses involving days away from work 

for children under age 18, by Stat42 States, 1993' 

rn 

m Median 

: Estimated days away Frequent industries' Frequent events and exposures' 

5 

a 

(% total cases) J State' frequency from work (% total cases) 

Alabama 330 6 Eating and drinking places (32%) Fall on same level (23%) 

Grocery stores (16%) Overexertion in lifting (1 8%) 

Struck by object not elsewhere classified (12%) 

Alaska 86 3 Laundry, cleaning, and garment Inhalation of caustic, noxious, or allergenic 

services (17%) substances (17%) 

Grocery stores (16%) 

Misc. food prep. and kindred 

products (16%)" 

Struck against stationary object (16%) 

592 

238 

California 1,418 

Connecticut 220 

Delaware 39 

2 

Eating and drinking places (71%) Struck by object (37%) 

Fall on same level (19%) 

Fall on same level to floor, walkway, etc. (26%) 

Overexertion in lifting (1 6%) 

Contact with hot objects or substances (1 1%) 

Contact with hot objects or substances (21%) 

Bodily reaction and exertion, unspecified (13%) 

Bodily reaction (12%) 

Fall on same level (24%) 

Overexertion in lifting (1 1%) 

Fall on same level to floor, wahay, etc. (20%) 

Overexertion in liftiig (14%) 

Eating and drinking places (40%) 

Grocery stores (13%) 

Eating and drinking places (30%) 

Social services (24%)" 

Grocery stores (33%) 

Fating and drinking places (28%) 

Eating and drinking places (46%) 

- See footnotes at end of table (cootioued) 
Table 2 (continued). Work injuries and illnesses involving days away from work 

for children under age 18, by Stat42 States, 1993' 

Median 

Estimated days away Frequent industries: 

state' frequency from work (% total cases) 

Frequent events and exposuresP 

(% total cases) 

Florida 1,527 

Georgia 499 

Hawaii 141 

Indiana 706 

Iowa 340 

KanSaS 225 

490 

2 Kentucky - 

a 

0 

D 

m 

c 

0 

5 

g 

3 Eating and drinking places (34%) 

Grocery stores (23%) 

Misc. amusement and rec. 

services (13%)" 

Fall on Same level (27%) 

Overexertion (1 8%) 

Struck against object (12%) 

3 Eating and drinking places (42%) 

Grocery stores (16%) 

Fall on same level to floor, walkway, etc. (30%) 

Contact with hot objects or substances (16%) 

4 Construction--special trade Contact with hot objects or substances (33%) 

Slip, trip, loss of balance-without fall (10%) 

Fall on same level (25%) 

Contact with hot objects (16%) 

Struck by falling object (23%) 

Slip, trip, loss ofbalance-without fall (13%) 

contractors (22%p Overexertion (21%) 

3 Eating and drinking places (45%) 

Food stores (15%) Overexertion (18%) 

Health services (14%) 

Eating and drinking places (47%) 

Grocery stores (13%) 

Nursing and personal care facilities (10%) 

Eating and drinking places (53%) 

3 

Overexertion (19%) 

Struck against stationary object (1 1%) 

Fall on same level to floor, walkway, etc. (10%) 

Fall on same level to floor, walkway, etc. (25%) 

Contact with hot objects or substances (15%) 

Overexertion (10%) 

3 

3 Eating and drinking places (54%) 

- 

z 

ID See footnotes at end of table a (continued) 
Table 2 (continued). Work injuries and illnesses involving days away from work 

for children under age 18, by Statd2 States, 1993' . 

_I 

P 

$ 0 Median 

3 7 Estimated days away Frequent industries' 

c? z State' frequency from work (% total uses) 

Frequent events and exposures' 

(% total cases) D 

a 

Louisiana 175 4 Grocery stores (37%) 

Maine 

Maryland 

Massachusetts 

Michigan 

Minnesota 

Mississippi 

93 

425 

519 

544 

336 

227 

4 

Grocery stores (37%) 

Fall on same level to floor, walkway, etc. (23%) 

Overexertion in ling (23%) 

Struck by fallig object (16%) 

Overexertion in lifting (30%) 

Struck against stationw object (16%) 

Caught in running equipment or machinery (12%) 

Eating and drinking places (50%) Struck against object (24%) 

Struck by falling object (20%) 

Fall on same level to floor, walkway, etc. (17%) 

Overexertion in lifting (20%) 

Struck by slipping handheld object (10%) 

Eating and drinking places (32%) 

Grocery stores (22%) 

Department stores (10%) 

Department stores (14%) 

Grocery stores (10%) 

Struck against stationaq object (25%) 

Overexertion (1 3%) 

Fall on same level (1 1%) 

Grocery stores (19%) 

Nursing and personal care facilities (1 1 %) 

Eating and drinking places (43%) 

Grocery stores (16%) 

Fall on same level (1 1%) 

Contact with hot objects or substances (18%) 

Fall on same level to floor, walkway, etc. (15%) 

Struck by slipping handheld object (14%) 

- 

VI See fwtnotes at end of table. (continued) 
Table 2 (continued). Work injuries and illnesses involving days away from work 

for children under age 18, by State-42 States, 1993' 

Median 

Estimated days away Frequent industries' Frequent events and exposuress 

State' frequency from work (% total cases) (% total cases) 

Missouri 615 5 Eating and drinking places (53%) 

Grocery stores (12%) 

Montana 84 4 General merchandise stores (12%) 

Nebraska 

Nevada 

New Jersey 

440 

159 

248 

3 - New Mexico 23 1 

6 

0 

e 

3 

a 

Cr 

m 

E 

3 

2 

Wholesale groceries and related 

products (10%) 

Eating and drinking places (27%) 

Hotels and motels (3 1%) 

Misc. amusement and rec. 

services (12%)" 

Grocery stores (27%) 

Eating and drinking places (58%) 

Grocery stores (18%) 

Fall on same level (2 1%) 

Struck against stationary object (17%) 

Slip, trip, loss of balance-without fall (1 1%) 

Skin contact with caustic, noxious, or allergenic 

Slip, trip, loss of balance-without fall (13%) 

Overexertion in pulling or pushing objects (12%) 

Struck by falling object (65%) 

Exposure to caustic, noxious, or allergenic 

substances (22%) 

substances (1 1%) 

Inhalation of caustic, noxious, or allergenic 

Fall on same level to floor, wakway, etc. (19%) 

Slip, trip, loss of balance-without fall (1 2%) 

substances (23%) 

Fall on same level (28%) 

Overexertion in liffing (16%) 

Caught in runOing equipment or machiery (13%) 

Skin contact with caustic, noxious, or allergenic 

Overexertion not elsewhere classified (1 8%) 

Fall on same level to floor, walkway, etc. (14%) 

substances (20%) 

- 5 

a See fmmotes at end of table (continued) 
Table 2 (continued). Work injuries and illnesses involving days away from work 

for children under age 18, by Statd2 States, 1993' 

~~~~ ~ ~~ 

Median 

Estimated days away Frequent industries' Frequent events and exposures) 

State' frequency from work (% total cases) (% total cases) 

New York 1,060 6 Eating and drinking places (34%) Caught in or compressed by equipment or object (1 5%) 

Grocery stores (32%) 

Hospitals (10%) 

Contact with hot objects or substances (13%) 

Fall on same level (13%) 

North Carolina 947 3 Eating and drinking places (51%) Fall on same level (29%) 

Grocery stores (1 1%) Struck against stationary object (13%) 

Overexertion in lifting (10%) 

Oklahoma 383 

Oregon 410 

Pennsylvania 719 

Rhode Island 158 

South Carolia 234 

Eating and drinking places (60%) 

Grocery stores (13%) 

Fall on same level to floor, walkway, etc. (22%) 

Contact &ith hot objects or substances (20%) 

Overexertion in liftiig (14%) 

Struck by slipping handheld object (30%) 

Struck against object (19%) 

Slip, trip, loss ofbalance-without fall (10%) 

Fall on same level to floor, walkway, etc. (25%) 

Overexertion in lifting (13%) 

Struck by slipping handheld object (10%) 

Fall on same level to floor, walkway, etc. (31%) 

Contact with hot objects or substances (24%) 

Struck by swinging or slipping objects (16%) 

Eating and drinking places (57%) 

Eating and drinking places (27%) 

Grocery stores (16%) 

Eating and drinking places (53%) 

Grocery stores (29%) 

Misc. amusement and rec. 

services (15%?1 

Fall on same level to floor, walkway, etc. (21%) 

Overexertion in lifting (1 1 %) 

Struck by swinging or slipping objects (10%) 

- See footnotes at end of table. u 

(Continued) 
Table 2 (continued). Work injuries and illnesses involving days away from work 

for children under age 18, by State42 States, 1993’ 

Median 

Estimated days away Frequent industries’ 

State’ frequency from work (“7 total cases) 

Frequent events and exposuress 

(% total eases) 

Tennessee 859 4 Eating and drinking places (62%) 

Texas 

Utah 

Vermont 

992 3 Eating and drinking places (46%) 

Grocery stores (19%) 

303 3 Grocery stores (14%) 

Hotels and motels (1 1%) 

Virginia 

Washmgton 

0, -. 

Wisconsin - P 

m 

m 

a’ 

0 

m 

3 

z 

0 

T 

m See fwmotes at end of table. c 

24 

686 

361 

435 

Hotels and motels (27%) 

Eating and drinking places (39%) 

Eating and drinking places (62%) 

Grocery stores (17%) 

Eating and drinking places (37%) 

Fall on same level (23%) 

Contact with hot objects or substances (22%) 

Overexertion in lifting (16%) 

Fall on same level to floor, walkway, etc. (21%) 

Overexertion (21%) 

Struck by slipping handheld object (1 1%) 

Fall on Same level (29%) 

Struck against stationary object (12%) 

Contact with hot objects or substances (1 1%) 

Fall on same level to floor, walkway, etc. (27%) 

Exposure to sun (22%) 

Struck by slipping handheld object (21%) 

Overexertion (28%) 

Struck by falling object (14%) 

Fall on same level to floor, walkway, etc. (1 1%) 

Struck against object (27%) 

Fall on same level (21%) 

Overexertion in lifting (17%) 

Fall on same level to floor, walkway, etc. (18%) 

Overexertion in lifting (14%) 

Contact with hot objects or substances (13%) 

(continued) 
Table 2 (continued). Work injuries and illnesses involving days away from work 

for children under age 18, by Statd2 States, 1993' 

io : Medim 

5 

: Estimated days away Frequent industries' Frequent events and exposures' 

state' frequency from work (% total cases) (%total cases) J 

0- 

Wyoming 43 6 General merchandise stores (1 7%) Fall through roof surface (28%) 

Contact with hot objects or substances (14%) 

Skin contact with caustic, noxious, or allergenic 

substances (14%) 

'Data are from the Survey of Occupational Injuries and Illnesses, Bureau of Labor Statistics, US. Department of Labor. 

'Data are not available from Colorado, the Dishict of Columbia, Idaho, Illinois, New Hampshire, North Dakota, Ohio, South Dakola, and West Virginia because the samples in these States 

'Office of Management and Budget. Standard Indushial Classification Manual 1987. Washington DC US Government Printing Office, 1982. This is a hierarchical ding structure; both 

bureau of Labor Statistics. Occupational Injury and Illness Classification Smcms 1992: Code Descriptions. Washington, DC: US. Depamnent of Labor, This is a hierarchical coding 

were not designed to generate State-specific estimates. 

specific and collapsed codes are presented in the table, depending on the available data fM each State. Top three indushies acwunhg for at least 10% each of cases are reported. 

shucfure; both specific and collapsed codes are presented in the table, depending on the available data for each State. Top three events acwunting for at least 10% each of cases are 

reported. 

Includes the manufacfure of the following products: canned and cured fish and seafoods, prepared fiesh M frozen fish and seafoods, roasted coffee; potato chips, corn chips, and similar 

snacks, manufactured ice; macaroni, spaghetti, vermicelli, and noodles. 

"Includes establishments providing social services and rehabilitation services to those persons with social or personal problems requiring special services and to the handicapped md the 

disadvantaged, including job mining and vocational rehabilitation services. 

t*Includes the following services: physical timess facilities; public golf courses; win-operated amwement devices; amusement parks, membership sports and recreation clubs etc. 

D5Locludes special trade contractors who undertake activities of a type that are specialized either to building construction, or to both building and nonbuilding projects. These activities 

.. 

include painting, electrical work, carpenby work, plumbing, beating, air-conditioning, roofing, and sheet metal work. 
2 BACKGROUND 

Schober et al. 1988; State of Wyoming 19841. 

With one exception [Parker et al. 1994b], studies calculating injury rates by individual year 

of age have found increasing rates with age 

through adolescence [Layne et al. 1994; Belville et al. 1993; Brooks et al. 1993; State of 

Wyoming 19841. Males consistently experience greater numbers and rates of injury [CDC 

1996b; Brooks and Davis 1996; Cooper and 

Rothstein 1995; Miller 1995; Parker et al. 

1994a; Layne et al. 1994; Castillo et al. 1994; 

Parker et al. 1994b; Belville et al. 1993; 

Brooks et al. 1993; Dunn and Runyan 1993; 

Banco et al. 1992; Suruda and Halperin 1991; 

Schober et al. 19881. Many studies indicate 

that retail trades have large numbers and relztively high rates of injury among workers under age 18 [CDC 1996b; Brooks and Davis 

1996; NIOSH 1995; Miller 1995; Layne et al. 

1994; Castillo et al. 1994; Bush and Baker 

1994; Belville et al. 1993; Banco et al. 1992; 

Schober et al. 1988; State of Wyoming 19841. 

Lacerations, sprains and strains, contusions, 

and bums are among the most common nonfatal injuries in young workers [CDC 1996b; 

Brooks and Davis 1996; Miller 1995; Parker et 

al. 1994a; Layne et al. 1994; Parker et al. 

1994b; Bush and Baker 1994; Belville et al. 

1993; Brooks et al. 1993; Banco et al. 1992; 

Schober et al. 1988; State of Wyoming 19841. 

Adolescent sprains and strains to the back are 

ofparticular concern. In Minnesota, 73% of all 

sprains and strains were to the low- and midback [Parker et al. 1994al. In these analyses, 

sprains and strains were the most common 

cause of severe occupational injury, and 39% 

of severe injuries (61 of 157) were to the back. 

Of the severe back injuries, 21% (13 of 61) 

were to the lumbar disc. Back sprains and 

strains accounted for 15% of all workers’ compensated injuries among adolescents in Massachusetts [Brooks and Davis 19961. Back pain 

is atypical in adolescence [Kelsey and Golden 

19871, and first episodes of back pain are 

unusual before age 20. A history of back pain 

has been identified as a risk factor for new back 

injuries in two studies [Mitchell et al. 1994; 

Venning et al. 19871. 

State-specific analyses are important for illustrating the magnitude of the problem in each 

State and targeting prevention efforts. Some 

States report considerable numbers and rates 

of injury for young workers in industries not 

otherwise prominent in the national statistics. 

Examples are manufacturing and construction 

in Massachusetts, Washington, and New York; 

public administration in Washington and Connecticut; and agriculture in Washington and 

New York [Brooks and Davis 1996; Miller 

1995; Belville et al. 1993; Banco et al. 19921. 

State-specific research holds potential beyond 

developing an industry profile of adolescent 

work injuries in each State. For example, 

analysis by residence in Massachusetts indicated that rates were highest in the southeast 

region of the State [Brooks and Davis 19961. 

This area was selected for an innovative, 

community-based intervention (supported by 

NIOSH) to enhance young workers’ occupational safety and health [Child Labor Coalition 

19951. Because findings indicated that more 

than one-third of lacerations in Connecticut 

were associated with the use of case-cutters, 

researchers suggested prevention strategies 

targeted at this instrument [Banco et al. 19921. 

State-specific analyses have also provided 

unique findings not available from other studies. For example, survey data in Minnesota 

suggested that back injuries were more common in smaller workers and were positively associated with the amount of weight lifted 

[Parker et al. 1994al. Investigations of bum 

events in Colorado and Minnesotaandanalysis 

of survey data led to recommendations for preventing serious bum injuries in restaurants, 

which are common among adolescents [Heinzman et al. 19931. 

20 Child Lobor Rereorch Needs 
Data gathered on both the national and State 

levels document that occupational injuries 

among adolescents are frequent and severe and 

that better efforts are needed to protect working children. The data can also be used to target 

prevention efforts. The statistics are still incomplete, however. 

Limitations of the Surveillance Systems 

and the Data 

Gaps in Surveillance Systems 

Existing surveillance systems contain significant gaps. A very conservative estimate is that 

11% of working youths are not represented by 

the SO11 [CDC 1996bl. In addition, estimates 

from the SO11 exclude injuries and illnesses 

not resulting in days away from work. Because 

children under age 18 frequently work part 

time, some injuries and illnesses may require 

limitations in activity that are not reflected in 

time away from work because the limitations 

coincide with normal days off from work. 

Work-related injuries treated outside emergency departments (estimated to be about 

two-thirds of work injuries) are not captured in 

the NEISS [Layne et al. 19941. Although the 

intent of workers’ compensation is to provide 

coverage for all workers, no State laws cover 

all forms of employment [U.S. Chamber of 

Commerce 19911. Groups ofworkers who frequently are not covered under workers’ 

compensation laws include employees in small 

businesses, farm laborers, domestic servants, 

and casual employees. Evidence also indicates 

that adolescents are less likely than adults to 

have their injuries documented in workers’ 

compensation systems [Brooks and Davis 

19961. 

Unreliable Identification 

of Work-Relatedness 

Surveillance systems depend on the reliable 

identification of work-relatedness. Coroners, 

medical examiners, and health care providers 

may not consider work-relatedness in cases involving children. Work-relatedness may also 

be difficult to identify in informal employment 

situations such as family farming or family 

fishing operations. Identifying work-related 

injuries and illnesses is particularly difficult 

among migrant workers who travel from area 

to area and may not seek medical treatment or 

report injuries and illnesses to their employers. 

In addition, data systems do not include injuries to nonworking children that result from 

exposure to a hazardous work environment. 

Family farms, farms employing migrant laborers and their families, and sweatshops in the 

needle trades are only three examples of situations in which young children are routinely exposed to hazardous work environments. 

Inadequate Documentation of 

Agricultural Injuries in Children 

Agricultural injuries in children are not well 

documented in standard occupational injury 

surveillance systems. Yet in 1995, an estimated 

132,000 children aged 16 and 17 were employed in agriculture [BLS 19961, an industry 

that consistently ranks among the most dangerous in the United States [NIOSH 19931. In 

1991, an estimated923,OOO childrenunder age 

15 resided on farms and ranches [Dacquel and 

Dahmann 19931. Farm children are exposed 

daily to agricultural hazards and may be involved in work. Children of hired farm workers who do not live on farms may accompany 

their parents to work [National Committee for 

Childhood Agricultural Injury Prevention 

19961. Because ofthe unique characteristics of 

agricultural work, surveillance of and research 

into childhood agricultural injuries require 

unique methods. Most of the data on agricultural injuries in children are aged, and new surveillance must be implemented [Stallones and 

Gunderson 19941. 

- _- 

Child Lobor Research Needs 21 
Occupational Illnesses 

in Young Workers 

___ . 

ability [Belville et al. 19931. The number of 

working children and adolescents who sustain 

disabling injuries and illnesses, and the impact 

of these outcomes on their fUture productivity 

need to be quantified for the Nation and for individual states, The costs of work injuries and 

illnesses among youths and the payers of these 

costs need to be identified to understand the 

true extent of the problem. 

Most information about the health outcomes of 

youth employment deals with injuries, but illness may also result when children and adolescents are exposed to hazardous materials or 

working conditions. Youths may be exposed to 

pesticides during farm work or lawn care, benzene during work at gasoline stations, lead during auto body repair, asbestos and silica during 

construction and maintenance work, and loud Risk Factors Unique to Children 

noise during manufacturing, construction, and and Adolescents 

farm work [Committee bn Environmental 

Health 1995; Pollack et al. 1990; NIOSH 

1994; Broste et al. 19891. For example, audiometric threshold testing of vocational agriculture students in Wisconsin revealed that 57% 

of students who lived and worked on a farm 

had noise-induced hearing loss compared with 

33% of students having little or no farm exposure [Broste et al. 19891. Exposures to hazardous materials and working conditions may 

result in immediate illness or illness that is not 

detected for months or years after exposure. In 

both cases, the association with work exposures may not be recognized. 

Inadequate Knowledge about 

the Relative Risks of Jobs 

The relative risks of different jobs and information about outcomes need to be clarified. 

Although the risk of injury has been assessed 

for industry goups, it has not been assessed for 

various types of work or machines. Such data 

could inform decisions about what is appropriate work for children. 

- - __ __ __ - 

Lack of Data on the Number 

and Cost of Disabling Injuries 

Analysis of workers’ compensation data in 

New York suggested that 44% of the compensated adolescents suffered permanent dis- 

____-_ 

A maxim of pediatrics states that children are 

not little adults. Most biological systems in the 

human body do not mature until about the age 

of 18 [National Research Council 19931. Although adolescents are more like adults than 

younger children, their bodies are still growing 

and maturing. Many differences in anatomy, 

physiology, and psychology distinguish them 

from adults. These differences may translate 

into unique risk factors for occupational injuries and illnesses. 

Physical and Physiological Risk Factors 

Size 

-. 

Adolescents vary greatly in size. A lack of fit 

between machines and the physical dimensions and strength of children and adolescents 

may increase the risk for injury. For example, 

studies conducted by the Consumer Product 

Safety Commission found that certain ages, 

heights, and weights were associated with 

higher rates of injury during the use of ride-on 

mowers [CPSC 19931: 

Operators aged 5 to 14 had higher injury 

rates than older adolescents and adults. 

Operators with heights of 60 in. or less 

had higher injury rates than taller persons. 

22 Child Lobor Rerearch Needs 
Operators weighing less than 125 Ib or 

more than 199 Ib had higher injury rates 

than operators of other weights. 

The association of ride-on mower injuries with 

small body size raises concerns about the operation of ride-on mowers and other machinery 

by children aged 14 and 15. Growth charts suggest that more than 50% of girls aged 15 and 

50% of boys aged 15 weigh less than 125 Ib. 

Height is a smaller issue, since only 10% of 

girls aged 15 and less than 5% of boys fall below 60 in. [NCHS 19761. 

Growth 

Among military recruits in Israel, data demonstrated a decreasedrisk for stress fractures with 

each year of age above 17 [Milgrom et al. 

19941. These results suggest that adolescent 

bones may not have reached full structural maturity. Adolescence is characterized by a rapid 

growth rate, which is exceeded only by the 

growth rates during infancy and early childhood wational Research Council 19931. Diminished coordination during periods of rapid 

growth could increase the risk for work injury. 

Sleep Requirements 

Sleep research has shown that the transition 

from the childhood to the adult sleep-wake cycle includes several distinct steps and requires 

several years to complete. The adult pattern of 

aftemoon sleepiness is first seen in children 

about halfway through puberty [Carskadon et 

al. 19801. Yet the adult pattern of a reduced 

need for sleep (8 hr per night) is not observed 

until sometime after age 18. Current laboratory 

research suggests that adolescents through age 

18 (and perhaps older) require approximately 9 

hr of sleep per night [Carskadon 19901. However, cross-sectional surveys report an average 

of 7 hr of sleep per night for high school students with part-time jobs-particularly among 

juniors and seniors working 20 to 30 hr per 

week [Carskadon 1989,1990]. These data corroborate observations from high school teachers who report sleepy students, especially 

during early morning classes. Heavy part-time 

work schedules may result in inadequate sleep, 

fatigue, and increased risks for injuries while 

working or commuting. 

Sleep research is rapidly unraveling a complex 

set of phenomena. The current indications are 

as follows: 

Episodes of early morning and midafternoon sleepiness in adolescents have 

a clear physiological basis. 

Rapidly growing adolescents require as 

much or more sleep than their younger 

peers. 

School, work, and social pressures combine to create a pattern of sleep deprivation and fatigue, particularly during the 

workweek, and particularly for students 

working 20+ hr per week. 

Cumulative sleep deprivation and fatigue may place adolescents at increased 

risk for work-related injuries and illnesses-as well as for unintentional 

sleep episodes while driving to or from 

work. 

Susceptibility to Injuries and __ Illnesses .- 

Body weight, surface area, and fat composition 

vary between younger and older adolescents 

[National Research Council 19931. These 

physiological differences may result in different degrees of susceptibility to occupational 

exposures during different periods of adolescence. 

Child Lobor Research Needs 23 
2 BACKGROUND I__ 

Growth and maturation are not constant across 

organ systems [National Research Council 

19931. The thymus grows most rapidly, exceeding adult size during most of childhood 

and decreasing to adult size beginning at about 

age 13. The brain approaches full adult size at 

about age 4, though behavioral development 

occurs through adolescence. The kidneys, 

spleen, and ovaries all grow steadily from 

about 40% of adult organ weight at age 8 to 

100% at age 17. The testes and uterus increase 

dramatically from about 10% of adult weight 

at age 8 to 100% at age 17. Damage to an immature organ or organ system may permanently prevent normal physical maturation, 

and organ systems may be more susceptible 

during rapid periods of growth mational Research Council 19931. For example, atomic 

bomb survivors have demonstrated increased 

risk for breast cancer among those exposed under the age of20 compared with those exposed 

at age 40 or after [Merke and Miller 19921. 

Psychosocial Risk Factors 

Psychological Factors 

In addition to the physical and physiological 

changes noted above, children experience profound psychological changes as they mature. 

This psychological transition is often less visible than the physical one, requires more time to 

complete, and typically lags behind physical 

maturation. Thus psychological immaturity 

may be obscured by a relatively mature physical appearance in an adolescent. As a result, a 

young worker may be assigned to a task for 

which he or she is emotionally or cognitively 

unprepared. In addition, a young worker will 

not have adequate experience to judge his or 

her ability to complete an assignment safely. 

The terms most often used to describe the psychological attributes of adolescence are poor 

judgment, sensation seeking, poor risk assessment, vulnerability to peer pressure, incomplete self-image, pressure to excel, need to 

prove independence and maturity, desire to 

conform, and (conversely) need to rebel. Although these attributes are relevant throughout 

the life span, adolescence is the time when the 

individual first encounters the possibility of 

making independent, adult decisions and experiencing adult consequences. Poor risk assessment combined with a tendency toward 

sensation seeking may lead to feelings of invulnerability while operating a motor vehicle. 

The natural desire to prove one’s independence 

and skills as well as to help the family may 

cause a young adolescent to take on a task for 

which he or she is not equipped. Such impulses 

have often resulted in deaths and permanent injuries to children in tractor rollovers, grain bin 

entrapments, and equipment entanglements 

while working on the family farm. At least in 

agriculture, concerns about cognitive and emotional maturity as well as overall lack of experience have been added to the ergonomic 

concerns about young workers noted earlier 

[Aherin and Todd 1989; National Committee 

for Childhood Agricultural Injury Prevention 

19961. 

The literature about adolescent development 

and risk-taking centers on sexual behavior, the 

use of alcohol and other drugs, and the operation of motor vehicles-particularly in conjunction with the consumption of alcohol [e.g., 

Kidd and Holton 19931. Sensation seeking has 

recently been shown to be a fairly complex 

(and even protective) phenomenon when examined in a context such as school sports 

[Smith et al. 19921. However, the consequences of risky behaviors during adolescence 

are generally severe [e.g., Zuckerman and 

Duby 19851. Two studies are currently under 

way to shed further light on risk-taking behavior in adolescence: the Youth Risk Behavioral 

Surveillance System conducted by the National Center for Chronic Disease Prevention 

and Health Promotion, and the Adolescent 

Health Study conducted by the University of 

24 Child Labor Research Need5 
2 BACKGROUND 

North Carolina. Neither study emphasizes occupational issues. 

Lack of Work Experience 

No easy method exists for summarizing the 

complex issues of psychological development 

during adolescence and the potential consequences for working adolescents. However, 

lack ofwork experience is a contributing factor 

in all of the issues examined above. Additional 

research is necessary to confm this hypothesis, but this brief review indicates that general 

lack of work experience coupled with nornial 

adolescent psychological development places 

adolescents at high risk of injury on the job. 

Lock of Training and Supervision 

Factors related to work organization-such as 

the amount of safety training and supervision-may increase the risk for work injuries 

and illnesses among children and adolescents. 

In a telephone survey of workers aged 14 to 16 

with work injuries identified through the 

NEISS, 54% reported receiving no training in 

methods to prevent their injuries [Knight et al. 

19951. Classroom discussions with 180 students in California also found low levels of 

training about job safety [Bush and Baker 

19941. In the NEISS telephone survey, a supervisor was present at the time of injury in only 

about 20% ofthe cases [Knight et al. 19951. To 

counteract the lack of work experience, workrelated training and supervision for adolescents must be both developmentally appropriate to the task and sufficient to achieve 

mastery. Only when teens adequately appreciate their risks on the job will they begin to 

adopt self-directed, self-monitored, safe work 

practices. 

Inappropriate Work Assignments 

Inappropriate work assignments also contribute to deaths and injuries of young workers. In 

the NEISS telephone survey, 19% of the respondents appeared to have been injured in 

jobs typically prohibited by Federal child labor 

laws for workers of their age [Knight et al. 

19951. Studies of work-related fatalities 

among minors have found that 38% to 86% of 

such fatalities occurred during work typically 

prohibited under Federal child labor laws 

[NIOSH 19951. And as discussed earlier, 70% 

of the deaths of children investigated by 

OSHA involved safety violations [Suruda and 

Halperin 19911. 

Summary 

Children and adolescents are not little adults. 

In addition to physical differences, young 

workers have differences in psychology, cognitive abilities, and skills. A recent report 

about preventing childhood agricultural injuries called for “developmentally appropriate” 

guidelines for children’s agricultural work 

based on research findings, theories, and principles associated with psychological and 

physical development [National Committee 

for Childhood Agricultural Injury Prevention 

19961. The need for age-appropriate or developmentally appropriate standards for adolescent work applies to nonagricultural work as 

well. 

Psychosocial Effects of Youth 

Employment 

Research on the psychosocial effects of adolescent employment has focused primarily on 

part-time work during high school. Although 

some adolescents drop out of high school to 

work full time and many high school students 

work full time over summer breaks, the primary interest of researchers in adolescent development has been on work during the school 

term. The main issues raised by this research 

[e.g., Steinberg andCaufFman 19951 have been 

the many positive and negative consequences 

of part-time work in the context of secondary 

Child Labor Rereorch Needs 25 
2 BACKGROUND 

education, extra-curricular activities, family, 

peer group activities, and work experience 

relevant to future jobs. 

The context of discussions about occupational 

safety and health in adolescent workers is 

somewhat broader than for adult workers. 

Adolescent work experience has the potential 

for exerting an important influence on the continuum of education and training in which adolescents participate. The task is to encourage 

young workers to learn positive work values 

(including how to work safely) while fully protecting them from workplace hazards and organizational stressors. 

Positive Effects of Part-Time Work 

Some of the positive effects that have been 

cited for part-time work for adolescents (e.g., 

by Finch et al. [1997]) include the acquisition 

of basic work skills such as those needed to 

gain and keep a job and those needed to interact with coworkers, supervisors, and customers, (promptness, dependability, etc.). 

Longer-tern career enhancement may accrue 

as well, but these effects are not well demonstrated and remain equivocal. Similarly, development of a personal identity as a worker as 

well as a high school student may enhance 

self-confidence and self-esteem. 

As work-based learning programs become 

more widespread, specific connections between education and work-related training 

may become more apparent and may enhance 

the overall educational experience of both 

school and work. Meanwhile, it is probably 

more accurate to conclude that although some 

work experiences benefit the educational performance of some high school students, these 

benefits are not yet known to occur in a widespread or systematic fashion. 

Some adolescents undoubtedly supplement 

limited family resources with their pay, but 

data suggest that most working adolescents use 

their wages for personal expenses and savings. 

Similarly some scholars reason that adolescents who are working cannot be involved in 

certain delinquent behaviors. Again, the evidence for these conclusions is equivocal. 

Negative Effects of Part-Time Work 

The two most salient and best documented 

negative effects of part-time work for some 

high school students are decreased school performance and increased use of alcohol. Decreased school performance has taken the form 

of declining grades and selection of classes 

that make few demands on the student. Substance abuse is not confined to alcohol, but increased alcohol use is the effect most clearly 

linked to part-time work during the school 

tern, primarily because of the increased financial resources of working adolescents. 

Other negative effects of part-time work include decreased participation in sports and 

other extracurricular activities and (as noted 

above earlier) a pattern of sleep deprivation 

that appears to be linked to the number of 

hours worked per week. In addition, student 

focus groups have identified harassment and 

fear of workplace violence as specific concerns of working adolescents [Duran and Miara 19951. 

In summary, part-time work during the school 

term has both positive and negative outcomes 

for adolescent workers. The pattern of these 

outcomes and the net benefit or harm derived 

depends on the ability to schedule adolescent 

activities and achieve a balance that allows 

adequate time for school, sleep, and interaction 

with peers and family. 

26 Child Labor Reseorch Needs 
2 BACKGROUND 

Needs and Opportunities for 

Education and Training 

Health Education at the Community 

level 

Promoting the safe and healthful employment 

of children and adolescents requires health 

education efforts at the community level. Such 

an approach is appropriate when (1) a large 

population is at risk, (2) a large number ofpeople and organizations within a community may 

have an impact on the problem, and (3) the 

community lacks information and skills to deal 

with the health problem. All three criteria are 

satisfied in the area of safety and health for 

young workers [Bush and Baker 19941. Although limited impacts are often reported for 

health education efforts at the community level 

[COMMIT Research Group 1995; Luepker et 

al. 1994; Fortmann et al. 19931, these efforts 

indicate that the method should be refined, not 

abandoned [Susser 19951. 

Educating and Training Primary 

Stakeholders 

Using Community Groups 

To maintain the safety and well-being of children and adolescents while they are at work, it 

is necessary to provide education and training 

in occupational safety and health to the primary stakeholders+hildren and adolescents 

as well as to their parents and employers (e.g., 

managers and front-line supervisors). One approach to providing occupational safety and 

health training is to use community groups 

such as the parent-teacher associations, chambers of commerce, Kiwanis, 4-H, Scouts, and 

FFA. These groups can provide information to 

the primary stakeholders and thereby foster 

awareness and recognition of the following: 

Health hazards in the workplace 

Safety hazards in the workplace 

Good work practices and interventions 

that will prevent or control exposures to 

hazards 

Reaching industry and Labor Groups 

Another approach to disseminating safety and 

health information is to use outreach programs 

directed to primary stakeholders. Industry and 

labor groups need to be aware of specific concerns for young workers and prevention strategies that work. Violations of child labor laws 

are common and too frequently result in serious injury or death [Knight et al. 1995; Castillo 

et al. 1994; Dunn and Runyan 1993; Suruda 

and Halperin 1991; GAO 1990, 19911. A survey of injured adolescents indicated that 54% 

had not received training in prevention of their 

injury, and only 20% had a supervisor present 

at the time of the injury [Knight et al. 19951. 

Employers need to know and comply with 

child labor laws, provide a safe and healthful 

work environment, ensure that adolescents 

recognize hazards and are competent in safe 

work practices, and provide appropriate supervision. Occupational safety and health information must be communicated not only to 

owners and managers but also to front-line supervisors who deal directly with young workers on a daily basis. 

Tapping into the Educational System 

Educafors-Educators play a role in the occupational safety and health of children and adolescents by approving work permits, preparing 

students for the world of work, and providing 

or facilitating work experience. School staff 

who sign work permits should be familiar with 

child labor laws and not sign off on work that is 

prohibited for minors. 

Child Labor Rereorch Needs 27 
2 BACKGROUND 

Vocational education programs.-Vocational education courses are included in many 

secondary schools to provide students with 

marketable job skills. Vocational education 

courses are more commonly taken by students 

with disabilities (both physical and psychosocial) than by students without disabilities 

[Blackorby 19931. An estimated 99% of students with disabilities took at least one vocational course in high school, and students with 

learning disabilities were most likely to take 

four or more related vocational courses [Wagner and Blackorby 19961. Vocational education is considered a successful intervention for 

students with disabilities, as it is strongly associated with subsequent employment and 

higher earnings [Terman et al. 19961. A safe 

and healthful environment for developing vocational skills along with knowledge and skills 

in safe work practices should be (but is not always) an integral component of vocational 

education programs. State departments of education were surveyed regarding required occupational safety and health education in high 

school agriculture classes [Ehlers 19921. Of 

the 43 respondents, 14% had requirements in 

eye safety only, and 19% had no requirements. 

Serious injuries associated with vocational 

training classes have been reported to the Massachusetts Occupational Safety and Health 

Program [Massachusetts SENSOR Program 

1993,19951. A case investigated by the Massachusetts program involved a student who lost 

his right arm and part of his scalp while working on a lathe at school [Massachusetts SENSOR Program 19951. NIOSH researchers 

recently took part in an industrial hygiene survey of a vocational school and found unsafe 

conditions, including exposure to high noise 

levels and hazardous dusts and metals [Fajen et 

al. 19961. 

School-to-work initiative.---In May 1994, 

President Clinton signed into law the Schoolto-Work Opportunities Act (Public Law 

103-239). This and other work-based learning 

initiatives aim toprepare students for the world 

of work by providing integrated school- and 

work-based instruction in “all aspects ofthe industry.” The Act intends to provide this instruction to all students, not just to those who 

are in vocational programs or do not plan to go 

to college. Occupational safety and health is 

included in the definition of “all aspects of the 

industry.” The school-to-work initiative holds 

tremendous potential for providing our future 

workforce with knowledge and skills in hazard 

recognition and remediation, safe work practices, and workers’ rights and responsibilities. 

Since this initiative will increase exposure of 

young people to work and work environments, 

it is paramount that these work experiences not 

threaten the safety and health of our youths. 

Experts in occupational safety and health need 

to pursue involvement in school-to-work programs to ensure that we produce a future workforce skilled in occupational safety and health 

and free of the specter of increased injuries resulting from increased exposures. 

Health education in schools.-Education in 

occupational safety and health also dovetails 

with comprehensive school health efforts. 

Comprehensive school health comprises eight 

interrelated components, including health education, a healthy school environment, staff 

health promotion, and parent and community 

involvement [Allensworth and Kolbe 19871. 

The rationale for including health education in 

the school environment is that many unhealthy 

behaviors that result in substantial morbidity 

and mortality begin in youth. Work is a reality 

for many students, and most students will work 

at some point in their adult lives. The workplace frequently poses serious hazards to 

safety and health. Education in the ability to 

recognize and control hazards should be considered a critical life skill and incorporated into 

the educational system. Researchers in California used interviews, discussion sessions, 

and focus groups to solicit views from high 

28 Child Lobor Rerearch Needs 
2 BACKGROUND 

school teachers about educational needs and 

opportunities [Bush and Baker 19941. All the 

instructors agreed that students needed to be 

educated in workplace safety and health and 

that schools were an appropriate place for this 

education. 

Educating and Training Secondary 

Stakeholders 

The numerous secondary stakeholders (e.g., 

child safety advocates, equipment manufacturers, insurers, and policy makers) need to be 

made more aware of occupational safety and 

health issues for children and adolescents. 

Childhood injury prevention advocates and 

professionals often fail to recognize that workplace hazards pose injury threats to children 

and adolescents. Information about workplace 

hazards could be incorporated into their prevention and research activities. Medical providers who sign work permits need to know 

child labor laws and ensure that they do not 

sign off on work that is prohibited for minors. 

Medical providers can also take work histories 

to assess the role of work in injuries and illnesses of children and adolescents; in addition, 

they can deliver preventive messages about 

workplace hazards during routine visits. 

Manufacturers should design equipment that 

will protect young workers who are small or 

lack skills. Manufacturers should also clearly 

label equipment that is not appropriate for use 

by children and adolescents. Insurers may be 

able to provide financial incentives to employers who provide job safety training to young 

workers and exclude them from prohibited activities. In addition to providing jobs for outof-school and disadvantaged youths, job programs should work to provide the knowledge 

and skills that will keep young workers safe 

and healthy. Policy makers require state-ofthe-art knowledge about occupational safety 

and health issues to inform their decisions 

about workforce development and child labor 

regulations. 

Child Lobor Reseorch Needs 29 
OSHA Regulations 

SHA strives to make the workplace safe 0 for everyone, regardless of age. The 

agency uses a 45-year working life (occurring 

between ages 2 1 and 65) as standard and, with 

one exception, does not differentiate on the basis of age. The only age-specific OSHA regulation concerns exposure to ionizing radiation 

[29 CFR' 1910.96@)(3)1. 

Federal Child labor Laws 

The child labor provisions of the FLSA [29 

USC Ch. 8 $201-219] were enacted to protect 

the educational opportunities of minors and 

prohibit their employment in jobs and under 

conditions detrimental to their health or wellbeing. The provisions include restrictions on 

both occupations and hours of work for minors 

under age 16; they prohibit all minors under 

age 18 from performing work within the nonagricultural hazardous occupations orders 

(HOsCjobs declared by the U.S. Secretary of 

Labor as too dangerous for minors to perform. 

The regulations also provide for the enforcement of the child labor provisions and fines of 

up to $10,000 per violation [29 CFR 570,579, 

and 5801. 

The FLSA applies to minors engaged in interstate commerce, the production of goods for 

interstate commerce, or activities closely related and directly essential to such commerce. 

The Act also applies to minors employed in 

certain enterprises covered by the Act. The 

'Code ofFederal Regulations. See CFR in references. 

courts generally interpret the coverage of the 

Act broadly and its exemptions narrowly because of the remedial purposes of the law. 

However, not all minors are covered by Federal child labor laws. By statute, the Federal 

child labor provisions do not apply to the following: 

Youths under age 16 employed by their 

parents in occupations other than manufacturing or mining, or in occupations 

declared hazardous by the US. Secretary of Labor (however, children employed in agriculture may perform any 

work on farms owned or operated by 

their parents) 

Youths under age 18 employed as actors 

or performers in motion pictures or in 

theatrical, radio, or television productions 

Youths under age 18 engaged in the delivery of newspapers to the consumer 

Homeworkers under age 18 who make 

wreaths composed principally of natural 

holly, pine, cedar, or other evergreens 

(including the harvesting of the evergreens) 

Additional exemptions have been created by 

regulation. Professional sports attendants who 

are aged 14 and 15 and perform traditional 

sports attendant duties outside of school hours 

are exempt from the hours standards of Child 

Labor Regulation No. 3 under the FLSA. The 

Work Experience and Career Exploration Program is an exception to the hours standards of 

child labor regulations. This program also allows the Wage and Hour Administrator to 

30 Child Labor Rereorch Needs 
3 APPLICABLE REGULATIONS 

grant variances that permit enrollees to be employed in othenvise prohibited occupationsbut not in manufacturing, mining, or the other 

17 HOs. The Work Experience and Career Exploration Program is designed to provide a 

carefully planned work experience and career 

exploration program for youths aged 14 and 15 

who can benefit from a career-oriented educational program designed especially to meet the 

participants’ needs, interests, and abilities. Exemptions from certain HOs apply to apprentices and students enrolled in vocational 

education programs under conditions that assure safe, well supervised employment. 

Although agricultural employment can be extremely hazardous, the Federal child labor provisions for farm work still reflect the bucolic 

ideology often described as the “agrarian 

myth” [Kelsey 19941. Coverage is limited and 

protections are few for young farm workers. 

Hazardous work in nonagricultural industries 

is prohibited for youths under age 18. But in 

agriculture, hazardous work is prohibited only 

for youths under age 16 who are formally employed away from the family farm. As mentioned, the child labor provisions contain a 

statutory exemption that permits the children 

of farmers to perform any job on a family farm. 

The U.S. Department of Labor (DOL) conducted a comprehensive review of the nonagricultural child labor regulations to consider 

significant social, economic, and technological changes that have occurred in the workplace during the past decade. As part of this 

review, DOL published an Advanced Notice of 

Proposed Rulemaking in 1994 [59 Fed. Reg.’ 

25164 (1994)l. NIOSH submitted comments 

on the Proposed Rulemaking [NIOSH 19941 

and hopes that some revised Regulations will 

be issued in 1997. 

Several bills are being considered by Congress 

this year to limit the enforcement of Hazardous 

Occupations Order Number 2 (HO 2) (which 

deals with motor vehicle driving and outside 

helpers*) and HO 12 (which deals with powerdriven paper products machines). Legislation 

has also been introduced to permit minors aged 

16 and 17 to spend as much as 49% of each 

workday driving. Since the child labor provisions place absolutely no limits on the number 

ofhours these minors may work, the amount of 

time spent behind the wheel could be substantial. Legislation has been introduced to permit 

minors aged 16 and 17 to load but not operate 

or unload paper balers and compactors that 

meet safety and engineering standards issued 

by the AmericanNational Standards Institute. 

State Child labor laws 

Almost all States have child labor laws, mandatory school attendance laws, and requirements for issuance of work permits or age 

certificates. State laws often mimic the Federal 

provisions, but many differences exist. The effectiveness of State laws often depends on the 

numbers and kinds of exemptions permitted 

and the commitment made to enforcement. 

When both the Federal and State child labor 

provisions apply, the employer is held to the 

stricter standard. 

State Workers’ Compensation 

laws 

State workers’ compensation laws also affect 

child labor. Reporting requirements can provide 

valuable injury data for industries and other 

workplace settings where minors are injured. 

‘Federal Register. See Fed. Reg. in references. 

$An outside helper is any person other than a driver 

whose work includes riding on a motor vehicle outside 

the cab for the purpose of assisting in transporting or 

delivering goods. 

Child Lobar Rerearch Needs 31 
3 APPLICABLE REGULATIONS 

Some State compensation laws may also provide for increased rates or fines when youths 

under age 18 are injured in violation of Federal 

or State child labor laws. However, many State 

laws also limit the legal remedies for the occupational injury or death of youths under age 18. 

32 Child Lobor Rerearch Needs 
4 NATIONAL OBJECTIVES FOR THE 

OCCUPATIONAL SAFETY AND HEALTH OF YOUTHS 

OTH the Federal Government and the pri- B vate sector have numerous national objectives that intersect with the mission of the 

Child Labor Working Team to reduce injuries 

and illnesses in young workers and to prepare 

them for encountering workplace hazards. 

These objectives are summarized below and 

outlined in more detail in Appendix D. 

Federal Objectives 

The Federal Government has identified national objectives for the occupational safety 

and health of youths at the departmental level 

(US. Department of Health and Human Services [DHHS]) and within the Centers for Disease Control and Prevention (CDC) and 

NIOSH. Congress has established similar objectives in recent legislation. 

The U.S. Secretary of Health and Human Services and the Russian Minister of Health and 

Medical Industry signed a joint policy statement on health education for children in January 1996 [Shalala and Tsaregorodtsev 19961. 

This statement affms the importance of giving children fundamental knowledge about 

how to live healthy lives. The statement also 

calls on citizens and education and health professionals to support and provide quality 

health education that uses families, communities, and educational and health institutions to 

transmit essential information about health 

risks. 

Healthy People 2000 [DHHS 19941 is a national strategy for significantly improving the 

health of the Nation during 1990-2000. This 

document calls for a reduction in adolescent 

work injury rates and an increase in school 

health education (including instruction in injury prevention and control and communitybased approaches to meet Healthy People 

2000 objectives) [DHHS 19941. 

Youths are the newest priority area for CDC 

[CDC 1996al. One of the 21 research priority 

areas identified in the NIOSH National Occupational Research Agenda is special populations at risk, which includes children and 

adolescents [NIOSH 1996bl. 

The School-to-Work Opportunities Act (Public Law 103-329), the Goals 200kEducate 

America Act (Public Law 103-227), and the 

Carl D. Perkins Vocational and Applied Technology Education Act (Public Law 101-392) 

all seek to produce students who are prepared 

for the world of work. The School-to-Work 

Opportunities Act and the Carl D. Perkins Vocational and Applied Technology Education 

Act specifically require instruction in “all aspects of the industry,” a term that explicitly includes occupational safety and health. 

Private Sector Objectives 

Public health and child advocacy groups in the 

private sector have called for research and prevention efforts focused on the occupational 

safety and health of youths. The National 

Committee for Childhood Agricultural Injury 

Prevention has published a report with 13 recommendations for reducing the toll of 

Child Lobor Research Needs 33 
4 NATlONAl~ OBJECTIVES FOR THE OCCUPATIONAL SAFETY AND HEALTH OF YOUTHS - 

agriculture on children [National Committee for 

Childhood Agricultural Injury Prevention 19961. 

All but one of these recommendations fall within 

the purview of NIOSH (including surveillance, 

etiologic and intervention research, and educating the public and specific stakeholders about 

agricultural risks to children). The National 

Safety Council has released a policy statement 

encouraging research to reduce the risks posed 

to children by tractors-a machine that accounts 

for substantial numbers of childhood agricultural 

deaths each year [National Safety Council 19961. 

The American Public Health Association 

(APHA) recommends conducting research into 

the safety and health of working children, incorporating occupational safety and health training into school curricula, educating stakeholders about the occupational risks of youths, and 

coordinating the efforts of the DHHS and the 

DOL in controlling and preventing occupational 

injuries in youths [APHA 19951. The Child Labor Coalition of the National Consumers League 

has called for research and a comprehensive 

multiagency response to occupational safety and 

health concerns about young workers [Child 

Labor Coalition 19931. 

34 Child Labor Reseorch Needs 
5 NIOSH PROJECTS FOCUSED ON CHILDREN AND 

ADOLESCENTS 

OST NIOSH research and activities IMh ave implications for children and adolescents. For example, the FACE Program investigates certain types of deaths and injuries 

of children and adolescents, and the Dirty 

Dozen Project (which conducts hazard surveys 

in selected workplaces) has investigated health 

hazards in vocational education programs. 

Programs supported by the Agricultural Safety 

Promotion System affect children as well as 

adults in agricultural communities. Workplace 

designs that deter robbery and robbery-related 

homicide affect youths as well as older workers. 

And control technologies that minimize or reduce exposures to hazardous substances benefit 

all potentially exposed workers, regardless of age. 

The NIOSH projects described in this section 

were in progress as of July 1,1996. These projects have a particular focus on children and 

adolescents and take into account the unique 

characteristics and needs of this worker population as well as unique opportunities for prevention. The impacts of these projects will not 

be restricted to working children and adolescents. Control measures that reduce hazardous 

exposures to children will also protect older 

workers with similar exposures. Evaluation of 

community-based educational efforts can 

guide similar efforts for other worker groups. 

Also, providing children and adolescents with 

occupational safety and health knowledge and 

skills may reduce injury and illness rates in our 

future workforce. 

Occupational Injuries in Children 

and Adolescents 

A number of existing injury databases have unfulfilled potential for closing information gaps 

about occupational injuries in adolescents and 

children. Databases with the potential to advance our knowledge about this problem include the SOII, the National Hospital 

Ambulatory Medical Care Survey, hospital 

discharge databases, CFOI, NTOF, and 

NEISS. These and other databases will be 

evaluated to determine their potential to (1) 

supplement knowledge about the size of the 

problem, (2) provide detailed information 

about circumstances or risks that could promote prevention efforts and research, (3) provide information about the impact of the 

injuries on young lives and futures, and (4) 

evaluate changes in the patterns or incidence of 

injuries over time. 

Promising analyses are pursued and findings 

are disseminated through the Child Labor 

Working Team, presentations at meetings, and 

publication in peer-reviewed journals and health 

education documents. The Child Labor Working Team has successfully encouraged the use 

of available data in intervention and research 

activities-both by NIOSH and other stakeholders such as the Wage and Hour Division of 

the DOL and the School-to-Work Program. 

Hazard Surveillance and Injury 

Investigation of Paper Baling 

Machinery 

Recent congressional activities may result in 

the relaxation of restrictions on the current 

child labor regulation that prohibits the use of 

paper balers by children under age 18. NIOSH 

and others are concerned that this shift in policy may result in substantial numbers of disabling injuries and deaths among working 

adolescents. This project has initiated active 

Child Lobor Rerearch Needs 35 
5 NIOSH PPO!FCTS FOCUSED ON CVIKDREN AN5, ADOXSCENTS 

surveillance to identify injuries that occur in 

adolescents and to collect information about 

the circumstances ofbaler-related injuries. The 

case surveillance involves (1) review of data as 

they come into NIOSH from the NEISS and 

FACE projects, (2) notification by DOL investigators (Wage and Hour Division) of injuries 

to minors, (3) notification by the NIOSHsupported Sentinel Event Notification System 

for Occupational Risks (SENSOR) Program of 

serious work injuries to minors, (4) notification by the SENSOR Program of amputations, 

(5) notification by the Maryland FACE program of cases identified through review of 

workers’ compensation data, (6) notification 

by a network of medical examiners and coroners of the deaths of minors, and (7) notification by a newspaper clipping service of deaths 

and injuries of minors. Investigations based on 

the FACE model will be conducted for fatal 

and nonfatal injuries. 

Hazard Control Evaluation of the 

Safety Device Technology for 

Cardboard Paper Balers 

Evidence indicates a need to improve the 

maintenance technology for hydraulic interlock safeguarding in paper baling equipment. 

The need has been suggested in a NIOSH report to the DOL Wage and Hour Division with 

regard to their standards for protecting workers 

aged 16 and 17. The project objective is to provide a hazard control assistance report to users 

of cardboard baling equipment. The report will 

(1) describe the range of hydraulic interlock 

(gate-type) safeguard technology being used 

on cardboard balers in the United States, (2) 

provide the results of a safety analysis of types 

that have not been previously reviewed by 

NIOSH, and (3) recommend gate-type, hydraulic interlock safeguards whose effectiveness should be tested in the laboratory. 

The project team is composed of NIOSH and 

external personnel with appropriate control 

technology skills. Project methods involve site 

visits to evaluate the safeguarding ofpaper baling equipment, laboratory reviews of safeguarding methods, and task team development 

of a comprehensive equipment survey report 

and recommendations. During the current 

project year, the team identified areas that need 

to be reviewed to assure safer hydraulic equipment such as balers. These areas include the 

actual and required structural strength of safeguard components (such as support structures, 

fasteners, and barrier material areas), development of interlocking for gate-type safeguards 

that responds to structural indications of 

jammed equipment, and laboratory evaluation 

of machine components for safely starting and 

stopping machine motion. The Team plans a 

workshop to examine the review area and recommend priorities for effective research on 

preventing machine-related injuries. 

Hazards of Youth Work 

This project was funded by NIOSH as a research grant to the North Carolina Injury Prevention Research Center through the National 

Center for Injury Prevention and Control. The 

following description of the project is based on 

a draft progress report [Runyan 19961. The 

study is one of the first in the Nation to seek information about exposures of adolescents to 

workplace hazards. The goal of this interdisciplinary project is to describe the following: 

hazards to which adolescents are exposed in 

the workplace, protective practices used by 

adolescents in specific jobs, adolescent perceptions and reactions to workplace hazards, 

and knowledge of adolescent workers about 

hazards, protective strategies, and child labor 

restrictions. This study includes a telephone 

survey of a Statewide sample of 572 working 

youths aged 14 to17 and a survey of a Statewide purposive sample of 323 youths aged 

36 Child Labor Rerearch Needs 
5 NIOSH PROJECTS FOCUSED ON CHILDREN AND ADOLESCENTS 

14 to 17 involved in a 4-H program via selfadministered questionnaire. The project includes a followup survey of youths interviewed in 1995 and focus groups of selected 

youths working in targeted industries (food 

service, grocery stores, and other retail trades). 

This project lays the foundation for a national 

study of exposures to work-related hazards 

among youths. 

Massachusetts SENSOR-Serious 

Occupational injuries to Youths 

In a cooperative agreement with NIOSH, the 

Massachusetts Department of Public Health is 

working to develop and evaluate a Statewide, 

case-based surveillance and intervention system for occupational injuries to youths under 

age 18. At the core of this system are departmental regulations requiring physicians and 

hospitals to report work-related injuries of 

youths under age 18 to the Department. The 

Department is conducting active outreach to 

hospital emergency departments to solicit reports and to explore the use of computerized 

emergency department or billing data to generate reports. Workers’ compensation claims for 

minors, hospital discharge data, Massachusetts 

Bum Registry data, and CFOI data are also 

used to determine cases. Interviews are conducted with youths having serious injuries and 

with those having less serious injuries in selected occupations. Memoranda of understanding have been signed with the DOL 

Region I Wage and Hour Division and OSHA 

to facilitate referrals. The Massachusetts Department of Public Health is working with 

other agencies on a variety of educational interventions. 

A new component was added to this project in 

FY96 to begin filling information gaps about 

work-related health hazards that may cause 

short- or long-term health effects. The project 

industrial hygienist arranges workplace visits, 

makes observations, and interviews employers, supervisors, and working youths. The industrial hygienist observes work tasks 

performed by youths and identifies hazardous 

exposures or conditions. Protective measures 

are noted, including ventilation, personal protective equipment, training, and supervision. A 

special focus in the upcoming year will be hazards in vocational schools. A summary report 

will include recommendations for future 

health hazard research. 

Missouri Agricultural Safety 

Promotion System 

The Agricultural Safety Promotion System is 

designed to stimulate the development and implementation of agricultural safety and health 

intervention programs to reduce agricultural 

injuries and exposures to safety hazards. The 

primary emphasis is to assess the effectiveness 

of proposed intervention programs. The program is intended to (1) reduce the incidence of 

agricultural injuries and fatalities by implementing intervention projects immediately, 

and (2) provide practitioners with useful information about the effectiveness of the intervention programs. The Missouri Agricultural 

Safety Promotion System aims at preventing 

youth injuries through peer education. The 

University of Missouri at Columbia is therefore developing a peer approach to educating 

youths about agricultural safety. A multidisciplinary team of adult leaders is being trained to 

develop youth safety programs for FFA members. These members are instructed to teach 

agricultural safety (safety hazards, prevention 

measures, and concepts) to younger children. 

The premise is that children learn more readily 

from other children. One curriculum has been 

developed for use by FFA members, and another is being developed for classroom use by 

FFA instructors. This approach requires adequately trained adults to support the instructors. The primary target audience is FFA 

members, and the secondary target audience is 

Child Labot Rereorch Needs 37 
5 NlOSH PROJECTS FOCiJStD ON CHILDREN AND ADOLESCENTS ~~ 

rural elementary students. The program effectiveness will be evaluated by assessing the behavioral intentions of the target populations. 

Pre- and post-testing will provide data to 

evaluate whether behavioral intentions were 

measurably improved in both FFA instructors 

and students. College courses in agricultural 

safety will also be developed. 

Promoting Safety and Health in 

Vocational, Technical, and 

industrial Programs: Guidelines 

and Curricula 

The immediate goal of this project is to increase the safety awareness and education of 

the Nation’s vocational school teachers and administrators so that they can pass this information to students before they enter the work 

environment. The ultimate goal is to produce 

students (future American workers) knowledgeable in occupational safety and health. Industries will thus be provided with employees 

informed about occupational safety and health 

issues. Toward these goals, this project will develop training materials to help students recognize safety and health hazards in vocational 

shops, employ safe work practices, and eliminate hazards. The 1981 edition of Safety & 

Health for IndustriaNVocational Education 

will be revised and updated. The training materials in the manual will be evaluated through a 

pilot test and revised before a mass printing of 

the manual. Training materials could be developed in a CD-ROM or CD-interactive format 

and displayed on the NIOSH Home Page on 

the Internet. NIOSH will collaborate with the 

American Vocational Association, the Vocational Industrial Clubs of America, State vocational directors, and the U.S. Department of 

Education to develop or disseminate recommended curricula and policy for occupational 

safety and health in all vocational schools. A 

secondary objective is to expand the program 

to colleges that graduate teachers for vocational schools. 

Enhancing Young Workers’ Safety 

and Health Through Community 

Education Efforts 

In FY96, the NIOSH Education and Information Division embarked on three 2-year community health education projects to enhance 

young workers’ occupational safety and 

health. The partners in this effort are (1) the 

Massachusetts Department of Health (and the 

Brockton Public Schools, Brockton, Massachusetts), (2) the University of California at 

Berkeley (and the Oakland Unified School 

District, Oakland, California), and (3) the University of California at Los Angeles (and the 

Los Angeles Unified School District). These 

projects attempt to arouse a community response to young workers’ safety and health issues and thereby stimulate a variety of 

education and awareness efforts by community members. A project advisory group has 

been established in each community. This 

group broadly represents community interests such as labor, education, business, government, public health, parents, young workers, 

etc. 

The early months of the projects have been 

spent collecting formative data about (1) employment patterns of young workers, (2) 

knowledge and attitudes about young worker 

safety and health issues, and (3) health education and peer counseling services that now exist for youths within the communities. A 

survey of knowledge and attitudes was administered to a convenient sample of students in 

each community and to a sample of students in 

North Carolina (administered by the University of North Carolina, Injury Prevention and 

38 Child Labor Research Needs 
5 NIOSH PROJECTS FOCUSED ON CHILDREN AND ADOLESCENTS __ 

Research Center). These data can be used to 

compare baseline knuwledge and attitudes 

across communities. 

Health educators on the staffs of the three partner public health organizations are working 

with community members to devise materials 

for use in awareness sessions in community 

groups and school classrooms. The early 

phases of the projects emphasize creating an 

awareness of the issues. The second year emphasizes establishing an ongoing effort to educate students and other community members. 

These health educators have already developed innovative approaches suc’. ?.s risk analysis games, risk-mapping exerc,, A, and photo 

novella vignettes, which they are testing in the 

communities. 

Two types of evaluation data are being collected process and outcome. Process evaluation data allow analysis of the community 

intervention effort at the community level. The 

life of each community project (its successes 

and failures, the’ timing of events, participation, etc.) will be assessed to provide administrative guidance for future efforts in other 

communities. Outcomes will be evaluated primarily using individuals as units of analysis. 

Knowledge and behavior changes will be assessed to identify the education strategies that 

worked best. From these data, a community 

education handbook (precise medium to be determined) will be developed for other communities to undertake similar efforts. 

Adverse Neurobehavioral Effects in 

Children of Farm Workers 

The University of California Center for Agricultural Research, Education, and Disease and 

Injury Prevention (one of eight such centers 

funded by NIOSH) is conducting a study to determine the risk of adverse neurobehavioral effects in the children of farm workers. 

Researchers at this Center are evaluating children’s exposure to oiganophosphate pesticides, which may occur through their parents’ 

agricultural field work. Exposed children may 

be more likely to show adverse neurobehavioral effects than children whose parents do not 

work in agriculture. This study focuses on the 

prevalence of organophosphate pesticide exposures in infants and preschoolers, the prevalence of neurobehavioral problems that might 

result from such exposures, and parental occupation as a potential source of the children’s 

exposure. 

Support of Farm Safety 4 Just Kids 

The eight NIOSH-supported Centers for Agricultural Research, Education, and Disease and 

Injury Prevention support chapters of the national organization Farm Safety 4 Just Kids. 

Established by a farm mother as a result of her 

12-year-old son’s death, this organization 

alerts parents and children to the hazards of 

farm work. The network of chapters in the 

United States is growing-partly as a result of 

their collaboration with the staff at the 

NIOSH-funded Centers, who share health education materials and tools for increasing participation among farm children. 

Child Labor Research Needs 39 
6 RESEARCH NEEDS 

W HEN identifying occupational safety and health research needs for children 

and adolescents, the Child Labor Working 

Team considered existing knowledge, current 

research efforts, and needs expressed by stakeholders. These research needs are outlined in 

the following subsections. 

Improved Surveillance for WorkRelated Injuries and Illnesses of 

Children and Adolescents 

Substantial gaps exist in the coverage provided 

by occupational injury surveillance systems, 

and concerns exist about their underestimation 

of injuries in children and adolescents. Problems are greatest in the agricultural sector, but 

they occur across all industries. The occupational safety and health community needs to 

standardize nomenclature and establish a minimum data set to be collected on occupational 

injuries in children and adolescents. We need 

better understanding of the types of work children and adolescents do, the hazards they are 

exposed to, and the distribution of risk factors. 

The health outcomes of childhood work exposures have been hypothesized but not quantified. Information is needed to define the 

severity of disease and injury and the economic and social consequences. Consequently, 

we do not know the true impact of injuries and 

illnesses among children and adolescents. We 

need detailed information about the circumstances and contributing factors to inform intervention and research efforts. Surveillance at 

the State or local level can be an effective 

means for determining the focus for local intervention efforts. 

Research to Identify Risk Factors 

for Work Injuries and Illnesses of 

Children and Adolescents 

Children and adolescents appear to have a 

relatively high rate of occupational injury 

compared with adults. Numerous factors 

unique to children and adolescents may increase their risk for injury and illness. These 

factors include minimal work experience, lack 

of training in hazard recognition and safe work 

practices, and risk factors associated with 

physical and psychosocial development. To direct intervention efforts, we need to assess and 

quantify risk factors for injury and illness 

among working children and adolescents. 

Research to Assess the AgeAppropriateness of Work Tasks 

At least two groups with substantial expertise 

in agricultural work injuries and illnesses have 

called for research to assess age-appropriate or 

developmentally appropriate work tasks: the 

National Committee for Childhood Agricultural Injury Prevention [ 19961 and the Agricultural Division of the National Safety Council 

[ 19961. Guidelines for age-appropriate tasks 

are needed for the nonagricultural sector as 

well. Ultimately, child labor regulations serve 

as lists of age-appropriate and -inappropriate 

work tasks. Decisions about appropriate work 

tasks for children and adolescents need to be 

40 Child Labor Research Needs 
6 RESEARCH NEEDS 

guided by scientific data, theory, and principles in both regulatory and nonregulatory environments. 

Intervention Research 

A broad range of intervention research is 

needed to address the engineering, administrative, and behavioral aspects of child labor hazards. These aspects must be addressed both 

separately (with targeted interventions that 

have narrowly defined outcome measures) and 

collectively (with interventions that have mktiple outcome measures) [Goldenhar and 

Schulte 1994, 19961. A solid research base is 

needed to focus interventions effectively. Implementation barriers and aides must be identified. Numerous interventions have been made 

to prevent work injuries to children and adolescents. Their effectiveness must be rigorously 

evaluated to identify the most efficient strategies and to assure that interventions do not 

have adverse consequences such as increased 

injury or illness rates from increased exposures. 

CosVBenefit Analyses of Models 

for the Healthful Employment of 

Children and Adolescents 

Occupational safety and health professionals 

associate investments in injury and illness prevention with reduced costs as well as saved 

lives and limbs. However, data have not always been collected to document this association. Employers may be reluctant to invest in 

efforts with intangible benefits, especially if 

they perceive a low risk for injury and illness 

among their workers. A useful tool for safety 

and health programs would be model programs 

or best practices for healthful employment of 

working children and adolescents, with documented impacts on costs and productivity. 

Research to Promote Occupational 

Safety and Health Education for 

Adolescents in School-Based 

or -Facilitated Work Experience 

Programs 

Recent Federal initiatives such as School-toWork heighten awareness about the occupational risks facing adolescents, and they provide opportunities for youths to be trained in 

occupational safety and health during their formative years. Recent NIOSH initiatives have 

assessed hazards and training needs in the vocational education environment. NIOSH hazard assessments in 11 vocational schools 

indicate the need for further evaluation. Not all 

of the schools were aware of the safety and 

health concerns associated with the industrial 

trades. The NIOSH assessments noted a lack 

of respirator programs and minimal hearing 

conservation programs. Many of the students 

were learning disabled. Hazard identification 

and intervention programs are needed to ensure safe educational environments for children and to provide critical knowledge about 

occupational safety and health. 

Refinement and Expansion of 

Community-level interventions to 

Promote Safe and Healthful Work 

Experiences for Children and 

Adolescents 

Every community sees the protection of its 

youth as a high priority. Children and adolescents, parents and other family members, 

school teachers and counselors, employers and 

community groups all have a stake in safe and 

healthful work experiences for children and 

adolescents. Targeted approaches to prevention hold tremendous potential for success and 

institutionalization of efforts. NIOSH demonstration projects will need to be tested in other 

communities to broaden our understanding 

and build on this knowledge. 

Child Labor Rereorch Needs 41 
COLLABORATION, AND PARTNERSHIPS 

ROTECTING young workers in the Na- P tion’s labor force requires the efficient efforts of multiple stakeholders. Several Federal 

agencies have active programs, and the need 

exists for routine communication, collaboration, and coordination of these programs. A 

number of State programs exist to protect 

young workers, and Federal agencies may cooperate in these efforts. Finally, the public sector should be an active partner in protecting 

working children and adolescents and preparing them for the world of work. 

Interagency Coordination and 

Collaboration 

The DOL has a number of agencies active in 

areas that affect young workers. The Wage and 

Hour Division of the Employment Standards 

Administration establishes Federal child labor 

standards, including standards for employing 

workers and standards listing certain types of 

work as too dangerous for children. NIOSH 

and the Wage and Hour Division have worked 

closely on several of these issues. NIOSH 

should continue to provide technical expertise 

to the Wage and Hour Division and to encourage the DOL to review and update child labor 

standards routinely as new data accumulate. 

OSHA has jurisdiction over safety and health 

in the workplace, including certain workplaces 

employing a high percentage of young workers. Some of these workplaces (such as eating 

and drinking establishments) have high rates 

of injury. NIOSH needs to coordinate efforts 

with OSHA in studying injuries and illnesses 

among young workers in these industrial 

sectors. NIOSH should encourage OSHA to 

consider youths when setting standards and 

targeting interventions. OSHA should also be 

encouraged to continue the cross-training of 

OSHA inspectors on child labor issues. 

NIOSH should encourage BLS to conduct surveys and report data in a form that provides information about young workers. Surveys 

should include information about workers under age 15, and data should be published in age 

groupings that facilitate interpretations of 

child labor issues. BLS should be encouraged 

to address survey design issues such as the use 

of proxies, which may contribute to inaccurate 

estimates of youth employment. Finally, BLS 

should be encouraged to conduct periodic supplements to the CPS to generate stable, Statespecific estimates of youth employment. 

NIOSH should also work with the School-toWork Office (which is jointly administered by 

the Departments of Labor and Education) and 

the Office of Vocational and Adult Education 

within the Department of Education to ensure 

that youths in these programs work in safe and 

healthful work environments and receive 

knowledge and skills in occupational safety 

and health. NIOSH should also encourage 

these agencies to institutionalize the reporting 

of injuries and illnesses associated with 

school-based or -facilitated work experience 

programs (as British Columbia does [Province 

of British Columbia Ministry of Education 

19951). NIOSH should work with the Division 

of Adolescent and School Health of the National Center for Chronic Disease Prevention 

42 Child Labor Research Needs 
7 RECOMMENDATIONS FOR COORDINATION, COLLABORATION, AND PARTNERSHIPS 

and Health Promotion (CDC, DHHS) to include basic occupational safety and health in 

school health efforts. 

NIOSH should encourage other agencies that 

conduct surveys of youths or families to incorporate questions that fill data gaps about outcomes of youth employment. Examples of 

such surveys are the Health Interview Survey 

conducted by the National Center for Health 

Statistics (CDC, DHHS), the Survey of Income and Program Participation conducted by 

the Bureau of the Census, and the Youth Risk 

Behavioral Surveillance System conducted by 

the Division of Adolescent and School Health 

of the National Center for Chronic Disease 

Prevention and Health Promotion (CDC, 

DHHS). 

NIOSH should communicate regularly with 

the National Center for Injury Prevention and 

Control (CDC, DHHS) about issues surrounding youths. Such communication would identify potential collaborations and foster the 

exchange of information about risk factors for 

adolescent injury. The Ofice of Rural Health 

Policy of the Health Resources and Services 

Administration (DHHS) has programs directed at young workers on farms, as does the 

US. Department of Agriculture. The Child Labor Working Team has representatives from 

both groups. 

NIOSH and other Federal agencies should 

coordinate research and intervention efforts 

when young workers are exposed to toxic 

substances with chronic effects--especially 

carcinogens and neurotoxics. The U.S. Environmental Protection Agency (EPA) has made 

children’s health a priority and is developing 

risk assessment models for children and infants [APHA 19961. The Agency for Toxic 

Substances and Disease Registry has a new 

children’s health initiative that emphasizes 

child health in all of the Agency’s programs 

and activities. 

NIOSH should communicate with the Maternal and Child Health Bureau of the Health Resources and Services Administration (DHHS) 

to determine its possible role in their program 

entitled Preparing for Adolescent Transitions: 

Healthy and Ready for Work. 

State Partnerships 

States often serve as the jurisdictional unit for 

intervention and data collection efforts. 

NIOSH should recognize State roles in research and prevention and use the expertise 

they can provide. NIOSH should also promote 

its ability to provide technical expertise to 

States. 

Private Organization Partnerships 

NIOSH should continue to encourage relationships with labor and trade organizations, child 

health advocates, and research and public 

health groups to promote safe and healthy 

workplaces for youths. NIOSH needs to be responsive to the information needs of these 

groups and to use them to disseminate critical 

information about occupational safety and 

health for youths. 

Child Labor Research Needs 43 
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Child Lobor Research Needs 49 
APPENDIX A 

CHARGE TO THE NIOSH CHILD LABOR 

WORKING TEAM* 

In April 1992, Dr. Millar addressed the Childhood Agricultural Injury Prevention Symposium with 

the question: “Who will save the children?” While Dr. Millar was speaking of the children who 

work on farms, this is an equally important question for the children who work in other sectors of 

the workforce. I know the problem of child labor is not simple, and for too long the magnitude of the 

problem of work-related injuries to children has not been appreciated. Efforts to prevent these injuries will require the combined efforts of NIOSH, regulators, medical providers, educators, and employers. I believe NIOSH must take an active role in the prevention of work-related injuries and 

illness among our Nation’s youth. NIOSH has played a central role over the past decade in rediscovering the problem of injuries and illness associated with child labor. That is why I am asking your 

team to assess current research and prevention activities in the Federal Government (including the 

Departments of Health and Human Services, Labor, Agriculture, Education, and others as appropriate), State government, and universities with the goal of identifying research, surveillance, and intervention actions to be undertaken for the prevention of injuries and illness that limit the health, 

well being, or potential of our working youth in this country. As Champion for your working team, I 

look forward to your recommendations on this very important subject. 

‘Richard A. Lemen, Ph.D., Deputy Director of NIOSH, April 11,1994 

50 Child Lobor Research Needs 
APPENDIX B 

NIOSH CHILD LABOR WORKING 

TEAM MEMBERSHIP 

NIOSH Members 

Heinz Ahlers, Education and Information Division (EID) 

Dawn Castillo, Division of Safety Research (DSRFLeader 

John Decker, Division of Surveillance, Hazard Evaluations, and Field Studies (DSHEFS) 

Janet Ehlers, DSHEFS 

John Fajen, DSHEFS 

William Halperin, DSR 

David Hard, DSR 

E. Lynn Jenkins, Office of the Director (OD) 

Deborah Landen, DSR 

Jane Lipscomb, OD 

Larry Mazzuckelli, DSHEFS 

John Palassis, EID 

Teri Palermo, Division of Respiratory Disease Studies (DRDS) 

Ted Scharf, Division of Biomedical and Behavioral Science (DBBS) 

Ray Sinclair, EID 

Nancy Stout, DSR 

Joann Wess, EID 

Mary Lynn Woebkenberg, Division of Physical Sciences and Engineering @PSE) 

Child Lobor Research Needs 51 
APPENDIX B 

Members from Other Federal Agencies 

Margarett Davis, Division of Adolescent and School Health, National Center for Chronic 

Disease Prevention and Health Promotion, CDC, DHHS 

William Fern, Wage and Hour Division, Employment Standards Administration, DOL 

Judith Gilbert, School-to-Work Office, DOL and U.S. Department of Education 

Art Kerschner, Jr., Wage and Hour Division, Employment Standards Administration, DOL 

Bradley K. Rein, Cooperative State Research, Education and Extension Service, 

U.S. Department of Agriculture 

Cathy Wasem, Office of Rural Health Policy, Health Resources and Services 

Administration, DHHS 

52 Child Labor Rereoich Needs 
APPENDIX C 

EXPERT PRESENTATIONS TO NIOSH 

CHILD LABOR WORKING TEAM 

Fe&ral Child Lubor Regulation 

and Enforcement 

Art Kerschner, Jr., and William Fern, Wage 

and Hour Division, DOL 

Available Data from the National Center 

for Health Stahitics (hCHS) 

Felicia LeClere, NCHS 

Available Data from the Bureau 

of Labor Statistics 

Larry Leith, BLS, DOL 

Research on How to Educate Youth 

about Workplace Health and Safev 

Robin Baker, University of California at 

Berkeley 

School-to- Work 

Ron Castaldi and Jack Repoire, Department of 

Education 

Judith Gilbert, School-to-Work Office, Departments of Education and Labor 

OSHA’s Role with Respect lo Child Labor 

John Solheim, OSHA 

Washington State’s Child Labor 

Regulatory Efforts 

Suzanne Mager and Mary Miller, Washington 

Department of Labor and Industries 

Survey of Injured Adolescent Workers 

Dawn Castillo, NIOSH 

APHA Poky Statement on Child Labor 

Mary Miller, Washington Department of Labor 

and Industries 

Office of Rural Health Policy 

(ORHP) Activities 

Colleen Hennessy, ORHP, HRSA, DHHS 

Psychosocial Aspects of Adolescent Work 

Mike Shanahan, University of North Carolina 

Psychosocial Aspects of Adolescent Work 

Larry Steinberg, Temple University 

Sleep-Related Concerns for Child Labor 

Mary Carskadon, Brown University Medical 

School 

NIH-Funded Survey of Adolescent Health 

Susan Newcomer, National Institute of Child 

Health and Human Development, National Institutes of Health 

Cooperative State Research, Education, and mension Service (CSREES) Activiks 

Brad Rein, CSREES, U. S. Department of Agriculture. 

ChiUhood Agrieultural Injury PreveM’on 

Barbara Lee, National Farm Medicine Center 

Review of NIOSH Agricukure Program 

Teri Palenno, NIOSH 

Child Labor Research Needs 53 
APPENDIX C 

Occupational Health Nurses in Agricultural 

Communities Program 

Janet Ehlers, NIOSH 

Washington State Agriruliural Regulations 

Suzanne Mager, Washington Department of 

Labor and Industries 

Minnesota FACE Investigations of Child Fatalities 

David Parker, Minnesota Department of 

Health 

Farm Stress Injuiy Model and Eqected 

Consequences for Adolescent Family Members 

Ted Scharf, NIOSH 

Emerging Issues and Changing Nature of 

Agriculture-Updaie on National Cornminee Reporl 

to ihe Secretary of HHS 

Sue Bernstein, ORHE', HRSA, DHHS 

CoordiMied School Health Programs 

Margarett Davis, Peter Hunt, and Laura Kann, 

Division of Adolescent and School Health, 

National Center for Chronic Disease Prevention and Health Promotion, CDC, DHHS 

Industrial Hjgiene Surveys at Vocational Schook 

John Fajen, NIOSH 

Safety and Healih Training for Vocational Teachers 

and Administraiors 

John Palassis, NIOSH 

Enhancing Young Workers' Safetyand Healih 

ihrough Community Educahon Efforis 

Ray Sinclair, NIOSH, Letitia Davis, Massachusetts Department of Public Health 

Youth Focus Groups on Occupational 

Safety and Health 

Letitia Davis, Massachusetts Department of 

Public Health 

Occupational Safety and Health Research Needs for 

Children and Adolescents 

Kenneth Kolash, National Safety Council 

Occupational Safety and Healih Research Nee& for 

Children and Adolescents 

Larry Offit, Burger King Corporation 

Occupational Safety and Health Research Nee& for 

Children and Adolescents 

Rosco Vaughn and Brian Daniel, National 

Council of Agricultural Education 

OccupationalSafety and Healih Research Nee& for 

Children and Adolescents 

Dorianne Beyer, National Child Labor Committee 

OccupaiionaI Safety and Healih Research Needs for 

Children and Adohcents 

Keith Mestrich, AFL-CIO and Child Labor 

Coalition 

Development of Educational Materials for Teens in 

Massachusens 

Robin Dewey, Massachusetts Department of 

Public Health 

Healih Hazar& Survey in Teen Workplaces 

Elise Morse, Massachusetts Department of 

Public Health 

54 Child Lobor Rereorch Needs 
APPENDIX D 

NATIONAL OBJECTIVES FOR THE OCCUPATIONAL 

SAFETY AND HEALTH OF YOUTHS 

The following materials illustrate the national objectives of both Federal and non-Federal agencies 

involved in the occupational safety and health of youths. Included are excerpts from various publications and Acts of Congress. 

Joint Declaration on Health Education for Children 

[Shalala and Tsaregorodtsev 19961 

The following declaration was signed November 2, 1995, and issued January 26, 1996, by 

Donna Shalala (Secretary of the U.S. Department of Health and Human Services) and Alexander Tsaregorodtsev (Russian Minister of Health and Medical Industry): 

As chairpersons of the Health Committee of the United States-Russia Joint Commission 

on Science and Technology, we address the leaders and citizens of our two nations on the 

important subject of health education for the children who will be citizens of the 21st century. 

We aAflim that: 

The health of children in the present and their prospects for healthy lives in the future as 

adults depend on caring families, good nutrition, sufficient physical exercise, protection 

from hazards, and access to appropriate medical care; in addition, children must have basic 

knowledge and understanding to be able to develop habits and behaviors that build, rather 

than destroy, good health. 

Our challenge as nations is to assure educational and community environments in which our 

children can attain the fundamental knowledge on which to build healthy lives and can engage in activities that support the development of healthy habits and patterns of life. 

Therefore, we call upon our fellow citizens in the United States and the Russian Federation: 

To make health education a priority for our educational systems, defining health education 

broadly to engage families, communities, and educational and health institutions in the 

Child Lobor Reseoich Needs 55 
APPENIDX D 

transmission of essential information about life sciences and risks to health, as well as in 

provision of opportunities to engage in health-supporting activities and to live their childhoods in health-sustaining environments, 

To support necessary training of the people who teach children in schools and who provide 

health services to them in clinics and hospitals, in order that they may transmit sound information and provide effective educational experiences to the children with whom they work. 

To support and enhance health-related research, through our respective research institutions 

at each level of government, in order to seek new knowledge of the causes of disease, measures to prevent illness and injury, and effective ways to achieve our educational goals. 

We call especially on our fellow professional leaders infields of education andpedagogv, medicine and health: 

To make a commitment to expand and improve the quality of health education provided to 

our nations’ children as one of the fundamental obligations of our professions. 

To accept and affirm our own roles as health educators, as an essential part of whatever specific work that we do. 

To make our common goal, linking together our professional fields of endeavor and the organizations and systems in which we serve, to achieve healthy American and Russian children who are growing and learning to become healthy adults. 

Finally, we amrm our own responsibility as health leaders of our two nations by endorsing these 

principles on behalf of the Department of Health and Human Services of the United States of 

America and the Minktry of Health and Medical Industry of the Russian Federation. 

Healthy People 2000 

[DHHS 19941 

Reduce work-related injury rates among adolescent workers to 3.8 per 100 full-time 

workers. 

Increase to at least 75% the proportion of the Nation’s elementary and secondary schools 

that provide planned and sequential kindergarten through 12th grade quality school 

health education. 

Provide academic instruction on injury prevention and control, preferably as part of quality school health education, in at least 50% of public school systems. 

56 Child Labor Reseorch Needs 
APPENDIX D 

Establish community health promotion programs that separately or together address at 

least three of the Healthy People 2000 priorities and reach at least 40% of each State’s 

population. 

School-to-Work Opportunities Act 

[Public Law 103-2391 

To improve the knowledge and skills of youths by integrating academic and occupational 

learning, integrating school-based and work-based learning, and building effective linkages between secondary and postsecondary education. 

A School-to-Work Opportunities program under this Act shall provide participating students, to the extent practicable, with strong experience in and understanding of all aspects 

ofthe industry the students are preparing to enter. The term “all aspects of an industry” includes planning, management, finances, technical and production skills, underlying principles of technology, labor and community issues, health and safety issues, and 

environmental issues, related to such industry or industry sector. 

Goals 2000-Educate America Act 

[public Law 103-2271 

All workers will have the opportunity to acquire the knowledge and skills, from basic to 

highly technical, needed to adapt to emerging new technologies, work methods, and markets through public and private educational, vocational, technical, workplace, or other 

programs. 

Carl D. Perkins Vocational and Applied Technology Education Act 

[Public Law 101-3921 

It is the purpose of this Act to make the United States more competitive in the world economy by developing more fully the academic and occupational skills of all segments of the 

population. This purpose will principally be achieved through concentrating resources on 

improving educational programs leading to academic and occupational skill competencies needed to work in a technologically advanced society. 

States desiring to receive funds shall submit aplan which includes an analysis of “. . . the 

capability of vocational education programs to provide vocational education students, to 

the extent practicable, with-” “strong experience in and understanding of all aspects of 

the industry the students are preparing to enter (including planning, management, finances, technical and production skills, underlying principles of technology, labor and 

community issues, and health, safety, and environmental issues)” 

Child Labor Research Needs 57 
APPENDIX D 

Centers for Disease Control and Prevention Priorities 

[CDC 1996al 

CDC’s newest priority focuses on the vulnerability of our youth to adopt unhealthy behaviors leading to disease, death, and societal problems. Scientific evidence indicates that 

we can intervene with young people to prevent them from adopting these unhealthy behaviors. This investment in the health and safety of our youth today will pay health and 

economic dividends to our nation tomorrow. 

National Occupational Research Agenda 

[NIOSH 1996bI 

Priority Research Area: Special Populations at Risk. Occupational hazards are known to 

be distributed differentially, and workers with specific biologic, social, and/or economic 

characteristics are more likely to have increased risks of work-related diseases and 

injuries. 

Children and Agriculture: Opportunities for Safety and Health: 

[National Committee for Childhood Agricultural Injury Prevention 19961 

A National Action Plan 

Establish and maintain a national system for childhood agricultural injury prevention 

Establish that childhood agricultural injury prevention programs are supported with sufficient funding and cooperation from the public and private sectors 

Establish guidelines for children’s and adolescents’ work in the industry of agriculture 

Ensure that the public is aware of general childhood agricultural safety and health issues 

Establish and maintain a comprehensive national database of fatal and nonfatal childhood 

agricultural injuries 

Conduct research on costs, risk factors, and consequences associated with children and 

adolescents who participate in agricultural work 

Use systematic evaluation to ensure that educational materials and methods targeted toward childhood agricultural safety and health have demonstrated positive results 

Ensure that farm and ranch owners/operators, farm workers, parents, and caregivers understand relevant agricultural safety and health issues that pertain to children and adolescents 

Ensure that rural safety and health professionals understand the issues relevant to children 

and adolescents exposed to agricultural hazards 

58 Child Labor Rereorch Needs 
APPENDIX D 

Influence adult behaviors which affect protection of children and adolescents through the 

use of incentives and adoption of voluntary safety guidelines 

Provide a protective and supportive environment for children exposed as bystanders to 

agricultural hazards 

Establish uniform standards that address protection of children and adolescents fiom agricultural occupational hazards 

Childhood Risks Involving Tractors 

mational Safety Council 19961 

The Council urges appropriate agencies and professionals to identify and implement effective strategies and for manufacturers to implement appropriate design features to decrease the proportion of children’s injuries that involve tractors in operation. 

Currently, there is little research data available on appropriate age, cognitive and physical 

development required for the operation of tractors by youths. There is also little data on 

the effectiveness of current programs that educate youth in the safe operation of tractors 

and other farm equipment. The Council encourages studies in these areas so that more reliable data can be developed. 

Protection of Child and Adolescent Workers 

[APHA 19951 

Recommends that existing child labor regulations be reviewed periodically to update and 

expand prohibited duties based on research findings and knowledge about adolescent development capabilities, and where appropriate, reduce the number of allowable work 

hours and adjust quitting times. 

Recommends that Federal and State labor departments and public health agencies work 

with youth educators to incorporate health and safety training into school curricula and 

that States involved in the School-to-Work Opportunities Act of 1994 include comprehensive health and safety training modules in their curricula. 

Recommends that more resources be provided to improve data sources, expand research 

activities, and identify intervention strategies leading to prevention. 

Encourages the coordination of public health efforts with the U.S. Department of Labor 

and Department of Health and Human Services to control and prevent workplace injuries 

among minors through efforts that improve education and training about the hazards associated with work for children and adolescents for educators, parents, teens, employers, 

health care providers, occupational safety and health professionals, and others in the field 

of public health. 

Child Labor Rereorch Needs 59 
APPENDIX D 

Child Labor Update and Recommendations for Action 

[Child Labor Coalition 19931 

Gather more data on industries/work- placedprocesses currently covered and review 

those which have only become prominent since the inception of the FLSA and the Hazardous Occupation Orders, but that, based upon an examination of injuries/accidents/ illnesses, seem to be detrimental to youth. 

Solving our child labor problems requires a comprehensive, multi-agency approach. 

Linkages among government agencies will promote information-sharing, creative 

problem-solving, and joint efforts and initiatives.” 

60 Child Lobor Research Needs 
Delivering on the Nation's promise: 

Safety and health at work 

For all people 

Through research and prevention 

DHHS (NIOSH) Publication No. 97-143