NOIRS (National Occupational Injury Research Symposium). Preventing Workplace Injuries in a Changing World. May 10-12, 2022.
2022 NATIONAL OCCUPATIONAL INJURY RESEARCH SYMPOSIUM 2 

cover: NOIRS (National 

Occupational Injury Research 

Symposium). Preventing 

Workplace Injuries in a 

Changing World. May 10-12, 

2022. 

Logo: NIOSH (National Institute 

for Occupational Safety and 

Health). 

SPECIAL ACKNOWLEDGEMENT

NOIRS would not be possible without the support of our co-sponsors:

American Society of Safety Professionals

Board of Certified Safety Professionals (BCSP) and BCSP Foundation

National Safety Council

West Virginia University (WVU) Board of Governors

WVU School of Public Health

WVU Benjamin M. Statler College of Engineering and Mineral Resources 

WVU Safety and Health Extension
2022 NATIONAL OCCUPATIONAL INJURY RESEARCH SYMPOSIUM 3 

May 2022

NOIRS 2022 Participants: 

I would like to welcome you to the 2022 National Occupational Injury Research Symposium (NOIRS 2022). We are proud of 

the high-quality scientific program supporting this year’s symposium theme, Preventing Workplace Injuries in a Changing 

World. NOIRS is the only forum exclusively dedicated to the presentation and discussion of the latest methods, findings, and 

translation activities related to occupational acute traumatic injury research and prevention. The conference brings together

researchers, academicians, labor union representatives, safety professionals, industry leaders, and students from multiple 

disciplines and fields to advance the public health mission of keeping workers safe on the job.

Now more than ever, it is evident how a changing world can impact the workplace. Many of us have adapted how and where 

we work due to the COVID-19 pandemic. Work stress and mental health concerns have expanded, and fatigue is a greater 

concern due to nonstandard schedules and increased demands. An aging workforce makes the issue of healthier workers 

more pressing, and emerging technologies have transformed the work environment. What does all of this mean for how we 

approach preventing workplace injuries?

To address this question, the NOIRS 2022 conference agenda features emerging issues in occupational safety and cuttingedge occupational injury research findings from leading experts. Conference topics range from occupational safety during the 

COVID-19 pandemic, to mental health, substance use, engineering controls for fatigue, sleep, and work hours, and industryspecific presentations related to the construction, agriculture, and public safety sectors. Special sessions will further explore 

these topics and many more highlighted in the agenda below.

Although NOIRS 2022 is going virtual, we hope by hosting online we can welcome more attendees who may not have been 

able to join us in person. Please share your feedback via our conference evaluation link available at the end of this conference 

book.

NOIRS 2022 would not be possible without the support of our co-sponsors: American Society of Safety Professionals, Board 

of Certified Safety Professionals (BCSP) and BCSP Foundation, National Safety Council, West Virginia University (WVU) 

Board of Governors, WVU School of Public Health, WVU Benjamin M. Statler College of Engineering and Mineral 

Resources, and WVU Safety and Health Extension. Each contributed to planning the scientific program and outreach for the 

symposium. Also, thanks to the National Safety Council, a special issue of the Journal of Safety Research will highlight 

research presented at NOIRS 2022.

While progress is being made in reducing the toll of workplace injury and death, NOIRS 2022 provides an opportunity to reenergize our efforts to improve the safety of all workers. I offer my best wishes for a productive interchange of science and 

prevention strategies and the development of new partnerships as we work toward our common goal to prevent acute 

traumatic injuries and fatalities in the workplace. Enjoy NOIRS 2022!

John Howard

Director, National Institute for Occupational Safety and Health
2022 NATIONAL OCCUPATIONAL INJURY RESEARCH SYMPOSIUM 4 

ACKNOWLEDGEMENTS

NOIRS 2022 is being convened by the NIOSH Division of Safety Research

Dawn N. Castillo, Director

Timothy J. Pizatella, Deputy Director

We gratefully acknowledge our co-sponsors for their contributions and support:

American Society of Safety Professionals

Board of Certified Safety Professionals (BCSP) and BCSP Foundation

National Safety Council

West Virginia University (WVU) Board of Governors 

WVU School of Public Health

WVU Benjamin M. Statler College of Engineering and Mineral Resources

WVU Safety and Health Extension

Special acknowledgements are made to the following for their support and dedication to planning NOIRS 2022

Conference Management Committee

Tim Pizatella [Chair], Dawn Castillo,

Gene Hill, Christine Schuler, Christina Socias-Morales, Rebecca Knuth, Kelly Henkins

Scientific Program Committee

Christine Schuler and Sergey Sinelnikov [Chairs]

Christina Socias-Morales [Co-Chair] 

Angela Giotto, Gordon Smith, Jan Wachter, 

Hugo Camargo, James Collins, Hongwei Hsiao, Jennifer M. Lincoln, Audrey Reichard

Symposium Support Services

NOIRS Website

Joyce Spiker

NIOSH Division of Safety Research

Symposium Planning Support

On Par Productions, LLC
2022 NATIONAL OCCUPATIONAL INJURY RESEARCH SYMPOSIUM 5 

CONTENTS 

SPECIAL ACKNOWLEDGEMENT ............................................................................................................ 2 

PREFACE .......................................................................................................................................................... 3 

ACKNOWLEDGEMENTS ............................................................................................................................ 4 

CONTENTS ..................................................................................................................................................... 5 

GENERAL INFORMATION ......................................................................................................................... 6 

AGENDA AT A GLANCE ............................................................................................................................. 7 

SESSIONS AGENDA ...................................................................................................................................... 9 

DAY 1: TUESDAY, MAY 10, 2022 ......................................................................................................... 9 

DAY 2: WEDNESDAY, MAY 11, 2022 ................................................................................................ 13

DAY 3: THURSDAY, MAY 12, 2022 .................................................................................................... 17

OPENING AND CLOSING PLENARY SPEAKERS ............................................................................... 21

ABSTRACTS .................................................................................................................................................. 31

DAY 1: TUESDAY, MAY 10, 2022 ....................................................................................................... 32

DAY 2: WEDNESDAY, MAY 11, 2022 ................................................................................................ 58

POSTER ABSTRACTS ............................................................................................................................ 93

LIST OF FEATURED POSTERS ........................................................................................................... 94

DAY 3: THURSDAY, MAY 12, 2022 .................................................................................................. 103

ABSTRACT AND SESSION PROPOSAL REVIEWERS....................................................................... 125

INDEX OF PRESENTERS .......................................................................................................................... 126
2022 NATIONAL OCCUPATIONAL INJURY RESEARCH SYMPOSIUM 6 

GENERAL INFORMATION

Symposium Goal

The goal of NOIRS is to provide a forum for researchers and other professionals to share their findings and experiences 

aimed at preventing traumatic occupational injury through research and prevention. In addition to presenting current 

research findings, NOIRS also seeks to foster collaboration among researchers from a broad range of disciplines and 

perspectives; showcase innovative and state-of-the-art approaches to research and prevention; demonstrate the effectiveness 

of transferring research results to the workplace for prevention; and promote further research that will advance the goals of

the National Occupational Research Agenda.

How to Access Bizzabo 

Google Chrome is the preferred browser for accessing Bizzabo, the virtual platform for NOIRS 2022. You need to enable third 

party cookies to access Bizzabo. See the FAQ/Troubleshooting Guide and Third Party Consent guidance for more 

information.

You can also do a Technology Check to make sure your computer, internet connection and related equipment are working 

properly before accessing Bizzabo for NOIRS 2022. 

Your link to access NOIRS 2022 is unique to the email address you used to register, so please do not share it with 

anyone else. If the link is shared, you will not be able to access the presentations during the symposium. If you did not 

receive an email from Bizzabo with your unique conference link by May 9, 2022, please contact Kelly Henkins at 

(304) 285-5904 or ocy1@cdc.gov. 

How to Access the Poster Session

A one-hour poster session will take place at 4:00 p.m. on May 11, 2022. You can access the session using the 

Poster Session Zoom link. 

Meeting ID: 160 099 5398 

Passcode: NOIRS2022! 

A link to the poster session is also available on the NOIRS 2022 Bizzabo page. 

Questions? 

If you have any issues during the symposium, please contact Tim Pizatella (tjp2@cdc.gov) or Christina Socias-Morales

(wzo4@cdc.gov). 
2022 NATIONAL OCCUPATIONAL INJURY RESEARCH SYMPOSIUM 7 

NOIRS 2022 AGENDA AT A GLANCE 

DAY 1 TUESDAY –MAY 10, 2022

12:00 – 1:00 pm Opening Plenary Session

1:00 – 2:00 pm

Concurrent Sessions A

A1: Human-Robot 

Interaction in the 

Workplace

A2: Work-Related Injuries 

Related to Substance Use

A3: Research to Practice in 

the Construction Industry

A4: Surveillance in 

Agriculture, Forestry, and 

Fishing

2:00 – 3:00 pm 

Concurrent Sessions B

B1: Using Workers’ 

Compensation Systems to 

Conduct Injury 

Surveillance

B2: Work-Related Mental 

Health Considerations to 

Reduce Injuries

B3: Research in the 

Construction Industry 

Part 1 

B4: Special Topics in 

Agriculture, Forestry, and 

Fishing

3:00 – 4:00 pm 

Concurrent Sessions C

C1: NIOSH Fatality 

Investigations

C2: Occupational Safety 

During the COVID-19 

Pandemic

C3: Emerging Protective 

Technology in 

Construction

C4: High-Risk Workers in 

Agriculture, Forestry, and 

Fishing

DAY 2 WEDNESDAY –MAY 11, 2022

12:00 – 1:00 pm

Concurrent Sessions D

D1: Advancing Surveillance 

Efforts to Improve EMS 

and Firefighter H&S 

Outcomes

D2: Occupational Stress 

and Work Organization

D3: Understanding and 

Visualizing Recent 

Construction Safety and 

Health Trends

D4: Robotics in 

Agriculture 

1:00 – 2:00 pm 

Concurrent Sessions E

E1: Occupational Injury 

Surveillance in the US 

Military

E2: Fatigue, Sleep, and 

Work hours

E3: Helmet Research on 

Work-Related Traumatic 

Brain and Musculoskeletal 

Injuries 

E4: Interdisciplinary 

Approaches Along the 

Translational Research 

Continuum to Reduce 

Children’s Injuries in 

Agriculture

2:00 – 3:00 pm 

Concurrent Sessions F

F1: Occupational Injury 

Surveillance, Part 1 

F2: Crew Resource 

Management: Critical 

Decision Making in The 

Hazard Zone

F3: Research in the 

Construction Industry 

Part 2 

F4: All-Terrain Vehicle 

Safety in Agriculture

3:00 – 4:00 pm 

Concurrent Sessions G

G1: Occupational Injury Surveillance, 

Part 2 

G2: Ergonomics and Musculoskeletal 

Disorders

G3: Efforts to Document and 

Address the Risk of Fatigue in the 

Agriculture, Forestry, and Fishing 

Sector

4:00 – 5:00 pm Zoom Poster Breakout Session
2022 NATIONAL OCCUPATIONAL INJURY RESEARCH SYMPOSIUM 8 

DAY 3 THURSDAY –MAY 12, 2022

12:00 – 1:00 pm

Concurrent Sessions H

H1: Work-Related Vehicle 

Crashes

H2: Industrial Mobile 

Robots: Best Practices for 

Worker Safety

H3: Special Considerations 

for High-Risk Workers

H4: Participatory SelfManagement to Promote 

Safety Culture/Climate and 

Sustainability in 

Hazardous Work 

Environments

1:00 – 2:00 pm

Concurrent Sessions I

I1: Use of Workers' 

Compensation Claims to 

Advance Safety

I2: Measuring and 

Predicting Footwear Slip 

Risk

I3: The Role of Worker Age 

in Occupational Injuries 

I4: Connecting Safety 

Climate/Culture to Safety 

Management: A Brief 

Summary

2:00 – 3:00 pm 

Concurrent Sessions J

J1: New Bureau of Labor Statistics 

Office of Safety and Health Program 

Methods and Approaches

J2: Laboratory Studies to Reduce 

Work-Related Injuries

J3: Special Topics in Work-Related 

Injuries

3:00 – 4:00 pm Closing Plenary Session and Remarks
2022 NATIONAL OCCUPATIONAL INJURY RESEARCH SYMPOSIUM 9 

NOIRS 2022SESSIONS AGENDA

DAY 1: TUESDAY, MAY 10, 2022

12:00 – 1:00 pm OPENING PLENARY SESSION

Preventing Workplace Injuries in a Changing World

Opening

Dawn N. Castillo, MPH

Director, Division of Safety Research

National Institute for Occupational Safety and Health

Plenary Speakers

John M. Howard, MD

Director

National Institute for Occupational Safety and Health

Lorraine M. Martin, MS

President and CEO

National Safety Council

Ron Gantt, M Eng, CSP

Director and Principal Consultant

Reflect Consulting Group

Christopher J. Martin, MD, MSc

Director, Occupational Medicine Residency Program

West Virginia University

Discussion
2022 NATIONAL OCCUPATIONAL INJURY RESEARCH SYMPOSIUM 10

1:00 – 2:00 pm CONCURRENT SESSIONS A 

A1 Human-Robot Interaction in the Workplace

Moderator: Hongwei Hsiao

1:00 A1.1 Safety Challenges of Human-Robot Interaction at the Future of Construction Work

Idris Jeelani

1:15 A1.2 Real-Time Adjustment of Moving Trajectories for Collaborative Robotic Devices

Marvin Cheng

1:30 A1.3 Assessing Challenges and Technology Needs for Safe Self-Escape from Underground Coal Mines

Eugene Gyawu

A2 Work-Related Injuries Related to Substance Use

Moderator: Hope Tiesman

1:00 A2.1 Census of Fatal Occupational Injuries (CFOI): 10 years of Drug and Alcohol Surveillance Pilot Data

Christen Byler

1:15 A2.2 Opioid Overdose Deaths by Worker Industry Groups and Demographic Characteristics, 

United States, 2007-2014

Andrea Steege

1:30 A2.3 Investigating the Shooting Death of a Firefighter Who Responded to an Opioid Overdose

Stephen Miles & Sophia Chiu

A3 Research to Practice in the Construction Industry

Moderator: Scott Earnest

1:00 A3.1 Stand-Downs to Raise Awareness and Prevent Fatalities in Construction

Elizabeth Garza

1:15 A3.2 Identifying Common Root Causes of Work-Related Falls from Heights Through Self-Reported 

Data from Individuals Who Experienced, Witnessed, or Investigated Fatal and Nonfatal Falls

Jessica Bunting

1:30 A3.3 Behavioral Economics in the Construction Industry: Use of Choice Architecture Techniques to 

Accelerate Acceptance and Adoption of Health and Safety Research Findings and Solutions

Sue Ann Sarpy

A4 Surveillance in Agriculture, Forestry and Fishing

Moderator: KC Elliott

1:00 A4.1 Challenges in Regional Surveillance for Commercial Fishing Injuries: The Utility of State 

Trauma Registry Data

Viktor Bovbjerg

1:15 A4.2 Fatal Agricultural Injuries in Florida: Building an Injury Surveillance System

Serap Gorucu

1:30 A4.3 Using Machine Learning on Pre-Hospital Care Report Data to Identify Occupational 

Injuries in Agriculture

Erika Scott
2022 NATIONAL OCCUPATIONAL INJURY RESEARCH SYMPOSIUM 11

2:00 – 3:00 pm CONCURRENT SESSIONS B

B1 Using Workers’ Compensation Systems to Conduct Injury Surveillance

Moderator: Steven Wurzelbacher

2:00 B1.1 How Workers' Compensation Claims Can Inform Health and Safety in the Landscaping 

Services Industry

Barbara Alexander

2:15 B1.2 Construction Industry Workers’ Compensation Injury Claims Due to Slips, Trips, and Falls – 

Ohio, 2010-2017

Christina Socias-Morales

2:30 B1.3 Workers’ Compensation Injury Claims Among Firefighters in Ohio, 2001-2017

Tyler Quinn

B2 Work-Related Mental Health Considerations to Reduce Injuries

Moderator: Eric Carbone

2:00 B2.1 Circumstances Contributing to Construction Worker Death from Suicide

Jonathan Davis

2:15 B2.3 Suicides Among First Responders─ National Violent Death Reporting System, 27-37 

U.S. States or Territories, 2015-2017

Leslie Carson

B3 Research in the Construction Industry Part 1

Moderator: Douglas Trout

2:00 B3.1 Job Hazard Analysis in Construction: Challenges and Solutions

Babak Memarian

2:15 B3.2 Assessing the Potential of Passive Exoskeletons in Construction

Carisa Harris Adamson

2:30 B3.3 Construction Trainer and Trainee Perspectives on the Quality and Effectiveness of the 

OSHA 10 Construction Course

Mark Fullen

B4 Special Topics in Agriculture, Forestry and Fishing

Moderator: KC Elliott

2:00 B4.1 Confined Space: Reducing Grain Bin Related Injuries and Fatalities

Linda Fetzer, Michael Dyer & Serap Gorucu

2:15 B4.2 Epidemiology of Diving-Related Fatalities in the U.S. Commercial Fishing Industry

Samantha Case

2:30 B4.3 Slips, Trips and Falls in the Pacific Northwest Commercial Fishing Industry

Laurel Kincl
2022 NATIONAL OCCUPATIONAL INJURY RESEARCH SYMPOSIUM 12

3:00 – 4:00 pm CONCURRENT SESSIONS C

C1 NIOSH Fatality Investigations

Moderator: Jeffrey Funke

3:00 C1.1 Case Study: One Firefighter Dies and Another Injured in High Pressure Natural Gas Line 

Explosion – NIOSH Fire Fighter Fatality Investigation and Prevention Program

Karis Kline-Field

3:15 C1.2 Fatality Assessment and Control Evaluation (FACE) Program – Law Enforcement Officer 

Struck-by Fatality Investigations

Melanie Fowler

C2 Occupational Safety During the COVID-19 Pandemic

Moderator: Lisa Steiner

3:00 C2.1 How COVID-19 Changed Law Enforcement: Voices from Those who Serve

Yoon-Sung Nam

3:15 C2.2 COVID-19 Perceptions and Practices Among Agricultural Producers and Stakeholders: The Need 

for Tailored Communication Campaigns

Josie Rudolphi

3:30 C2.3 Response to the COVID-19 Pandemic in the Construction Industry

Douglas Trout

C3 Emerging Protective Technology in Construction

Moderator: Justin Haney

3:00 C3.1 Effects of Wearing Unpowered Upper and Lower Body Exoskeletons on Visual Attentional 

Performance During Simulated Overhead and Squatting Peg-in-Hole Tasks

HeeSun Choi

3:15 C3.2 Suspension Systems with Air-Bubble Cushioning Liner for Improved Shock Absorption 

Performance of Type I Industrial Helmets

John Wu

3:30 C3.3 Characterization of Shock Absorption Performance of Construction Helmet in Top Impacts

Chris Pan

C4 High-Risk Workers in Agriculture, Forestry and Fishing

Moderator: Miranda Dally

3:00 C4.1 Injury and Severity in Greenhouse and Nursery Workers: Using Data and Collaboration to Drive 

Prevention Through Engineering Design

Katherine Schofield

3:15 C4.2 A Pilot Study of Personal Risk Factors Moderating the Relationship Between Occupational Heat 

Exposure and Injury Risk

Miranda Dally

3:30 C4.3 Timber-Safe – Reduction of WV Logging Hazards through the Implementation of a Logging 

Operations Safety and Health Management System

Mark Fullen

4:00 pm Adjourn Day 1
2022 NATIONAL OCCUPATIONAL INJURY RESEARCH SYMPOSIUM 13

DAY 2: WEDNESDAY, MAY 11, 2022

12:00 – 1:00 pm CONCURRENT SESSIONS D

D1 Advancing Surveillance Efforts to Improve EMS and Firefighter H&S Outcomes

Moderator: John H. Oates

12:00 D1.1 EMERG-ing Data - Multi-City Surveillance of Violence Against EMS Responders

Jennifer A. Taylor

12:15 D1.2 Descriptive Epidemiology of the Fire Service Organizational Culture of Safety (FOCUS) 

Beta-Test Data: Differences by Safety Climate

Ashley Geczik

12:30 D1.3 Firefighter Exposure Tracking: Challenges and Opportunities

David Bernzweig

D2 Occupational Stress and Work Organization

Moderator: Douglas Myers

12:00 D2.1 Passive Safety Leadership, Stress, Anxiety and Diminished Firefighter Safety Behavior Outcomes

Todd Smith

12:15 D2.2 Safety Climate and Noncombat Injury Events Among United States Air Force Workers

Christina Socias-Morales

12:30 D2.3 Psychological Strains as Mediators of the Relationship Between the Work Environment 

and Work Injuries

Nathan Bowling

D3 Understanding and Visualizing Recent Construction Safety and Health Trends

Moderator: Richard Rinehart

12:00 D3.1 Visualizing and Disseminating Data on Fatal and Severe Injuries in the U.S. Construction Industry

William Harris

12:15 D3.2 Mental Health Among Construction Workers in the United States

Samantha Brown

12:30 D3.3 Prescription Opioid Use and Stigmatized Attitudes Among Apprentice Construction Workers

Ann Marie Dale

D4 Robotics in Agriculture

Moderator: Jennifer M. Lincoln

12:00 D4.1 Literature Review: Does Improved Agriculture Technologies Mean Improved Safety?

Darlene Weaver

12:15 D4.2 Livestock Technology Review - Application to Worker Safety & Health

Marie Hayden

12:30 D4.3 Severe Occupational Injuries from Food Packaging and Movement in the U.S. Supply Chain

Judd Michael
2022 NATIONAL OCCUPATIONAL INJURY RESEARCH SYMPOSIUM 14

1:00 – 2:00 pm CONCURRENT SESSIONS E

E1 Occupational Injury Surveillance in the U.S. Military

Moderator: Melody Gwilliam

1:00 E1.1 Beginning to Grasp Finger, Hand and Wrist Injuries in the U.S. Air Force

Melody Gwilliam

1:15 E1.2 Estimated Costs of Lower Extremity Fractures Among U.S. Army Soldiers

Michelle Canham-Chervak

1:30 E1.3 The Impacts of the Transition to ICD-10-CM on U.S. Army Injury Surveillance

Anna Schuh-Renner

E2 Fatigue, Sleep and Work Hours

Moderator: Karl Sieber

1:00 E2.1 Assessing the Impact of Work Hours on Worker Safety and Health in the Stone, Sand and 

Gravel Mining Industry

Todd Smith

1:15 E2.2 Findings from a Systematic Review of Fatigue Interventions in Industrial Settings

Zoe Dugdale

1:30 E2.3 Survey of Working and Sleeping Time by Industry and Occupation of Fulltime Workers 

in the U.S.

Guang Chen

E3 Safe Helmet Research on Work-Related Traumatic Brain and Musculoskeletal Injuries

Moderator: Chris Pan

1:00 E3.1 Assessment of Fall Protection Performance of Type I Industrial Helmets

Chris Pan

1:15 E3.2 Evaluation of Hard Hats for the Reduction of Head Injuries due to Falls

Steve Rowson

1:30 E3.3 Designing a Safe Envelope of Weight and Center of Gravity of Firefighting Helmet Through 

Biomechanical Measurements and Modeling

Suman Chowdhury

E4 Interdisciplinary Approaches Along the Translational Research Continuum to Reduce Children’s 

Injuries in Agriculture

Moderator: Florence Becot

1:00 E4.1 25 Years of Progress and Persistent Challenges in Childhood Agricultural Safety

Barbara Lee

1:15 E4.2 Surveillance of Medically Attended Agricultural Injuries in Farm Children

Jeffrey VanWormer

1:30 E4.3 Agricultural Youth Work Guidelines

Andrea Swenson
2022 NATIONAL OCCUPATIONAL INJURY RESEARCH SYMPOSIUM 15

2:00 – 3:00 pm CONCURRENT SESSIONS F

F1 Occupational Injury Surveillance, Part 1

Moderator: Audrey Reichard

2:00 F1.1 Time Series, Seasonality and Trend Evaluation of 6-Year (2015-2020) OSHA Severe Injury Data

Harold Gomes

2:15 F1.2 Using Multiple Surveillance Systems to Understand Potential SARS-Co-V-2 Exposures Among 

EMS and Firefighters

Emily Haas

2:30 F1.3 SOII vs. MarketScan: What Can Alternative Data Tell Us About the Seasonality of Injuries?

Benjamin Raymond

F2 Crew Resource Management: Critical Decision Making in the Hazard Zone

Moderator: Murrey Loflin

2:00 Presenters: Dennis L. Rubin, Murrey Loflin

F3 Research in the Construction Industry Part 2

Moderator: Scott Earnest

2:00 F3.1 Improving Residential Construction Safety Through Safety Leadership and 

Fall Prevention Training

Bradley Evanoff

2:15 F3.2 Development of a Mast Climbing Work Platform Visual Inspection Tool

Bryan Wimer

2:30 F3.3 Highlights from the CPWR Small Studies Program and Future Priorities and Opportunities

Richard Rinehart

F4 All-Terrain Vehicle Safety in Agriculture

Moderator: Christine Schuler

2:00 F4.1 ATV Safety Design Features: Examining Cultural Awareness and Piloting an Educational Program 

Among U.S. Young Adults in Agriculture

Jenna Gibbs

2:15 F4.2 Protecting Farmworkers in Agricultural All-Terrain Vehicle Rollover Incidents

Farzaneh Khorsandi

2:30 F4.3 Evaluating Youths' Capability to Ride Agricultural All-Terrain Vehicles Using Computer 

Simulations

Guilherme De Moura Araujo

3:00 – 4:00 pm CONCURRENT SESSIONS G

G1 Occupational Injury Surveillance, Part 2

Moderator: Kitty Hendricks

3:00 G1.1 A Time Series Analysis of Nonfatal Occupational Injuries Treated in United States Emergency 

Departments from 2012 to 2019

Eric Lundstrom
2022 NATIONAL OCCUPATIONAL INJURY RESEARCH SYMPOSIUM 16

3:15 G1.2 Surveillance of Acute Nonfatal Occupational Inhalation Injuries Treated in US Hospital 

Emergency Departments, 2014-2017

Kitty Hendricks

3:30 G1.3 Severe Injuries in the Oil and Gas Industry: An Analysis of OSHA’s Severe Injury Reporting 

System from 2015-2020

Vidisha Parasram

G2 Ergonomics and Musculoskeletal Disorders

Moderator: Bradley Evanoff

3:00 G2.1 Use of a Job Exposure Matrix to Study Both Recent and Past Work Exposures on the Incidence of 

Carpal Tunnel Release Surgery in the CONSTANCES Cohort

Bradley Evanoff

3:15 G2.2 Iterative Design of Novel Aerosol Containment Hood Using Ergonomic Assessment

Katrina Cernucan

3:30 G2.3 Occupational Demands Associated with Rotator Cuff Disease Surgery: Results from a Novel 

Linkage of a Job-Exposure Matrix to the U.K. Biobank

Elizabeth Yanik

G3 Efforts to Document and Address the Risk of Fatigue in the Agriculture, Forestry and Fishing Sector

Moderator: David Douphrate

3:00 Presenters: KC Elliott, Jeff Levin, Athena K. Rowan, Erika Scott, Julie Sorensen, Laurel Kincl, and Leigh McCue

4:00 – 5:00 pm Zoom Poster Session

Moderator: Christina Socias-Morales

P1 Response Time Following Local Vibration in Tasks Mimicking Truck Drivers Performance

Juan Manuel Castellote

P2 A Mixed-Methods Approach to Examining Safety Climate Among Truck Drivers

Emily Yueng-Hsiang Huang

P3 Accidents in the Truck Driver Sector and the Health Paradox of this Demanding Occupation

Juan Manuel Castellote

P4 A Hard Day’s Night: Shift Work, Fatigue and Cardiovascular Risk Factors Among Maine’s 

Logging Workforce

Erika Scott

P5 Investigation of a Fatality that Occurred when a Logging Processor Lost Traction and Rolled 

Down a Hillside

Jennifer E. Lincoln & Jeff R. Funke

P6 The NIOSH Fatality Assessment and Control Evaluation (FACE) Program – Law Enforcement 

Officer Motor Vehicle Fatality Investigations

Melanie Fowler

P7 Use of the CDC’s Social Vulnerability Index to Characterize Firefighters’ and Medical First 

Responders’ Potential Exposure to SARS-CoV-2 During Routine Emergency Responses

Alexa Furek
2022 NATIONAL OCCUPATIONAL INJURY RESEARCH SYMPOSIUM 17

P8 Reliability and Validity of a Safety Hazard and Management Assessment Questionnaire

Libby Moore

P9 Workplace Violence Training among Young Workers 14–24 Years of Age in the U.S.

Camryn Lopez

P10 Perceptions of Workplace Hazards in a Sample of West Virginia Sawmill Employees

Wayne Lundstrom

P11 Polypropylene Honeycomb in Industrial Safety Helmets

Shengke Zeng

P12 What’s Stopping You? Organizational Constraints as a Multi-Facet Work Stressor

Nathan Bowling

5:00 pm Adjourn Day 2 

DAY 3: THURSDAY, MAY 12, 2022

12:00 – 1:00 pm CONCURRENT SESSIONS H 

H1 Work-Related Vehicle Crashes

Moderator: Eva Shipp

12:00 H1.1 Driver Injuries in Heavy vs. Light and Medium Truck Local Crashes, 2010- 2019

Terry Bunn

12:15 H1.2 Trends in Work-Related Fatalities Due to Motor Vehicle Crashes, United States, 2011–2019

Srinivas Konda

12:30 H1.3 Lessons Learned from Using Crash Records for Injury Surveillance in the AFF Sector

Eva Shipp

H2 Industrial Mobile Robots: Best Practices for Worker Safety

Moderator: Carole Franklin

12:00 Presenters: Carole Franklin, Mark Lewandowski, Jeremy Marvel, Aaron Prather, Federico Vicentini

H3 Special Considerations for High-Risk Workers

Moderator: Tamara Small

12:00 H3.1 Promoting Safety and Well-Being Among Sheet Metal Worker Women Through Mentoring 

Marissa Baker

12:15 H3.2 Evaluating the Accidents and Level of Compliances in Construction Sites

Somendra Rana

12:30 H3.3 Revisiting Formative Research to Identify Gaps in Hazard Recognition Research for 

High-Risk Workers

Brianna Eiter

H4 Participatory Self-Management to Promote Safety Culture/Climate and Sustainability in Hazardous 

Work Environments

Moderator: Ted Scharf
2022 NATIONAL OCCUPATIONAL INJURY RESEARCH SYMPOSIUM 18

12:00 H4.1 A Brief History of Worker Engagement in Safety Initiatives

Lisa Kath

12:12 H4.2 “Non-compliance,” “Complacency,” and Other Explanations for Unsafe Work Practices that 

Blame Workers for Systemic Failures: One Psychologist’s Perspective

Ted Scharf

12:25 H4.3 The Promise Of, and Problems With, Worker Participation

Scott Schneider

12.37 H4.4 Using Close Call Reports to Empower Worker-Led Interventions

Emily Haas

12:50 Discussion 

David LeGrande

1:00 – 2:00 pm CONCURRENT SESSIONS I

I1 Use of Workers' Compensation Claims to Advance Safety

Moderator: Steven Naber

1:00 I1.1 The Impact of a State-Based Workers’ Compensation Insurer’s Risk Control Services on Employer 

Claim Frequency and Cost Rates

Steven Wurzelbacher

1:15 I1.2 Surveillance of Agricultural Injuries: Comparison of State Trauma and Workers' Compensation 

Data Sources

Marizen Ramirez

1:30 I1.3 Workers’ Compensation Claim Counts and Rates by Injury Event/Exposure Among State-Insured 

Private Employers in Ohio, 2007-2017

Steven Wurzelbacher

I2 Measuring and Predicting Footwear Slip Risk

Moderator: Jennifer Bell

1:00 12.1 A Portable Device for Measuring Shoe-Floor Coefficient of Friction in Situ

Kurt Beschorner

1:15 12.2 Predicting Footwear Slip Risk Using a Low-Cost, Portable, Shoe Tread Scanner

Sarah Hemler

1:30 12.3 Predicting the Friction Performance of Footwear Based on Outsole Features

Kurt Beschorner

I3 The Role of Worker Age in Occupational Injuries

Moderator: James Collins

1:00 13.1 Risk of Work-Related Reinjury Among Older Workers With and Without a Work-Related 

Permanent Impairment: Are Work-Related Injury Rates Differentially Underestimated for 

Workers Aged 65 and Older?

Jeanne Sears

1:15 13.2 Environmental Factors of Ladder Overreaching in Older Adults

David Williams
2022 NATIONAL OCCUPATIONAL INJURY RESEARCH SYMPOSIUM 19

1:30 13.3 Traumatic Injuries and Fatalities Among Young Workers in Alaska: 2014-2018

Richard Evoy

I4 Connecting Safety Climate/Culture to Safety Management: A Brief Summary

Moderator: Ted Scharf

1:00 Presenters: Ted Scharf, Lisa M. Kath, and Emily J. Haas

2:00 – 3:00 pm CONCURRENT SESSIONS J

J1 New Bureau of Labor Statistics Office of Safety and Health Program Methods and Approaches

Moderator: Elizabeth Rogers

2:00 Presenters: Daniel Friel, Julie Krautter, Christen Byler, and Imani Drayton-Hill

J2 Laboratory Studies to Reduce Work-Related Injuries

Moderator: Jennifer Bell

2:00 J2.1 Developing a Test for When Worn Shoes Should be Replaced - Research to Practice

Kurt Beschorner

2:15 J2.2 The Relationship Between Weight Shifts, Discomfort and Seated Breaks During Standing

Julie Rekant

J3 Special Topics in Work-Related Injuries

Moderator: James Collins

2:00 J3.1 Work Schedules, Commutes, and Risky Driving Behaviors from a Cross-Sectional Survey of U.S. 

Oil and Gas Extraction Workers

Kaitlin Wingate

2:15 J3.2 Demonstrating the Impact of Interventions to Prevent Work-Related Injuries

James Collins

2:30 J3.3 Occupational Injury in Group Homes

Adam Moskowitz
2022 NATIONAL OCCUPATIONAL INJURY RESEARCH SYMPOSIUM 20

3:00 – 4:00 pm CLOSING PLENARY SESSION & REMARKS 

Change for the Better: Improving Safety Equity

Through a Diverse Workforce and Research

Moderated by Dawn N. Castillo, MPH

Director, Division of Safety Research 

National Institute for Occupational Safety and Health 

Plenary Speakers

Michael Flynn, PhD

Social Scientist, Division of Science Integration

National Institute for Occupational Safety and Health 

Jack O. Ogutu, PhD

Associate Professor

Occupational Safety & Environmental Health Program Coordinator 

Millersville University of Pennsylvania

Richard Olawoyin, PhD, CSP 

Associate Professor, Industrial and Systems Engineering

Oakland University

Amy K. Liebman, MPA, MA

Director of Environmental and Occupational Health 

Migrant Clinicians Network 

Discussion

4:00 pm Adjourn Day 3 
2022 NATIONAL OCCUPATIONAL INJURY RESEARCH SYMPOSIUM 21

NOIRS 2022 OPENING AND CLOSING

PLENARY SPEAKERS
2022 NATIONAL OCCUPATIONAL INJURY RESEARCH SYMPOSIUM 22

Dawn Castillo is the Director of the Division of Safety Research at the National Institute for Occupational Safety and Health 

(NIOSH) in Morgantown, West Virginia. The Division serves as the focal point for traumatic occupational injury research 

and prevention programs at NIOSH.

Ms. Castillo began her NIOSH career in 1991 as an epidemiologist. Between 1998 and 2011, she served as Chief of a Division 

Branch responsible for occupational injury data collection, analysis, and interpretation. Ms. Castillo was the fourth recipient, 

in 2000, of the James. P. Keogh award, an annual NIOSH award recognizing a current or former NIOSH employee for 

exceptional service to the field of occupational safety and health. Ms. Castillo was appointed as Director of the Division of

Safety Research in July 2011. She manages two NIOSH virtual Centers: Center for Motor Vehicle Safety and Center for 

Occupational Robotics Research. She also co-chairs the National Occupational Research Agenda (NORA) Traumatic Injury 

Prevention Council.

Ms. Castillo has authored numerous articles, book chapters, and technical documents on a variety of occupational injury 

topics, including occupational injuries among young workers, older workers, fire fighters, and workplace violence. Ms. 

Castillo received her B.S. in Biology from the University of California, Irvine and her Masters of Public Health in 

epidemiology from the University of California, Los Angeles.

Dawn Castillo, MPH

Director, Division of Safety Research

National Institute for Occupational Safety and Health
2022 NATIONAL OCCUPATIONAL INJURY RESEARCH SYMPOSIUM 23

John Howard is the Director of the National Institute for Occupational Safety and Health, and the Administrator of the 

World Trade Center Health Program in the U.S. Department of Health and Human Services.

Dr. Howard was first appointed NIOSH Director in 2002 during the George W. Bush Administration and served in that 

position until 2008. 

In 2009, Dr. Howard worked as a consultant with the US-Afghanistan Health Initiative. In September of 2009, Dr. Howard 

was again appointed NIOSH Director, and was reappointed for a third six-year term in 2015 and a fourth six-year term in 

2021.

Prior to his appointments as NIOSH Director and WTC Health Program Administrator, Dr. Howard served as Chief of the 

Division of Occupational Safety and Health in the State of California’s Labor and Workforce Development Agency from 1991 

through 2002.

Dr. Howard earned a Doctor of Medicine from Loyola University of Chicago; a Master of Public Health from the Harvard 

University School of Public Health; a Doctor of Law from the University of California at Los Angeles; and a Master of Law in 

Administrative Law and Economic Regulation, and a Master of Business Administration in Healthcare Management, both 

degrees from The George Washington University in Washington, D.C.

Dr. Howard is board-certified in internal medicine and occupational medicine. He is admitted to the practice of medicine and 

law in the State of California and in the District of Columbia, and he is a member U.S. Supreme Court bar. He has written 

numerous articles on occupational health, policy, and law.

John Howard, MD

Director

National Institute for Occupational Safety and Health
2022 NATIONAL OCCUPATIONAL INJURY RESEARCH SYMPOSIUM 24

Lorraine Martin is the president and CEO of the National Safety Council, a nonprofit with a century-long legacy of 

eliminating preventable deaths and injuries from the workplace to anyplace. Throughout her 35 years of experience in 

aerospace, including leading and developing global and international businesses as an executive at Lockheed Martin, Lorraine 

has been singularly focused on showing up for safety and supporting employees to reach their full potential.

As a leader of the National Safety Council, Lorraine is passionate about helping people live their fullest lives. She is the chair 

of the Road to Zero Coalition, with more than 900 organizations focused on eliminating roadway fatalities by doubling down 

on proven measures, advancing technology, and building safe systems. She is spearheading national conversations on 

eliminating workplace fatalities through promising technologies, addressing impairment and safety leadership.

Over her career she has led global aircraft and complex system development and manufacturing, always with a focus on the 

safety of employees and those who used the products, often in high consequence environments. Among her top 

achievements, Lorraine led the largest defense program for the F-35 Lightning II stealth fighter aircraft. She also spearheaded 

the successful operational and cultural integration of Sikorsky, a global leader in helicopters.

Lorraine is the co-founder and president of the Pegasus Springs Foundation, a nonprofit organization dedicated to providing 

opportunities for educators, students, and community members to collaborate on learning models. She is an enthusiastic 

advocate for school, community, and national resource engagement. As a proud champion for advancing women and girls in 

STEM, Lorraine was named among STEMConnector’s 100 Corporate Women Leaders. She has worked with numerous 

organizations in support of this mission including Girls Inc., Girls Who Code and Blue Ribbon Schools of Excellence, where 

she also served on the Board of Directors. In addition, she has served on the Board of Directors for INROADS and Big 

Brothers, Big Sisters of Orlando.

Lorraine currently serves on the Board of Directors and Audit Committee for Kennametal, a $2.4 billion global materials 

science firm that serves customers across aerospace, earthworks, energy, general engineering, and transportation. She is 

honored to have served as an officer in the U.S. Air Force, where she held various leadership positions for software-intensive 

technology and development programs. She has earned a M.S. in Computer Science from Boston University and a B.A. in 

Computational Mathematics from DePauw University.

Lorraine M. Martin, MS

President and CEO

National Safety Council
2022 NATIONAL OCCUPATIONAL INJURY RESEARCH SYMPOSIUM 25

Ron Gantt is the Director and Principal Consultant for Reflect Consulting Group in San Ramon, California. Reflect is a 

consulting firm specializing in helping organizations improve systems and processes related to safety management, 

leadership, culture, organizational learning, and resilience. Ron has over 20 years’ experience in health and safety 

management, working with industries such as construction, utilities, and chemical manufacturing. He has undergraduate 

degrees in psychology and occupational safety, as well as a graduate degree in advanced safety engineering and management 

from the University of Alabama at Birmingham. 

Ron is also currently finishing his PhD in resilience engineering at the Ohio State University. He is a Certified Safety 

Professional and a Certified Instructional Trainer. Ron has been named a Rising Star in Safety by the National Safety Council

in 2013, a Young Talent by the Resilience Engineering Association in 2014, and Safety Professional of the Year by the 

American Society of Safety Professionals San Francisco chapter in 2017. 

He has authored numerous articles and book chapters on topics such as disaster psychology, the safety profession, human 

performance, human factors, and managing safety differently. 

Ron Gantt, M.Eng, CSP

Director and Principal Consultant

Reflect Consulting Group
2022 NATIONAL OCCUPATIONAL INJURY RESEARCH SYMPOSIUM 26

Dr. Christopher Martin is a Professor of Medicine and Public Health and Director of the Global Engagement Office for the 

Health Sciences Center (HSC) at West Virginia University (WVU). He is a Fellow of the Royal College of Physicians of 

Canada in Occupational Medicine, a Fellow of the American College of Occupational and Environmental Medicine 

(ACOEM) and is board certified in occupational medicine by the American Board of Preventive Medicine. 

Dr. Martin has collaborated with NIOSH on two large studies demonstrating increased mortality among cohorts with 

disabling occupational injuries and has authored or co-authored five book chapters and numerous peer-reviewed 

publications. He maintains an active clinical practice and has served as a consultant to the US federal government (NIOSH, 

Vaccine Injury Compensation and Radiation Exposure Compensation Act Programs). 

Dr. Martin oversees global partnerships for the HSC and is an active educator and scholar within WVU, nationally and 

internationally. He serves as Program Director for the Occupational Medicine residency and Designated Institutional Official 

with responsibility for Graduate Medical Education in the WVU School of Public Health. He is the Principal Investigator of a 

Training Project Grant from NIOSH and a Preventive Medicine Residency Training Program Grant from the Health 

Resources and Services Administration. 

He is currently a member of the NBME and also serves on the Global Advisory and Evidence-Based Medicine Item Review 

Committees. He has served as a member of the Education Committee of the Consortium of Universities for Global Health. 

Dr. Martin is the 2022 recipient of ACOEM’s Excellence in Education or Research Award.

Christopher J. Martin, MD, MSc

Director, Occupational Medicine Residency Program

West Virginia University
2022 NATIONAL OCCUPATIONAL INJURY RESEARCH SYMPOSIUM 27

Michael Flynn is an applied anthropologist with over 25 years of experience working on issues related to social inequality 

both domestically and abroad. His interests include health equity, organizational culture change, translation research and 

social determinants of health. He currently serves as a Lead Research Social Scientist with the National Institute for 

Occupational Safety and Heath where he coordinates the Occupational Health Equity program. He is also the project officer 

for a research program to better understand and improve the occupational health of immigrant workers. 

Before coming to NIOSH in 2004, he worked for ten years in non-governmental organizations in the United States and Latin 

America. Michael is the NIOSH representative to the CDC Health Equity Leadership Network, a Research Fellow of the 

Consortium for Multicultural Psychology Research at Michigan State University and a member of the Ventanillas de Salud

National Advisory Board, a program of the Ministries of Health and Foreign Affairs of Mexico. He holds a master’s degree in 

Anthropology from the University of Cincinnati and is currently pursuing a PhD in Anthropology at the University of 

Kentucky. His awards include the CDC Health Literacy Hero Award, the Mexican Foreign Ministry Ohtli Award, and the 

NIOSH Director’s Intermural Award for Extraordinary Science.

Michael A. Flynn, PhD 

Social Scientist, Division of Science Integration

National Institute for Occupational Safety and Health
2022 NATIONAL OCCUPATIONAL INJURY RESEARCH SYMPOSIUM 28

Jack O. Ogutu, Ph.D., is Associate Professor and Program Coordinator of Occupational Safety & Environmental Health 

(OSEH) at Millersville University. In addition, Dr. Ogutu serves as the Program Director for the NIOSH Training Program 

Grant (TPG), and the Program Director for OSHA’s Susan Harwood Training Grant (SHTG) Program at Millersville 

University. The SHTG program’s target audience includes Limited-English speakers, small businesses, and at-risk worker 

populations.

Dr. Ogutu obtained his BS in Mechanical Engineering from The University of Nairobi (2004) and his MS and PhD in 

Industrial & Systems Engineering with a concentration in Occupational Safety & Ergonomics from Auburn University, 

Alabama (2013). Dr. Ogutu has published peer-reviewed articles and book chapters in the areas of Occupational Ergonomics, 

Biomechanics, Risk Platforms, and Safety Engineering. Dr. Ogutu is an authorized OSHA 10- & 30-hour general industry 

trainer. 

Dr. Ogutu serves as faculty advisor to several student organizations at Millersville University including the American Society 

of Safety Professionals (ASSP), National Society of Black Engineers (NSBE), and the African & Caribbean Student Association 

(ACSA).

Dr. Ogutu serves as Commissioner for the ABET-ANSAC commission. He is a member American Society of Safety 

Professionals’ Education Standards Committee and Professional Development Chair of ASSP’s Environmental Practice 

Specialty. Dr. Ogutu was named the “Environmental Safety Professional of the Year – 2022”.

Jack O. Ogutu, PhD 

Associate Professor, Occupational Safety & Environmental Health Program 

Coordinator

Millersville University of Pennsylvania
2022 NATIONAL OCCUPATIONAL INJURY RESEARCH SYMPOSIUM 29

Dr. Richard Olawoyin is Associate Professor in Industrial and Systems Engineering at Oakland University. Dr. Olawoyin is a 

scientist and an engineer with multidisciplinary research interests in stochastic system optimization, functional system safety 

analysis, biomechanics and ergonomics, environmental and energy systems modeling - using machine learning, intelligent 

mapping, and other computational techniques. His teaching efforts include engineering risk analysis, statistical methods in 

engineering, safety engineering and occupational biomechanics at Oakland University, Statistics for Industrial Engineers at 

Changchun University of Technology, China, and Human Factors/Ergonomics and Advanced Safety Engineering at Texas 

Tech. University, Costa Rica. He holds a bachelor’s degree in Geology from the University of Calabar – Nigeria, master’s and 

Ph.D. degrees in Energy Engineering from the Pennsylvania State University, University Park.

He serves as the faculty adviser for the National Society of Black Engineers at OU since 2014. He serves on the ABET 

Inclusion Diversity and Equity Advisory (IDEA) Council, ABET Accreditation Council Training Committee and on the 

ABET ANSAC Executive Committee. He was elected in 2018 as the administrator for the ASSP Environmental Practice 

Specialty. He received the ASSP Charles V. Culbertson Outstanding Award in 2019, the Fulbright Scholarship 2022-2023, 

among other awards.

He serves as the Regional Lead for Recognition and Appreciation for the American Red Cross Disaster Workforce 

Engagement in the Michigan Region. He is a book chief editor, book author and has authored numerous peer-reviewed 

journal publications. He is passionate about broadening participation in STEM, particularly in OSH education.

He has presented at several international & national conferences on quality education, engineering, systems safety, 

environmental, and intelligent automation solutions.

Richard Olawoyin,PhD, CSP 

Associate Professor, Industrial and Systems Engineering

Oakland University 
2022 NATIONAL OCCUPATIONAL INJURY RESEARCH SYMPOSIUM 30

Amy K. Liebman has devoted her career to improving the safety and health of disenfranchised populations through research, 

policy, advocacy, and education. She has served as Migrant Clinicians Network’s Director of Environmental and 

Occupational Health since 1999, establishing nationally recognized training and technical assistance programs for 

community groups and health centers throughout the country. She has been a national leader in applying culturally 

appropriate train-the-trainer programs based on the Community Health Workers model. She has authored journal articles, 

training curricula and educational materials. 

Prior to her current position, Liebman directed programs on both sides of the US-Mexico Border, including an awardwinning, community-based hygiene education program that reached thousands of families living without water or sewer 

services. She advocates for improved policies to protect workers and immigrant families, spearheading several national efforts 

including strengthening the Worker Protection Standard, a key federal regulation to protect farmworkers from pesticide 

exposure. She has been a strong advocate for worker health and safety during the COVID-19 pandemic, pursuing regulatory 

protections for workers and leading programs to improve access to care and education for migrants and immigrants. 

Her programs have won awards including the EPA Children’s Environmental Health Champion Award and the National 

Safety Council Research Collaboration Award. In 2011, Liebman received the Lorin Kerr Award, an American Public Health 

Association honor recognizing public health professionals for their dedication and sustained efforts to improve the lives of 

workers. She is past Chair of APHA’s Occupational Health and Safety Section and recently ended her term on the Pesticide 

Program Dialogue Committee, a federal advisory committee to the US EPA Office of Pesticide Programs. Liebman holds a 

master’s degree from the LBJ School of Public Affairs at the University of Texas at Austin, and a M.A. from the Institute of 

Latin American Studies at the University of Texas at Austin.

Amy Liebman, MPA, MA

Director, Environmental and Occupational Health

Migrant Clinicians Network
2022 NATIONAL OCCUPATIONAL INJURY RESEARCH SYMPOSIUM 31

NOIRS 2022 ABSTRACTS

(Presenters Underlined) 

Although the abstracts in this publication were proofread to eliminate obvious errors 

in spelling, punctuation, and grammar, they were neither edited nor officially cleared 

by the National Institute for Occupational Safety and Health (NIOSH). Therefore, 

NIOSH is not responsible for the content, internal consistency, or editorial quality of 

the abstracts. That responsibility lies solely with the individual authors. Any use of 

company names and products throughout this publication does not imply 

endorsement by NIOSH, the Centers for Disease Control and Prevention, the Public 

Health Service, or the Department of Health and Human Services.
2022 NATIONAL OCCUPATIONAL INJURY RESEARCH SYMPOSIUM 32

DAY 1: TUESDAY, MAY 10, 2022

Session A1

Human-Robot Interaction in the Workplace

Moderator: Hongwei Hsiao

A1.1 

Title: Safety Challenges of Human-Robot Interaction 

at the Future of Construction Work

Authors: Idris Jeelani, Masoud Gheisari

As the U.S. economy continues to grow, advancements in 

technology continue to reshape how Americans work, 

where they work, and who they work with. According to 

the International Federation of Robotics, the use of robots 

in the U.S. workplace has more than doubled in the last 

decade. As construction has been struggling with a 

shortage of skilled workers, robots are steadily but 

increasingly making their way into construction sites.

We have already seen a tremendous increase in the use of 

aerial robots or drones on construction that has grown 

more than 200% in just one year. Similarly, unmanned 

ground robots such as quadrupeds are also becoming 

increasingly popular in construction. With the predicted 

increase in construction activities to address the nation’s 

growing infrastructure needs, coupled with the rising 

demand for automation due to labor shortages, it is 

expected that there will be more interaction between 

human workers and robots on construction sites. 

Construction is already the most dangerous industry to 

work in.

Every year about 60,000 fatalities are reported from 

construction jobsites worldwide. In the U.S., the 

construction industry accounts for about 20% of all 

workplace fatalities while employing just over 5% of the 

workforce. While beneficial, the integration of robots in 

construction raises novel occupational safety and health 

issues for construction workers, which are critical to 

identify, understand, and evaluate. Risks arise from 

unintended physical contact between these robots and 

human workers or due to the cognitive interaction 

between workers and Robots that may affect worker’s 

attentional and psychological states.

Every interaction, cognitive or physical, creates the 

potential for an accident. In this presentation, we discuss 

the safety challenges of human workers working with or 

near two specific types of commonly used robots on 

construction jobsites: (1) Drones: owing to their small 

size, precise maneuverability, and ability to operate in 

hard-to-reach areas are very popular on construction sites 

(2) Quadrupeds: These four-legged robots due to their 

stability on rough terrains, ability to climb multiple levels, 

and carrying different payloads and sensors are becoming 

very popular in construction.

In this presentation, we first envision a future of 

construction work where human workers constantly 

interact and collaborate with these collaborative robots to 

do their work on the construction jobsites. We then 

discuss the novel health and safety risks that result from 

these worker-drone-quadruped interactions. We will 

mainly focus on the physical risks, attentional cost, and 

psychological impacts of such interactions on human 

workers who work directly or indirectly with or around 

these robots. Finally, we will provide recommendations 

and guidelines to ensure the safe integration of these 

robots in construction.

A1.2 

Title: Real-Time Adjustment of Moving Trajectories for 

Collaborative Robotic Devices

Authors: Marvin Cheng, Justin Haney

Introduction: The factory of the future will be characterized 

by complex products, flexible production, and 

competitive cost with various collaborative and mobile 

robots, which work alongside with human workers in the 

same workspace. Current practices consistent with 

industrial standards require that collaborative robots 

work in a reduced speed mode or stop while human 

workers are present within a certain range, which can 

greatly affect production efficiency. Though sensors are 

available to detect the presence of human workers, most 

collaborative robot control strategies are not designed to 

navigate around human workers while they are present. 

Instead, the functions of most safety sensors are to 

monitor specific regions for human worker presence and 

signal the robots to slow down or stop when a human 

worker’s presence is detected. For a working environment 

in which human workers need to work with robots, such a 

safety procedure can undoubtedly affect the productivity 

of collaborative robots. This research aims to fill the 

emerging human-robot interface gap through the 

development and validation of a smart path planning 

algorithm to ensure adequate protection of workers from 

the safety risks associated with new and emerging types of 

collaborative robots, while honoring human workers’ 

versatility and maintaining manufacturing efficiency.
2022 NATIONAL OCCUPATIONAL INJURY RESEARCH SYMPOSIUM 33

Methods: Safety controls through speed and separation 

monitoring have been adopted in the ANSI/RIA 15.06 

and ISO/TS 15066 standards with inherent reductions in 

robot work efficiency. To restore the working efficiency of 

the robotic devices, a path planning algorithm that 

determines the contact-free trajectory of the tool center 

point (TCP) from its current position to the targeted 

destination with adequate moving speed is necessary. In 

this study, an enhanced three-dimensional A* search 

method has been developed to find the waypoints of the 

TCP to avoid the potential contacts between existing 

human workers and the robotic devices. The proposed 

method divides the workspace into evenly distributed 

cells. Cells occupied by body parts of human workers and 

components of involved robotic devices were marked as 

contact-avoidance zones. Once the waypoints were 

identified, the trajectory generation algorithms, Kalman 

filter, and forward/backward kinematics were applied to 

generate the moving trajectories for individual joints. This 

method ensures that adequate paths can be implemented 

by the adopted robotic devices. The procedures were 

repeated if the human workers changed their postures or 

motions until the TCP of the robot reached its 

destination. With this approach, moving trajectories of a 

collaborative robot can be generated automatically to 

avoid potential contacts with human workers and other 

components by maintaining its optimal moving speed.

Results: With the integration of motion acquisition devices 

and the robotic device, the contact avoidance zones of the 

human workers can be identified in real-time. Based on 

the current physical setup, the TCP trajectory of the 

collaborative robotic device can be updated within one 

second. The computation efficiency can be further 

improved by grouping the related joints. The proposed 

methodology has been tested in an emulated 

environment. The physical experimental environment 

and the robotic device will be adjusted to simplify the 

required calculation and motion acquisition procedures 

based on the emulated results.

Discussion/Conclusions: The proposed approach allows the 

collaborative robotic device to actively avoid potential 

injuries of human workers due to unexpected contacts 

while maintaining the desired working efficiency. Such a 

path planning method can serve as a useful tool in the 

control software for robot manufacturers and robotics 

system integrators to advance robot movement path 

planning for improved worker safety, and for the 

ANSI/RIA R15.06 and R15.08 consensus standard 

committees to refine the voluntary standards.

A1.3 

Title: Assessing Challenges and Technology Needs for Safe 

Self-Escape from Underground Coal Mines

Authors: Eugene Gyawu, Kwame Awuah-Offei, Denise Baker

Disasters in underground coal mines in the United States, 

such as those at the Sago and Upper Big Branch Mines in 

2006 and 2010, respectively, are rare but can be 

devastating. There has been increased research and use of 

safety technologies to aid miners during mining 

emergencies. However, much of these efforts have not 

been driven by user-centered, or in this case minercentered, human factors design. This research elicited 

direct feedback from miners to identify and understand 

their perceptions about the potential efficacy of proposed 

self-escape technologies. The research also examines how 

these perceptions related to a miner’s personal beliefs 

about their knowledge, skills and abilities (KSAs) to 

perform related self-escape tasks for which such 

technologies might be used. Using a scenario-based online 

survey, 29 miners from five coal mines in the United 

States were asked to read and consider a hypothetical 

mining emergency. At critical points in the emergency 

scenario, miners responded to closed and open-ended 

questions about potential technological interventions. 

Among those technological interventions that participants 

felt would be highly useful were a self-contained selfrescuer (SCSR) that allows verbal communication while 

wearing, improved SCSR switchover that prevents 

breathing contaminated air, and refuge alternatives (RA) 

with information display capabilities such as location of 

other miners, and gas and temperature data in the mine. 

Surprisingly perceptions about confidence in performing 

a skill were not correlated with usefulness of the related 

technology, however, importance of a KSA and usefulness 

of the related technology were generally positively 

correlated. The results suggest there is a need for 

technological improvements in technology, usability and 

comfort of safety equipment’s required to self-escape 

during an emergency. Findings from this study will be 

directly applied to a series of proof of concept and 

prototype studies as part of an ongoing CDC-funded 

project aimed at improving self-escape technologies 

through human-centered research and design.
2022 NATIONAL OCCUPATIONAL INJURY RESEARCH SYMPOSIUM 34

Session A2

Work-Related Injuries Related to Substance Use

Moderator: Hope Tiesman

A2.1 

Title: Census of Fatal Occupational Injuries (CFOI): 

10 Years of Drug and Alcohol Surveillance Pilot Data

Author: Christen Byler

Background: In 2011, the Census of Fatal Occupational 

Injuries (CFOI) began collecting pilot drug and alcohol 

data. Two variables indicate whether drugs or alcohol 

were present in fatally injured workers’ systems at the 

time of incident and the specific substance(s) found. The 

addition of 2020 data, to be released in December 2021, 

will mark 10 years of this series. This presentation will 

examine the trends and changes in findings of drug and 

alcohol data over this 10-year period (2011-2020).

Methods: Data were aggregated for reference years (RY) 

2011-2019; RY2020 will be added upon its release in late 

2021. From 2011-2019 the CFOI identified 4,782 out of 

44,483 fatally injured workers (11 percent) who tested 

positive for drugs at the time of fatal incident. These cases 

were verified by an authoritative medical source (e.g., 

autopsy, medical examiner, and toxicology reports) to 

have had any legal or illegal drug or substance present in 

their system. Free form text fields containing information 

about the specific type of drug or substance were classified 

into major drug type categories. Descriptive statistics and 

relative risk were generated for demographics, drug type, 

fatal event type, occupation, and industry.

Results: Preliminary results (excluding 2020 data) show 

that the number of recorded CFOI drug deaths in 2019 

was more than 3 times higher than in 2011 (206 compared 

to 924). The proportion of drug-positive cases over all 

CFOI cases increased steadily over the study period from 

4 percent in 2011 to 17 percent in 2019. Thirty six percent 

(1,711) of workplace deaths were the result of drug 

overdoses. The remaining 64 percent (3,071) of deaths 

were due to accidents at work where drugs or alcohol was 

found in the worker’s system at the time of the incident. 

The most frequently identified drug type in overdose 

deaths was opiates, including fentanyl (1,521 workers), 

followed by alcohol (1,249 workers) and 

methamphetamine (1,051 workers).

Conclusions: A decade of drug data provides opportunity to 

evaluate trends of drug-related work fatalities over a 

significant period of the ongoing opioid epidemic. The 

data show a steady increase of drug-related work incidents 

since the start of collection in 2011. They also reflect 

variation in the types of substances used over the study 

period. CFOI drug data also provides surveillance 

information on the presence of drugs in other fatal 

workplace events besides just overdose deaths. With the 

addition of RY2020 data, we hope to gain additional 

insight into the effects of the 2020 labor market changes 

on drug use at work compared to prior years. While 

geographic differences in posthumous drug testing limit 

conclusions from these pilot data, they still provide a 

nationally representative perspective of how drugs affect 

American workers.

A2.2 

Title: Opioid Overdose Deaths by Worker Industry Groups and 

Demographic Characteristics, United States, 2007-2014 

Authors: Sarah Fryman, Andrea Steege

Background: The United States continues to suffer through 

an opioid epidemic. Changes in the availability, 

utilization, and prescription practices over the past two 

decades have escalated opioid abuse in America. U.S. 

industry has been affected by opioids, including by loss of 

productivity, workplace injuries, absenteeism, and other 

worker-specific personal factors like decreased morale 

and increased illness. Work-related injuries and other 

occupational and personal risk factors connected to 

employment have been found to increase exposure to 

opioids, and therefore are associated with opioid-related 

deaths.

Objective: Determine the distribution of opioid-involved 

overdose deaths of U.S. workers by usual industry and 

demographic characteristics (2007-2014).

Methods: Mortality data from 21 U.S. states reported to 

the National Occupational Mortality Surveillance 

(NOMS) system was used to examine opioid-related 

mortality within 20 industry groups.

Results: Natural/semi-synthetic prescription opioids were 

the most frequent opioid type involved in opioid-related 

deaths from 2007-2014 (49.4% of opioid deaths). Of these, 

the majority were in males (70.0%) and non-Hispanic 

White decedents (88.0%). Deceased workers aged 35-49 

years accounted for 5.9% of total deaths in the NOMS 

2007-2014 data, however, they accounted for the majority 

(38.1%) of opioid-related deaths. Elevated overall opioidrelated proportionate morality ratios include: 1) 
2022 NATIONAL OCCUPATIONAL INJURY RESEARCH SYMPOSIUM 35

Construction (1.30 [95% CI 1.27, 1.33]); 2) Administrative 

and Support and Waste Management and Remediation 

Services (1.08 [1.03, 1.13]); 3) Health Care and Social 

Assistance (1.14 [1.11, 1.18]); 4) Arts, Entertainment, and 

Recreation (1.15 [1.08, 1.22]); 5) Accommodation and 

Food Services (1.16 [1.12, 1.20]); and 6) Other Services 

(except Public Administration) (1.09 [1.05, 1.13]).

Conclusion: With multiple industry groups associated with 

significant proportions of opioid deaths, there is a need 

for alternatives to pain and stress management for 

workers at high risk of injury and stress. More research is 

needed on opioid-related mortality among arts and 

entertainment, personal service, and healthcare industries.

Clinical Significance: We identified multiple U.S. industry 

groups associated with high proportions of opioid 

overdose deaths during 2007-2014. This study adds to the 

evidence of a need for the development of alternative 

plans for pain and stress management for workers at risk 

of injury and high levels of physical or mental labor.

A2.3 

Title: Investigating the Shooting Death of a Firefighter Who 

Responded to an Opioid Overdose

Authors: Stephen Miles, Sophia Chiu

Background: As the opioid overuse epidemic in the United 

States continues, first responders might encounter 

persons experiencing overdose who may require 

naloxone, an opioid reversal agent. On May 15, 2019, a 

career firefighter was killed, and a police officer and a 

civilian were injured after being shot while on an 

emergency medical services (EMS) incident involving a 

patient who overdosed. The firefighter was part of a crew 

dispatched along with a private ambulance company 

based on the report of a patient who had a seizure on a 

public bus at a bus terminal. The fire department 

requested assistance from the National Institute for 

Occupational Safety and Health (NIOSH) Fire Fighter 

Fatality Investigation and Prevention Program (FFFIPP) 

to conduct an independent investigation of the incident.

Methods: In July 2019, NIOSH investigators traveled to 

Wisconsin to investigate this incident. They met with 

senior staff officers and representatives of the fire 

department. NIOSH investigators met with and 

interviewed the career firefighters, the fire department 

officers, and the private EMS ambulance crew involved in 

the incident. NIOSH investigators obtained and reviewed 

fire department training records, standard operating 

procedures (SOPs), incident scene photographs and 

drawings, and medical records. The police officers who 

responded were not available to be interviewed. However, 

NIOSH investigators reviewed a redacted version of the 

official police report and redacted body camera footage.

Results: NIOSH investigators identified the type of 

medical emergency, the lack of scene safety, and decreased 

situational awareness as contributing factors to the 

shooting. When firefighters first responded to the scene, 

the patient was not breathing adequately and required 

emergency medical attention. Based on the initial 

assessment, an opioid overdose was more likely than 

seizure. Two doses of intravenous naloxone were 

administered. After the patient exited the bus under his 

own power, he produced a concealed handgun and fired 

at firefighters, law enforcement, EMS, other workers, and 

civilians. Prior to the shooting, police officers made 

multiple attempts but did not complete a search of the 

patient. An autopsy confirmed the patient/shooter had 

methamphetamine, fentanyl, and 4-anilino-N-phenethylpiperidine (4-ANPP, a metabolite of fentanyl or fentanyl 

analogues) in his system.

Conclusions: The vast majority of incidents involving 

persons who overdose do not end in violence against first 

responders. However, key recommendations based on this 

investigation can help first responders and agencies as 

well as authorities having jurisdiction (AHJs) better plan 

for delivery of medical assistance and scene safety in 

incidents involving overdose. First responder agencies 

who deliver medical assistance to patients who overdose 

should train staff on standard operating procedures for 

naloxone administration, including an understanding of 

the objective of naloxone therapy and the possibility, 

albeit unusual, of agitation and combativeness from 

persons after receiving naloxone. Fire, EMS, and police 

departments should take steps to help ensure scene safety 

including taking all necessary actions to protect 

themselves when providing lifesaving care to a patient. 

The fire service and standards setting organizations 

should consider developing scene safety SOPs and 

training that provide detailed guidance on the specifics of 

keeping first responders safe while providing lifesaving 

care to patients. AHJs, such as municipalities, areas, or 

departments, should consider developing SOPs or guides 

that specify when (1) a patient should receive a pat down 

to identify information that might be useful for patient 

care or identify items that pose a threat to the patient or 

responders and (2) a patient might be restrained if the 

patient poses a threat to themselves or responders.
2022 NATIONAL OCCUPATIONAL INJURY RESEARCH SYMPOSIUM 36

Session A3

Research to Practice in the Construction Industry

Moderator: Scott Earnest

The construction industry employs more than 11 million 

workers, is very diverse, and has significant health and 

safety challenges. Identifying and implementing strategies 

and evaluation approaches for putting research into 

practice (r2p) is a central focus of the NIOSH 

Construction Program, CPWR – The Center for 

Construction Research and Training (CPWR), and the 

NORA Construction Sector Council. Together, they strive 

to ensure that research findings are used by stakeholders 

to reduce occupational injuries and illnesses on jobsites by 

developing new translational products, identifying, and 

testing strategies for reaching targeted audiences, using 

new technologies to disseminate research findings, and 

evaluating efforts for formative and sustainable 

improvement. Partnerships are an integral part of the r2p 

focus.

The complex task of improving occupational safety and 

health in the construction industry requires multipronged approaches. This session will discuss important 

national construction industry initiatives, a collaborative 

effort to learn more about the upstream factors that lead 

to falls and how to modify them, new methods, including 

use of “choice architecture” or behavioral economics to 

positively influence construction employers’ and workers’ 

safety and health decisions.

Presentations 

1. Stand-Downs to Raise Awareness and Prevent Fatalities 

in Construction 

Presenter: Liz Garza

This presentation discusses important safety hazards in 

the construction industry and how NIOSH, CPWR, and 

OSHA worked collaboratively with the NORA 

Construction Sector Council to develop multiple 

campaigns and stand-downs – an opportunity for 

employers to pause work and focus on fall safety with 

their crews – that encourage industry leaders to act and 

address persistent industry hazards. We will walk you 

through steps taken to launch the Falls Campaign and 

initiate and maintain the NORA Falls and Struck-by

Workgroups and two National Stand-Downs. We’ll share 

the successes and challenges of these national initiatives as 

well as some best practices for others considering 

developing their own Stand-Downs.

2. Identifying Common Root Causes of Work-Related 

Falls from Heights Through Self-Reported Data from 

Individuals Who Experienced, Witnessed, or Investigated 

Fatal and Nonfatal Falls

Presenter: Jessica Bunting

During this presentation, attendees will hear about the 

development and dissemination of a Fall Experience 

Survey for stakeholders in construction and other 

industries with high rates of falls from heights. This 

includes findings from the survey and how data are being 

used to influence resource development, outreach and 

education efforts, and related actions by ASSP/ANSI 

voluntary consensus standards committees.

3. Behavioral Economics in the Construction Industry: 

Use of Choice Architecture Techniques to Accelerate 

Acceptance and Adoption of Health and Safety Research 

Findings and Solutions

Presenter: Sue Ann Sarpy

This presentation will: (1) discuss Behavioral Economics 

concepts used to influence health and safety decisions in 

the workplace and (2) introduce a pilot study that is 

testing the use of these concepts in the construction 

industry. Information will be presented on how to use 

these concepts (choice architecture techniques; nudges) 

with decision-makers in the construction industry to 

accelerate the acceptance and adoption of health and 

safety research findings and solutions.

A3.1 

Title: Stand-Downs to Raise Awareness and Prevent Fatalities in 

Construction

Author: Elizabeth Garza

Falls have been a leading cause of death for construction 

workers, with hundreds of fatalities and thousands of 

injuries each year for many years. These events have 

remained persistently and tragically elevated over the last 

decade; for example, 401 construction worker deaths due 

to fatal falls to a lower level occurred in 2019, accounting 

for 36% of all construction fatalities in 2019. National 

efforts to address these events were increased when the 

National Campaign to Prevent Falls in Construction 

(“Falls Campaign”) was launched in 2012 through the 

NORA Construction Sector Council with key leadership 

from NIOSH, OSHA and CPWR – The Center for 

Construction Research and Training. The NIOSH 

Construction Program through the NORA Fall 

Prevention Workgroup has played a pivotal role with this 

Falls Campaign with the creation, in 2014, of the first 

Stand-Down to Prevent Falls in Construction. The Stand-
2022 NATIONAL OCCUPATIONAL INJURY RESEARCH SYMPOSIUM 37

Down concept takes its cue from the military, in which 

operations stop, or “stand down,” when a critical safety 

problem is identified. Each year as part of the Falls 

Campaign, a Falls Stand-Down is held to focus on fall 

prevention. It usually coincides with Construction Safety 

Week. The primary goal of the Falls Stand-Down is to 

raise awareness and equip worksites and workers with 

information to help them prevent falls. Educational 

materials for the national campaign are available from 

NIOSH, OSHA, CPWR and other partners at our main 

campaign site www.stopconstructionfalls.com as well as 

on the Stand-Down page https://www.osha.gov/stop-fallsstand-down. The Falls Stand-Down has served as a model 

for other national initiatives inside and outside of 

construction. Following the establishment of the Falls 

Campaign and Falls Stand-Down NORA Construction 

Sector leadership established a “Struck-by Prevention 

Workgroup” made up of management, labor, academic 

and other stakeholders with expertise and experience in 

many aspects of construction safety and health. Struck-by 

injuries (occurring when a worker is struck by a moving 

vehicle, equipment, etc.) are the leading cause of nonfatal 

injuries and the second most common cause of fatalities 

among construction workers. That workgroup decided to 

pursue a National Stand-Down to Prevent Struck-by 

Incidents and in 2020 held the first annual Struck-by 

Stand-Down taking place during National Work Zone 

Awareness Week. During this event, construction 

employers and employees learn about best practices and 

methods to prevent struck-by incidents. The initial focus 

was on highway work zone safety. Lift zone safety 

(working around cranes) was added for the 2021 StandDown. This presentation will walk you through steps 

taken by the NORA Construction Sector Council to 

launch the Falls Campaign and initiate and maintain the 

Falls and Struck-by Workgroups and two National StandDowns. We’ll share the successes and challenges of these 

national initiatives as well as some best practices for 

others considering developing their own Stand-Downs. 

2022 marks the 10-year anniversary of the launch of the 

National Campaign to Prevent Falls in Construction. We 

will be sharing some of our ideas on what next? We look 

forward to sharing our knowledge and hope to learn from 

others on how we can continue to increase awareness of 

these national initiatives and increase impact in the 

construction industry and save construction lives.

A3.2 

Title: Identifying Common Root Causes of Work-Related 

Falls from Heights Through Self-Reported Data from Individuals 

Who Experienced, Witnessed, or Investigated Fatal and 

Nonfatal Falls

Authors: Jessica Bunting, Thomas Kramer, Grace Barlet, 

Rosa Greenberg

Despite regulations on the use of fall protection and 

efforts by stakeholders to improve awareness and proper 

use of fall prevention and protection solutions, falls 

continue to be the leading cause of death in the 

construction industry. They are also a top cause of death 

in industries such as manufacturing, mining, and utilities. 

In 2019, there were 401 fatal falls to a lower level in 

construction, accounting for 36% of all construction 

fatalities, and thousands more were injured (1). Across all 

industries, fall protection in construction is the most 

frequently cited standard for violations by the Occupation 

Safety and Health Administration. To better understand 

and prevent both fatal and nonfatal falls, the ANSI/ASSP 

Z359 Full Committee created the Z359 National Work at 

Heights Task Force. As part of this Task Force, CPWR – 

The Center for Construction Research and Training led 

the development of a fall experience survey for 

stakeholders in construction and other industries with 

high rates of falls from heights. The survey was created in 

both English and Spanish using Qualtrics and was 

available online. There were 671 respondents, 74% of 

which had been involved in, witnessed, or investigated a 

fall incident. During this presentation, we will share how 

the survey was developed and disseminated, and will 

review the findings, including reported contributors to 

falls from heights and other underlying factors identified 

through the survey. We will also discuss how the results 

are being used to improve fall prevention efforts, 

including resource development, outreach and education, 

and the decisions of standards committees for the 

ANSI/ASSP Z359 Fall Protection Code. (1) 

https://www.cpwr.com/wpcontent/uploads/DataBulletin-February-2021.pdf
2022 NATIONAL OCCUPATIONAL INJURY RESEARCH SYMPOSIUM 38

A3.3 

Title: Behavioral Economics in the Construction Industry: Use of 

Choice Architecture Techniques to Accelerate Acceptance and 

Adoption of Health and Safety Research Findings and Solutions

Authors: Sue Ann Sarpy, Eileen Betit, Grace Barlet, Alan Echt, 

Jessica Bunting

Background: The construction industry continues to 

experience one of the highest rates of occupational 

injuries and illnesses of any U.S. industry. The challenge 

facing safety and health researchers, particularly those 

involved in translation research, is accelerating acceptance 

and adoption of evidence-based solutions (e.g., 

equipment, work practices) that can improve the 

industry’s safety record. Behavioral economics, a relatively 

new field of study that combines insights from psychology 

and economics, may have promise for influencing these 

safety and health decisions. Behavioral economics 

acknowledges that decisions are made that may not be in 

an organization’s or individual’s best interest. It provides 

choice architecture techniques or nudges that can be used 

to design an environment that increases the likelihood 

that more informed and thereby better decisions will be 

made.

Methods: A literature review was conducted to explore the 

extent to which behavioral economics concepts have been 

used to influence health or safety decisions in the 

workplace. Using PubMed, PsycInfo, and EconLit 

databases, 62 peer-reviewed journal articles were 

identified that used behavioral economics to influence 

health or safety decisions or practices in an occupational 

setting or were potentially applicable to the construction 

industry. The literature review synthesized findings from 

56 primary studies and 6 meta-analyses/systematic 

reviews that utilized 12 choice architecture techniques 

across 3 decision-making categories. The review utilized a 

common typology to categorize the choice architecture 

techniques (decision information; decision structure; 

decision assistance) and included an expanded scope of 

occupational safety and health interventions.

Results: The primary studies reviewed found that the 

choice architecture techniques used most often involved 

using feedback, reminders, incentives, and social norms to 

enhance: (1) how available information is presented 

(Decision Information - feedback, social norms); (2) the 

arrangement of options and effort required or 

consequences (Decision Structure - incentives); and (3) 

decision-makers’ follow through with their intentions 

(Decision Assistance - reminders). The studies

highlighted in this review demonstrate the appeal of using

choice architecture techniques (simple, cost effective, and 

can be incorporated into existing safety and health 

interventions), and their effectiveness in supporting a 

wide array of safety and health decisions and related 

practices and outcomes across various occupational 

settings. The results demonstrate that these techniques 

can be effectively tailored and used in combination to 

address deficiencies in decision information, structure, 

and following through with decision-making intentions. 

The findings also provide evidence of their effectiveness 

and support across stakeholder groups (employers, 

supervisors, employees, customers) and, importantly, 

across diverse worker subpopulations including 

vulnerable workers.

Discussion: The findings suggest that choice architecture 

techniques in the form of nudges empower individuals, 

including employers and employees, by helping them to 

make more informed safety and health decisions.

Information will be presented on how to use these 

concepts (choice architecture techniques; nudges) with 

decision-makers in the construction industry to accelerate 

the acceptance and adoption of health and safety research 

findings and solutions. Further, a pilot study will be 

discussed, which includes multiple stakeholder 

involvement, to design, implement, and test the 

effectiveness of a health and safety intervention that 

involves specific choice architecture techniques within the 

construction industry.

Session A4

Surveillance in Agriculture, Forestry and Fishing

Moderator: KC Elliott

A4.1 

Title: Challenges in Regional Surveillance for Commercial 

Fishing Injuries: The Utility of State Trauma Registry Data

Authors: Viktor Bovbjerg, Jasmine Nahorniak, Amelia Vaughan, 

Samantha Case, Solaiman Doza, Laurel Kincl

Background: Despite commercial fishing remaining a highrisk occupation, comprehensive injury surveillance for 

non-fatal injuries remains an elusive goal. Similar to other 

industries, surveillance efforts are complicated by passive 

reporting, regional challenges and availability or 

accessibility of data. Short of conducting primary data 

collection, merging of complementary data sources holds 

the greatest promise for achieving greater breadth and 

depth of commercial fishing injury surveillance. The Risk 

Information System for Commercial Fishing (RISC) 

project in the Pacific Northwest assessed the utility of 

merging state trauma registry data with existing databases 
2022 NATIONAL OCCUPATIONAL INJURY RESEARCH SYMPOSIUM 39

constructed from US Coast Guard injury and vessel 

incident data.

Methods: As part of the larger RISC project to improve 

commercial fishing surveillance, we acquired 2009-2016 

data from the Oregon Trauma Registry (OTR) for all 

incidents coded as occupationally related within the 

agriculture, forestry, and fishing sectors. From those 

incidents, we used location, activity, and external cause 

codes, combined with clinical narratives, to identify 

incidents associated with commercial fishing. We then 

matched those cases with incidents identified from USCG 

data contained in the NIOSH Commercial Fishing 

Incident Database (CFID) supplemented with non-fatal 

injury data within the RISC project for the equivalent time 

frame (2009-2016).

Results: From 750 OTR incidents in agriculture, forestry, 

and fishing, we identified 11 incidents associated with 

commercial fishing. Of the 11 incidents, 7 matched with 

the 125 incidents based on USCG data (87 CFID incidents 

and 48 non-fatal injury incidents). Of the four OTR cases 

which did not match, two appear to have occurred outside 

of Oregon, and two may have been related to recreational 

fishing. For those incidents which matched, OTR data 

elements contained information not typically captured in 

USCG data, including detailed description of pre-hospital 

emergency care, detailed patient care narratives, multiple 

definitive ICD-9 and ICD-10 diagnostic and external 

cause codes, hospital and emergency department 

procedure codes, comorbid conditions, toxicology 

screens, and patient functional status and disposition at 

discharge.

Discussion: Consistent with our previous work on nonfatal injuries in commercial fishing, and with the relatively

few fishing incidents compared to farming and forestry, 

trauma registry data on commercial fishing injuries may 

represent underreporting. Similarly, trauma registry data 

were available for relatively few of the incidents identified 

in USCG-based reporting systems. Factors specific to 

commercial fishing (e.g. distance from care (including 

hospitals that provide trauma care), delays in obtaining 

care for emergent conditions at sea, resolution of 

emergent conditions before returning to shore) and the 

region (e.g. high proportion of smaller vessels with fewer 

crew members) may have contributed to relative underidentification of cases in the trauma registry. State trauma 

system data (and by extension emergency medical services 

data), while likely to identify emergent injury incidents in 

terrestrial occupations such as farming and forestry, may 

be of limited utility in identifying commercial fishing 

injury incidents.

A4.2 

Title: Fatal Agricultural Injuries in Florida: Building 

an Injury Surveillance System

Author: Serap Gorucu

Background/Introduction: Agriculture, Forestry, and 

Fishing (AFF) sector is one of the most important 

economic sectors in Florida and heavily depend on the 

labor force. The health and safety of the workers are 

crucial for the sector which is one of the most hazardous 

industry sectors in the U.S. To prevent agricultural 

injuries, accurate information on injury sources, injury 

patterns, and trends as well as workers’ demographics are 

needed. However, existing surveillance for Florida 

agricultural injuries are lacking detailed information. This 

study illustrates the effort to build a state-level agricultural 

fatal injury surveillance data by using multiple data 

sources.

Methods: To provide information on the occurrence of 

(AFF) fatalities, available data sources were combined 

together in a database: Florida Department of Health Vital 

Statistics data, Occupational Safety and Health 

Administration’s Integrated Management Information

System, AgInjurynews.org, Fatality Analysis Reporting 

System, data obtained through an online web search. Data 

were coded according to ASABE‘s Farm and Agricultural 

Injury Classification (FAIC) code and the U.S. Bureau of 

Labor Statistics‘ Occupational Injury and Illness 

Classification System (OIICS) for source and event or 

exposure types.

Results/Findings: Between Jan 1, 2015, and December 31, 

2020, a total of 151 AFF deaths were identified. Of the 151 

deaths, 123 of them were agricultural, 23 of them were 

fishing and 5 of them were forestry and logging related. 

Each data source was assessed for the victims’ 

characteristics, available information for AFF relatedness, 

and coding purposes. Cases from the FL Department of 

Health Vital Statistics data accounted for the majority of 

the cases (77%). Death Certificate data by itself was not 

always detailed enough to assign codes for workrelatedness and injury source and events. Most detailed 

information for the fatality cases were acquired through 

the news media and OSHA’s IMIS investigations.

Discussion/Conclusions: This study illustrated how multiple 

data sources were utilized to create a state-level 

agricultural fatal injury database. By using the multiple 

data sources, it was possible to identify the risk 

populations as well as injury agents and contributing 

events for target intervention programs and efforts.
2022 NATIONAL OCCUPATIONAL INJURY RESEARCH SYMPOSIUM 40

A4.3 

Title: Using Machine Learning on Pre-Hospital Care Report Data 

to Identify Occupational Injuries in Agriculture

Authors: Erika Scott, Liane Hirabayashi

Purpose: Current injury surveillance efforts in agriculture 

are considerably hampered by the limited quantity of 

occupation or industry data in current health records. 

This has impeded efforts to develop more accurate injury 

burden estimates and has negatively impacted the 

prioritization of workplace health and safety in state and 

federal public health efforts. This abstract describes the 

development of a Naïve Bayes machine learning 

algorithm to identify occupational injuries in agriculture 

using existing administrative data, specifically in prehospital care reports (PCR).

Methods: A Naïve Bayes machine learning algorithm was 

trained on PCR datasets from 2008-2010 from Maine and 

New Hampshire and tested on newer data from those 

states between 2011 and 2016. Further analyses were 

devoted to establishing the generalizability of the model 

across various states and various years. Dual visual 

inspection was used to verify the records subset by the 

algorithm.

Results: The Naïve Bayes machine learning algorithm 

reduced the volume of cases that required visual 

inspection by 69.5 percent over a keyword search strategy 

alone. Coders identified 341 true agricultural injury 

records (Case class = 1) (Maine 2011-2016, New 

Hampshire 2011-2015). In addition, there were 581 (Case 

class = 2 or 3) that were suspected to be agricultural 

acute/traumatic events but lacked the necessary detail to 

make a certain distinction.

Conclusions: The application of the trained algorithm on 

newer data reduced the volume of records requiring visual 

inspection by two thirds over the previous keyword search 

strategy, making it a sustainable and cost-effective way to 

understand injury trends in agriculture.

Session B1

Using Workers’ Compensation Systems to Conduct 

Injury Surveillance

Moderator: Steven Wurzelbacher

Introduction: This thematic research session will describe 

recent workers’ compensation claims surveillance analyses 

that were conducted through a partnership between the 

Ohio Bureau of Workers' Compensation (OHBWC) and 

the National Institute for Occupational Safety and Health 

(NIOSH) Center for Workers' Compensation Studies 

(CWCS).

Background: Workers’ compensation (WC) involves 

state-governed systems that were established in the early 

1900s in the US to provide medical care and partial 

income protection to employees who are injured or 

become ill due to their job. These systems also provide 

employers risk assessment and control services and 

incentives to prevent work-related injury and illness. A 

majority of employers purchase WC insurance coverage 

through private insurers or state-certified compensation 

insurance funds. Larger employers may also have the 

option to self-insure. In 2013, NIOSH established the 

CWCS maximize the use of WC claims data and systems 

to improve workplace safety and health through 

partnerships. A main partnership has been with the 

OHBWC, which is the largest of the US state-certified 

WC funds.

Methods and Findings: Studies have demonstrated that 

large state datasets of WC claims can be successfully 

linked to state employment data to examine claim counts 

and rates by industry and cause of injury. OHBWC and 

CWCS partnered to publish several of these seminal WC 

claim studies to describe linkage methods, text mining 

approaches, and analyses to identify prevention priorities 

in a variety of industries 

(https://www.cdc.gov/niosh/topics/workercomp/cwcs/pu

blications.html).

A number of recent studies will be presented during this 

session, featuring a variety of researchers from OHBWC 

and NIOSH:

Title: How Workers' Compensation Claims Can Inform 

Health and Safety in the Landscaping Services Industry

Authors: Barbara M. Alexander, Steven J. Wurzelbacher, 

Rachel J. Zeiler, Steven J. Naber

Description: This study analyzed 18,037 landscaping 

services industry WC claims from 2001-2017. Freetext descriptions of claims were used to identify 

particularly hazardous tasks such arborist work and 

loading/unloading of work vehicles. Engineering and 

administrative controls were summarized to prevent 

future injuries.

Title: Slip, Trip, and Fall Injuries Within Construction 

Industry Workers’ Compensation Claims, Ohio, 

2010-2017
2022 NATIONAL OCCUPATIONAL INJURY RESEARCH SYMPOSIUM 41

Authors: Christina Socias-Morales, Srinivas Konda, 

Jennifer Bell, Steven J. Wurzelbacher, Steven J. Naber, 

G. Scott Earnest, Elizabeth P. Garza, and 

Ted Scharf

Description: This study analyzed 9,517 construction 

industry slip, trip, and fall (STFs) WC claims from 

2010-2017. Risk, contributing factors, and prevention 

approaches for these claims are discussed.

Title: Workers’ Compensation Injury Claims Among 

Firefighters in Ohio, 2001-2017

Authors: Tyler Quinn, Suzanne M. Marsh, Steven J. 

Naber, Kierstyn Oldham, Steven J. Wurzelbacher

Description: A total of 33,069 firefighter WC claims 

from 2001-2017 were identified and included in this 

analysis. This study provides a descriptive basis for the 

development of focused firefighter injury prevention 

programming and training. Prevention efforts focuses 

on the most frequently reported injury events and 

diagnoses may be warranted.

Discussion: As with other data sources, there are several 

limitations associated with the use of WC claims data for 

occupational safety and health surveillance. This includes 

underreporting, which differs by industry, especially for 

illnesses. CWCS and partners have demonstrated that 

state-level WC claims data can be used to augment other 

surveillance systems (such as the Survey of Occupational 

Injuries and Illnesses and the Census of Fatal 

Occupational Injuries) to understand injury trends by 

cause and industry. The CWCS and other researchers are 

also successfully using WC insurer systems to identify 

evidence-based prevention programs, assess exposure 

trends, and conduct health services research.

Conclusions: WC systems can be useful for injury 

surveillance and improving workplace safety and health. 

CWCS will continue to work partners to tap the potential 

of these systems to prevent injury and improve injured 

worker care.

B1.1

Title: How Workers' Compensation Claims Can Inform Health 

and Safety in the Landscaping Services Industry

Authors: Barbara Alexander, Steven Wurzelbacher, 

Rachel Zeller, Steven Naber

Background/Introduction: The landscaping services industry 

(NAICS code 56173) is one of the more dangerous in the 

U.S., with higher rates of both fatal and nonfatal injuries 

than the all-industry average. There is a high proportion 

of vulnerable workers in this industry, with Hispanic 

workers making up 42.7% of the workforce, as compared 

to 17.6% of the all-industry workforce.

Methods: This study used claims from the Ohio Bureau of 

Workers’ Compensation (OHBWC) database to identify 

high rates of serious occupational injuries and illnesses in 

this industry in Ohio. The causes of those illnesses and 

injuries are highlighted to identify the most common 

factors to identify areas where safety can be improved. 

The OHBWC database includes injured-worker industry 

identification, occupation, business size, demographics, 

diagnoses, and free-text descriptions of injury 

circumstances. We identified landscaping service industry 

claims from 2001 to 2017 and studied annual claim counts 

and rates.

Results/Findings: Over the 17-year period studied, 18,037 

landscaping services industry claims were accepted by the 

OHBWC, with “Struck by object or equipment” and 

“Overexertion involving outside sources” being the most 

common events or exposures (causes of the injury or 

illness). Sprains and fractures were the most prevalent of 

the more serious lost-time (LT) injuries. The OHBWC 

defines LT claims as those that involve eight or more days 

away from work. Although the rates of LT claims are 

slowly decreasing, the percent of claims that are LT are 

increasing. The total cost of claims to the OHBWC from 

the landscaping services industry for 2001 – 2017 was over 

$226,000,000. Almost $214,000,000, or 94.4%, was for LT 

injuries and illnesses, even though LT claims comprise 

only 18% of total claims. Reducing these more serious 

claims could decrease human pain, suffering, and loss of 

livelihood; save companies money and business 

disruption; and improve worker morale.

Discussion/Conclusions: Free-text descriptions of claims 

indicate that arborist work and loading/unloading of work 

vehicles and trailers are particularly hazardous. Loading 

and unloading may not have been previously identified as 

a leading risk for injury. Younger and shorter-tenured 

workers were injured most frequently, although the 

average worker's age was higher for LT claims. 

Engineering and administrative controls are preferred to 

personal protective equipment to enhance safety for 

workers in the landscaping services industry. Lifting assist 

equipment; improved safety features on trucks, trailers, 

and ramps; good preventive maintenance on tools and 

equipment; and improved training are strongly 

recommended to reduce falls, overexertion, and struck-by 

injuries. Innovative solutions may be needed in areas 

where no available engineering controls exist.
2022 NATIONAL OCCUPATIONAL INJURY RESEARCH SYMPOSIUM 42

B1.2

Title: Construction Industry Workers’ Compensation Injury 

Claims Due to Slips, Trips, and Falls – Ohio, 2010-2017 

Authors: Christina Socias-Morales, Srinivas Konda, Jennifer Bell, 

Steven Wurzelbacher, Steven Naber, G.Scott Earnest, 

Elizabeth Garcia, Ted Scharf

Introduction: Falls are a common cause of fatal and nonfatal work-related injuries. Compared to other industries, 

construction workers have higher risks for serious fall 

injuries. The National Institute for Occupational Safety 

and Health (NIOSH) partnered with the Ohio Bureau of 

Workers’ Compensation (OHBWC) to describe the 

burden and circumstances surrounding injuries related to 

compensable slip, trip, and fall (STF) injury claims from 

private construction industry workers.

Methods: The OHBWC provides workers’ compensation 

insurance for two-thirds of Ohio’s workers. OHBWC 

compensable claims were shared with the NIOSH Center 

for Workers’ Compensation Studies as part of a 

longstanding research partnership. Construction industry 

(North American Industry Classification System = 

23XXX) claims from 2010-2017 were identified, and STF 

injury claims were included and manually reviewed by 

internally trained coders for accuracy. Claims were 

further classified into four categories by type of fall (falls 

to a lower level [FLL], falls on the same level [FSL], slips 

or trips without a fall [STWOF], and other). Claim 

narratives were reviewed to categorize work-related risk 

and contributing factors. Demographic, employer, and 

injury characteristics were examined among STF claims 

by claim type (medical-only and lost-time (≥8 days away 

from work)) and the type of fall. Claim rates per 10,000 

estimated full-time equivalents (FTE) were calculated

using Ohio unemployment insurance data and the Bureau 

of Labor Statistics Labor Productivity and Costs program 

data.

Results: In total, 9,517 construction industry STF claims 

were identified during the 8-year period with an average 

annual rate of 75 claims per 10,000 FTE construction 

workers. The overall rate of construction STFs decreased 

by 37% from 2010 to 2017. About half of the claims were 

FLL, 29% were FSL, 17% were STWOF, and 3% were 

other. Nearly 40% of all STF claims were lost-time, and 

most claimants were male (96%). FLL injury rates were 

highest in the following industry sectors: Foundation, 

Structure, and Building Exterior Contractors (52 per 

10,000 FTE); Building Finishing Contractors (45 per 

10,000 FTE); and Residential Building Construction (45 

per 10,000 FTE). The rate of both STWOF and FSL LT 

claims increased as construction firms became larger. 

Conversely, the highest rate of FLL LT claims was for the 

smallest firms (10 or fewer workers), with the rate of FLL 

decreasing as construction firms became larger. 

Information on contributing factors was extracted from 

93% of the claim narratives (8,822). The top three 

contributing factors for each type of fall were: slip/trip 

hazards (21%), floor irregularities (18%), and ice/snow 

(17%) for STWOF; floor irregularities (37%), trip/slip 

hazards (21%), and ice/snow (13%) for FSL; and ladders 

(38%), vehicles (11%), and stairs/steps (8%) for FLL.

Discussion: This study identified circumstances associated 

with STFs among construction workers’ compensation 

injury claims and highlighted specific contributing factors 

for multi-faceted prevention efforts such as hazard 

elimination and improving safety climate. Ladders and 

vehicles were identified as leading contributing factors for 

nonfatal FLL. However, ladders, scaffolds, and roofs are 

often noted as contributing factors in fatal FLL research. 

Contributing factors for FSL identified in this study 

resembled previous research such as floor irregularities, 

ice/snow, and tripping hazards. Limitations of this study

include the possibility of incomplete data from 

unreported claims or self-insured employers (one third of 

Ohio employers). Ohio results may differ from other 

states due to regional/legislative differences. Although 

STF rates declined over time, stakeholders should focus 

on high-risk subsectors and small construction firms (<10 

or fewer employees) which were at highest risk for FLL, 

the type of fall with the highest risk for severe injury and 

death.

B1.3

Title: Workers’ Compensation Injury Claims Among Firefighters 

in Ohio, 2001-2017 

Authors: Tyler Quinn, Suzanne Marsh, Kierstyn Oldham, 

Steven Wurzelbacher, Steven Naber

Background: Firefighters are at high risk for non-fatal and 

fatal occupational injuries. While some past research has 

quantified firefighter injuries using emergency 

department data and other data sources, no previous 

research has utilized the Ohio workers’ compensation 

injury claims data to describe the nature of firefighter 

injuries.

Methods: Public and private firefighter claims, including 

volunteer and career firefighters, from Ohio’s workers’ 

compensation data for 2001-2017 were identified based 

on standard occupational classification codes and manual 

review of the claimant occupation title and injury 

description. The task being done during the injury 

(firefighting, patient care, training, other/unknown, etc.) 
2022 NATIONAL OCCUPATIONAL INJURY RESEARCH SYMPOSIUM 43

was manually coded by the researchers based on the 

injury description. Injury claim counts and associated 

proportions were described across claim type (medicalonly or lost-time), worker demographics, task during 

injury, injury events, and principal diagnoses.

Results: A total of 33,069 firefighter claims were identified 

and included in this analysis. The majority of claims were 

medical only (66.28%, <8 days away from work) and 

involved males (92.81%) between the ages of 25-54 years 

(86.54%). While the largest percentage of narratives 

(45.96%) could not be categorized to the task being done 

at time of injury, the largest percentage that could be 

categorized occurred while firefighting (20.48%) and 

doing patient care (17.60%) The most common injury 

events were overexertion and bodily reaction (40.95%), 

contact with objects and equipment (23.28%), and slips, 

trips, and falls (18.92%). The most frequent principal 

diagnoses were back sprains (16.02%) followed by lower 

and upper extremity sprains (14.46% and 11.98%, 

respectively). 

Conclusions: This study provides a preliminary basis for 

the development of focused firefighter injury prevention 

programming and training. Obtaining associated 

denominator data, enabling the calculation of rates, would 

further strengthen the characterization of risks to this 

worker population. Based on the current data, prevention 

efforts focusing on the most frequently reported injury 

events and diagnoses may be warranted.

Session B2

Work-Related Mental Health Considerations to Reduce 

Injuries

Moderator: Eric Carbone

B2.1

Title: Circumstances Contributing to Construction Worker Death 

from Suicide

Authors: Jonathan Davis, Bradley Evanoff, Ling Zhang, 

Corrine Peek-Asa

Background: Suicide is a leading cause of death for working 

age adults. The risk of suicide is affected by a person’s 

occupation. The National Violent Death Reporting 

System (NVDRS) is a surveillance system that collects 

information on violent deaths including suicides. The 

NVDRS collects information about a decedent’s 

demographics and circumstances that may have 

contributed to the death using information from the death 

certificate, medical examiner report, and law enforcement 

report. Occupation is identified using autocoding 

programs that rely on the occupation title included as free 

text on the death certificate. The classification of 

occupational groups by autocoding has been evaluated 

and found to be accurate. Prior calculations of suicide 

rates by occupation found that construction workers had 

the highest rate of all occupational groups. Construction 

workers had a rate of suicide nearly twice as high as the 

general population. This research compares suicide 

circumstances, including those related and not related to 

work, between construction workers and all other 

occupation groups.

Methods: NVDRS data for individuals aged 16 to 64 was 

used to identify deaths from suicide occurring during 

2013 to 2017. Records with an unknown or unspecified 

race or sex were excluded, as well as records that did not 

have any contributing circumstance identified. The 

likelihood of a circumstance occurring around the death 

of a construction worker compared to those with a nonconstruction occupation was compared using logistic 

regression models controlling for age, sex, race, and 

education level. Job problem is a circumstance collected in 

NVDRS. Job problem can be indicated when work related 

circumstances such as tension with co-workers, poor 

performance review, increased pressure, or losing the job 

occur before the death. We further analyzed how deaths 

with a job problem were related to other circumstance for 

construction workers using logistic regression to compare 

those with death from suicide with and without a job 

problem.

Results: There were 57,531 decedents of suicide that met 

our inclusion criteria of having an autocoded occupation 

and at least one circumstance related to their death 

identified in the NVDRS record. Construction workers 

made up 14.7% (n=8,483) of the records. Construction 

workers were less likely to have a job problem identified 

than other occupations (OR=0.73; 95% CI: 0.68-0.79). 

Problems related to alcohol (OR=1.24; 95% CI: 1.17-1.31) 

and substance abuse (OR=1.66; 95% CI: 1.57-1.76) were 

more frequently found in the construction group when 

compared to other workers. Within construction workers, 

a death was more likely to have a job problem identified 

when financial problems and evictions also occurred 

around the death.

Discussion: Despite having the highest rate of death from 

suicide, construction workers were less likely to have a job 

problem as a contributing circumstance to their death. 

Construction workers more frequently had drug or 

alcohol problems as a contributing circumstance. 

Substance use problems could be related to the decedent’s 

job but not coded as a specific job problem, for example if 

the substance use was a prescription opioid resulting from 

job-related pain. Deaths with a job problem also more 
2022 NATIONAL OCCUPATIONAL INJURY RESEARCH SYMPOSIUM 44

frequently had financial issues identified as contributing 

to the death. The independent contributions of substance 

use, and financial hardship suggest that financial support 

during unemployment and substance use recovery 

support could help prevent job related deaths from 

suicide.

Conclusions: Prevention of construction worker suicide 

should incorporate measure to reduce alcohol use, 

substance abuse, and addiction in these workers. 

Additionally, programs to support workers after a loss of a 

job will help reduce occupationally related deaths from 

suicide.

B2.3

Title: Suicides Among First Responders ─ National Violent 

Death Reporting System, 27-37 U.S. States or Territories, 

2015-2017 

Authors: Leslie Carson, Suzanne Marsh, Melissa Brown, 

Kate Elkins, Hope Tiesman

Background: First responders, including law enforcement 

officers (LEOs), firefighters (FFs), emergency medical 

services (EMS) clinicians, and public safety 

telecommunicators, are crucial to ensuring public safety, 

public health, and national security. First responders may 

be at elevated risk for suicide because of the environments 

in which they work, including organizational culture and 

occupational stress. Previous research has documented 

that first responders have an elevated risk of suicide 

compared to the general adult population. Many of these 

studies have been limited by state or only involved specific 

occupations. While mental health stressors among first 

responders have been studied, data on suicide deaths 

among first responders are scarce. This analysis used data 

from the 2015-2017 National Violent Death Reporting

System (NVDRS) to characterize suicides among first 

responders. 

Methods: First responders were identified from NVDRS 

for 2015-2017, the most recent years available at time of 

analysis, from 27-37 U.S. states and territories. NVDRS 

contains detailed information on deaths and potential 

precipitating circumstances from death certificates, and 

coroner/medical examiner and law enforcement reports. 

Occupation codes assigned by the NIOSH Industry and 

Occupation Computerized Coding System were used to 

identify LEOs, FFs, EMS, and public safety 

telecommunicators. We categorized workers as first 

responders or non-first responders. Descriptive statistics 

were reviewed for each group by demographics, mental 

health issues, and associated potential contributing 

factors. Method of injury for suicide, associated 

characteristics, suicidal history, and toxicology were also 

explored. T-tests and chi-square tests identified 

statistically significant differences at p=0.05 between 

select demographics, comorbidities, potential 

contributing factors, and substance use for both groups. 

We also compared select indicators across types of first 

responders. The Bonferroni correction and adjustment 

procedure for multiple comparisons was used to adjust all 

p-values.

Results: From 2015-2017, first responders made up 1% of 

the 61,579 suicides captured in NVDRS. Of the 676 first 

responder suicides identified, 58% were LEOs. Compared 

to non-first responders, first responders were more likely 

to have served in the military (23% vs. 11%, p<0.0001), 

used a firearm as the method of injury (69% vs. 44%, 

p<0.0001), and been male (88% vs. 76%, p<0.0001). First 

responders were significantly more likely than non-first 

responders to have intimate partner problems (p<0.0001) 

and job problems (p=0.0002). With few exceptions, first 

responders were less likely to report suicide risk factors. 

There were also differences across types of first 

responders. A greater proportion of EMS (57%) clinicians 

had a mental health problem than other first responders 

(37% [LEOs] & 43% [FFs]). History of suicidal thoughts 

was over twice as common among LEOs than among FFs 

and EMS (13% vs. 5%). The leading method of injury for 

suicide across all first responder groups was a firearm.

Conclusions: First responders in our study were more likely 

to have job and intimate partner problems than non-first 

responders. This may point to a potential issue with worklife balance and indicate a need for agencies and 

departments to consider stress management options and 

fostering a climate conducive to seeking assistance. First 

responders may be less likely to disclose certain suicidal 

risk factors than non-first responders, which is not 

surprising given first responder culture. Because of the 

lack of national data on first responders, it is unknown 

whether they were overrepresented among suicides 

during the study period. More complete data are needed 

to better define the problem, encourage research, and 

develop culturally competent, evidence-based 

interventions to promote first responder wellness.

Session B3

Research in the Construction Industry Part 1

Moderator: Douglas Trout

The construction industry employs more than 11 million 

workers, is very diverse, and has significant health and 

safety challenges. A consortium of scientists supported by 

NIOSH, CPWR – The Center for Construction Research 
2022 NATIONAL OCCUPATIONAL INJURY RESEARCH SYMPOSIUM 45

and Training (CPWR), and the NORA Construction 

Sector Council conduct research on existing and emerging 

hazards facing the industry. They target NIOSH and 

NORA constructions goals on persistent and emerging 

hazards faced by workers on the job, identify causes and 

solutions for safety and health risks, and test the impact of 

disseminating effective interventions to the industry that 

result in evidence-based technologies being applied and 

good work practices to prevent occupational injuries and 

illnesses. This session highlights selected research projects 

on a variety of topics funded by NIOSH and CPWR, 

through the NIOSH-supported National Construction 

Center. 

Presentations 

Job Hazard Analysis in Construction: Challenges and 

Solutions

Presenter: Babak Memarian

This presentation will summarize the findings of 23 

interviews with construction health and safety 

practitioners on pre-task Job Hazard Analysis (JHA). It 

will first identify current shortcomings and challenges in 

developing and implementing JHA. Then, it will present 

practices and interventions to enhance the efficacy of the 

JHA process from practitioners’ perspectives and 

conclude with an iterative technique to fill the gap in the 

process.

Assessing the Potential for Exoskeletons in Construction

Presenter: Carisa Harris Adamson

This presentation will review preliminary results from a 

current five-year research project on a rapidly emerging 

wearable technology – exoskeletons (EXOs) – that have 

the potential to help construction workers lift and move 

tools and materials and reduce the risks for strain and 

sprain injuries. The project is designed to provide a 

comprehensive understanding of who uses them, how 

they are used, and how the effects of their use can lead to 

poor practices and unintended consequences to avoid 

these pitfalls in the future.

Construction Trainer and Trainee Perspectives on the 

Quality and Effectiveness of the OSHA 10 Construction 

Course 

Presenter: Mark Fullen

The presentation will discuss preliminary findings from 

an ongoing five-year project to improve OSHA 10-hour 

construction safety training outcomes. Interviews were 

conducted with OSHA Training Institute Education 

Center instructors and trainees to characterize for the first 

time how the OSHA 10 is being used nationally and to 

inform future evidence-based recommendations to 

improve learning outcomes. This presentation will 

summarize the results of these interviews and how they 

are being used to formatively design actions for other 

aims of the research project.

B3.1

Title: Job Hazard Analysis in Construction: Challenges and 

Solutions

Authors: Babak Memarian, Sara B. Brooks, Jean Christophe Le

Introduction: Construction workers experience a 

disproportionately high rate of work-related injuries and 

fatality compared to other sectors. According to the U.S. 

Bureau of Labor Statistics, the construction industry 

remained one of the highest-risk sectors in the U.S. in 

2019 with a recordable injury rate of 2.8 per 100 full-time 

employees. While construction workers made up about 

5.8% of the U.S. labor force in 2019, they experienced 

close to seven percent of all recordable injuries. However, 

research suggests that if hazards are proactively 

recognized and properly controlled, most of these 

incidents can be prevented. This emphasizes the 

importance of pre-task planning and implementing 

effective job hazard analysis (JHA) to reduce occupational 

incidents and injuries. JHA is intended to identify and 

address the existing or potential hazards associated with 

each step of work and recommend actions to eliminate or 

mitigate these hazards. However, the construction 

industry still lacks well-defined guidelines on how to 

properly design and implement JHA for ease of use by 

craft workers.

Methods: To help fill this gap, this study pursued two 

objectives: (1) to identify challenges and shortcomings of 

current JHA practices and (2) to explore effective 

practices and interventions to enhance the efficacy of the 

JHA process from practitioners’ perspectives. To this end, 

23 construction safety and health practitioners 

representing 17 companies were interviewed. The range 

and breakdown of participants’ years of industry 

experience included: 1-10 years: 27%; 11-20 years: 32%; 

21-30 years: 14%; and more than 31 years: 27%. The 

participating companies ranged in size from 90 to 52,000 

employees. Interviews took place over a period of three 

months and lasted an average of 30 minutes each.

Results: Approximately 61% of interviewees cited worker 

and foreman complacency and pencil-whipping as major 

challenges to an effective JHA process. Thirteen percent of 

participants also discussed a lack of worker input as a 

major stumbling block. According to interviewees, the 

failure to solicit input from all participants can lead to 

generic, nonspecific JHAs that do not match actual task 
2022 NATIONAL OCCUPATIONAL INJURY RESEARCH SYMPOSIUM 46

conditions. JHAs that are wordy, overcomplicated, or 

excessively long were also identified by 22% of 

respondents as negatively affecting craft ability to 

recognize and mitigate hazards. Interviews revealed that 

65% of respondents preferred using traditional paper JHA 

forms or whiteboarding over electronic JHA management 

systems and application of software and mobile devices. 

However, larger companies were more likely to prefer an 

electronic system.

Conclusions: The findings of this study emphasized 

management’s role in filling the gap in the current JHA 

process. To reach optimum outcomes and ensure 

construction worker safety and health, management 

should: (1) be present and active on the jobsite, (2) solicit 

input from workers performing the task, (3) empower 

workers and give them the opportunity to rotationally 

lead the pre-task JHA meetings, and (4) continuously 

update JHA content with specific, clear language and 

visual aids to reflect current jobsite conditions. Moreover, 

to facilitate continuous improvement, it is recommended 

that management teams establish a process to regularly 

monitor, examine, and update the JHA process and 

content. 

B3.2

Title: Assessing the Potential of Passive Exoskeletons in 

Construction

Authors: Carisa Harris Adamson, Maury Nussbaum, 

David Rempel, Alan Barr, Sunwook Kim, Albert Moore, 

Nancy Gutierrez, Aanuoluwapo Ojelade

Background: Occupational exoskeletons (EXOs) are a 

rapidly emerging technology with clear potential for 

beneficial applications in the workplace. Most devices are 

designed to provide assistive forces/torques about the 

shoulder and low-back, and thus EXO use may reduce 

physical demands on the body regions most commonly 

impacts by work-related musculoskeletal disorders 

(WMSDs) in construction. However, to facilitate the safe 

and effective adoption and use of EXOs in construction, 

workers perceptions about EXOs need to be assessed.

Methods: Between July 2020 and January 2021, 

construction industry stakeholders completed a selfadministered online survey after viewing a 3-minute 

introductory video on exoskeletons. The survey included 

70 open-and closed-ended questions regarding prior 

exoskeleton knowledge, work history, personal factors, 

task characteristics, perceived benefits, perceived health 

and safety concerns, and facilitators for adoption and use 

of exoskeletons in construction. A summation score 

method was used to summarize a participant’s benefits 

score, barriers score, (exoskeleton use) perceptions score, 

and readiness to use score. Spearman correlations and 

simple linear regression models were used to assess 

relationships between participants’ benefits, barriers, 

perceptions, and their readiness to use scores. Responses 

were stratified by race (White vs. Non-White), sex (male 

vs. female/other), and age (<47 years vs. ≥47 years); 

Pearson’s chi-squared tests were used to assess differences 

in each stratum.

Results: A total of 361respondents completed the survey.

A majority of respondents were White men (46%) over 40 

years of age (65%). About three-quarters of respondents 

thought that exoskeletons would reduce fatigue, 70% 

noted that it would make their work easier and 62% 

thought it could make them more productive. Potential 

barriers to exoskeleton use included numerous safety 

concerns, such as increased slips/trips/falls, interference 

with tool belts, hindering movement when climbing poles 

or ladders, and conductive/dangerous when performing 

electrical work. A higher benefits score (p-value <0.00) 

and a higher perceptions score (p-value <0.00) were both 

significantly associated with a higher readiness to use 

score. There were significant differences in high vs. low 

barriers scores by race (White vs. non-White) (p-value = 

0.03) and sex (male vs. female/other) (p-value <0.00).

Discussion: While the results demonstrated a large interest 

and enthusiasm by workers about exoskeleton usage for 

specific construction tasks, results also highlight the 

specific concerns and increased demand to understand 

the most effective and safe way to introduce exoskeleton 

technology to construction workers, particularly those 

who are female and non-white. The increased perceived 

barriers for both non-White and female/other 

construction workers highlight existing barriers to health 

and safety among these populations and emphasizes the 

need to ensure proportionate access to the potential 

benefits of exoskeleton technology through proper 

involvement of these populations in the implementation 

process.

B3.3

Title: Construction Trainer and Trainee Perspectives on the 

Quality and Effectiveness of the OSHA 10 Construction Course

Authors: Mark Fullen, Brandon Takacs, Eric Lundstrom, 

Kimberly Rauscher, Wayne Lundstrom, Doug Myers

Background/Objectives: The OSHA Outreach Training 

Program’s 10-hour construction safety training course 

(OSHA 10) is the most widely utilized foundational 

construction safety and health (OSH) training course in 

the industry. Currently, we are conducting one of the first 
2022 NATIONAL OCCUPATIONAL INJURY RESEARCH SYMPOSIUM 47

large scale evaluations of this course. As part of our 

formative work, we spoke with OSHA 10 authorized 

trainers with the objective of understanding more about 

their teaching approaches, the materials, and activities 

they use, as well as how they view the strengths and 

weaknesses of the current OSHA 10 course.

Methods: Interviews were conducted with 14 trainers and 

14 trainees. Trainers were asked about their training 

materials, methods and subjects, their evaluation 

practices, what does and does not work when effectively 

teaching the OSHA 10, and what barriers they face in 

teaching the course, specifically around using 

participatory methods. Interviews with trainees asked 

about the training methods used by trainers, their view of 

the practical application of what was taught, safety topics 

they would like to see added or removed from the course, 

and what they view as the most effective and impactful 

training methods they experienced. Interview recordings 

were transcribed and then independently coded and 

analyzed by study team members to identify emerging 

themes and common topics.

Results: While our analysis revealed several themes, the 

most prevalent for trainers were: (a) trainers self-identify 

as being engaged and conduct student led learning and 

resist lecture-based training, (b) trainers do not develop 

their own curriculum and use existing training materials 

developed by others, (c) trainers do not conduct student 

evaluations or engage in knowledge assessments, (d) when 

asked to re-imagine an OSHA 10 course from the ground 

up had difficulty in suggesting any major changes to the 

program. The most prevalent themes from the trainee 

interviews were: (a) trainees believed that the trainer was 

effective at teaching the course (b) engaged, hands-on and 

student led training is the preference, but is not frequently 

provided (c) seated classroom lecture training is not 

preferred but is the norm (d) trainees believed the 

knowledge gained from the course would help keep them 

safe at work they have used what they have learned on the 

jobsite. Participants in both groups agreed that the OSHA 

10 training program is important and effective. Many 

stated an interest for more training time, topics and 

materials.

Conclusions: OSHA 10 trainers must complete and pass an 

OSHA 500 course. Adult learning methodology is taught 

in the course so there may be an expectation by those 

providing the OSHA 10 curriculum OSHA, OTIECs, and 

others) that the trainer is adequately prepared to deliver 

the training material using appropriate, effective and 

engaging techniques without added explanation or 

instructions. But the reality of OSHA 10 training is that 

(a) trainers are often consultants that come into an 

organization with limited knowledge of specific hazards 

and worksite conditions (b) or have a mixture of trainees 

from different trades and companies (c) utilize 

curriculum developed by others without trainer guides or 

lesson plans (d) curriculum is primarily Microsoft 

PowerPoint presentations, videos, and handouts (e) the 

training is not always able to be customized to the 

audience (f) they are often held in hotel or office 

conference rooms with little to no opportunity for handson training. The trainers strongly desire guidance, 

material and ideas on how to deliver topic material using 

more engaging methods beyond what is taught in the 

OSHA 500 and all trainees prefer more engaging delivery 

of training material. This provides an opportunity to 

develop resources on how to convert or make static 

training material more engaging for trainees that clearly 

do not prefer to set in a classroom for 10 hours for 

lecture-based training.

Session B4

Special Topics in Agriculture, Forestry and Fishing

Moderator: KC Elliott

B4.1

Title: Confined Space: Reducing Grain Bin Related Injuries 

and Fatalities

Authors: Linda Fetzer, Stephen Brown, Roderick Thomas, 

Randall Bock, Michael Dyer, Serap Gorucu

There are approximately 35 (known and additional 

suspected unreported) grain bin related fatalities per year. 

The ANSI/ASABE S64 – Grain Bin Access Design Safety 

standard was published in August 2018. This standard 

recommends that grain bins manufactured after 2018 be 

built to accommodate a bin entry lifeline system. The 

recommended system includes two anchor attachment 

points with one located near the roof peak and one near 

the roof access. Each anchor point must support a 

minimum ultimate load of 2,000 pounds. Through a 

research grant from the Northeast Center for 

Occupational Health and Safety, Penn State University 

combined computer modeling and experimental 

measurements to examine safe use of anchor points on a 

pre-2018 grain bin. Vertical roof deflection of the bin was 

measured using a precision phase-comparison laser while 

applying incremental dead loads to the retrofitted rescue 

anchor points. The measured deflections compared well 

to defections predicted by finite element analysis 

(SolidWorks Simulation). The SolidWorks Simulation 

model may be used to estimate other loading scenarios in 

a safe and nondestructive way. The model is specific to 

this grain bin and loading scenarios and is not currently 

intended for generalization. Based on the research 
2022 NATIONAL OCCUPATIONAL INJURY RESEARCH SYMPOSIUM 48

findings, the project team recommends that the suitability 

of any bin to safely accommodate a lifeline and anchor 

point system must be verified on a case-by-case basis. 

Evaluation by a professional structural engineer and 

consulting with the manufacturer is recommended. This 

recommendation extends to all grain bins, including those 

post-2018. Engineering valuation for safely 

accommodating a lifeline and anchor point system is 

essential for bins that are modified, damaged, or have 

other signs of degradation. The research team developed 

inspection guidelines to assist professional engineers 

during their evaluation. Educational efforts will focus on 

technologies and best practices that can reduce the need 

for grain bin entry. This presentation will provide an 

overview of the research approach, recommendations on 

grain bin inspections for anchor points and lifeline 

systems, and the use of emerging technologies and best 

practices to reduce the need to enter grain bins.

Aims/Learning Objectives: 1. Understand the limitations of 

the ANSI/ASABE S64 – Grain Bin Access Design Safety 

standard. 2. Understand the need for inspection criteria 

for new and older grain bins prior to equipping with a 

lifeline and anchor point system. 3. Understand available 

technology and best practices to reduce the need for 

individuals to enter grain bins.

B4.2

Title: Epidemiology of Diving-Related Fatalities in the 

U.S. Commercial Fishing Industry 

Authors: Samantha Case, Richard Evoy

Introduction: Commercial fishing involves harvesting fish 

or shellfish using a variety of methods, gear, and vessels. 

Some commercial fishermen conduct dives to collect 

different species such as urchin, sea cucumber, and 

lobster. Additionally, some fishermen conduct unplanned 

dives to perform tasks at sea like clearing a fouled 

propeller. Dive training and certification are generally not 

required in the commercial fishing industry. Commercial 

fishing is the most dangerous job in the United States, 

with a work-related fatality rate over 40 times higher than 

the average job. A study of commercial fishing fatalities by 

Lucas and Case (2017) indicated there were 34 total diving 

fatalities in the industry nationwide during 2000-2014, 

and while not a leading contributor to fatalities among 

fishermen, Alaska dive harvesters had one of the highest 

fatality rates across all fleets during this period. Additional 

information on these incidents, such as specific 

characteristics of the dives, divers, or health risk factors, 

has not been published. The purpose of this study was to 

provide in-depth information about the circumstances of 

dive-related fatalities to identify safety and health risk 

factors and suggest relevant prevention strategies.

Methods: This study used data from the NIOSH 

Commercial Fishing Incident Database (CFID) to 

examine diving-related fatalities in the U.S. fishing 

industry. CFID is a surveillance system that contains 

detailed information on work-related fatalities among 

commercial fishermen. Information about diving-related 

fatalities was extracted from CFID and descriptive 

statistics were used to explore the circumstances 

surrounding diving fatalities and contributing factors. 

Safe diving practices from recreational and commercial 

diving sources were identified to determine their use in 

these incidents.

Results: Preliminary findings show that during the 20-year 

period 2000-2019, there were 42 diving-related fatalities in 

the commercial fishing industry. These fatalities most 

often occurred on the East Coast (28.6%), Gulf of Mexico 

(26.2%), and Alaska (23.8%). The average age of victims 

was 42.3 years (22-67 years) and all victims were male. 

Cause of death was most frequently drowning (78.6%), 

followed by arterial gas embolism (11.9%), carbon 

monoxide exposure/poisoning (4.8%), and one case each 

of cardiac arrythmia and oxygen toxicity. Most fatalities 

occurred while dive harvesting (73.8%), with the 

remaining deaths occurring during unplanned dives. 

Drugs and/or alcohol were contributing factors in seven 

cases (16.7%). Fourteen victims (33.3%) had pre-existing 

health conditions that may have affected their ability to 

dive safely, such as epilepsy, obesity, and coronary artery 

disease. Other variables that will be examined include 

diving method/air source used, dive depth, water 

conditions, and administered treatments.

Conclusions: Diving best practices include training and 

certification, using proper dive gear, inspecting and 

maintaining gear and equipment, conducting pre-dive 

briefings, diving with a partner and/or tender, monitoring 

sea and weather conditions, and planning for emergency 

situations. Many of these best practices were absent from 

the dive operations that resulted in fatalities. Further, 

diving is physically demanding and requires good 

respiratory and circulatory health. Chronic health risk 

factors were identified among many of the victims. Based 

on these findings, researchers, the US Coast Guard, 

fishing associations, and marine safety trainers can work 

with fishermen who dive to increase their awareness of 

dive-related hazards and adoption of safe diving practices.
2022 NATIONAL OCCUPATIONAL INJURY RESEARCH SYMPOSIUM 49

B4.3 

Title: Slips, Trips and Falls in the Pacific Northwest Commercial 

Fishing Industry

Authors: Laurel Kincl, Amelia Vaughan, Solaiman Doza, 

Samantha Case, Viktor Bovbjerg

Objective: Unique slip, trip and fall hazards on commercial 

fishing vessels result in injury and are preventable. The 

deck of a vessel may be in constant motion, slippery, 

uneven, and filled with gear and equipment needed for 

the fishing. There are also ladders and steps to other levels 

on a vessel, and fish holds with hatches in the deck. While 

working on deck, such hazards can potentially result in a 

fall overboard or on deck. We examined both fatal and 

nonfatal data from our Risk Information System for 

Commercial (RISC) Fishing database to identify factors 

related to slips, trips and falls, and to inform prevention 

opportunities in the US Pacific Northwest fleets.

Methods: Commercial fishing nonfatal and fatal 

information for 2000-2018 was obtained for Oregon and 

Washington waters from the RISC Fishing database, an 

ongoing injury surveillance project in the Pacific 

Northwest. Using the Occupational Injury and Illness 

Classification System (OIICS) event codes adapted in our 

commercial fishing surveillance (Division 4 for falls, slips, 

trips) and Incident type (Fall overboard), we identified 

relevant cases and summarized incident narratives, work 

process codes and worker information.

Results: Among 245 nonfatal injuries and 93 fatalities 

involving commercial fishermen in Oregon and 

Washington from 2000-2018, we found 44 (18%) nonfatal 

injuries and 18 (20%) fatalities related to slips, trips or 

falls, including falls overboard. For the nonfatal injuries 

reported, more than half (55%) took place on the deck 

(n=24) while others were inside the vessel (n=6, galley, 

engine room and bunk), on the outrigger (n=6), or coded 

as unknown. Half of the nonfatal injuries involved 

deckhands or processors, and 68% involved a fall. The 

nonfatal cases were distributed across a variety of work 

tasks, with the greatest number associated with traffic on 

ladders/stairs with 10 cases, followed by traffic on deck 

with 4 cases. From the incident narratives, we identified 

slips & spills, ladders & stairs, poor housekeeping, and 

open hatches as common hazards for nonfatal injuries. 

One fatality was an onshore injury involved a fall from a 

dock resulting in a drowning. Seventeen falls overboard 

resulted in fatalities, among deckhands (71%) and 

owner/operators (29%). None of the fall-overboard 

victims were wearing personal flotation devices. The 

majority of the falls overboard were a result of a trip/slip 

or loss of balance (35%) followed by knocked by gear or 

gear entanglements (29%), while four were due to 

unknown circumstances. The Dungeness crab fishery 

accounted for the most fall overboard fatalities (n=7) with 

tuna, cod, salmon and eel accounting for 1 to 3 fatalities 

each. The most common contributing factor for the fall 

overboard fatalities was being alone (n=7).

Conclusion: Slips, trips, and falls are important 

contributors to both fatal and nonfatal injuries in Pacific 

Northwest commercial fishing. In developing hazard 

assessments from the RISC Fishing database, the 

prevalent events leading to injury, including slips, trips 

and falls, were the focus. While different factors may 

result in a fall on deck or fall overboard, addressing 

common hazards may mitigate the risk of falls or loss of 

balance. Due to the varying factors related to slips, trips 

and falls on commercial fishing vessels, we developed 

different Hazard Sheets, which are being disseminated 

through social media and regional training of fishermen. 

Future outreach to promote personal flotation device use 

in the Pacific Northwest fleets can feature the slip, trip, fall 

prevention resources and measures. Nationally, further 

efforts to prevent injuries and fatalities due to slips, trips 

and falls in commercial fishing must be undertaken.

Session C1

NIOSH Fatality Investigations

Moderator: Jeffrey Funke

C1.1 

Title: Case Study: One Firefighter Dies and Another Injured 

in High Pressure Natural Gas Line Explosion – NIOSH 

Fire Fighter Fatality Investigation and Prevention Program

Author: Karis Kline-Field

Introduction: The National Institute for Occupational 

Safety and Health Fire Fighter Fatality Investigation and 

Prevention Program (FFFIPP) conducts independent 

investigations of select firefighter line-of duty deaths 

(LODDs) to identify and define contributing factors, 

recommend ways to prevent future fatalities and injuries, 

and disseminate prevention strategies to the fire service.

In July 2018, NIOSH investigated an incident in which a 

34-year-old paid-on-call/volunteer fire captain died, and 

another firefighter was injured, in a building explosion 

while responding to a report of a natural gas leak. This 

investigation revealed unique hazards that natural gas 

leaks pose to firefighters, as well as several best practices 

that fire departments can consider when developing 

standard operating guidelines and training. The findings 

highlight the benefits of unified training, community 

engagement and education, and assessing risk versus gain 
2022 NATIONAL OCCUPATIONAL INJURY RESEARCH SYMPOSIUM 50

when determining fireground strategies during similar 

incidents.

Methods: The NIOSH FFFIPP conducts LODD 

investigations with cooperation from fire departments, 

labor organizations and other investigative entities. 

Investigators collect agent, host, and environmental 

information about the pre-event, event, and post-event 

phases of the fatal incident. For this case, investigators 

interviewed crews from the fire departments that had 

responded to the original emergency call, along with the 

police crews, EMS, and the dispatchers who were on shift 

during the LODD event. The investigators also conducted 

a site visit to document and understand the scene’s layout. 

At the time of the investigation, much of the cleanup from 

the blast had already begun; however, the entire area was 

fenced off and entrance was monitored. Investigators also 

gathered documents from the fire department, including 

relevant standard operating guidelines and firefighter 

training documentation. The information collected was 

evaluated to identify contributing factors and 

recommendations aimed at controlling each factor. A 

narrative report describing the incident, contributing 

factors, and recommendations was developed. This report 

was developed with fire service subject matter expert 

input and disseminated via the FFFIPP web page, the 

FFFIPP listserv, and through messages on the NIOSH 

social media pages.

Results: NIOSH investigators identified several factors that 

contributed to the July 2018 LODD. The best practices 

identified for the fire service when responding to high 

pressure natural gas incidents include ensuring 

continuous situational awareness, using a risk versus gain 

analysis, and completing regular combined training with 

utility professionals and community building managers. 

This investigation found that civilians who were dining in 

nearby restaurants lingered on-scene despite fire 

department orders to evacuate, resulting in crews 

remaining in the “hot zone” longer than necessary and 

potentially exposing them to life threatening danger. 

Therefore, investigators also emphasized the importance 

of community education.

Conclusions: Utility emergencies present a unique set of 

hazards, and it is every responder’s responsibility to 

continuously size-up the scene and report changes to 

incident command. Utility employees should be involved 

in controlling leaks and included when developing 

standard operating guidelines. Fire departments should 

engage in pre-incident planning, including coordination 

with affiliate agencies (EMS, police, and community 

emergency managers.) Incident Commanders should 

continuously evaluate the risk versus gain when making 

operational decisions during evacuation operations. 

Finally, Fire Departments should ensure that their 

members are provided training in the latest tactics for 

responding to hazardous materials situations.

C1.2 

Title: Fatality Assessment and Control Evaluation (FACE) 

Program – Law Enforcement Officer Struck-by Fatality 

Investigations

Authors: Melanie Fowler

Introduction: There are more than 750,000 state and local 

law enforcement officers (LEO). These officers face many 

job hazards, including physical exertion, psychological 

and organizational stressors, and various other risks to 

health and well-being. In the last 10 years, on average, one 

officer per week was killed on our nation’s roads. Most 

years, motor vehicle-related incidents — crashes and 

being struck by moving vehicles while on foot — are the 

leading cause of death for officers. From 2010-2019, there 

were 1,558 officer line-of-duty deaths. Of that total, 393 

officer line-of-duty deaths were due to vehicle crashes 

(25% of total), and 132 officer line-of-duty deaths were 

due to being struck by a vehicle (8% of total). Although 

LEO fatalities from motor vehicle incidents are common, 

detailed information pertaining to these incidents is not 

routinely analyzed for prevention purposes.

Methods: The National Institute for Occupational Safety 

and Health’s (NIOSH) Fatality Assessment and Control 

Evaluation (FACE) Program investigates LEO line-ofduty deaths (LODD) due to motor vehicle events. The 

goal of the FACE program is to prevent occupational 

fatalities by identifying work situations involving high risk 

for injury, investigating fatalities that occur in those 

situations, and formulating and disseminating prevention 

strategies to those who can intervene in the workplace. 

Following the public health model, the NIOSH FACE 

Team works with the fallen officer’s department and other 

agencies at the municipal, state, and federal levels to 

investigate motor-vehicle LODD. Information is collected 

on the incident circumstances using a standardized 

procedure, including interviews with witnesses and 

department officials as well as review of medical 

examiner, police, and crash reconstruction reports. Agent, 

victim, and environmental information is evaluated to 

identify contributing factors and develop prevention 

recommendations. A report describing the event, 

contributing factors, and ‘lessons learned’ is published on 

the NIOSH Law Enforcement Officer Motor Vehicle 

Safety web page and the NIOSH FACE web page for 

access by police departments, officer organizations, and 

safety and health researchers.
2022 NATIONAL OCCUPATIONAL INJURY RESEARCH SYMPOSIUM 51

Findings: In 2013, a Sergeant was fatally injured when he 

was struck by a motorist while investigating several motor 

vehicle crashes on an interstate highway. In 2014, a police 

officer died when he was struck by a motorhome while 

assisting with traffic control. In 2015, a Trooper was 

struck by a vehicle while investigating a crash on an 

interstate highway. Among the three struck-by 

investigations, the identified contributing factors 

included: distracted motorists, poor visibility, positioning 

of patrol units, LEOs decreased situational awareness.

Conclusions: Findings from these investigations help us 

understand the risks LEOs face and identify ways to 

prevent similar LEO deaths. These investigations led to 

several prevention recommendations such as: 1) public 

awareness campaigns to inform motorists of the risks that 

law enforcement officers face while operating along the 

roadside and the need to follow “Move Over” laws; 2) law 

enforcement officers and emergency responders should 

work in a safe area within an established temporary traffic 

control zone and maintain situational awareness; 3) 

develop a standard operating procedure that includes 

guidance on how to properly establish a temporary traffic 

control plan; 4) position patrol units and other emergency 

vehicles as they arrive on-scene to maximize the protected 

work zone for the emergency responders; 5) wear an 

American National Standards Institute (ANSI)-approved 

high visibility safety vest; and 6) understand the incident 

command structure.

Session C2

Occupational Safety During the COVID-19 Pandemic

Moderator: Lisa Steiner

C2.1 

Title: How COVID-19 Changed Law Enforcement: Voices 

from Those Who Serve

Author: Yoon-Sung Nam

Background/Introduction: The unique challenges 

introduced by COVID-19 have significantly disrupted 

daily operations as law enforcement agencies struggle to 

strike a delicate balance between serving the community 

and protecting their workforce. The health and wellness 

impact from the sudden disruption of COVID-19 remains 

relatively unknown and may have lasting consequences 

yet to be identified. This pilot study sought to identify and 

discuss the impact of COVID-19 on law enforcement.

Methods: A total of 37 civilian and sworn personnel were 

purposively sampled from two large urban law 

enforcement agencies. Interviews followed a semistructured interview guide exploring COVID-19 workrelated issues. Inductive coding and thematic analysis 

were applied to qualitative data.

Results/Findings: Preliminary themes are: (1) COVID-19 

protocols impacting services; (2) Personal concerns 

regarding COVID-19; and (3) Fears of infecting those at

home. The first theme describes how COVID-19 

protocols have unintentionally created barriers including 

inability to efficiently interview victims of violence, new 

challenges of managing outbreaks in close-quarter 

detention centers, and unique modifications of Personal 

Protective Equipment that doesn’t restrict movement 

during the response to violent events. The second theme 

discusses respondents’ personal concerns about COVID19 and how it influenced responses to potential exposures. 

Some respondents were highly concerned about their risk 

of infection while others were undeterred and carried out 

service unbothered. Varying responses to safety 

workplace protocols ranged from, “think you are crazy if 

you clean your desk” to “officers aren’t concerned about 

having contact.” The third theme highlights the fears of 

constant exposure to COVID-19 and unknowingly 

infecting their children and elderly parents.

Discussion/Conclusion: This pilot study identifies obstacles 

experienced by law enforcement during COVID-19 that 

have brought changes in public interactions and services. 

Findings can aid in developing strategies to promote the 

safety of this unique workforce during pandemics. This 

pilot study highlights the exploratory themes to generate 

future hypotheses and inform interventions in response to 

the global pandemic. In conclusion, this study shows how 

COVID affects every job position differently. As such, law 

enforcement agencies must respond in a variety of ways to 

meet unique needs of the workforce.

C2.2 

Title: COVID-19 Perceptions and Practices Among Agricultural 

Producers and Stakeholders: The Need for Tailored 

Communication Campaigns

Authors: Josie Rudolphi, Courtney Cuthbertson, 

Jesus Natividad Sarol, Amandeep Kaur

Introduction/Background: The COVID-19 pandemic has 

required mass engagement in protective behaviors such as 

social distancing, wearing face masks, and frequent hand 

washing to curb the spread of the potentially fatal virus. 

Several factors may increase risk of COVID-19 among 

people in agricultural occupations, including that 

agriculture has been deemed essential and social 

distancing is not always possible. This study aimed to 

identify homogeneous groups of agricultural producers 
2022 NATIONAL OCCUPATIONAL INJURY RESEARCH SYMPOSIUM 52

and stakeholders based on their perceptions of 

effectiveness and use of COVID-19 protective behaviors 

and demographic and health characteristics that are 

associated with these groups.

Methods: We conducted an online survey of agricultural 

producers and stakeholders (N= 1,432) from April to July 

2020 through Qualtrics. Participants were recruited from 

agricultural interest groups. Producers and stakeholders 

responded to 7 statements about COVID-19 protective 

behavior effectiveness on a 3-point Likert scale (not, 

somewhat, very effective), and 7 statements about 

participation in COVID-19 protective behaviors in the 

previous two weeks on a 5-point Likert scale (never, 

rarely, sometimes, usually, always). These statements 

covered hand washing, disinfecting, refraining from 

touching face, covering when coughing, staying at home, 

social distancing and wearing face mask. Additional 

survey sections included demographics and health 

history. We performed separate latent class analysis 

(LCA) to identify clusters of farmers’ perceptions and 

practices of COVID-19 related preventive measures based 

on their pattern of responses. Chi-square test was used to 

test the association of clusters of perceptions of 

effectiveness and practices of COVID-19 related 

protective measures. We also examined whether these 

clusters are associated with demographic variables such as 

sex, education, race, occupation, self-employment, age, 

residence, and health conditions using chi-square test.

Results: Based on model fit and interpretability of LCA 

models, we were able to determine 5 distinct clusters 

based on beliefs in effectiveness and 3 clusters based on 

use of protective behaviors in the past 2 weeks among 

respondents. The description and percentage of clusters 

based of beliefs in effectiveness of protective behaviors are 

1) universal believer (33%); 2) believer in protective 

behaviors for oneself (26%); 3) believer in protective 

behaviors towards others (16%); 4) moderate believer 

(17%); 5) skeptical of protective behaviors towards others 

(8%). For the clusters based on use of protective 

behaviors, these were high adherence (45%), moderate 

adherence (15%) and low adherence (40%). Majority 

(72%) of universal believers are highly adherent, majority 

(59%) of believers in protective behaviors for oneself are 

lowly adherent and higher percentages of believers in 

protective behaviors for oneself (50%), believers in 

protective behaviors towards others (44%) and moderate 

believers (54%) are moderately adherent. Those who are 

females, older, have serious heart condition and diabetes 

are more likely to be universal believers and highly 

adherent. Moreover, high adherence is more likely seen 

among those who live in urban areas, have chronic lung 

disease and moderate to severe asthma.

Conclusions: Results suggest varying level of adherence to 

recommended COVID-19 protective behaviors which are 

associated with perceived effectiveness of protective 

behaviors and several demographic and health 

characteristics. Public health campaigns that increase 

motivation or maintain motivation to comply with 

protective behaviors should be developed and 

implemented specific for agricultural populations.

C2.3 

Title: Response to the COVID-19 Pandemic in the Construction 

Industry

Author: Douglas Trout

Background: The construction industry has among the 

highest percentage of COVID-19 related cases and rates of 

death among workers of all industrial sectors. There are 

several factors leading to a disproportionate impact of 

COVID-19 on construction workers. Construction work 

continued “in-person” in many jurisdictions during 2020 

and 2021, putting workers at greater risk of infection from 

SARS-CoV-2. Construction work often requires personto-person interaction, making social distancing difficult. 

While many construction projects are outside, work 

commonly occurs indoors where ventilation may be 

inadequate. Over 90% of construction firms in the U.S. 

employ 20 or fewer employees; small businesses, with 

limited resources, face challenges from traditional safety 

and health hazards and emerging hazards such as 

COVID-19. Construction workers include persons at 

greater risk for severe COVID-19 illness. In addition to 

the traditional hazards, the construction industry has 

important challenges related to mental health issues 

(including suicide) and substance use disorders (including 

opioid use disorder). The challenges presented by the 

COVID-19 pandemic has presented a convergence of 

factors significantly exacerbating suicide risk and opioid 

use among construction workers.

Methods: The NIOSH Construction Program leadership 

worked directly with the CDC COVID-19 Response 

structure, and specifically with the NIOSH Worker Safety 

and Health Team, on construction-related issues related 

to the pandemic. The Construction Program leveraged 

existing initiatives and developed others in collaboration 

with partners and stakeholders, including the OSHA 

Directorate of Construction, to respond to the challenges 

presented by the pandemic. The Construction Program 

also continued and increased ongoing collaborations with 

CPWR—The Center for Construction Research and 

Training.

Outputs/Results: Many research, training, and service 

activities were performed including the following: --
2022 NATIONAL OCCUPATIONAL INJURY RESEARCH SYMPOSIUM 53

Several Data Reports, such as Construction Employment, 

Businesses, and COVID-19 Vaccinations During the 

Pandemic in 2021 to help improve and focus ongoing 

vaccination efforts U.S. --A series of newly developed 

interactive data dashboards regarding COVID-19 

vaccination data relevant to the construction workforce. --

More than 25 live COVID-19 webinars were held in 2020 

and 2021 for all stakeholders in the construction industry; 

the webinars are now available on demand. --The 

COVID-19 Resources web page for training, education, 

and research initiatives and resources. The resources 

include the COVID-19 Construction Clearinghouse 

which is a central resource for construction employers 

and workers to find the latest research, guidance 

documents, training materials, and other resources. -The 

Office developed guidance and checklists. --Stakeholders 

and partners published manuscripts in peer reviewed 

journals. Newly developed collaborations and initiatives 

included: --Initiation of the NORA Construction Sector 

Council COVID-19 Workgroup, composed of a wide 

range of stakeholders and launched in May 2020 to 

discuss challenges and share solutions/innovative 

approaches related to COVID-19 and the construction 

industry. --Participation in the NIOSH COVID-19 

Intergovernmental Personnel Act (IPA) Agreement. This 

program was developed by NIOSH leadership to support 

(and develop new) extramural partnerships to increase the 

national capacity to assist employers, workers, and public 

health officials.

Discussion: This presentation will describe proactive steps 

being taken by the NIOSH Construction Program and its 

partners to address and minimize the ongoing risks and 

future challenges posed by the COVID-19 pandemic in 

the context of many traditional construction safety and 

health hazards.

Session C3

Emerging Protective Technology in Construction

Moderator: Justin Haney

C3.1 

Title: Effects of Wearing Unpowered Upper and Lower Body 

Exoskeletons on Visual Attentional Performance During 

Simulated Overhead and Squatting Peg-in-Hole Tasks

Authors: HeeSun Choi, Daniel Liebman, Daxton Mitchell

Background/Introduction: Rapid technological advances 

have allowed many workplaces to utilize emerging 

technologies, such as exoskeletons and wearable robots, to 

improve worker performance and safety. Exoskeletons 

enhance the wearer’s physical strength and endurance and 

assist people with load carriage and repetitive movement. 

Exoskeletons provide great potential for reducing fatigue 

and work-related musculoskeletal disorders. Despite the 

apparent benefit of exoskeletons on physical and 

physiological health and safety, there is limited 

understanding of how this assistive and augmenting 

technology may affect our cognitive performance. Only 

limited research investigated the precise effects of wearing 

exoskeletons on the wearer’s cognitive performances.

Objectives: The current study focused on the effects of 

wearing exoskeletons on the wearers’ attention. Attention 

allows us to perform everyday activities and job tasks and 

detect and avoid potential hazards. Thus, decrements in 

attentional functions have critical impacts on workers’ 

safety. Specifically, this study aimed to examine the effects 

of wearing an unpowered shoulder or leg exoskeleton on 

visual attentional task performance during peg-in-hole 

tasks requiring maintaining an overhead or squatting 

posture. 

Methods: A total of 31 participants completed a series of 

peg-in-hole tasks, during which they also completed a 

secondary cognitive task involving visual target detection. 

The participants completed two types of peg-in-hole 

tasks, overhead and squatting, and each task was 

completed once with an exoskeleton worn and once 

without. Only fifteen participants were able to complete 

the entire experiment. The participants wore an upperbody exoskeleton (Levitate AIRFRAME) during the 

overhead task and a lower-body exoskeleton (SuitX LegX) 

during the squatting task. The secondary visual attention 

task was administrated using a Head-Mounted Display 

(HMD) augmented reality headset, Hololens2. Visual 

stimulus (e.g., flashing light) was presented in a visual 

field at varying locations and visual eccentricities (i.e., 

angles). The accuracy and reaction time of responses to 

the visual targets were measured.

Results: A repeated-measures ANOVA was conducted to 

compare performance on the visual attention task 

between with and without wearing an exoskeleton and 

between during overhead and squatting peg-in-hole tasks. 

The reaction time results showed there was no main effect 

of exoskeleton condition nor task condition. However, 

there was a significant interaction of exoskeleton and task 

conditions, F(1, 14) = 5.35, p < .05, η2 = .28. The reaction 

time was faster when wearing an exoskeleton (M = 723.46, 

SD = 79.48) compared to the performance without an 

exoskeleton (M = 744.64, SD = 90.37) during the 

overhead task, p < .05, but not during the squatting task. 

Although accuracy measure did not present significant 

differences, there was a trend showing accuracy was 

higher when wearing an exoskeleton (M = .81, SD = .08) 

compared to performance without an exoskeleton (M = 
2022 NATIONAL OCCUPATIONAL INJURY RESEARCH SYMPOSIUM 54

.78, SD = .10) during the overhead task, whereas accuracy 

was comparable with an exoskeleton (M = .74, SD = .16)

vs. without an exoskeleton (M = .75, SD = .16) during the 

squatting task.

Discussion: The current results suggest that an exoskeleton 

may affect attentional task performance while assisting 

the wearer’s physical task performance. Interestingly, the 

effects of wearing an exoskeleton on cognitive 

performance may differ with different types of physical 

demands or exoskeletons assisting such tasks. The 

differential effects may attribute to the fit or comfort of an 

exoskeleton or the levels of physical task demands that 

may determine the benefits of an exoskeleton. The 

findings contribute to understanding how worker assistive 

technologies affect workers’ cognitive performance, which 

has significant implications for preventing worker injury 

risks and improving workplace safety.

C3.2 

Title: Suspension Systems with Air-Bubble Cushioning Liner for 

Improved Shock Absorption Performance of Type I Industrial 

Helmets

Authors: Chris Pan, Bryan Wimer, Mahmood Ronaghi, 

Mathew Hause, John Wu

Background: Many epidemiological studies suggest that 

work-related traumatic brain injury (WrTBI) is thought 

to be one of the most serious injuries among construction 

workers. The industrial helmet (IH) is the most common 

and effective personal protective equipment (PPE) to 

reduce WrTBIs. A traditional IH has a belt-type strap 

suspension system, which helps absorb and evenly 

redistribute the impact shock. Air-bubble cushions (ABC) 

have been used to reduce contact stress or to absorb small 

impact force in the contact interface between the human 

head and an impact surface. It is proposed in the current 

study that the application of the air-bubble cushions in 

traditional IHs would help improve their performance. 

The objective of this study was to test if ABCs can be used 

to improve the shock absorption performance in Type I 

IH. 

Methods: IH impact tests were performed according to the 

Type I impact protocol as outlined in the ANSI Z89.1 

standard. A drop tower test machine was used in the tests. 

The IH was fixed on an aluminum headform. An 

aluminum impactor was dropped, in a guided rail, from a 

predetermined height to impact onto the IH at the top of 

the crown. The transmitted impact forces were measured 

via a force sensor installed between the base plate and the 

headform. The accelerations of the impactor were 

collected via a single axial accelerometer installed near the 

impactor’s mass center. Both force and acceleration data 

were collected at a sampling rate of 25 kHz. The velocity 

of the impactor immediately before impact was measured 

via an optical sensor in the drop tower. Typical off-theshelf IHs from a manufacturer were used in the study. The 

IHs were randomly assigned to one of two test groups. 

IHs tested in Group I were unmodified and served as the 

control group. IHs in Group II were equipped with ABC. 

The effect of ABC on the IH’s shock absorption 

performance was evaluated by comparing these two test 

groups. Commercially available ABC sheets were used for 

the cushioning liner. In a natural, undeformed state, an 

individual air bubble had a diameter of approximately 9 

mm and a height of approximately 4 mm. The ABC liner 

was made of two layers of ABC wrap sheets, with their 

bubble sides placed against each other. Drop impact tests 

were performed at six drop heights. Four replications 

were performed for each of the tests in both Group I and 

II. 

Results/Discussion: Results show that the effects of ABCs on 

the shock absorption of IHs is dependent on the impact 

magnitude. At lower drop heights, h<1.63 m, adding an 

ABC did not reduce the impact force for a typical IH with 

a strip-type suspension system. The effects of the ABC on 

shock absorption were only seen at higher drop height, 

h≥1.73 m. At the highest drop height, 1.93 m, as tested in 

the study, adding ABCs to a typical Type I IH reduced the 

peak impact force magnitude by over 80%. Results also 

show that the endurance of a typical IH under repeated 

impacts was improved substantially by adding an ABC 

liner. A typical IH can be subjected to repeated impacts of 

a drop height of 0.61 m without compromising its shock 

absorption performance. When the IHs are equipped with 

ABC liners, this number increased from 0.61 m to 1.52 m. 

Using a concept of an IH endurance limit for repeated 

impacts, adding an ABC liner helped increase the IH’s 

shock absorption performance by 145%. In summary, 

adding an ABC liner to a basic Type I IH will substantially 

increase the shock absorption performance for large 

impacts and increase its endurance limit for repeated 

impacts. These findings can help helmet manufacturers 

improve their IH designs, thereby reducing WrTBIs.

C3.3 

Title: Characterization of Shock Absorption Performance of 

Construction Helmet in Top Impacts 

Authors: Chris Pan, Bryan Wimer, John Wu

Background: Work-related traumatic brain injury (WrTBI) 

is one of the most common occupational injuries among 

construction workers, resulting in extensive medical care 

and rehabilitation, multiple days away from work, 

permanent disability, or death. Multiple construction 
2022 NATIONAL OCCUPATIONAL INJURY RESEARCH SYMPOSIUM 55

industry trades have been identified as being at the 

greatest risk for an occupational fatality caused by impactrelated head injuries. Presently, construction helmets are 

considered the most common and effective personal 

protective equipment available to protect against WrTBI 

in the US construction industry. The Occupational Safety 

and Health Administration (2012) regulation requires 

that a helmet must be worn when working in areas where 

there is potential for injury to the head from falling 

objects. The purpose of this study was to develop an 

approach that could determine the performance 

characterization of a construction helmet. We 

hypothesized that the shock absorption performance of a 

construction helmet is dependent on the magnitude of the 

impact force or impact kinetic energy; specifically, the 

helmets’ shock absorption performance will decrease with 

increasing magnitude of the impact force or impact 

kinetic energy.

Methods: Impact force transmission tests of the helmets 

were performed using a commercial drop tower test 

machine, which complies with the ANSI Z89.1 standard. 

The drop tower consisted of a pedestal, a headform, linear 

bearing rail, drop carriage, drop impactor, and lift 

mechanism. The forces transmitted to the headform were 

measured using a force cell with a single axis in the 

impactor drop direction. The force cell was installed 

between the base of the tower and the headform. The 

acceleration was measured using a single axis 

accelerometer, which was installed at the mass center of 

the impactor. The impact velocity was measured at 

approximately 0.5 in (12.5 mm) before the impact via an 

optical laser velocity gate; the recording frequency of the 

gate was 25.6 kHz. The impactor had a mass of 3.6 kg and 

was semispherical with a radius of 48 mm at the striking 

face. According to ANSI Z89.1, an ISEA-certified 

headform was used. The headform was made of 

aluminum and has a mass of 3.64 kg. The force and 

acceleration data were collected at a sampling rate of 25 

kHz. A total of 31 drop impact tests, using a 

representative type I helmet model, were performed at 

drop heights from 0.30 to 2.23 m, which were estimated to 

result in impact speeds from 2.4 to 6.6 m/s. The timehistories of force were processed using a custom program 

developed using MATLAB software to find the maximal 

peaks, which appeared in the initial impact.

Results/Discussion: Based on our results, we identified a 

critical drop height that was used to evaluate the

performance of helmets. The peak impact forces and peak 

accelerations varied non-proportionally with the drop 

height. When the drop height was less than the critical 

height, both the peak force and peak acceleration 

increased gradually with increasing drop height. When 

the drop height was greater than the critical height, the 

peak force and peak acceleration increased steeply with 

even a slight increase in drop height. Based on the critical 

drop height, we proposed an approach to determine the 

safety margin of a helmet. The proposed approach would 

make it possible to determine the performance 

characteristics of a helmet and to estimate the safety 

margin afforded by the helmet if the helmet first passes 

the existing standardized tests. The proposed test 

approach would provide supplementary information for 

consumers to make knowledgeable decisions when 

selecting construction helmets.

Session C4

High-Risk Workers in Agriculture, Forestry and Fishing

Moderator: Miranda Dally

C4.1 

Title: Injury and Severity in Greenhouse and Nursery Workers: 

Using Data and Collaboration to Drive Prevention Through 

Engineering Design

Authors: Katherine Schofield, Abigail Clarke-Sather

Introduction: Greenhouse and nursery (GH&N) hazards 

may be similar to those in other agricultural sectors, but 

also include areas of highly mechanized operations, 

shipping and loading, dynamic buildings, and a sizable 

percentage of indoor working environments. Engineered 

controls to reduce risk of worker injury would be wellsuited for this work environment. Injury research and 

prevention priorities for GH&N establishments can be 

combined with curriculum-based undergraduate 

engineering capstone projects as a means to put researchinto-practice and assist workplaces, otherwise unable to 

dedicate resources, in reducing risk of worker injury 

through engineering design and innovation. The goal of 

this research was to ascertain injury rates in a GH&N 

population, evaluate comparative risk factors for injury 

and severity based on worker, job, and injury event 

characteristics, and determine areas of high injury 

prevention priority and engineering design feasibility for 

student projects.

Methods: Workers’ compensation (WC) and payroll data 

(2000-2017) calculated injury rates and determined risk 

factors for injury and severity based on worker, job, and 

injury event characteristics. Text fields were analyzed for 

details on circumstances surrounding injury. We 

recruited an industry partner and deployed an 

undergraduate mechanical engineering design team and 

faculty members to the host site. Hazards, challenges, and 

potential solutions were noted during multiple site visits. 
2022 NATIONAL OCCUPATIONAL INJURY RESEARCH SYMPOSIUM 56

Twenty-two employees were interviewed (English and 

Spanish) to determine their concerns and injury risk 

factors. Potential projects were evaluated on multiple 

factors and scoring criteria.

Results: Results indicate 61 establishments incurred a 

combined 1229 injuries with an overall injury rate of 4.9 

per $1million of payroll, 13.5% of which resulted in losttime. Workers under age 30 suffered 37% of all injuries; 

29% of injuries were to women. High-severity injuries 

involved: moving/loading trees, erecting/maintaining 

greenhouses, and material handling. Frequent injuries 

involved: hand tools, material-handling, hand-digging, 

lifting/moving equipment, and operation of motorized 

vehicles. Ergonomic, material handling, and lifting-related 

injuries caused the largest percentage of injuries (38%).

Tool and equipment-related causes resulted in 9% of total 

injuries. Two projects were selected to reduce the worker 

risks of repetitive hole-punching in hanging basket pots 

with unsafe equipment, and repetitive lifting and carrying 

methods of plant inventory movement on greenhouse 

tables over uneven surfaces and narrow walking paths.

The team designed, prototyped, and tested solutions 

specific to these problem areas, developing a greenhouse 

plant transport cart and a plant pot hole-puncher. The 

cart reduced physical demands and made loading easier.

Additionally, the cart allowed a greater number of plants 

(4-6 more) to be transported simultaneously. Together, 

these factors should improve navigation of walkways 

between tables and reduce risk of strain, trips, falls and 

contusions and lacerations caused by collision with tables. 

The hole-puncher eliminated electrical hazards, 

unguarded moving parts, and dust generation. The new, 

manual design improved ergonomic positioning and 

reduced force/grasp requirements, and reduced holegeneration from14 seconds to ~2 seconds. These design 

solutions are currently implemented into practice.

Discussion: The research provided a greater understanding 

of risk factors in GH&N workers. We were able to pilot an 

interdisciplinary approach to rapidly deploy and 

implement engineered intervention to reduce injury risk.

This methodology could be widely used and would be 

especially impactful in agricultural, high-risk, underserved, and/or small business establishments.

Additionally, site-specific engineering 

solutions/prototypes may have a wider industry 

translation to other agricultural or applicable operations.

C4.2 

Title: A Pilot Study of Personal Risk Factors Moderating the 

Relationship Between Occupational Heat Exposure 

and Injury Risk

Authors: Miranda Dally, Krithika Suresh, Mike Van Dyke, 

Kathy James, Lyndsay Krisher, Lee Newman

Background: Crop production is one of the most 

hazardous jobs in the agriculture, forestry, and fishing 

sector. Recent research suggests that for crop production, 

the number of daily recorded occupational injuries 

increases 3% for every 1°C in wet blub globe temperature 

(WBGT) beyond 30°C. Individual vulnerabilities such as 

preexisting or chronic health conditions, age, and 

immigration status can increase susceptibility to the 

adverse health consequences of ambient heat exposure. In 

this pilot study we examine how these vulnerabilities 

amplify the risk of occupational injuries in hot 

environments.

Methods: We obtained pre-employment health screening 

data, daily productivity data, and occupational injury logs 

from a large agribusiness in Southwest Guatemala for the 

2014 and 2015 harvest seasons. Meteorological data was 

obtained from a weather station centrally located near the 

harvest fields and daily mean and daily max WBGT were 

calculated. We used generalized linear mixed models to 

assess the association between WBGT measure and odds 

of injury at the daily, individual level. Stratified models for 

BMI < 18.5 and BMI ≥ 25, blood pressure ≥ 130/80 

mmHg, and both BMI ≥ 25 and blood pressure ≥ 130/80 

mmHg, and whether an individual smoked tobacco, 

consumed alcohol, or was in their first sugarcane harvest 

season were assessed.

Results: There were 4521 unique workers who were 

employed for the entirety of either the 2014 or 2015 

harvests. All workers were male over the age of 18. There 

were 84 (2%) of workers who had at least one injury 

recorded during the observation period. Overall, for each 

1°C in daily average WBGT the odds of injury increased 

1.8% (95%CI: -13%, 19%; p-value: 0.82). Stratified 

analyses suggest a differing effect between WBGT, and 

injury risk based on individual risk factors. For workers 

with either low or high BMI for each 1°C in daily average 

WBGT the odds of injury increased 25% (95%CI: -5%, 

64%; p-value: 0.11). For workers with high blood pressure, 

for each 1°C in daily average WBGT the odds of injury 

increased 22% (95%CI: -5%, 58%; p-value: 0.13). For 

workers with both high blood pressure and high BMI, for 

each 1°C in daily average WBGT the odds of injury 

increased 37% (95%CI: -2%, 92%; p-value: 0.06). New 

workers, and workers who reported either smoking or 
2022 NATIONAL OCCUPATIONAL INJURY RESEARCH SYMPOSIUM 57

alcohol consumption were less likely to be affected by 

increases in daily average WBGT. Results based on daily 

max WBGT were similar.

Discussion: While no results were statistically significant 

this pilot analysis provides valuable effect size estimates to 

power future studies. The results from this analysis 

suggest that personal risk factors may increase the 

vulnerability of crop producers in hot environments and 

should be incorporated into risk communication between 

employers and employees. There is a need to better 

understand these risk factors and the mechanisms for 

which increasing temperatures impact the risk of 

occupational injury among agricultural workers.

C4.3 

Timber-Safe – Reduction of WV Logging Hazards Through the 

Implementation of a Logging Operations Safety and Health 

Management System

Authors: Mark Fullen, Eric Lundstrum, Doug Myers, 

Wayne Lundstrum, Patrick Donnelly

Background: Logging is one of the most dangerous 

occupations in the United States. In 2018, workers in the 

logging industry experienced approximately 153 

workplace fatalities per 100,000 workers, which is 43.7 

times higher than the national average for all workers.

West Virginia loggers consistently have a fatal injury rate 

higher than the national rate. West Virginia’s 

mountainous terrain requires a much higher use of 

manual felling of trees as opposed to the safer mechanized 

timber harvesting equipment which is thought to be some 

of the cause for the higher fatality rate. West Virginia, 

along with many states and regions, has implemented 

safety certification and training programs for loggers with 

little to no impact on the fatality or injury rates. OSHA 

regulations, which are more stringent in logging 

compared to other industries have also not led to a 

reduction in injuries or deaths among West Virginia 

loggers. In this study, we evaluated a safety and health 

management system program for logging operations 

developed by researchers from West Virginia University. 

The program was designed to educate small, primarily 

family-owned West Virginia logging companies on the 

importance of truly implementing all aspects of a safety 

and health management program. The intervention 

included training all company employees on the safety 

and health management program, implementing the 

program, training a site auditor, and establishing a regular 

routine for gathering data on hazards and implementing 

controls. The site hazard audits are designed to gather 

evidence that can be used to determine whether known 

hazards that lead to injury and death have been reduced 

or eliminated following the intervention. Data collection 

is on-going but is approximately 85% complete. Here we 

report on preliminary findings.

Methods: An experimental design was employed; 31 

logging companies participated in the study. Data on each 

site were gathered via on-site safety audits every 9 weeks 

over a 108-week period (to date; data will be gathered 

through week 144). Half of the sites were randomly 

assigned at baseline to the experimental (n=16) and 

control groups (n=15). Experimental sites’ baseline data 

were gathered prior to implementation of the program. 

The control sites will receive the intervention (and followup measures) after a ‘control’ observation period, allowing 

all sites access to the tool and improving efficiency of the 

study analyses. Analysis of safety program 

implementation scores are presented for baseline (audits 

1-3) and intervention scores (audits 3-12); differences in 

scores were assessed via one-way repeated measures 

analysis of variance (ANOVA).

Results/Findings: Preliminary results show that both 

control and intervention safety intervention scores 

improved between baseline and intervention periods; 

intervention and control scores were not significantly 

different at baseline (p = 0.37). Post-intervention scores 

were higher for intervention companies (43.8%) than 

controls (36.4%) (p = 0.06). Data collection and analysis is 

ongoing.

Discussion/Conclusions: Though the present study is 

ongoing, preliminary results suggest intervention 

companies improved in their implementation of safety 

management programs compared to the control group. 

While this difference was outside of the traditional range 

of significance, further data collection and analysis may 

alter these results; ongoing analysis of pre- and postintervention field safety audit scores will further explore 

program effectiveness. Given the hazardous nature of the 

West Virginia logging industry, the improvements 

observed in participant companies are promising. 

Implications for further research and practice will be 

discussed.
2022 NATIONAL OCCUPATIONAL INJURY RESEARCH SYMPOSIUM 58

DAY 2: WEDNESDAY, MAY 11, 2022

Session D1

Advancing Surveillance Efforts to Improve EMS 

and Firefighter H&S Outcomes

Session Chair and Discussant: John H. Oates

This session was originally proposed by Lori MooreMerrell, who has since been appointed U.S. Fire 

Administrator. The newly appointed CEO for the 

International Public Safety Data Institute (IPSDI), John 

H. Oates, is now moderating this session to discuss 

cohesive and coordinated surveillance efforts at the local 

department, state, and federal levels to offer a 

comprehensive view of firefighter and EMS workers’ risks 

on the job. U.S. firefighters respond to a diverse range of 

medical and emergency incidents. Consequently, firebased Emergency Medical Service (EMS) responders have 

a dynamic, mobile workplace that contributes to 

additional job stressors, including burnout, fatigue, stress, 

reduced performance, and negative health and safety 

outcomes [1-5]. Recently, it has been argued that a 

primary barrier to improving firefighter and EMS worker 

safety, health, and wellbeing is the paucity of surveillance 

data at the national level [6].

Specifically, current surveillance systems capture different 

data points in diverse ways, each with nuanced 

exclusion/inclusion criteria [7-8]. National surveillance 

systems within firefighting include those overseen by the 

National Fire Protection Association, the International 

Association of Fire Fighters, the Bureau of Labor 

Statistics’ Census, and case data from NIOSH’s Fire 

Fighter Fatality Investigation and Prevention Program. 

Additionally, there are private entities (i.e., International 

Public Safety Data Institute [IPSDI]) as well as university 

research centers (i.e., the Center for Firefighter Injury 

Research and Safety Trends) that aim to support or 

conduct research that advances data collection and 

translation to support firefighter and EMS worker safety 

and health. Finally, individual computer-aided dispatch 

(CAD) systems are often unique to a municipality and fire 

departments often opt to collect and report varying 

information, usually based on the type of software system 

being used within a department. These varying systems 

make it difficult to collect accurate and timely 

information, much less be able to inform prevention 

efforts. 

The Centers for Disease Control and Prevention has 

discussed the availability of timely surveillance data as a 

primary goal in its future of work data modernization 

initiative. To this end, it is necessary to ascertain what has 

been learned through existing surveillance systems, 

efforts, and resulting data as well as what can be gleaned 

for future data modernization. This thematic session 

contains three presentations that collect, examine, and/or 

use existing datasets that stem from varying systems. The 

first presentation uses a reporting system led by the 

Center for Leadership, Innovation, and Research in EMS 

to address and describe the incidence and prevalence of 

workplace violence among three metropolitan fire 

departments. Free-text and categorical data were analyzed 

to describe perpetrator characteristics, mental and 

physical injuries, and risk factors. The outcome of this 

research showed support for other national data sources 

to collaborate on data collection of violence exposure 

data.

In the second presentation, results of data collected 

through the Fire Service Organizational Culture of Safety 

(FOCUS) beta-test survey will be reported using 

descriptive statistics and regression analyses. FOCUS is a 

psychometrically validated tool for the surveillance of the 

industry-specific safety climate of the US fire and rescue 

services. The last presentation illustrates how the 

Columbus Fire Department uses exposure surveillance at 

the incident vs. individual firefighter levels. Individual 

data collection allows more granularity and higher 

resolution, adding to the quality of the data. However, 

encouraging individual firefighters to consistently provide 

exposure information after an incident remains a primary 

barrier to the department’s application of their findings.

These presentations provide practical advancements in 

worker safety and health, elucidate gaps in current data 

surveillance, and how improvements in data 

modernization can benefit the public safety sector to 

proactively identify and mitigate job-related risks. 

Following the presentations, a discussion will be 

facilitated to help tie in the presentations and ensure any 

additional audience questions are answered by the 

presenters. 
2022 NATIONAL OCCUPATIONAL INJURY RESEARCH SYMPOSIUM 59

1. EMERG-ing Data - Multi-City Surveillance of Violence 

Against EMS Responders

Presenter: Jennifer Taylor, PhD

2. Descriptive Epidemiology of the Fire Service 

Organizational Culture of Safety (FOCUS) Beta-Test 

Data: Differences by Safety Climate

Presenter: Ashley M. Geczik, MPH

3. Firefighter Exposure Tracking: Challenges and 

Opportunities 

Presenter: David Bernzweig

Chair and Discussant: John H. Oates

References:

1. Walton, S.M.; Conrad, K.M.; Furner, S.E.; Samo, D.G. 

Cause, type, and workers’ compensation costs of injury 

to fire fighters. Am. J. Ind. Med. 2003, 43, 454–458.

2. Marsh, S.M.; Gwilliam, M.; Konda, S.; Tiesman, H.M.; 

Fahy, R. Nonfatal injuries to firefighters treated in U.S. 

emergency departments, 2003–2014. Am. J. Prev. Med. 

2018, 55, 353–360.

3. Lee, D.J.; Fleming, L.E.; Gomez-Marín, O.; Leblanc, W. 

Risk of hospitalization among firefighters: The 

national health interview survey, 1986–1994. Am. J. 

Public Health 2004, 94, 1938–1939.

4. Smith, T.D.; DeJoy, D.M.; Dyal, M.-A.; Pu, Y.; 

Dickinson, S. Multi-level safety climate associations 

with safety behaviors in the fire service. J. Saf. Res. 

2019, 69, 53–60.

5. Smith, T.; Hughes, K.; DeJoy, D.M.; Dyal, M.-A. 

Assessment of relationships between work stress, 

work-family conflict, burnout and firefighter safety 

behavior outcomes. Saf. Sci. 2018, 103, 287–292.

6. Maguire, B.J.; O’Neill, B.J.; Phelps, S.; Maniscalo, P.M.; 

Gerard, D.R.; Handal, K.A. COVID-19 Fatalities 

among EMS Clinicians. EMS. Available: 

https://www.ems1.com/ems-products/personalprotective-equipment-ppe/articles/covid-19-fatalitiesamong-ems-clinicians-BMzHbuegIn1xNLrP/ 

(accessed on 15 April 2021).

7. Butler, C.; Marsh, S.; Domitrovich, J.W.; Helmkamp, J. 

Wildland firefighter deaths in the United States: A 

comparison of existing surveillance systems. J. Occup. 

Environ. Hyg. 2017, 14, 258–270.

8. Estes, C.R.; Marsh, S.M.; Castillo, D.N. Surveillance of 

traumatic firefighter fatalities: An assessment of four 

systems. Public Health Rep. 2011, 126, 540–551.

D1.1 

Title: EMERG-ing Data – Multi-City Surveillance of Violence 

Against EMS Responders

Authors: Jennifer Taylor, Rozhan Ghanbari, Regan Murray, 

Andrea L. Davis

Background: Emergency Medical Service (EMS) 

responders deliver patient care in high-risk, high-stress, 

and highly variable scenarios. This unpredictable work 

environment exposes EMS responders to many risks, one 

of which is violence. While physical violence is captured 

in many national data systems, verbal violence is not. And 

there is no system that captures violence exposures 

(whether physical or verbal) when injury does not result. 

While prior research identified reasons why firefighters 

and EMS responders would not report violence, the 

degree of underreporting of violence and violence-related 

injury in EMS is unknown.

Objectives: To address reporting concerns and describe the 

incidence and prevalence of workplace violence in three 

large metropolitan fire departments, an existing data 

system, EMERG, led by the Center for Leadership, 

Innovation, and Research in EMS – was modified. The 

EMERG platform was selected because of its patient safety 

component. It has regulations tied to it that other data do 

not. We previously heard from first responders that they 

are hesitant to share their stories for a lot of different 

reasons including fear of retribution. EMERG is one of the 

most locked-down data capture systems that we could 

provide fire departments to ensure that their stories are 

taken seriously and affirm that they are submitting to a 

confidential source.

Results: Analysis of free-text and categorical data 

describing perpetrator characteristics, mental and 

physical injuries, and risk factors will be described. As an 

example, in one department, we saw quadruple the 

number of reports in six months to EMERG compared to 

previous surveillance we conducted using the first report 

of injury forms. Over one year of EMERG operation, we 

received 126 reports from all three departments. Patients 

were the most frequently reported perpetrator of violence 

(80%). The majority of violence occurred on scene (82%), 

with the most frequently reported places of assault as: 

ambulance (46%), street or highway (27%) and home or 

residence (25%). Sixty-two (62%) of violence was 

perceived to be committed intentionally. Additionally, 

83% of reports indicate that the EMS provider had no 

knowledge that the patient or location was potentially 

violent. The most frequently reported injury was 

emotional stress (70%). Occurrence of verbal and physical 

violence simultaneously was reported in 41% of cases, 
2022 NATIONAL OCCUPATIONAL INJURY RESEARCH SYMPOSIUM 60

followed by verbal violence only (40%) and physical 

violence only (19%). A closer look at the method of verbal 

violence revealed general verbal violence (68%), verbal 

violence using slurs and hate speech (45%), and graphic 

threats (39%) as the top three types.

Conclusion: The results from this reporting system can 

inform prevalence and incidence estimates of workplace 

violence in the fire and rescue service. This is one 

potential solution to the intractable problem of 

underreporting in occupational safety and health. 

However, in order to ensure useful surveillance, it remains 

likely that triangulation of multiple data sources will still 

be required to approximate the true burden. It would be 

helpful if other national data sources collecting violence 

exposure data collaborate to use the same data dictionary.

D1.2 

Title: Descriptive Epidemiology of the Fire Service 

Organizational Cultureof Safety (FOCUS) Beta-Test Data: 

Differences by Safety Climate

Authors: Ashley Geczik, Jin Lee, Andrea L. Davis, 

Joseph A. Allen, Jennifer Taylor

Background: Safety climate is one of the most pronounced 

upstream predictors of safety behaviors (e.g. safety 

compliance), organizational outcomes (e.g. burnout, 

engagement), and safety outcomes (e.g. injuries). The Fire 

Service Organizational Culture of Safety (FOCUS) survey 

measures the industry-specific safety climate of the 

United States fire and rescue service, which was 

psychometrically validated. It is expressed by two factors, 

Management Commitment to Safety and Supervisor 

Support for Safety. FOCUS is a well-utilized tool for the 

surveillance of fire service safety climate, having been 

administered in over 600 fire departments (60,000 

firefighters) with many departments administering 

multiple times.

Methods: The FOCUS beta-test is a random sample of 132 

fire departments stratified by Federal Emergency 

Management Agency region and their organization type 

(career, combination, volunteer). For our descriptive 

analysis the baseline sample was that of the beta-test data 

used in the psychometric validation (8,575 firefighters 

within 615 stations in 130 fire departments). After 

exclusionary criteria was applied, our analytic sample 

resulted in 8,414 individuals nested within 611 stations in 

125 fire departments--all of which had emergency medical 

services (EMS). The average response rate in the sample 

was 62.3%. We reported descriptive statistics to assess the 

distribution of all continuous (mean ± standard deviation 

(SD), range) and categorical variables (counts, 

percentages) stratified by organization type. These 

descriptive variables were collected at the individual and 

department level. Regression analyses were conducted to 

investigate the associations between safety climate, safety 

behaviors, and organizational outcomes by organization 

type. 

Results: The mean age was 40.2 years and the mean years 

of experience was 16.1 years. 1,406 respondents (16.7%) 

reported that they had experienced an injury in the past 

12 months prior to completing the survey. This sample 

included 53.6% career, 27.2% combination (career and 

volunteer), and 19.2% volunteer fire departments. The 

mean Management Commitment score was 71.4 and the 

mean Supervisor Support score was 81.7. The mean 

Management Commitment score varied between 

organizational types, implying a dose response 

relationship. The mean scores were 67.1 (±8.4), 72.2 

(±10.7), and 82.1 (±6.1), respectively for career, 

combination, and volunteer fire departments. The mean 

Supervisor Support score was not notably different by 

organization type. Regression analyses generally 

supported the beneficial role of safety climate, while 

suggesting organization type as a potential effect modifier. 

Specifically, departments with more volunteers tended to 

have weaker associations between safety climate and its 

potential outcomes. Overall, we observed that job 

satisfaction is associated with both Management 

Commitment and Supervisor Support for all organization 

types. 

Discussion: We investigated the descriptive statistics for 

125 of the participating fire departments, which reported 

data on EMS and fire response. Analysis of the nationally 

representative data from the fire service indicates that 

safety climate is indeed positively associated with safety 

behavior, safety outcomes, and organizational outcomes 

reflecting employee wellbeing. However, the findings 

suggest that the association may notably vary depending 

on organization type. Because FOCUS was designed, and 

has been used in a longitudinal fashion, it is a strong asset 

in the surveillance of fire service injuries and well-being 

outcomes. 

D1.3 

Title: Firefighter Exposure Tracking: Challenges and 

Opportunities

Author: David Bernzweig

Background: Firefighting is a dangerous profession with 

few jobs possessing a higher risk of job-related mortality 

(Maguire & Smith, 2013). While firefighter fatalities have 

decreased in the past decade, incidents have remained 

stable, indicating that current efforts are not enough to 
2022 NATIONAL OCCUPATIONAL INJURY RESEARCH SYMPOSIUM 61

improve health outcomes (Kahn et al., 2020). To that end, 

it is imperative to improve the consistency of data 

collection efforts to support policies and procedures that 

address the health risks of firefighting activities, including 

efforts to reduce exposures. One way to do this is to utilize 

pre-existing systems, such as the National Fire Operations 

Reporting System (NFORS) (Butry et al., 2019). NFORS 

automates real-time data collection through connection 

with pre-existing computer aided dispatch (CAD) systems 

to eliminate touch points, data entry duplication, errors, 

and the ability to link with the National Cancer Registry. 

This presentation discusses what the Columbus (OH) 

Division of Fire has learned by using such data systems as 

well as how we are trying to further leverage and promote 

individual firefighter participation in data surveillance 

activities.

Methods: The sophistication and recent adoption of 

mobile application (app) technology has presented an 

opportunity to revolutionize data collection and 

surveillance efforts in the workplace. Firefighters within 

the Columbus Division of Fire have been encouraged to 

download the NFORS Exposures Tracker Mobile App and 

document experiences encountered during emergency 

incident responses including possible exposures and types 

of personal protective equipment (PPE) worn. Although, 

in busier fire and rescue departments, it is likely not 

sustainable for firefighters to complete a response after 

every emergency incident response, there are times 

officers/managers should encourage participation such as 

when a possible exposure to SARS-CoV-2 or large fires 

with known carcinogens occur. This presentation explores 

trends that have been identified from thousands of 

incidents documented over the past few years including 

examples of dashboards that have been developed to 

guide decisions. We also discuss the difference in data 

quality, availability, and ease of collection at the 

department and firefighter levels.

Results: The Columbus Division of Fire has been able to 

make data driven decisions related to overdose responses, 

COVID-19, nighttime analytics, high demand EMS 

transport vehicles, and fire alarm responses. As a result of

using data to identify trends, the department has been 

able to reduce workload, improve response time and 

communication, predict busier times within certain 

communities in which we serve, and identify situations 

using hot spot mapping in which wearing PPE is an 

especially high priority. Some of these high-level results 

and dashboards are shared as case examples to support 

firefighter participation in data surveillance. These results 

have assisted with ongoing accreditation as well.

Practical Applications: This presentation shows that NFORS 

is an effective tool to observe worker risks in near real 

time and demonstrates that individual data [vs. incident 

level data] collection has a higher level of resolution. 

However, although mobile technology is convenient for 

personal tracking and data collection, the challenge of low 

response rate remains an issue. To this end, we 

consistently promote the documentation of exposures 

among our employees by making NFORS part of the 

narrative on the job and working with the fire chief and 

local union. Union stewards and officers have spoken 

about the importance of individual participation at each 

station. In summary, individual exposure data collection, 

even with the ease of electronic mobile applications, 

requires constant outreach and hands-on leadership to 

motivate firefighters. As lessons learned are shared, we 

will welcome feedback from others about new and unique 

ways to engage the workforce in such surveillance efforts.

Session D2

Occupational Stress and Work Organization

Moderator: Douglas Myers

D2.1 

Title: Passive Safety Leadership, Stress, Anxiety and Diminished 

Firefighter Safety Behavior Outcomes

Authors: Todd Smith, Mari-Amanda Dyal, 

Charmaine Mullins-Jaime, David DeJoy

Introduction: Passive safety leadership has been negatively 

linked to safety behavior outcomes. However, this 

relationship is not fully understood. Beyond safety 

climate, this research has not fully examined mediating 

factors or variables that may be influenced by passive 

leadership, which then influence safety behaviors. 

Research among firefighters in this context is particularly 

absent. As such, this study aims to examine the 

relationships between passive safety leadership, stress, 

anxiety, and safety behavior outcomes. 

Methods: This study used cross-sectional data from 742 

career firefighters and company officers. A path analysis, 

using Mplus, was completed to examine the hypothesized 

model and posited relationships between passive safety 

leadership, stress, anxiety and three safety behaviors, 

including compliance, personal protective equipment 

behaviors and safe work practices. Model fit was 

examined and paths were assessed for significance.
2022 NATIONAL OCCUPATIONAL INJURY RESEARCH SYMPOSIUM 62

Results: The hypothesized model fit was good (Χ2 = 

56.056, df = 7, p < 0.001; CFI = .95, RMSEA = .09, SRMR 

= .04). Posited relationships were confirmed. Passive 

safety leadership was positively, significantly associated 

with increased firefighter stress perceptions (β = .14, 

p<.001). Stress was positively, significantly associated with 

anxiety (β = .44, p<.001). Anxiety was negatively, 

significantly associated with all three safety behavior 

outcomes, including compliance behaviors (β = -.44, 

p<.001), personal protective equipment behaviors (β = -

.44, p<.001) and safe work practices (β = -.24, p<.001).

Conclusions: Passive safety leadership profoundly 

influences firefighter stress perceptions, which was 

associated with heightened levels of anxiety. Anxiety had 

significant negative influences on safety behavior 

outcomes. This study also underscores the importance of 

developing active leaders within the fire service to 

minimize leadership as a stressor and to control anxiety 

among fire service members as anxiety had detrimental 

influences on imperative safety behaviors necessary to 

protect firefighters from injury or fatalities.

D2.2 

Title: Safety Climate and Noncombat Injury Events Among 

United States Air Force Workers

Authors: Christina Socias-Morales, Melody Gwilliam, Emily 

Haas,Patrick Yorio, Cammie K. Chaumont Menendez, James 

Collins, Rachael Falcon, Nancy Delaney, Bruce Burnham, Heidi 

Stallings, David Stuever, Geoffrey Ewing, Stephen Stouder, 

Richard Soto

Background: Safety climate assessments can identify 

leading indicators to guide injury prevention efforts; 

however, few studies have examined the implications of 

safety climate over time across organizations for both 

military and civilian workers. The National Institute for 

Occupational Safety and Health (NIOSH) partnered with

the US Air Force (USAF) Safety Center to examine the 

association between perceptions of safety climate 

constructs and the occurrence of injury events.

Methods: Survey responses provided by USAF workers in 

maintenance, support, and operations occupations, as 

well as injury events (fiscal years (FY)2014-2018) were 

shared with NIOSH. The USAF administers voluntary, 

anonymous, occupation-specific safety climate surveys to 

USAF workers using the internal Air Force Combined 

Mishap Reduction System (AFCMRS, survey items 

publicly available: www.afcmrs.org). USAF unit leaders 

are invited to administer the survey among USAF civilian 

and military workers according to leadership priority. 

Exploratory factor analysis (EFA) was used to group 

individual survey questions into safety climate constructs. 

Noncombat, work-related injury events involving at least 

one worker documented within the Air Force Safety 

Automated System (AFSAS) were aggregated by squadron 

unit level and matched to squadrons with at least one 

squadron-wide survey administration. All injury events 

resulting in medical care beyond first aid are required to 

be recorded in AFSAS. Injury rates were calculated using 

the expected number of survey respondents as identified 

by leadership, for a given squadron. Using SPSS V. 25, 

researchers calculated bivariate correlations and estimated 

Rate Ratios (RRs) using negative binomial regression to 

examine the relationship between injuries and safety 

climate construct scores.

Results: A total of 1,547 squadrons administered the 

survey from FY14-18 with an average of each squadron 

administering the survey an average of 1.6 times during 

the study period (SD=0.92, minimum=1, maximum=12). 

On average, there were 144 workers/ squadron 

(SD=140.1, minimum=5, maximum=1,675) and the

average number of injuries during the 5-year period per 

squadron was 15.8 (SD=29.3, min=0, max=524). The EFA 

established the measurement of the following safety 

climate constructs on a 5-point Likert scale: Leadership 

and Communication (11 items), Overall Safety Climate (9 

items), Error Management (2 items), Resource Adequacy 

(4 items), and Deployment Safety (2 items). Higher safety 

climate construct scores were consistently correlated with 

decreasing number of injuries (p<0.001). Specifically, after 

controlling for the number of workers in squadrons, Rate 

Ratios (RRs) consistently revealed significant reductions 

in injury rates with each unit increase in safety climate 

perception: Leadership and Communication RR=0.40 

(95%CI: 0.32–0.48); Overall Safety Climate RR=0.50 

(95%CI: 0.40–0.64); Error Management RR=0.37 (95%CI: 

0.30–0.47); Deployment Safety RR=0.36 (95%CI: 0.29–

0.45). Resource Adequacy revealed a non-significant 

injury rate reduction RR=0.87 (95%CI: 0.73–1.04).

Conclusions: Squadrons reporting higher safety climate 

construct scores may be associated with lower injury 

events. To our knowledge, few studies have quantified 

safety climate over multiple years and examined the 

association with injury rates. Although safety climate 

measurements may be limited by frequent turnover and 

the self-reported, voluntary, anonymous nature of 

AFCMRS, the strength of this study lies in the census of 

injuries. We discuss potential intervention strategies, such 

as new programs, policies, and practices that could be 

adopted by the USAF using these results. Future research 

should include longitudinal analyses that track safety 

climate perceptions and injuries over a period of years 

and examine the impact of safety climate on injuries by 
2022 NATIONAL OCCUPATIONAL INJURY RESEARCH SYMPOSIUM 63

occupational groups and detailed injury circumstances, 

such as injuries related to falls, fatigue or body parts.

D2.3 

Title: Psychological Strains as Mediators of the Relationship 

Between the Work Environment and Work Injuries

Authors: Nathan Bowling, Naomi Swanson, Jeannie Nigam

Introduction: A large body of research has examined how 

various environmental conditions—including both work 

demands and resources—relate to psychological strains 

(Bakker & Demerouti, 2007). Widely studied 

environmental variables within this literature include role 

stressors (e.g., ambiguity and conflict; Bowling et al., 

2017), organizational constraints (Pindek & Spector, 

2016), and interpersonal conflict (Spector & Jex, 1998). 

Each of these environmental variables is related to various 

indicators of worker well-being, including psychological 

and physical symptoms. These indicators of well-being, in 

turn, may be directly related to work injuries. The current 

research uses a large archival dataset (N=>7,000) to test 

whether psychological strains mediate relationships 

between the work environment and work injuries.

Background: The possibility that psychological strains 

mediate the relationship between the work environment 

and work injuries is consistent with conservation of 

resources (COR) theory. In short, COR posits that people 

are motivated to maintain and grow their existing pool of 

psychological resources (Hobfoll, 1989). According to 

COR, the concept of “psychological resources” is 

inclusive—it comprises anything that a person either 

inherently values (e.g., healthy interpersonal 

relationships) or values because it can be used to acquire 

other resources (e.g., money). COR theory further argues 

that psychological strains occur whenever a worker either 

(a) is threatened with a future loss of resources, (b) 

experiences actual resource loss, or (c) fails to reap a 

resource gain he or she expected to achieve after a 

resource investment. Environmental variables may 

produce psychological strains via one or more of these 

three mechanisms. We expect psychological strains, in 

turn, to relate to work injuries. This may happen because 

managing strains diverts a worker’s attention, thus 

making accidents and injuries more likely. Significance: 

An understanding of the factors that predict work injuries 

can inform efforts to make work safer. Knowledge of 

which environmental factors relate to work injuries, for 

instance, could be used to guide planned changes to the 

work environment. Likewise, knowledge of which 

psychological strains relate to work injuries could provide 

insights into how organizations could leverage effective 

coping strategies as a means of reducing work injuries.

Method: The Quality of Work Life (QWL) Survey data 

were used to conduct the current analyses. The QWL, 

administered in five separate waves from 2002 to 2018, 

includes items assessing the nature of the work 

environment (e.g., “I have too much work to do 

everything well”), psychological strains (e.g., “How often 

do you find your work stressful?”), and work injuries (e.g., 

“In the past 12 months, how many times have you been 

injured on the job?”).

Results: Roughly 10.2% of QWL participants reported at 

least one work injury during the previous 12 months 

(mean number of injuries = .20). Contrary to our 

expectations, initial analyses indicate that the various 

environmental variables and psychological strains were all 

modestly correlated (rs < |.20|) with number of work 

injuries. Prior to the May 2022 conference, we will 

complete additional analyses to examine possible industry 

differences in the relationships among work environment, 

psychological strains, and work injuries. Industries that 

have a high potential for injuries may yield particularly 

strong predictor-injury relationships.

Discussion: A better understanding of the potential causes 

of work injuries can help guide organizational effects to 

improve worker safety and well-being. Although our 

initial analyses found that the variables assessed within 

the QWL are only modestly related to injuries, follow-up 

analyses that separately examine different industries may 

produce a pattern of results that more closely matches our 

predictions. 

Session D3

Understanding and Visualizing Recent Construction 

Safety and Health Trends

Moderator: Scott Earnest

The construction industry is one of the most dangerous 

industries in the United States. In addition to existing 

safety and health hazards in construction, emerging issues 

such as mental health, and opioids have had a major 

impact on the industry and require further examination to 

improve our understanding. This session will present 

important construction safety and health statistics on a 

variety of topics including fatal and severe injuries, mental 

health, and the impact of opioids. Presentations will 

highlight multiple publicly available data sources, data 

dashboards, and findings from an NIH-funded project.
2022 NATIONAL OCCUPATIONAL INJURY RESEARCH SYMPOSIUM 64

Presentations 

1. Visualizing and Disseminating Data on Fatal and 

Severe Injuries in the U.S. Construction Industry

Presenter: William Harris

This presentation will highlight two publicly available 

data dashboards on fatal and severe injuries in 

construction. These dashboards were developed by 

CPWR and are based on data from OSHA fatality and 

severe injury reports. 

2. Mental Health Among Construction Workers in the 

United States

Presenter: Samantha Brown

This presentation will examine (1) construction industry 

trends in psychological distress from 1999-2018 and (2) 

mental health indicators at the start of the COVID-19 

pandemic among U.S. construction workers using data 

from the National Health Interview Survey.

3. Opioids - Prescription Opioid Use and Stigmatized 

Attitudes among Apprentice Construction Workers

Presenter: Ann Marie Dale

This presentation focuses on presenting data from an 

NIH-funded project on opioids in construction and 

describes the use of prescription opioids and negative 

attitudes toward workers with opioid misuse and opioid 

use disorder.

D3.1 

Title: Visualizing and Disseminating Data on Fatal and Severe 

Injuries in the U.S. Construction Industry

Authors: William Harris, Amber Trueblood, Samantha Brown, 

Xiuwen Sue Dong

Background: Construction is one of the most dangerous 

industries in the United States. Despite continuous efforts, 

fatal and severe injuries still occur in construction 

workplaces at higher rates than most other industries. The 

objective of this project is to visualize fatal and severe 

injuries in construction in interactive data dashboards, 

providing timely and detailed information to all 

stakeholders. This presentation will introduce two 

dashboards.

Methods: Data on fatal injuries were mainly from 

Occupational Safety and Health Administration (OSHA) 

records of construction fatality investigations, which were 

requested from OSHA and recoded by the authors. Some 

fatal injuries were also collected from media and news 

reports by reviewing daily Google Alerts with the search 

terms “worker killed” and “construction.” Media reports 

and OSHA records were merged where applicable. Data 

on severe injuries were extracted from the OSHA Severe 

Injury Reports, a dataset composed of reports from 

employers required by OSHA beginning on January 1, 

2015. Severe injuries are defined as an amputation, inpatient hospitalization, or loss of an eye. The severe injury 

dataset does not include incidents under state plan 

jurisdiction. Both data sources provide detailed data, such 

as incident location, industry, major cause of injury, 

individual event narratives, and other relevant 

information. The information is organized and presented 

in interactive data dashboards that allow individuals to 

filter by major criteria such as year, state, and injury type. 

ArcGIS Dashboard and Tableau were used to create the 

dashboards for fatal and severe injuries, respectively. 

These dashboards are updated biannually when new data 

are available.

Results: The Construction Fatality Map dashboard 

contains 6,340 construction fatal injuries from 2011 

through 2020. The dashboard shows that the leading 

event type for fatal construction injuries in the United 

States was falls, slips, trips (34.7%). In addition, the top 

three states for fatal construction injuries were Texas (823 

deaths), California (550 deaths), and Florida (492 deaths). 

The Severe Injuries dashboard covers 11,000 severe 

injuries in construction from 2015 to 2020. Falls to a 

lower level comprised four out of the ten most common 

severe injury types illustrated by the dashboard. The top 

three construction subsectors by number of severe 

injuries were Commercial and Institutional Building 

Construction (1,165 injuries), Electrical Contractors and 

Other Wiring Installation Contractors (1,093 injuries), 

and Highway, Street, and Bridge Construction (912 

injuries). The results will be updated when new data are 

available.

Discussion: These interactive dashboards enable users to 

explore fatal and severe injuries in a dynamic fashion 

through filters and interactive chart elements. Users can 

have custom views of the charts as well as free download 

data files of the charts. These features provide a useful 

resource and tool for construction research and training. 

Since being posted in early May of 2021, the Construction 

Fatality Map dashboard has received 1,233 unique views 

over a five-month period. The Severe Injuries dashboard, 

posted in early August of 2021, has received 234 unique 

views in a two-month period. (The dashboards are 

available online: https://www.cpwr.com/research/datacenter/data-dashboards/).
2022 NATIONAL OCCUPATIONAL INJURY RESEARCH SYMPOSIUM 65

D3.2 

Title: Mental Health Among Construction Workers in the United 

States 

Authors: Samantha Brown, Amber Trueblood, William Harris, 

Xiuwen Sue Dong

Background: Historically, mental health has not been 

considered a safety priority in construction. The high 

suicide rate among construction workers tells us it is time 

to pay close attention. The COVID-19 pandemic has 

likely exacerbated mental health issues in this population. 

Despite the urgent need, mental health research in the 

construction industry is scarce. To better understand 

construction worker mental health and inform life-saving, 

evidence-based tactics that improve it, this study 

examines (1) trends in psychological distress from 1999-

2018 and (2) mental health indicators at the start of the 

COVID-19 pandemic among U.S. construction workers.

Methods: This study analyzed nationally representative 

data from the National Health Interview Survey (NHIS) 

from 1999-2018 and in 2020. (No industry and 

occupation measures in 2019 data). NHIS is a crosssectional household survey monitoring the health of the 

nation. The sample adult (aged 18 or older) file was 

downloaded from IPUMS. Construction workers were 

respondents who reported their main industry was 

construction regardless of occupation. Survey weights, 

strata, and clusters were used to account for the complex 

survey design. Self-reported psychological distress in the 

past 30 days was defined as Kessler-6 (K6) scores of 5-12 

(moderate) or ≥ 13 (serious). The prevalence of 

psychological distress among construction workers was 

estimated from 1999 to 2018, and differences between 

demographic and work-related subgroups from 2014 to 

2018 were compared using chi-square tests.

Results: A total of 32,048 construction workers were 

examined from 1999-2018, representing 13 million 

(weighted) construction workers annually. The prevalence 

of serious psychological distress doubled throughout this 

period, from an annual average of 1.4% from 1999-2003 

to 2.8% from 2014-2018. Moderate psychological distress 

also grew, with a prevalence of 9.6% from 1999-2003 and 

17.0% from 2014-2018. Both serious and moderate 

distress rose during and immediately following the Great 

Recession, reaching averages of 3.9% and 16.4% from 

2008-2011, respectively. Despite fluctuation, the 

prevalence of serious distress declined along with the 

economic recovery, while moderate distress somewhat 

increased from 2011 to 2018. From 2014 to 2018, 

moderate and severe distress were more prevalent in 

workers who were female, single, not college-educated, 

current cigarette smokers, or held a blue-collar 

occupation (p <0.05). Non-Hispanic racial minorities 

suffered the highest prevalence of serious (3.2%) and 

moderate (21.9%) distress, followed by white, nonHispanic (serious: 3.1%; moderate: 17.5%) and Hispanic 

(serious: 2.1%; moderate 13.9%) workers (p < 0.0001). 

Distress was also more likely to be reported by workers 

living below the poverty level (serious: 6.3%; moderate: 

24.5%) than those living above it (serious: 2.4%; moderate: 

15.9%; p < 0.0001). The prevalence of serious distress was 

nearly three times higher in unemployed than employed 

workers (5.6% versus 1.9%), and moderate distress was 

also more common in the unemployed (26.0% versus 

15.0%; p < 0.0001). Note: Results in 2020 will be added 

when the 2020 NHIS data are available.

Discussion: Psychological distress among construction 

workers increased over the past two decades, particularly 

during and immediately after the Great Recession, a 

period characterized by unemployment and economic 

insecurity. Findings also suggested that workers in some 

construction subgroups, such as females, racial minorities, 

and those with lower socioeconomic status, are more 

vulnerable to psychological distress. More research is 

needed to understand pathways to poor mental health 

outcomes among construction workers as well as effective 

workplace and policy interventions to address them, 

especially in the vulnerable subgroups identified.

D3.3 

Title:Prescription Opioid Use and Stigmatized Attitudes Among 

Apprentice Construction Workers

Authors: Ann Marie Dale, Sam Biver, John Gaal, Bradley Evanoff

Introduction: Construction leads all industries for opioidrelated overdose deaths. Construction workers also suffer 

from high rates of musculoskeletal pain due to physically 

demanding work. A previous study of construction health 

claims showed that one-third of workers seeking care for 

musculoskeletal pain received an opioid prescription, 

those prescribed opioids for musculoskeletal pain had a 

higher risk for long‐term opioid use, and these long-term 

users were nearly 10 times as likely to develop opioid use 

disorder. Training workers on the risks of opioids and 

development of OUD should reduce the use of using 

prescription opioids for pain management and reduce the 

widespread stigma toward workers with OUD. This is 

important for new workers, as apprentices are generally 

young and strong, so often expected to perform the most 

physically demanding tasks on worksites, placing them at 

greater risk of injuries. The purpose of this study was to 

describe apprentice construction workers’ awareness and 

attitudes toward workers struggling with substance use, 
2022 NATIONAL OCCUPATIONAL INJURY RESEARCH SYMPOSIUM 66

whether workers with substance misuse behaviors report 

greater stigmatized attitudes by employers and coworkers 

than workers without misuse behaviors, and whether 

workers trained about opioid risks show less stigma and 

negative attitudes toward workers with opioid use 

disorder than untrained workers.

Methods: We invited construction apprentices to complete 

an electronic survey on worker knowledge, attitudes, and 

behaviors about opioids and the workplace. Workers 

accessed the survey through a QR code during a training 

class and were given time to complete the survey. All 

responses were sent directly to the research team to 

ensure confidentiality.

Results: 459 apprentices (84% response rate) completed 

the survey during class (average completion time 7.5 

minutes), with each of the 8 training terms represented 

(9-16% of the workers). More than 90% of workers agreed 

that their job often required lifting heavy loads and 

required much physical effort; 72% reported having 

pain/discomfort in the past 12 months; 35% had seen a 

physician for pain, 21% had missed days from work due 

to pain, and 8% had received an opioid prescription for 

pain (11.4% of those prescribed opioids reported taking 

more than prescribed, and 21.6% of those with an opioid 

prescription reported taking pain medications prescribed 

to someone else). 28% of apprentices reported received 

training on risks of opioids and substance use, and 7% 

had training on administering naloxone. Workers with 

misuse problems (n=34) more often reported feeling 

negative attitudes and stigma from coworkers including 

thinking less of those with a substance use problem 

(p=0.001) and being overlooked for hire if treatment is 

known (p=0.001). Workers with misuse more often 

recognized that addiction is not a choice (p=0.03) and 

acknowledged that substance use is ignored by coworkers 

(p= 0.02) than other workers. Workers who reported 

prior training on opioid risks showed no differences in 

their knowledge and attitudes responses (addiction is a 

choice, fear of job loss for disclosure, negative opinion of 

those in recovery, overlooked for hire, and ignore 

substance use behaviors of coworkers) than untrained 

workers. 

Discussion: These findings mirror past studies and show 

that many new workers experience pain requiring medical 

treatment, and some receive or choose to take 

prescription opioids for pain management. Workers with 

substance use problems more often feel stigma and 

negative attitudes from coworkers. There was no 

difference among workers trained to untrained in their 

negative attitudes toward addiction, fear of job loss from 

opioid use, and plan to seek help if needed. These findings 

suggest that stigma persists in the workplace and that 

training alone does not appear sufficient to change worker 

opinions and workplace culture.

Session D4

Robotics in Agriculture

Moderator: Jennifer M. Lincoln

D4.1 

Title: Literature Review: Does Improved Agriculture 

Technologies Mean Improved Safety?

Authors: Darlene Weaver, Menekse Salar Barim, Marie Hayden, 

KC Elliott, Jennifer Lincoln, Michael A. Flynn

Introduction: Our study sought to evaluate the scientific 

literature to identify agricultural uses of new technologies, 

document potential benefits and hazards to workers, and 

identify knowledge gaps regarding occupational safety 

and health. The Food and Agriculture Organization 

(FAO) projects the total global population will increase 

25% by the year 2050 to 9.2 billion. To make 

improvements in the agriculture sector and to meet a 

growing demand for food, newer and more sophisticated 

technologies such as artificial intelligence and robotics are 

being used. It is well known that agricultural work is 

physically demanding and agriculture workers are at high 

risk of occupational injury and illness. The agriculture 

industry is increasing the use of robotics and artificial 

intelligence (AI) which has the potential to drastically 

change how food and other agricultural products are 

produced. Therefore, there is a need to understand the 

current status of these technologies, and more 

importantly, the potential occupational safety and health 

effects associated with their use.

Methods: We conducted a scoping literature review of 

articles pertaining to robotic and artificial intelligence 

systems used in agriculture. There were 3248 articles 

screened by two reviewers, according to the following 

criteria: (1) relevant to advanced technologies such as 

robotics and artificial intelligence systems, (2) written in 

English, and (3) published after 2015. Further analysis was 

performed, and 80 of the articles were about animal 

livestock, and 465 related to crop/harvesting. The 465 

articles were then separated into two different categories: 

(1) agricultural technologies used to enhance agricultural 

production and crop quality, and (2) agricultural 

technologies used to reduce the occupational safety and 

health risks of farmers and farm workers.
2022 NATIONAL OCCUPATIONAL INJURY RESEARCH SYMPOSIUM 67

Findings: The majority of articles focused on increasing 

production and quality of the crops, and very few were 

related primarily to reducing occupational and safety 

risks. There were 53% of the articles related to harvesting 

technologies to increase food production. These 

technologies relate to mechanization and manipulation 

tasks, such as harvesting robots. Another 12% of the 

articles related to the technologies of harvesting/cropping 

to increase efficient agricultural production. These 

technologies relate to Autonomous Driving Control, such 

as tractors. There were 25% of the articles pertaining to 

cropping technologies to improve the quality of the crops. 

These technologies relate to disease detection and 

monitoring and may use drones. Finally, 10% of articles 

were on technologies whose primary purpose was to help 

reduce occupational health and safety risks. These 

technologies relate to musculoskeletal disorders and 

repetitive motion tasks, such as exoskeletons. Technology 

is advancing towards the use of robotics, drones, and 

autonomous tractors to enhance agriculture production 

and quality of crops to address serious concerns related to 

labor shortages and an increasing food demand. Articles 

that relate to technologies that can reduce the 

occupational health and safety risk of the worker is very 

limited which is a concern because the Agriculture sector 

ranks among the most hazardous industries.

Discussion: These new technologies improve the quantity 

and quality of crops with the reduction of environmental 

hazards such as pesticides into the environment along 

with better detection of crop disease and monitoring of 

crops. However, there are still extensive knowledge gaps 

regarding occupational safety and health effects of these 

emerging technologies. Further investigation is needed to 

better understand how the adoption of emerging 

technologies may potentially benefit or compromise 

agriculture worker safety and health.

D4.2 

Title: Livestock Technology Review - Application to Worker 

Safety & Health

Authors: Marie Hayden, Menekse Salar Barim, Darlene Weaver, 

KC Elliott, Jennifer Lincoln, Michael A. Flynn

Introduction: Precision livestock farming expands the 

management capability of farmers to monitor animal 

health through reliable and affordable technologies due to 

growing production demands. These technologies range 

from robotics, and sensors, to artificial intelligence, which 

continue to change the traditional methods of manual 

tasks and limitations of humans monitoring multiple 

animals. The objective of this study was to review 

emerging technologies to better understand what is 

available and to determine if health and safety for the 

workers had been evaluated or considered.

Method: We conducted a scoping literature review and 

identified 3248 articles. Titles and abstracts were screened 

according to the following criteria: (1) technology with 

robotics, sensors or artificial intelligence (AI); (2) 

Agriculture applicable to United States; (3) written in 

English; (4) published after 2015; and (5) studies not 

related to meat production. Five independent reviewers 

performed the screening using Covidence. Documents 

required two reviewer agreements. If a conflict occurred a 

third reviewer provided input to arrive at a final decision. 

Based on the above criteria, 80 articles were selected for 

the full review article process specifically to livestock. 

These articles were classified into the following categories: 

type of technology (robotic, sensor, AI) and worker safety 

and health.

Results: Overall, 63% (50/80) of these studies applied 

technologies for monitoring animal health and welfare. 

The automated systems accounted for 56% (45/80) 

articles. Majority of automated systems were automatic 

milking systems (AMS) and automatic feeding systems. 

Ten articles focused on the data collected by the built-in 

AMS sensor to assess the health and milk yield quality of 

the cattle. Additional automated equipment consisted of 

automatic milk feeding systems to feed pre-weaned calves, 

automatic herding systems to direct traffic flow towards 

the AMS, automatic sprayers to clean cattle hooves, 

robotic scraper to clean cattle manure on the floor, and 

mobile robots to collect poultry eggs off the floor. 

Emerging technologies, 44% (35/80) of articles, included 

sensors, computer vision, machine learning and platforms 

devices for processing data. The sensors were used on 

cattle to detect reproductive health, early disease 

detection, monitor behavior or stress and lameness, while 

machine learning included tracking behavior and 

monitoring growth for pigs. More frequently studies 

combined technologies such as computer vision and 

machine learning for breed classification of sheep or 

tracking sow behavior or monitoring their growth. 

Additional studies combined sensors and machine 

learning for monitoring behavior or for early disease 

detection. When reviewed for worker safety and health 

evaluations, there were two topics which focused on 

human-health exposure and human-animal relationship. 

Two articles focused on human-health exposure by 

industrial hygiene sampling between a manual system 

versus an automated robotic system. One article reviewed 

studies that implemented different sensors and robotic 

technologies and discussed the concern of the humananimal relationship. There were few articles that 

acknowledged but had no consistent quantitative 
2022 NATIONAL OCCUPATIONAL INJURY RESEARCH SYMPOSIUM 68

evaluation on the equipment benefits on labor reduction, 

fewer repetitive tasks, flexibility in time, human animal 

relationship and mental workload.

Conclusion: Only two of 80 studies evaluated the health 

and safety of the worker using new technologies. The 

primary focus for all other articles was to improve animal 

health and well-being or to improve the quality of 

production and increase the economic benefits. These 

primary focuses contributed to the adoption of precision 

livestock farming; however, much remains unknown 

about their potential impact on the farmer’s health and 

safety. These findings suggest the potential impact of new 

technology could have on worker safety is significantly 

underexplored in the literature.

D4.3 

Title: Severe Occupational Injuries from Food Packaging and 

Movement in the U.S. Supply Chain

Authors: Judd Michael, Serap Gorucu

Background: The modern food supply chain presents 

unique hazards to employees that result in higher 

morbidity and mortality rates versus other industries. 

Employees in food manufacturing, wholesaling and even 

retailing experience unusually high numbers of 

occupational injuries and fatalities. One reason for the 

high hazard rates may be the reliance on a synergistic 

packaging system designed to load and transport food 

products within and between manufacturers, wholesalers, 

and retailers. Packaged food products are often aggregated 

using automated palletizers before they can be 

transported by forklifts and pallet jacks. Moving product 

within facilities is critical to the efficient functioning of all 

members of the food-related supply chain, but product 

movement is a common source of occupational injuries. 

No previous research has examined the cause and result of 

such hazards. The goal of this presentation is to examine 

severe injuries and fatalities related to the packaging and 

movement of food products in segments of the food and 

beverage supply chain from manufacturing to retailing.

Methods: We used an OSHA database to investigate all 

severe injuries in the six years from 2015 to 2020 for 12 

food and beverage-related industry segments. Our focus 

was on the food supply chain for the period since OSHA 

began mandating new reporting procedures for severe 

injuries in 2015. OSHA’s Integrated Management 

Information System and Severe Injury Database were 

searched for pallet, skid, crate, carton, palletizer, forklift, 

pallet jack or powered industrial vehicle related injuries. 

The methodology provides a specific overview and 

quantification of the occupational hazards associated with 

food-related manufacturing, wholesaling/warehousing 

and retailing firms in the US.

Results: Results show there were 42 fatalities and 1084 

severe injuries during the six-year period. Fractures of the 

lower extremities were most prevalent, with the most 

frequent event type being transportation-related such as 

pedestrian-vehicle incidents. Grocery wholesalers and 

grocery retail stores saw the highest number of injuries, 

followed closely by the warehousing and storage groups. 

The frequency of injuries generally trended higher across 

the years, with 2018 through 2020 being much higher 

than the first three years. The most prevalent injury event 

type was transportation incidents, with the “nonroadway 

incidents involving motorized land vehicles” (e.g., 

forklifts) category being first. When specifically 

considering forklift hazards the most dangerous industry 

sector was wholesaling and warehousing. Results indicate 

that the three industry segments differ by injured body 

part and event/exposure types.

Discussion: Significant differences were seen in the three 

parts of the food supply chain. The number of severe 

injuries rose significantly in 2020 which may have been a 

result of pandemic-induced supply chain pressures. 

Results suggest that the use of palletizers for unitizing and 

powered industry trucks (PITs) for transporting food 

products present varied opportunities for employees to 

suffer severe injuries and fatalities. PITs are critical to the 

efficient movement of food products and yet are a source 

of severe injuries and fatalities; the use of forklifts and 

pallet jacks are therefore a challenge in this industry as 

with others. The proportion of amputations in the 

manufacturing segment was significantly higher than the 

wholesaler, warehousing and storage segment. Narratives 

provided with each incident report suggest that palletizers 

are a common cause of amputations. These often occur 

when an employee reaches into the palletizer to clear a 

jam or retrieve broken product. The actual transport 

packaging (i.e., pallets and crates) was also the source of 

injuries, with a relatively higher number coming from 

slip, trip and fall injuries in retail locations.
2022 NATIONAL OCCUPATIONAL INJURY RESEARCH SYMPOSIUM 69

Session E1

Occupational Injury Surveillance in the U.S. Military

Moderator: Melody Gwilliam

E1.1

Title: Beginning to Grasp Finger, Hand and Wrist Injuries in the 

U.S. Air Force

Authors: Melody Gwilliam, Christina Socias-Morales, 

Bruce Burnham, Audrey Reichard, Heidi Stallings

Background: Fingers, hands, and wrists (FHW) are 

anatomically complex and FHW injuries can potentially 

impair a worker’s functional activities at work and home. 

Impairments from FHW injuries resulting in physical 

difficulties participating in work, leisure, and self-care 

activities can have social and emotional impacts and lead 

to a decreased quality of life. Although FHW are the most 

frequently injured body parts in work-related injuries, a 

limited number of studies have examined the 

characteristics of these occupational injuries. This study 

describes on-duty (work-related), non-combat FHW 

injuries among military and civilian U.S. Air Force 

(USAF) personnel to guide prevention efforts.

Methods: We conducted a retrospective analysis of all 

work-related, non-combat FHW injuries among military 

and civilian USAF personnel from fiscal year (FY) 2008 

through 2018. Data from the Air Force Safety Automated 

System (AFSAS) and the USAF Personnel Center’s 

(AFPC) Statistical Analysis and Retrieval System 

Demographics (STARS DEMOG) was used in this 

research study. AFSAS captures work-related injuries 

reported by local military base safety professionals and 

STARS DEMOG provides demographic data. A nondisclosure agreement was established between the USAF 

and the National Institute for Occupational Safety and 

Health (NIOSH) to conduct collaborative research. FHW 

injuries were grouped together from the injured body part 

variables “fingers” and “hand/wrist.” Occupational groups 

were created using job series codes for civilian and 

military personnel. Rates of FHW injuries per 1,000 

workers from FY 2008-2018 were calculated using injury 

numerators and aggregate USAF employment numbers 

for denominator data. Poisson regression was employed 

to calculate 95% confidence intervals for injury rates.

Results: There were 14,522 FHW non-combat injuries in 

the USAF between FY 2008-2018, accounting for 32% of 

all work-related, non-combat injuries among military and 

civilian personnel. We observed a statistically significant 

decrease in all work-related injuries (29%) during the 11-

year study period. There was also a statistically significant 

decrease (21%) in FHW injuries (p<0.0001) during the 

study period. The majority of FHW injuries were open 

wound injuries (52.8%) and fractures (19.5%). Most 

(62%) of the FHW injuries involved enlisted personnel. 

Aircraft maintainers had the highest number of FHW 

injuries (3,246 injuries, 22% of all FHW injuries), however 

metal workers had the highest rate of injury (14.5 per 

1,000 workers) but accounted for 6% of FHW injuries. 

USAF personnel aged 16 to 24 years had a higher rate of 

FHW injuries (4.5 per 1,000 workers) that was almost 

twice as high as workers 25 and older (2.3 per 1,000 

workers). 

Conclusions: FHW injuries substantially decreased 

throughout the USAF from 2008-2018. Efforts made by 

the USAF to improve worker safety may have contributed 

to the decline in FHW injuries. Some of the efforts made 

by the USAF included updates and improvements to 

safety policies, procedures, and activities. Future safety 

efforts should focus on implementing prevention 

strategies among high-risk groups such as young workers 

(16-24 years), enlisted personnel, metal workers and 

aircraft maintainers.

E1.2

Title: Estimated Costs of Lower Extremity Fractures Among U.S. 

Army Soldiers

Authors: Michelle Canham-Chervak, Lana Forrest, 

Steven Barnes, Veronique Hauschild, Anna Schuh-Renner, 

Tyson Grier, Ryan Steelman, Esther Dada, Bruce Jones

Introduction: With over 2 million medical encounters 

annually, injuries represent a leading U.S. Army health 

issue for which current monetary cost estimates are 

warranted. As the first step to developing a standard cost 

estimation approach for all injuries, this investigation 

focused on estimating expenditures for lower extremity 

fractures. 

Methods: Treatment for a lower extremity fracture was 

identified in the Military Health System Data Repository 

(MDR) for active duty soldiers in 2017. Lower extremity 

fractures were identified from medical encounters with 

the following International Classification of Diseases, 10th 

Edition, Clinical Modification (ICD-10-CM) codes in the 

first or second diagnosis position: S72 (fractures of hip, 

upper leg), S82 (fractures of knee, lower leg, ankle), or S92 

(fractures of feet, toes). Direct medical cost was defined as 

the total cost paid for a medical encounter by the Military 

Health System, as noted in the MDR. Indirect medical 

costs were calculated for lost (hospitalizations) and 

limited duty time using estimates from the literature, 

Defense Finance Accounting Services pay charts, and 
2022 NATIONAL OCCUPATIONAL INJURY RESEARCH SYMPOSIUM 70

assuming a 50% productivity estimate for limited duty 

time. 

Results: There were 5,287 soldiers with an initial 

encounter for a lower extremity fracture in 2017 (99% 

received outpatient care, n=5,247); most were men (83%) 

and younger than 30 years of age (56%). The estimated 

total cost of lower extremity fractures was approximately 

$116 million (M) based on combined direct medical costs 

($24M) and indirect medical costs ($92M; $91M limited 

duty; $900,000 lost duty). More than 90% of soldiers 

received care for fractures to the lower leg, ankle, foot, 

and toes (n=4,842); these fractures accounted for 89% 

($103M) of costs. By treatment setting, foot and toe 

injuries accounted for 53% ($52M) of outpatient costs and 

lower leg and ankle fractures accounted for 62% ($11M) 

of hospitalization costs.

Discussion: This analysis provides a foundation for future, 

broader cost estimation approaches that have been 

missing from military injury prevention planning and 

evaluation. The majority of costs were due to lost or 

limited duty time, indicating the need to include indirect 

cost estimates as a part of overall military injury cost 

calculations.

E1.3

Title: The Impacts of the Transition to ICD-10-CM on U.S. Army 

Injury Surveillance

Authors: Anna Schuh-Renner, Matthew Inscore, 

Veronique Hauschild, Bruce Jones, Michelle Chervak

Introduction: Injuries are the leading cause of medical 

encounters and lost work days in the U.S. Army, affecting 

over half of Active Duty Soldiers annually. This work 

describes how the transition from the International 

Classification of Diseases, Ninth Revision, Clinical 

Modification (ICD-9-CM) to the Tenth Revision (ICD10-CM) impacted U.S. military injury surveillance, by 

comparing injury rates and distributions under both 

systems. Historically, Army injury surveillance has 

captured both acute traumatic and overuse injuries due to 

cumulative micro-trauma.

Methods: Mapping ICD-9-CM codes to the expanded, 

more detailed, ICD-10-CM codes is not a straightforward 

endeavor; therefore, the U.S. Army Public Health Center 

incorporated ICD-10-CM codes into a comprehensive, 

systematic approach to taxonomically categorize injury 

diagnoses. This methodology was applied to Army 

injuries under ICD-10-CM (Calendar Years 2016-2019) 

and compared to ICD-9-CM Army injury surveillance 

definitions (Calendar Years 2012-2015).

Results: Soldier injury rates appeared to increase when 

surveillance with ICD-10-CM began. Soldiers experienced 

1,804 incident injury medical encounters per 1,000 

person-years in 2016 (ICD-10-CM), compared to 1,276 

injuries per 1,000 person-years in 2015 (ICD-9-CM), a 

41% increase. Importantly, the distribution of injuries also 

shifted, such that the average cumulative micro-traumatic 

injury rate increased by 42% during 2016-2019 (ICD-10-

CM) compared to the 2012-2015 average (ICD-9-CM), 

while acute traumatic injuries only increased by 17%.

Conclusions: The more detailed descriptions provided by 

ICD-10-CM codes and the applied taxonomic 

categorizations have improved Army injury surveillance, 

and data unequivocally demonstrate that most injuries in 

this physically active population are cumulative microtraumatic injuries. An added benefit of the comprehensive 

taxonomic structure is that it allows for focused analyses 

on subsets of injury diagnoses if desired. The taxonomy 

methodology can also be extended to injury surveillance 

in other populations and may allow for a more efficient 

transition to surveillance with ICD-11-CM. 

Session E2

Fatigue, Sleep and Work Hours

Moderator: Karl Sieber

E2.1

Title: Assessing the Impact of Work Hours on Worker Safety and 

Health in the Stone, Sand and Gravel Mining Industry

Authors: Todd Smith, Abdulrazak Balogun, Aurora Le, 

Charmaine Mullins-Jaime 

Introduction: Long work hours and overtime can 

negatively impact worker safety and health. Long work 

hours and overtime have been linked to increased 

occupational injury and illness outcomes, including

musculoskeletal disorders. Additionally, long work hours 

and overtime have been associated with stress and 

burnout, which can be detrimental to overall health. 

Research exploring these relationships within stone, sand 

gravel mining (SSGM) operations is limited. The focus of 

this presentation is to summarize completed studies 

assessing the impact of long work hours and overtime on 

worker health and safety outcomes to include 

musculoskeletal symptoms, stress, burnout, and overall 

health.

Methods: Survey data were collected from 459 workers 

employed in the SSGM sector within the U.S. Midwest. 

Two studies using these data were completed. In the first 

study, logistic regression analyses were completed to 
2022 NATIONAL OCCUPATIONAL INJURY RESEARCH SYMPOSIUM 71

examine the relationships between work hours and 

musculoskeletal symptoms (MSS) of the neck, shoulder, 

lower back and knee. The second study used multiple 

regression to examine relationships between long work 

hours and health impairment—particularly stress, 

burnout and overall health.

Results: Regarding the relationship between hours worked 

per week and MSS, we found that employees who worked 

more than 40 hours per week had higher odds of 

developing musculoskeletal symptoms. It was determined 

that work greater than 60 hours per week was the greatest 

concern. Employees who worked more than 60 hours a 

week had approximately five times the odds of developing 

low back MSS (OR: 4.7 95% CI: 1.9–11.5), knee MSS (OR: 

4.5, 95% CI: 2.0–10.3) and neck MSS (OR: 5.1, 95% CI: 

2.2–11.8) compared to those who worked at or below 40

hours per week. Employees who worked 51-60 hours per 

week also had significantly higher odds of developing 

neck MSS (OR: 2.7, 95% CI: 1.3–5.3) compared those who 

worked at or below 40 hours per week. Regarding the 

relationships between hours worked per week and health 

impairment, it was determined that work hours were 

positively significantly associated with stress (p<.001) and 

burnout (p<.001) and was significantly negatively 

associated with perceptions of overall health (p<.05).

Conclusions: Long work hours and overtime work are a 

significant concern within the SSGM sector. Workers 

working long hours and overtime are more likely to 

report MSS and report health impairment, including 

stress, burnout and diminished overall health. As such, 

work hours and overtime work policies and programs 

need to be examined by SSGM organizations. Strong 

evidence suggests that employers should not work 

employees more than 60 hours per week. Workers 

working more than 60 hours each week were 

approximately 5 times more likely to report low back, 

neck, and knee MSS. Human resource management and 

management/worker collaboration is needed to maintain 

pay, so not to burden workers if work hours are reduced. 

Additionally, job design changes may be necessary to 

maintain production. In addition, these findings point to 

the need for Total Worker Health® (TWH) oriented 

interventions in SSGM aimed at addressing job risk 

factors and health impairment. TWH strategies provide 

an opportunity for interdisciplinary and multidisciplinary 

interventions that can protect workers and improve the 

overall health and wellness of employees.

E2.2

Title: Findings from a Systematic Review of Fatigue 

Interventions in Industrial Settings

Authors: Zoe Dugdale, Brianna Eiter, Cammie K. Chaumont 

Menendez, Imelda Wong, Timothy Bauerle

Introduction: Fatigue and sleep deficiency remain key 

occupational health and safety concerns in many 

industries and subsectors, including in mining. Work 

schedules in the mining industry are often nonstandard, 

tasks can be physically and mentally demanding, and 

environments are sometimes hot, poorly lit, and loud. 

These are all fatigue risk factors and can lead to cognitive 

impairment and subsequent safety critical events. The 

purpose of this systematic review was to identify fatigue 

interventions that have been tested on industrial 

shiftworkers and explore their effects and the factors that 

may influence their application in a mine.

Methods: The protocol for this review adhered to the 

Preferred Reporting Items for Systematic Reviews and 

Meta-Analyses (PRISMA) checklist. Relevant studies 

published between 1980-2020 were identified by carrying 

out structured, systematic searches in electronic journal 

databases, consulting external subject matter experts, and 

manually reviewing the reference lists of a sample of 

studies. Articles were screened against pre-established 

inclusion criteria and appraised for methodological 

strength. Key characteristics such as occupational setting 

and job task, shift schedule, intervention type, outcome 

measures, and study findings and limitations were then 

extracted. Due to considerable heterogeneity in methods, 

participants, interventions, and findings, a narrative 

synthesis approach was taken.

Results: Two intervention types – lighting and training – 

were identified out of several frequently documented in 

other industries and sectors (e.g., planned naps, rest 

breaks, strategic caffeine use). Critically, no fatigue 

interventions were tested in mining. Our review provides 

strong evidence for bright light interventions at 

improving subjective sleep quality and reducing sleepiness 

in industrial shiftworkers. However, there is insufficient 

evidence to posit the benefits of blue-light blocking glasses 

and sleep hygiene and alertness management trainings. 

Notable factors influencing the effectiveness of the 

lighting interventions included when and how often the 

interventions were provided and their duration. The 

training interventions were primarily affected by choices 

in design and delivery, and the relevance of information 

to workers.
2022 NATIONAL OCCUPATIONAL INJURY RESEARCH SYMPOSIUM 72

Discussion: To improve effectiveness, interventions should 

be customized as much as possible for specific workers 

and with consideration for contextual factors within the 

workplace environment. Future studies should investigate 

whether lighting and sleep hygiene and alertness 

management trainings are effective fatigue risk 

management tools in mining-specific environments. 

Further, so that mines can adopt a more multifaceted 

approach to managing worker fatigue, a variety of other 

fatigue-related interventions should be evaluated across 

similar industrial settings since strategies found to be 

effective in these comparable environments may be 

feasibly adapted and implemented in mining contexts. 

Accompanying this intervention work should be studies 

that identify best practices for implementing these 

interventions in industrial workplace settings since 

intervention use and acceptability can impact adoption 

and sustained use over time.

E2.3

Title: Survey of Working and Sleeping Time by Industry and 

Occupation of Fulltime Workers in the U.S.

Author: Guang Chen

Introduction: Long working hours and inadequate sleeping 

time can lead to increased fatigue and fatigue-related 

injuries on the job, and decreased wellbeing for workers. 

This analysis examined working and sleeping time by 

occupation and industry among fulltime workers in the 

U.S.

Methods: This study analyzed publicly available microdata 

from the American Time Use Survey (ATUS) spanning 

2015−2017. ATUS is conducted by the U.S. Census 

Bureau for the Bureau of Labor Statistics (BLS) to assess 

how individuals spend their time. It is a nationally 

representative sample of persons aged 15 years or older 

living in U.S. households. During a 20-minute phone 

interview, participants were asked about their sequential 

activities going back 24 hours. Respondents’ occupation 

and industry were coded using Census Industry and 

Occupation Classification Systems. National estimates of 

average work and sleep hours were computed by general 

occupational and industrial groups.

Results: On average U.S. fulltime workers worked 8.1 

hours, slept 7.9 hours on a working day, and slept 9.7 

hours on a non-working day. Among the general 

industrial categories, Farming/Fishing/Forestry 

occupations had the longest working hours (8.7 hours a 

day) and Education/Training/Library occupations had the 

shortest working hours (7.3 hours). Utilities had the 

shortest average sleeping hours (7.3) and traveler 

accommodation had the longest average sleeping hours 

on a workday. Among the general occupational 

categories, Management of Companies and Enterprises 

had the longest working hours (9.2) and Internet 

Publishing and Broadcasting had the shortest working 

hours (5.7 hours). Architecture and engineering had the 

shortest sleeping hours (7.6) and food preparation and 

serving related occupations had the longest average 

sleeping hours (8.3) on a workday. Among certain 

individual occupations that characteristically worked 

irregular shifts, Emergency Medical Technicians and 

Paramedics worked 10.9 hours a day, Taxi Drivers and 

Chauffeurs worked 9.7 hours a day, Driver/Sales Workers 

and Truck Drivers worked 8.8 hours a day, and Physicians 

and Surgeons worked 8.3 hours a day. National estimates 

of average work and sleep hours were computed by 

general occupational and industrial groups.

Discussion: BLS recently (July 22, 2021) reported ATUS 

2019-2020 data highlighting the change in working at 

home in 2020 (during the COVID-19 pandemic) 

compared to 2019 (prior to the COVID-19 pandemic). 

The amount of time employed persons spent working was 

about the same in 2019 and 2020--7.7 hours in 2019 and 

7.6 hours in 2020. The percent of employed persons 

working at home on days they worked nearly doubled, 

rising from 22 percent in 2019 to 42 percent in 2020. 

Workers with higher levels of education were much more 

likely to work at home in 2020 than were those who had 

less education. By industry, from 2019 to 2020, there were 

large increases in the share of employed persons working 

at home on days worked for those employed in financial 

activities (up 40%); professional and business services (up 

25%); and education and health services (up 23%). By 

contrast, there were smaller increases for workers in 

leisure and hospitality (up 8%); transportation and 

utilities (up 9%); wholesale and retail trade (up 10%); and 

manufacturing (up 11%). No change in percentage of 

working at home among the following general 

occupational categories: farming, fishing, and forestry; 

construction and extraction; installation, maintenance, 

and repair; production; and transportation and material 

moving. The BLS report suggested that there is a need for 

comparing how American work before and after the 

COVID-19 pandemic.

Conclusion: This analysis provided national estimates of 

working and sleeping hours by industry and occupation 

for fulltime workers in the United States in 2015-2017, 

which will be updated by analyzing the ATUS 2019-2020 

microdata.
2022 NATIONAL OCCUPATIONAL INJURY RESEARCH SYMPOSIUM 73

Session E3

Helmet Research on Work-Related Traumatic Brain 

and Musculoskeletal Injuries

Moderator: Chris Pan

Approximately 7.3% of traumatic brain injury (TBI) cases 

identified by the Ontario Trauma Registry were workrelated (Kim et al., 2016). Work-related traumatic brain 

injury (WrTBI) accounted for approximately 20% of 

traumatic occupational injuries and 60% of work-related 

deaths in the state of Washington (Sears et al., 2013).

Some epidemiological studies suggest that WrTBI is 

thought to be one of the most serious workplace injuries 

(Konda et al., 2015; Tiesman et al., 2011). The industrial 

helmet (or hard hat) is the most commonly used and 

effective personal protective equipment to reduce 

WrTBIs. 

This session will include laboratory-based helmet research 

studies addressing rear, side, and oblique impacts and fall 

protection performance for Type I and II industrial 

helmets. Head and neck musculoskeletal injuries 

associated with wearing a firefighter helmet will also be 

presented. These helmets are designed to protect the 

firefighter’s head from thermal and low-velocity (7 m/s or 

less) direct impact. According to the U.S. Fire 

Administration’s National Fire Incident Reporting System 

(NFIRS), from 2015 to 2017, injuries to the head and neck 

accounted for 25% of all reported incidences—out of 

which, 40% involved overexertion (NFIRS, 2019).

More specifically, this session will present experimental 

results of three mechanical and biomechanical studies on 

helmet research to assess and prevent TBIs as well as head 

and neck musculoskeletal injuries. Using drop tower or 

manikin drop impacts tests on construction-type helmets, 

two of the studies will focus on: 1) chin strap and ratchet 

performance assessment; and 2) biomechanical 

comparison of Type 1 and II helmet fall protection 

performance to reduce risk associated with skull fracture 

and concussion.

The third study will look at biomechanical loading from a 

typical firefighter helmet equipped, with functional 

accessories, to the cervical spine. Loading to the cervical 

spine can possibly result in disc herniation and disc 

degeneration. Those doing research in these areas will 

find the session informative with leading edge research 

results. Practitioners will find the session provides them 

specific information on developments in the design of 

“hard hats” what will assist them in selection of more 

appropriate “hard hats” for their workforce.

Presentation Titles/Lead Authors:

1. Assessment of Fall Protection of Type I Industrial 

Helmets 

Presenter: Chris Pan, Senior researcher and safety 

engineer, NIOSH/DSR

2. Evaluation of Hard Hats for the Reduction of Head 

Injuries due to Falls

Presenter: Steve Rowson, Associate Professor and 

biomedical engineer, Virginia Tech University

3. Lessons Learned While Designing a Next-Generation 

Firefighting Helmet: Preliminary Data

Presenter: Suman Chowdhury, Assistant Professor and 

industrial engineer, Texas Tech University

E3.1

Title: Assessment of Fall Protection Performance of Type I 

Industrial Helmets

Authors: Chris Pan, Clayton Cobb, Andrew Moorehead, 

Bryan Wimer, Tsui-Ying Kau, John Wu

Background: The performance of Type I industrial helmets 

is regulated by the Z89.1 ANSI standard for head 

protection. However, there is no standard requirement for 

Type I helmets for fall protection, like there is for Type II 

helmets. Chin straps and suspension system adjustment 

mechanisms (ratchets) are two important components of 

a typical industrial helmet, but the effects of proper use of 

them on the protective performance of Type I helmets 

have not been evaluated. The current study was designed 

to analyze the fall protection performance of Type I 

industrial helmets and to evaluate if the use of a chin strap 

and tightness of the suspension system have any effect on 

protection performance.

Methods: Head impact tests were performed using an 

instrumented manikin that was subjected to a simulated 

fall to a lower level. The test manikin was custom-built 

using the body of an off-the-shelf manikin (50th 

Percentile Rescue Randy, Model #149-1344, GT 

Simulators, Davie, FL), a 50th percentile crash test 

dummy headform (Standard 50th Headform ATD-3215, 

Eyeglass Headform, Humanetics, Farmington Hills, MI), 

and a 50th percentile Hybrid III neck (Model #78051-90-

H, Humanetics, Farmington Hills, MI) with a custombuilt reinforced spine. The headform had an aluminum 

skull. The test manikin was further reinforced with 

aluminum shoulder elements. The height and body mass 

of the test manikin with all customarily revised elements 

were close to a standard 50th percentile male. The 
2022 NATIONAL OCCUPATIONAL INJURY RESEARCH SYMPOSIUM 74

manikin was fitted with a fall protection harness to 

facilitate lifting. The accelerations of the head during the 

impacts were measured using a triaxial, piezoelectric 

accelerometer (Model #66F11, Endevco, Depew, NY). The 

accelerometer was installed close to the center of gravity 

of the manikin’s head. At the start of the test, the manikin 

was hoisted, by a lifter, to a height of 5 feet (1.5 m) and 

was kept at a slightly inclined posture. Head impact tests 

were performed by letting the instrumented manikin free 

fall backwards, from a standing posture, so that the 

manikin would make head-first contact with a solid 

surface of two different materials (concrete and plywoodcovered). Two factors regarding proper wearing of the 

helmet were considered: (1) with or without chin strap 

usage, and (2) three levels of suspension system tightness 

(tight, comfortable, and loose). Four representative Type I 

helmet models (two basic models and two advanced 

models) were selected for the study. Each of the impact 

tests was replicated four times. In addition, impact tests 

were performed without a helmet under all other 

applicable test conditions as a control group. There was a 

total of 192 impact tests with helmets and eight impact 

tests for the control group.

Results/Discussion: Results show that all four tested helmet 

models demonstrated excellent performance for fall 

protection compared to the control group without 

wearing helmets. The fall protection performance of the 

advanced helmet models was substantially better than the 

basic helmet models. However, the effects of using chin 

straps and suspension system tightness on the helmets’ fall 

protection performance were statistically not significant. 

By imposing the mean HIC (Head Impact Criteria) values 

of the impacts without helmets and with different helmet 

models on the relationships between injury probability 

and HIC, the probabilities for serious and severe injuries 

in these scenarios can be estimated. The head injury risk 

level from a fall could be reduced to an acceptable level by 

wearing any of the four tested helmet models. The 

findings of our study provide information to help 

construction companies and manufacturers better 

manage the use of Type I helmets for fall protection, 

thereby reducing work-related traumatic brain injury 

risks.

E3.2

Title: Evaluation of Hard Hats for the Reduction of Head Injuries 

Due to Falls

Authors: Steve Rowson, Maura McCartney

The construction industry accounts for more fatal 

traumatic brain injury events (TBIs) than any other 

industry, with 57% related to falls. Despite this, hard hat 

standards do not focus on fall protection, and Type 2 

models, which are rated for off-center impacts, are not 

frequently used. This study’s purpose was to compare fallrelated injury risks between Type 1 and Type 2 hard hats. 

An analysis of construction-based accident reports was 

conducted using the Fatality and Catastrophe 

Investigation Summaries database provided by the 

Occupational Safety and Health Administration (OSHA). 

Low fall heights were commonly reported in construction 

accidents, and there is a large potential for injury 

reduction at these heights. A twin-wire drop tower was 

used with a carriage and size J metal headform that totaled 

5 kg. The headform was mounted on a ball joint with a 

single accelerometer positioned its center of gravity 

oriented along the z-axis. This allowed the resultant 

acceleration to be recorded from any orientation. Three 

impact locations were tested: rear, side, and oblique. 

Three models of Type 1 hard hats and two models of Type 

2 hard hats were each tested one time at each location, 

with drop heights between 0.3 and 2.4 m. Acceleration 

and impact velocity were recorded. Models were not 

tested at heights that would produce accelerations 

exceeding 400 g. Peak linear acceleration (PLA) and Head 

Injury Criterion (HIC) 15 ms were calculated. Skull 

fracture risk was estimated using HIC and concussion risk 

was estimated from PLA. Type 2 models had lower PLA 

and HIC values when compared to Type 1. At 5.7 m/s, 

Type 2 hard hats reduced skull fracture risk by 

approximately 64% (oblique), 92% (rear), and 34% (side) 

compared to Type 1. Concussion risk was reduced by 53% 

(oblique), 78% (rear), and 2% (side). Type 2 hard hats 

substantially reduce skull fracture and concussion risk 

when compared to Type 1 hard hats. These findings 

indicate that the risk of severe head injuries from falls in 

the construction industry would be substantially reduced 

if more workers wore Type 2 hard hats.

E3.3

Title: Designing a Safe Envelope of Weight and Center of 

Gravity of Firefighting Helmet Through Biomechanical 

Measurements and Modeling

Author: Suman Chowdhury

Recent injury reports suggest that the heavy-protective 

firefighter helmet, though designed to protect firefighter’s 

head from thermal and low-velocity direct impact, 

actually contributes to overexertion/sprain-related head 

and neck injuries. According to the U.S. Fire 

Administration’s National Fire Incident Reporting System 

(NFIRS), from 2015 to 2017, injuries to the head and neck 

accounted for 25% (15,750 cases out of 63,000 cases of 

fire-related firefighter injuries) of all cases—out of which, 

40% involved strains/overexertion, 33% were burns, and 
2022 NATIONAL OCCUPATIONAL INJURY RESEARCH SYMPOSIUM 75

27% were wounds/bleeding (NFIRS, 2019). The modern 

firefighting helmet also serves as a platform for 

supporting additional functional accessories, such as 

communication devices, face shield, visor, thermal 

imaging, and lighting equipment. The addition of these 

functional accessories has two major effects: 1) an increase 

in the total weight, and 2) a potential shift in the center of 

gravity (CoG) of the helmet system (i.e., helmet plus 

supporting accessories). These changes can lead to 

injuries to the cervical spine and fatigue of the neck 

muscles. In our preliminary investigation, we evaluated 

biomechanical risks and benefits of three structural 

firefighting helmets: a traditional-look (with-brim) helmet 

(58 oz), a jet-style helmet (62.25 oz), and the jet-style 

helmet with lighting and communication systems (70.85 

oz). We measured head-helmet dynamics (i.e., head-neck 

kinematics, head-helmet relative motions, neck muscle 

fatigue, and positional instability) of four male (31±3) 

subjects. We found some legitimate concerns for all 

helmet types: 1) excessive helmet weight causing neck 

hyper-flexion (7-10o), reduced neck-extension (20-25o), 

and reduced neck endurance (for maximum flexion 

position: 260 ± 9.09s for traditional helmet and 253 ± 

3.13s for jet-style helmet; for maximum extension 

position: 117 ± 35s for traditional helmet and 204.52 ± 

46s), and 3) the helmet CoG lies away from the midsagittal plane (anteriorly and right lateral)—causing 

imbalanced lateral bending (5-10o discrepancies to the left 

(traditional) and right (jet-style), and 4) the helmet was 

displaced about 10-20° anterior-posteriorly (traditional 

helmet) both during dynamic movement and roll-off test. 

The heavyweight and displaced CoG for both firefighting 

helmet types pose an increased risk of cervical spinal disc 

loading during prolonged wear. We are currently 

evaluating the effects of each helmet type on the cervical 

spinal disc (C1-C7) compression forces in various headneck full range of movements (flexion-extension, left and 

right rotations, and left and right lateral bending) in the 

OpenSim modeling platform. We then analyzed these disc 

compression forces in our head-neck finite element model 

(ANSYS/LS-DYNA platform) to calculate the von-Mises 

stress developed in cervical spinal discs. Our ongoing 

investigation is believed to reveal a safe envelope of 

helmet weight and CoG positioning, which could aid 

practitioners or manufacturers in fabricating a firefighting 

helmet that lies within the tolerable limit of cervical spinal 

soft tissues.

Session E4

Interdisciplinary Approaches Along the Translational 

Research Continuum to Reduce Children’s Injuries in 

Agriculture

Moderator: Florence Becot

In the United States, farm children, both working and 

non-working, experience significantly more injuries and 

fatalities than the general population. This high level of 

risk exposure stems from a complex set of factors ranging 

from the frequent overlap between the home and work 

spheres, the dangerosity of the agricultural worksite, 

dangerous behaviors of parents and children, and the 

exemption of the agricultural sector from key federal 

workplace safety and labor regulations.

The National Children’s Center for Rural and Agricultural 

Health and Safety (NCCRAHS) was first funded by CDCNIOSH in 1996 as the sole Center for Agricultural Safety 

and Health, out of 11, focused on the children population. 

Since then, it has developed a portfolio of research and 

outreach projects to further our understanding of 

children’s exposure to risk and interventions most 

effective at reducing these risks. The goal of this thematic 

session is to introduce conference attendees to 

NCCRAHS’ work and to generate interest in potential 

collaborations through the presentation of current 

research that highlights its interdisciplinary approach 

along the translational research continuum.

In the first presentation titled “25 Years of Progress and 

Persistent Challenges in Childhood Agricultural Safety”, 

NCCRAHS director and nursing scholar, Barbara Lee, will 

outline the historical evolution of childhood agricultural 

prevention and intervention research in the United States 

along with NCCRAHS’ approach to this work.

In the second presentation “Surveillance of Medically 

Attended Agricultural Injuries in Farm Children” 

epidemiologist, Jeffrey VanWormer, in collaboration with 

biomedical informatics scholar, Bryan Weichelt, will 

outline a surveillance research platform (T1) by 

presenting early findings of 20-year epidemiologic trends 

in medically attended agricultural injuries in farm 

children and adolescents using retrospective data from a 

large rural health care system in north-central Wisconsin.
2022 NATIONAL OCCUPATIONAL INJURY RESEARCH SYMPOSIUM 76

The last presentation “Agricultural Youth Work 

Guidelines” led by family studies scholar, Andrea 

Swenson, provides an example of implementation and 

adoption research (T4) as she will present the process that 

guided the updating the Agricultural Youth Working 

Guidelines and key findings from the research that guided 

the guidelines’ implementation and dissemination.

E4.1

Title: 25 Years of Progress and Persistent Challenges in 

Childhood Agricultural Safety

Author: Barbara Lee

Background: Since 1996 NIOSH has led the National 

Initiative for Childhood Agricultural Injury Prevention 

with a coordinating Center of Excellence through a 

competitive application process. The National Children’s 

Center for Rural and Agricultural Health and Safety 

(NCCRAHS) of Marshfield, WI has held that position for 

twenty-five years. The center’s approach is based upon 

Burden, Need and Impact principles integrated with 

research that has evolved from epidemiology of injuries 

(T1) to studies that focus on outcomes and effectiveness 

in populations (T4).

Methods: All of NIOSH’s agricultural centers include 

several research studies augmented with outreach 

activities, evaluation, and administrative functions. 

During the initial center years, a primary focus addressed 

understanding the scope and etiology of injuries and 

fatalities. In 2014, the Child Ag Injury Surveillance system 

was discontinued and NCCRAHS began to systematically 

gather and code publicly available news reports to fill the 

gap. Initially, attention was given to development and 

testing of basic safety guidelines for youth working in 

agriculture and young children living near worksites. 

Over time the strategies for knowledge mobilization in the 

farming community shifted from print media and 

presentations to social media and interventions based on 

the socio-ecological model that engaged influencers such 

as agricultural businesses, insurance providers, farm 

youth organizations, and the media.

Results: From 1997 to the present there have been notable 

changes in childhood agricultural injury and fatality rates, 

as well as variables associated with victims, agents of 

injury, and environmental/social factors. NCCRAHS’ 

research and outreach initiatives increased their focus on 

non-working youth, parental behaviors, and effectiveness 

of educational interventions. Capacity building has 

witnessed the expansion of child safety advocates (via the 

Child Ag Safety Network) from a handful of interested 

individuals and NGOs to more than 75 organization 

representatives collaborating on position papers, public 

service announcements, and national-level campaigns on 

issues such as “Keep Kids Off Tractors.” Persistent gaps in 

a national approach include acceptable strategies for select 

populations, e.g. Anabaptist, public policy for labor laws 

and child protective services and, in many situations, the 

“Farm Kid Paradox” that suggests benefits of youth 

working and living in agricultural settings outweigh any 

risk of injury or disease.

Conclusions: Injury and fatality data, combined with 

intervention evaluations have guided the focus, outputs 

and impacts of the NIOSH-funded childhood agricultural 

safety center. The numbers of serious and fatal injuries are 

declining, involvement of safety advocates has expanded, 

and public awareness of the preventability of childhood 

agricultural injury events has increased.

E4.2

Title: Surveillance of Medically Attended Agricultural Injuries in 

Farm Children

Authors: Jeffrey VanWormer, Bryan Weichelt, Katherine Barnes, 

Richard Berg

Background: There is no deadlier work for children and 

adolescents in the United Sates than farming. Despite this, 

relatively little is known about trends in agricultural 

injury risk because there is no comprehensive surveillance 

system for non-fatal, hospitalized, and fatal agricultural 

injuries. The purpose of this project is to establish a 

surveillance system of confirmed, medically attended 

agricultural injuries among children and adolescents who 

reside on farms in north-central Wisconsin. Multi-year 

epidemiologic trends in medically attended agricultural 

injuries, as well as population subgroups at highest risk 

for agricultural injury, will be estimated.

Methods: A retrospective cohort will be assembled 

including children and adolescents (age <18 years) who 

reside within a target 20-county region served by 

Marshfield Clinic Health System (MCHS). Specific cohort 

entry criteria will include: (1) residential address on an 

active farm within the targeted 20-county region, as 

evidenced by an agricultural production address listed on 

the state register of licensed dairy producers or a 

commercial vendor listing of farm residences, and (2) 

reasonably complete capture of their medical care within 

MCHS data systems, as evidenced by medically ‘homed’ 

status, member of the MCHS-affiliated health insurance 

plan (Security Health Plan of Wisconsin), or resident of 

the Marshfield Epidemiologic Study Area. The primary 

dependent variable will be medically attended agricultural 

injuries, per MCHS diagnostic codes and vital status from 

electronic health records, Wisconsin Trauma Care 
2022 NATIONAL OCCUPATIONAL INJURY RESEARCH SYMPOSIUM 77

Registry events, or Wisconsin Ambulance Runs Data 

System keywords indicative of an agricultural injury.

Results: A pilot demonstration of this system was created 

for year 2020. Farm status and MCHS patient record 

linkages identified 3,008 children and adolescents who 

resided on a known farm operation in the target 

population. Of these, there were 6 incident medically 

attended agricultural injuries during the year (estimated 

injury rate 2 per 1,000 farm children/adolescents). Half of 

all injuries were related to farm animals (e.g., cows, 

horses) and two were the result of play in and around 

farm equipment. There were no in-hospital fatalities.

Conclusions: Children and adolescents who live on farms 

are susceptible to serious injuries related to their 

environment. Future analyses will examine trends over 

time in incident youth farm injuries by person-year of 

follow-up, as well as more detailed injury, demographic, 

and circumstantial features to help identify the nature and 

changes of farm injury risks in the region. Lessons from 

this study will be applied to future research designed to 

build a model of childhood agricultural injury surveillance 

that can be replicated and scaled across other large 

healthcare systems and linked in a national surveillance 

network. 

E4.3

Title: Agricultural Youth Work Guidelines

Authors: Andrea Swenson, Marsha Salzwedel, 

Cassandra Peltier, Barbara Lee

Background: The North American Guidelines for 

Children’s Agricultural Tasks (NAGCAT) were developed 

between 1996–1999 as an occupational injury prevention 

resource for assigning agricultural work tasks to youth. A 

consensus-derived approach was used to develop 62 

detailed NAGCAT guidelines based on the job hazard 

analysis framework. NAGCAT became the gold standard 

for children’s work in agriculture and prompted several 

studies to validate content, dissemination strategies, and 

guideline efficacy. With more scientific evidence available 

and changes in technology influencing the types of work 

tasks youth performed, NAGCAT were updated and 

renamed Agricultural Youth Work Guidelines (AYWG; 

released in 2017). Recognizing the changing environment 

in which youth agricultural occupational injuries and 

fatalities occur, this presentation will describe the multipronged processes used for updating AYWG and the 

subsequent research guiding dissemination and 

implementation.

Methods: A 16-person steering committee comprised of 

representatives from various agricultural industries was 

formed to provide guidance on topics, practicality, 

relevancy to diverse audiences, and the overall design of 

the guidelines. Guideline topics were determined by the 

steering committee, content consultants created or 

updated job hazard analysis charts, and a child 

development specialist addressed developmental 

concerns. AYWG and associated materials on child 

supervision, communication, and benefits of farm work 

were created, translated, and posted online. 

Dissemination of AYWG included presentations, media 

kits, press releases, webinars, and trade booths. Following 

the creation of AYWG, several research studies were 

completed regarding implementation and dissemination 

of AYWG. One study included a needs assessment of 

agricultural health and safety organizations. Ninety-five 

organizations were asked to complete an online survey 

related to child agricultural injury prevention needs. A 

second online survey included a needs assessment of 215 

agricultural educators.

Results: Fifty-two organizations completed the 

organizational needs assessment (55% response rate). 

AYWG were one of the top three resources identified as 

being currently used by respondents, with over half (52%) 

of respondents using guidelines. Organizations identified 

the largest need for child agricultural health and safety is 

promotion and dissemination of agricultural safety 

resources and tools. In the assessment of agricultural 

educators, a majority of respondents reported they 

typically teach animal safety (80%) as well as tool and 

equipment safety (63%). Only 35% of educators reported 

teaching tractor safety, 22% taught all-terrain 

vehicle/utility task vehicle safety, and 15% taught rural 

road safety, despite transportation incidents being a 

primary source of fatality. When asked where respondents 

find their agricultural education materials, the most 

common sources were through their professional network 

or society, shared by a colleague, and through searches on 

the internet.

Conclusion: AYWG are an intervention translating 

research into practice. AYWG were recently updated to 

keep pace with emerging issues in agricultural work and 

occupational safety. This presentation will also describe 

newly launched projects which address (a) youth 

educators’ barriers and motivators for adopting AYWG 

into their curriculum; and (b) barriers and motivators for 

adopting AYWG within agricultural organizations, 

focusing on Latinx serving organizations. The process of 

updating these guidelines and the subsequent research 

findings offer insight into how different collaborators 

inform processes needed to maintain relevancy in an ever-
2022 NATIONAL OCCUPATIONAL INJURY RESEARCH SYMPOSIUM 78

changing world and reach target demographics to prevent 

occupational injuries and fatalities.

Session F1

Occupational Injury Surveillance, Part 1

Moderator: Audrey Reichard

F1.1 

Title: Time Series, Seasonality and Trend Evaluation of 6-Year 

(2015-2020) OSHA Severe Injury Data

Authors: Harold Gomes, Vidisha Parasram, 

Christina Socias-Morales, James Collins

Introduction: New regulatory requirements mandated 

employers to report severe work-related injuries (e.g., 

amputation, hospitalization) to the Occupational Safety 

and Health Administration (OSHA) since January 2015. 

This study examined the OSHA severe injury reports 

(SIR) to understand time-related trends and patterns in 

injuries, such as differences between days of the week, 

seasonal trends within a year, annual trend over time, and 

annual trends by industry and injury event.

Methods: OSHA SIR are accessible to the public on 

OSHA’s website, www.osha.gov/severeinjury, and include 

injury date, latitude, longitude, 2017 North American 

Industry Classification System (NAICS) industry codes, 

and Occupational Injury and Illness Classification System 

(OIICS), v2.01 injury variables. This study included all 

injury events from Jan 2015 to Dec 2020 (72 months) 

including 50 states, DC and 5 territories. Time functions 

were employed to extract the components of date that 

enabled aggregation by different time units. Data were 

visualized using Local Polynomial Regression (LOESS) as 

the trendline to monthly injuries to account for the 

moving average. Seasonality between 12 months were 

evaluated. Number of daily injuries were compared by day 

of the week. Time Series decomposition models (classical 

additive and multiplicative) were employed to produce a 

trend of injuries over time while adjusting for seasonal 

effect. We compared annual trends by 2-digit NAICS and 

separately by 1-digit OIICS injury event.

Results: There was a total of 61,540 injuries in the 72-

month study period. The number of severe injuries 

reported in a month ranged from 600 to 1,100 and 

showed seasonal fluctuations. Within an average year, 

severe injuries gradually decrease from January to April, 

increase from May to August, and then decrease again 

from September to December. The trend evaluation (6-

year) using LOESS moving average regression suggests a 

slight overall increase from January 2015 to August 2018, 

then a decrease up until December 2020. During COVID19 (March-December 2020), severe injuries were lower 

than previous years. The Time Series decomposition 

models indicate that a trend still exists even after 

adjusting for the seasonal component. The seasonality 

adjusted trend also indicates a gradual increase of injuries 

over time up until October 2018, then a substantial 

decrease. Daily severe injuries ranged from 2-68 per day 

depending on the day of the week. The mean injury 

reported on a weekday ranges from 30-36 and weekend 9-

14. In a yearly injury trend comparison by NAICS 

industry, Manufacturing (2,836-3,614 per year) and 

Construction (1,718-1,969 per year) incurred the highest 

yearly number of injuries compared to other NAICS 

industries (< 1,000 per year). Similarly, in a yearly injury 

trend comparison by OIICS injury event, Contact with 

Objects and Equipment (4,054-5,105 per year), and Fall, 

Slips, Trips (2,788-3,366 per year) show substantially 

higher yearly injuries compared to other OIICS injury 

types (<1,000 per year).

Discussion: This study describes the feasibility and 

usefulness of SIR to describe trends in severe, workrelated injuries. We found that two industry sectors, 

manufacturing and construction, shared the largest 

burden of severe injuries, and the most common injury 

events were Contact with Objects, and Falls, Slips, and 

Trips. SIR only include Federal OSHA Jurisdiction and 

are limited by suspected underreporting. However, the 

penalty was increased for not reporting a severe injury. 

Federal OSHA Jurisdiction includes State Plan states for 

specific activities, USPS nationwide, Military bases, Indian 

Reservations and certain maritime activities. Given the 

brief turnaround in SIR dissemination (about 6 months) 

in comparison to other national injury surveillance 

datasets that can take a year or more, OSHA should 

continue to make this underutilized dataset available for 

analysis to the public to improve work-related injury 

prevention. 

F1.2 

Title: Using Multiple Surveillance Systems to Understand 

Potential SARS-Co-V-2 Exposures Among EMS and Firefighters

Authors: Emily Haas, Alexa Furek, Katherine Yoon, 

Megan Casey, Susan Moore

Background: Emergency calls in some urban areas, such as 

New York City, have doubled during the pandemic, 

increasing firefighters and emergency medical service 

(EMS) workers’ risk of occupational exposure to SARSCoV-2 (i.e., COVID-19) (Watkins, 2020; Pilgrim et al., 

2020). This increased call volume and occupational risk 

points to the need for examination of EMS response types 
2022 NATIONAL OCCUPATIONAL INJURY RESEARCH SYMPOSIUM 79

to proactively identify scenarios that may need increased 

resources and risk mitigation strategies. This study 

explores how data coding within computer-aided dispatch 

(CAD) systems may influence the assigned likelihood of 

exposure to SARS-CoV-2, identifying the need for 

additional data cleaning and verification at the 

department level to inform accurate surveillance efforts.

Methods: Through a research collaboration with the 

International Public Safety Data Institute and three fire 

departments that utilize the National Fire Operations 

Reporting System, the National Institute for Occupational 

Safety and Health received monthly, post-call surveillance 

data generated by department CAD systems. CAD data 

reports response call characteristics and public health data 

such as potential exposure to SARS-CoV-2. From March 

to September 2020, 162,766 incidents were received and 

labeled as EMS (64.2%), Fire (29.6%), and “other” (6.2%). 

Just over 8% (n=13,197) of the incidents noted potential 

SARS-CoV-2 exposures. Within these probable exposures, 

86.2% were coded as EMS (M=.11, SD=.311), 9.9% Fire 

(M=.03, SD=.162), and the remaining 3.9% “other” 

(M=.05, SD=2.19). Researchers analyzed this data using 

Generalized Linear Model with binomial logistic 

regression in R (version 4.0.3) to understand whether 

SARS-CoV-2 exposure was significantly associated with 

response type.

Results: The regression results show that those who 

responded to a fire incident were 78% less likely to 

experience exposure to SARS-CoV-2 (66% less likely for 

“other” incidents) in comparison to those who responded 

to EMS calls, with other variables (population, state, and 

month) held constant. Although the initial results were 

not surprising, it prompted a closer examination of EMS 

call descriptions. Researchers coded original narratives of 

the 162,766 calls to understand what situations 

encompassed each response category, particularly EMS. A 

subsequent analysis added two additional variables (i.e., 

traffic/motor-vehicle related and hazmat) to account for 

common, complex situations that could fall into EMS 

and/or Fire. Researchers also added monthly averages of 

new COVID-19 cases using public data (The New York 

Times GitHub, 2021) to control for higher COVID-19 

cases within the three cities being studied. Researchers 

found that having an EMS call versus a fire call increased 

the odds of having a potential exposure to SARS-CoV-2 

by 236.4%, with all other variables (population, COVID19 new cases, state, and month) held constant. This effect 

was significant at the 0.001-level for a two-tailed test (z=-

44, p<.0001).

Conclusions: EMS calls had the highest predicted 

probability of responder SARS-CoV-2 exposure, followed 

by fire, other, hazmat, and auto calls (in order). However, 

the content analysis informed a new variable with five 

categories. The statistical difference in these two analyses 

show the high possibility of measurement error if 

response data is not standardized. These results show the 

importance of accurate data tagging including the need to 

update reporting systems after a response is complete to 

better identify high-risk scenarios to inform preparedness 

efforts. For example, results show responses that involve 

trauma or medical illness in which frontline workers may 

experience higher risks of occupational exposure, are at a 

far greater risk than those EMS calls that involve helping 

patients in auto accidents. The results show scenarios in 

which EMS workers should pay special attention to the 

COVID-19 guidelines available for EMS and first 

responders. 

F1.3 

Title: SOII vs. MarketScan: What Can Alternative Data Tell Us 

About the Seasonality of Injuries?

Author: Benjamin Raymond

Background: Previous research shows occupational injuries 

display a distinct seasonal pattern-- a spike in January and 

the summer months followed by a significant decline in 

November and December. It is unclear to what extent 

these seasonal patterns are caused by employer confusion 

regarding recordkeeping rules, changes in work exposure, 

or changes in reporting incentives for workers and firms.

Methods: The seasonality of case records from the Bureau 

of Labor Statistics' Survey of Occupational Injuries and 

Illnesses (SOII) was compared to workers' compensation 

data from the IBM MarketScan Research Databases. 

Seasonal effects were estimated using an Unobservable 

Components Model. The seasonal patterns of short-term 

disabilities claims, long-term disabilities claims, and 

private insurance claims from the MarketScan Research 

Databases were also examined for evidence of strategic 

seasonal substitution away from workers' compensation 

by workers. 

Results: While the workers' compensation data and the 

SOII display similar qualitative patterns, the year-end 

decline is much more muted in the MarketScan data (1/3 

to 1/2 the decline observed in the SOII). The short-term 

disability claims and private health insurance claims 

display seasonal patterns that are inversely related to the 

seasonality of reported occupational injuries. While these 

findings suggest workers may strategically substitute from 

workers' compensation to short-term disability claims or

private health insurance claims on a seasonal basis, the 
2022 NATIONAL OCCUPATIONAL INJURY RESEARCH SYMPOSIUM 80

underlying mechanism driving any potential strategic 

considerations is unclear.

Conclusions: Part of the year-end decline is likely the result 

of recordkeeping error. However, workers' compensation 

seasonal estimates suggest some other seasonal factor is 

significantly contributing to the end-of-year decline in 

occupational injuries. The seasonality observed in shortterm disability claims and private health insurance claims 

data suggests strategic seasonal substitution away from 

workers' compensation by workers may be partially 

driving the end-of-year decline.

Session F2

Crew Resource Management: Critical Decision Making 

in the Hazard Zone

Workshop Leader/Tutorial Organizer: Murrey Loflin

Crew Resource Management as an Example of a Safety 

Management System for Firefighting Operations

Purpose Statement: The most dangerous location for fire 

fighters to operate, in terms of fatalities and serious 

injury, is on the fireground and in the hazard zone. This 

session will discuss the importance of critical decision 

making on the fireground to improve firefighter safety. 

This session will show the proper use of Crew Resource 

Management as a practical example of an occupational 

health and safety management system (OHSMS), and how 

it can have long term results which improve the safety 

culture within a fire department.

Crew Resource Management (CRM) requires a 

commitment to change leadership and operating cultures 

that have evolved over generations within fire 

departments. The Unites States military, commercial 

aviation, health care, and shipping industries have 

adopted the concept of CRM. The similarities between the 

flight deck and the cab of an emergency vehicle suggest 

that CRM has application to the emergency services. CRM 

goals are to minimize the effect that human error has on 

operations and maximize human performance. Crews 

trained in CRM learn skills that enhance communication, 

maintain situational awareness, strengthen decision 

making and improve teamwork. Developing, adopting, 

and implementing CRM for the nation’s fire and rescue 

service is the next logical step. This process works toward 

a safer, more effective fire service.

Title: Crew Resource Management: Critical Decision Making in 

The Hazard Zone – Humble Beginnings 

Presenter: Dennis L. Rubin, Fire Chief, Upper Merion Fire 

Department, Upper Merion, PA

Description: Nationwide, the fire fighter’s personal 

protective ensemble, apparatus and equipment 

technology, available training, safety resources, and safety 

standards are at the highest, safest levels ever experienced 

in fire service history. However, United States Fire 

Administration statistics reveal a ten-year plateau of more 

than 100 fire fighter line-of-duty deaths and 

approximately 10,000 serious line-of-duty injuries each 

year. To worsen matters, fire fighters are being injured 

and killed on incidents at rates close to those of 20 years 

ago. Case analyses show that most of these line-of-duty 

deaths and injuries are preventable. Clearly, the fire and 

rescue service must change its attitudes, beliefs, and 

behaviors toward safety, if fire fighter injuries and 

fatalities are going to be reduced. CRM aims to foster a 

culture where authority may be respectfully questioned. 

This process recognizes that a discrepancy between what 

is happening and what should be happening is often the 

first indicator that an error is occurring.

Title: Crew Resource Management: Critical Decision Making 

in The Hazard Zone - The Program Principals

George A. Morgan, Training Specialist, Response Section, 

National Fire Academy

Description: Culture is generally defined as the behaviors, 

attitudes, values, and beliefs that are shared within a 

group or organization. It reflects the collective perception 

of right and wrong, good, and bad, or desirable and 

undesirable actions and characteristics.

The safety culture within a fire department is reflected 

through its members’ behaviors, attitudes, and actions in 

and out of the station as well as on the fire ground. Using 

CRM provides for:

• Better teamwork

• Newly acquired communication and problem-solving 

skills

• An operating philosophy that promotes team 

member input while preserving legal authority 

• Proactive accident prevention.
2022 NATIONAL OCCUPATIONAL INJURY RESEARCH SYMPOSIUM 81

Becoming familiar with the five factors is an essential first 

component:

• Communication

• Situational Awareness

• Decision Making

• Teamwork 

• Barriers 

Title: Crew Resource Management: Critical Decision Making in 

The Hazard Zone – Application in a Case Study

Presenter: Murrey Loflin, Investigator, NIOSH Fire Fighter 

Fatality Investigation and Prevention Program

Description: Operating in the hazard zone is categorically 

the most dangerous location in which firefighters operate, 

in terms of fatalities and serious injury. Statistics provided 

by the United States Fire Administration reveal a decrease 

in firefighter line-of-duty deaths in the past ten years, 

though there is still a need to concentrate on decision 

making in the hazard zone. Issues related to the lack of 

scene size-up and risk assessment; poor or inadequate 

incident management; inadequate communications; and 

standard operating procedures/standard operating 

guidelines or not following them have been listed as 

contributing factors in far too many National Institute for 

Occupational and Health (NIOSH) fire fighter line of duty 

death investigation reports. This case study will discuss 

the use of Crew Resource Management as a practical 

example of a safety management system that can have 

long term results which improve the safety culture of the 

American Fire Service.

Learning Objectives:

1. Review and discuss the principles of the proper 

application of Crew Resource Management.

2. Discuss how these skills are applied when 

operating in the hazard zone to prevent harm to 

firefighters. 

3. Describe how the five factors that are used in the 

Crew Resource Management can likely prevent 

an injury from occurring.

4. Discuss the effectiveness of crew resource 

management program while firefighters are 

operating in the hazard zone on the fireground 

by using a case study.

References: 

Blanchet, D. [2017]. Sterile cockpit, sterile crew. EMS 

World. November 2017. 

https://www.emsworld.com/article/219018/sterilecockpit-sterile-crew. 

Helmreich RL, Merritt AC, Wilhelm JA [1999]. The 

Evolution of Crew Resource Management Training; 

International Journal of Aviation Psychology 9(1), Pages 

19-32, 1999. 

IAFC [2002]. Crew resource management, a positive 

change for the fire service. Fairfax, VA. International 

Association of Fire Chiefs. https://www.iafc.org/topicsand tools/resources/resource/crew-resource-management. 

NIOSH [2018]. Two Fire Fighters Die and Three Fire 

Fighters Injured in a Fire. 

Apparatus Crash—West Virginia. Morgantown, WV: U.S. 

Department of Health and Human Services, Centers for 

Disease Control and Prevention, National Institute for 

Occupational Safety and Health, Fatality Assessment and 

Control Evaluation (FACE) Report F2018-08 

https://www.cdc.gov/niosh/fire/pdfs/face201808.pdf. 

Session F3

Research in the Construction Industry Part 2

Moderator: Scott Earnest

The construction industry employs more than 11 million 

workers, is very diverse, and has significant health and 

safety challenges. A consortium of scientists supported by 

NIOSH, CPWR – The Center for Construction Research 

and Training (CPWR), and the NORA Construction 

Sector Council conduct research on existing and emerging 

hazards facing the industry. They target NIOSH and 

NORA constructions goals on persistent and emerging 

hazards faced by workers on the job, identify causes and 

solutions for safety and health risks, and test the impact of 

disseminating effective interventions to the industry that 

result in evidence-based technologies being applied and 

good work practices to prevent occupational injuries and 

illnesses. This session highlights selected research projects 

on a variety of topics funded by NIOSH and CPWR, 

through the NIOSH-supported National Construction 

Center. 

Presentations 

1. Improving Residential Construction Safety through 

Safety Leadership and Fall Prevention Training

Presenter: Brad Evanoff

Safety training and safety practices in residential 

construction, particularly by small contractors, lag those 

in the commercial sector. Improving safety leadership 

skills of foremen is a critical step to reducing falls and 

other injuries. We adapted the successful Foundations for 

Safety Leadership (FSL) program to create the FSL4Res, a 
2022 NATIONAL OCCUPATIONAL INJURY RESEARCH SYMPOSIUM 82

version specific to the unique hazards and organizational 

challenges of residential construction. This presentation 

will discuss findings from a needs assessment that 

informed new trainer guides and three new video 

scenarios based on fall prevention in residential 

construction. We plan to disseminate these new training 

resources and track their reach and uptake.

2. Development of a Mast Climbing Work Platform 

Visual Inspection Tool

Presenter: Bryan Wimer

Mast Climbing Work Platforms, or mast climbers, are an 

alternative to traditional tube and coupler scaffolding. 

They consist of a power-driven working platform affixed 

to a structure allowing workers to reach multiple heights 

to complete various construction tasks. Mast climber 

incidents occur due to several factors including: improper 

or lack of worker training, anchoring, platform working 

conditions, guarding, and failure to follow manufacturer's 

recommended guidelines for assembly/disassembly. A key 

safety practice that can help prevent safety hazards is to 

complete a daily inspection of the equipment before use. 

This presentation highlights an online visual inspection 

walk through tool that was developed by NIOSH 

researchers. It allows potential users to do a virtual based 

daily inspection and presents safety items and hazards 

they should be aware of during the inspection process.

3. Highlights from the CPWR Small Studies Program and 

Future Priorities and Opportunities

Presenter: Rick Rinehart

CPWR has funded 30 one-year research projects from 

2016 to the present, with several ongoing. This 

presentation will highlight selected findings and outputs 

from these projects, discuss current priority areas and 

opportunities for future funding.

F3.1 

Title: Improving Residential Construction Safety Through Safety 

Leadership and Fall Prevention Training

Authors: Bradley Evanoff, Ann Marie Dale, Barry Stelzer, 

Anna Kinghorn, Linda Goldenhar

Introduction: Safety training and safety practices in 

residential construction, particularly in small contractors, 

lag behind those in the commercial sector. Residential 

foremen lead both safety and production on their sites 

and are critical to improving safety practices; improving 

the safety leadership skills of foremen is a critical step to 

reducing falls and other injuries. We adapted the existing, 

successful Foundations for Safety Leadership (FSL) 

program to create the FSL4Res, a version specific to the 

unique hazards and organizational challenges of 

residential construction.

Methods: The existing FSL was created by the Center for 

Construction Research and Training (CPWR) and uses 

animated scenarios and interactive discussion to teach six 

key safety leadership skills (Leading by example, Engages 

and empowers team members, Actively listens, Practices 

three-way communication, Develops team members, 

Recognizes team members for a job well-done). The FSL 

emphasizes the use of these safety leadership skills to 

promote safe behaviors, improve safety outcomes, and 

improve safety climate and culture on the job site. To 

develop a version of the FSL program that addresses the 

unique needs of foremen in residential construction, we 

conducted a systematic needs assessment to identify 

national and regional training needs, and to understand 

contractor capabilities and the learning preferences of 

construction foremen. Following the needs assessment, 

we convened a Curriculum Development Team of 

academics and industry experts to make adaptations to 

the FSL. We used a formal adaptation framework to 

describe modifications to the original FSL, including 

content modifications, contextual modifications, and 

organizational levels at which modifications occurred.

Results: 47 construction stakeholders participated in the 

needs assessment. Findings showed that the existing FSL 

was an effective training program and was well regarded 

by union-based and contractor-based trainers and safety 

professionals. The FSL was more widely used in 

commercial construction than in the residential sector. 

Other findings from the needs assessment suggested 

specific adaptations to the FSL to increase its reach (Have 

you heard about it?) and uptake (Have you used it?) into 

the residential sector. Suggested content modifications 

included the development of new teaching scenarios that 

focused on fall prevention and were specific to the 

residential construction setting, and the development of 

brief trainer guides for existing FSL scenarios that 

described situations commonly found in residential 

construction. Suggested contextual modifications 

included altering delivery format to allow multiple shorter 

training sessions instead of a single 2.5-3 hour session. 

Organizational modifications were suggested to expand 

the number of trainers who could deliver the FSL4Res, 

and to ensure that videos and other materials were 

suitable for shorter trainings at the worksite as well as in 

classroom or formal course settings.

Discussion: Based on findings from the needs assessment, 

we have created three new scenarios based on fall 

prevention in residential construction. We have also 

developed trainer guides and have begun to work with 
2022 NATIONAL OCCUPATIONAL INJURY RESEARCH SYMPOSIUM 83

CPWR and national contractor associations to publicize 

and disseminate the FSL4Res. Future work will include 

surveying and interviewing residential construction 

contractors to evaluate the reach and uptake of the 

FSL4Res, and to identify barriers to increasing reach and 

uptake. 

F3.2 

Title: Development of a Mast Climbing Work Platform Visual 

Inspection Tool

Authors: Bryan Wimer, Brianna Eiter, Christopher Pan, 

Timothy Orr

Background: Mast Climbing Work Platforms, or mast 

climbers, are an alternative to traditional tube and coupler 

scaffolding. They consist of a power-driven working 

platform affixed to a structure allowing workers to reach 

multiple heights to complete various construction tasks 

while offering higher productivity and cost savings over 

traditional equipment. Concerns by manufacturers, 

construction officials, and construction/safety groups 

have been raised that an increased exposure to serious or 

fatal incidents could be present as the use of mast climbers 

is on the rise. According to CPWR, there were 1,533 fatal 

falls in construction between 2011 and 2015, with 

approximately 33% from roofs, 24% from ladders, and 

15% from scaffolding. Several mast climber incidents, 

such as a collapse in March 2015 in Raleigh, North 

Carolina, resulted in three worker fatalities and one 

serious injury making up part of the 15% of falls from 

scaffolding resulting in fatalities. Mast climber incidents 

occur due to several factors including: improper or lack of 

worker training, anchoring, platform working conditions, 

guarding, and failure to follow manufacturer's 

recommended guidelines for assembly/disassembly. A key 

safety practice that can help prevent safety hazards is to 

complete a daily inspection of the equipment before use. 

During these inspections, many of the hazards present can 

easily be identified by those familiar and trained to set-up 

and use the equipment.

Methods: An online visual inspection tool has been 

developed utilizing both current and previous research 

where NIOSH addressed engineering and design 

considerations of mast climbers. Newer online training 

tools and emergent technology, such as virtual reality 

simulations, are more limited for mast climbers than for 

other similar types of equipment such as aerial lifts. This 

visual inspection tool helps guide potential users through 

a daily inspection of a mast climber from the ground up. 

The walkthrough tool is housed on the NIOSH website 

and includes images of a typical mast climber set up with 

highlighted areas that the user can click on to complete 

the daily inspection process. Best practices from 

manufacturers are included with each highlighted area 

along with potential hazards that can occur if identified 

areas are not properly inspected and safety requirements 

ignored. Relevant OSHA related standards are also 

presented when applicable.

Discussion: Based on feedback amongst end users, 

manufacturers, trade groups, and industry standard 

committees an additional need was also identified. 

Specifically, end users requested the mast climber tool be 

made available in Spanish as a significant portion of the 

construction workforce are Spanish speaking comprise 

approximately 30% of those who use mast climbers. Of 

those Hispanic workers, about 40% of reported that they 

cannot speak English very well, and 21% reported they 

cannot speak English at all, respectively. Therefore, the 

walkthrough tool was translated to Spanish to help reduce 

written/verbal language barriers. Both language versions 

are readily available and can be toggled between and 

repeated as needed on the NIOSH Mast Climber website.

F3.3 

Title: Highlights from the CPWR Small Studies Program and 

Future Priorities and Opportunities

Authors: Richard Rinehart, Patricia Quinn

Background/Introduction: Construction is a complex and 

highly hazardous industry with one of the highest rates of 

work-related acute traumatic injury in the U.S. Every day, 

millions of construction workers are employed on 

worksites in all types of different settings across the 

country. Each worksite and type of construction (e.g., 

residential, highway) involves distinct variables, including 

type of work performed (e.g., electrical, plumbing), 

number of employers and employees, project designs, 

materials and products used, and diverse working 

conditions. CPWR – The Center for Construction 

Research and Training (CPWR), which serves as the 

NIOSH-funded National Center for Construction Safety 

and Health Research and Translation, brings together 

researchers and industry stakeholders to conduct research 

on construction health and safety hazards and ways to 

communicate and mitigate the risks. This presentation 

will provide an overview of the CPWR Small Studies 

Program, highlight research findings on topics related to 

preventing acute traumatic injuries, show where to find 

study reports on the web, and introduce upcoming 

research priorities and opportunities for the audience.
2022 NATIONAL OCCUPATIONAL INJURY RESEARCH SYMPOSIUM 84

Methods: In 1993, CPWR established the Small Study 

Program to conduct and pilot hypothesis-generating 

research and attract new investigators into the field of 

construction health and safety research. This 

groundbreaking program continues to provide selected 

researchers with seed money of up to $30,000 and 

flexibility to initiate short-term studies up to 12 months. 

The research can investigate and assess the potential risks 

from emerging hazards and changes taking place in the 

construction industry, explore new approaches for 

addressing persistent hazards, target high-risk 

populations such as small employers, vulnerable workers, 

residential and light commercial construction firms. 

Studies often engage stakeholders, through partnerships 

and other means, to better understand the barriers to and 

motivators for adoption of best practices, address 

emerging issues and explore new technologies, evaluate 

promising research translation products and 

dissemination strategies, and/or create and test other 

promising methods and interventions to improve 

construction worker health and safety. Many major 

construction research projects began with a CPWRfunded small study.

Results/Findings: To date, approximately $3.75 million has 

been awarded to fund 127 small studies, 30 of which have 

been from 2016 to the present. The Small Study Program 

gives preference to studies that respond to industrydriven priorities, including NIOSH strategic goals, the 

National Occupational Research Agenda (NORA) for 

Construction, and more recently the 2018 NIOSH 

Construction Program Expert Panel Report 

recommendations. Results are communicated to research 

scientists and industry stakeholders through published 

reports posted on CPWR’s Small Study Program 

webpages, peer reviewed journal articles (more than 60% 

of investigators have published articles on their findings), 

researchers’ dissemination outlets, and products and 

outreach activities from CPWR’s research to practice 

(r2p) and communications programs. Recent studies have 

addressed a broad range of hazards and potential 

solutions, including prevention through design (PtD), 

workforce sustainability, safety training, ergonomics, the 

effects of policy on safety, r2p approaches, and other 

promising interventions to prevent occupational illnesses 

and injuries.

Discussion/Conclusions: These small studies generate standalone findings, innovative approaches, and pilot data 

which not only contribute to the body of scientific 

research on construction health and safety, but also 

provide new insights into emerging hazards, new 

technologies, potential solutions, and can also identify 

future research needs.

Session F4

All-Terrain Vehicles Safety in Agriculture

Moderator: Christine Schuler

F4.1 

Title: ATV Safety Design Features: Examining Cultural 

Awareness and Piloting an Educational Program Among 

U.S. Young Adults in Agriculture

Authors: Jenna Gibbs, Carolyn Sheridan, Aaron Yoder

Previous survey results from >800 Midwestern young 

adults in agriculture show that 56% have rolled an ATV, 

yet 76% report allowing extra riders and only 18% report 

wearing helmets when operating the device. Evaluation 

results from our previous programs indicated only small 

changes in behavior with regards to allowance of extra 

riders and helmet-use following the program. We 

developed a new ATV safety curriculum focused initially 

on engineering controls and safety features that can be 

highlighted at the point of purchase. This included a 

motion graphic to highlight engineering controls such as 

crush protection and other safety design features. The 

new program was delivered to 276 young adult 

participants in the U.S. in 2020-21. Participants were 

asked about awareness of specific ATV engineering 

features in a pre-survey. Higher proportions reported they 

were aware of windshields (78%), roll cages (69%), and 

safety flags (55%). Lower proportions were aware of dual 

wheel systems (35%), 55-inch-wide frames (26%), crush 

protection devices (21%), stability ratings (19%), GPS 

rollover alarms (17%), and Original Equipment 

Manufacturer (OEM) Approved Accessories (16%). 

Participants were asked if they would consider using any 

of the engineering controls that were discussed. Although 

many stated that they were “somewhat likely” to consider 

more engineering controls, the safety features they 

mentioned in a feedback section included windshields, 

roll bars, and OEM approved accessories. Following the 

program, about a quarter (26%) of participants indicated

that they were also “somewhat likely” to consider using a 

Crush Protection Device in the post-survey. The findings 

of this study are important for continued development of 

young adult ATV safety programs in agriculture. Our goal 

is that young adults to consider some of these safety 

features when purchasing their first ATV or ATV-related 

accessories after graduation.
2022 NATIONAL OCCUPATIONAL INJURY RESEARCH SYMPOSIUM 85

Following this presentation, participants will be able to: 1. 

Participants will understand how the NIOSH hierarchy of 

controls can be applied to ATV Safety Training, and how 

engineering controls are an important component of such 

a program. 2. Participants will be able to list and describe 

8 ATV engineering controls that may be considered at 

point of purchase. 3. Participants will learn how to 

consider some of these safety design features when 

considering purchase of a new ATV for the farm. 4. 

Participants will gain knowledge with regards to young 

adult’s knowledge and awareness of ATV safety controls 

and how to engage with young adults about this topic.

F4.2 

Title: Protecting Farmworkers in Agricultural All-Terrain Vehicle 

Rollover Incidents

Author: Farzaneh Khorsandi

Agriculture is one of the most dangerous industries in the 

United States. The ATV death rate is reportedly 100 times 

higher in the agriculture industry than in other U.S. 

industries. Rollover incidents constitute about 85% of 

ATV incidents in the agricultural industry. There is no 

practical solution to protect the operator in ATV rollover 

incidents in the United Sates. A Crush Protection Device 

(CPD) can potentially protect the operator in low-speed 

rollover incidents, such as the majority of agricultural 

ATV incidents. CPD has been designed and commercially 

produced in Australia. The CPD protects the operator by 

providing a Crush Protection Zone (CPZ) under the 

overturned vehicle. In this study, several operational and 

safety evaluation criteria for ATVs equipped with CPDs 

were determined based on results of previous studies. In 

addition, we evaluated some of the safety and operation 

criteria for three designs of CPD (Quadbar, Lifeguard, 

and AR-Quad) installed on 13 models of ATVs. Results 

showed that the installation of a CPD increased the CPZ 

volume compared to the baseline ATV. Increasing the 

CPD volume can potentially improve the operator 

protection in the event of a rollover accident. The ARQuad, Quadbar, and Lifeguard increase the rear CPZ 

volume with an average of 0.48 m3 (111% increase), 0.39 

m3 (92% increase), and 0.15 m3 (35% increase), 

respectively, compared to the average CPZ of a baseline 

ATV which is 0.44 m3. Also, a CPD can potentially 

protects the operator by increasing the distance between 

the seat point and the ground surface during a rollover 

accident.

F4.3 

Title: Evaluating Youths' Capability to Ride Agricultural 

All-Terrain Vehicles Using Computer Simulations

Authors: Guilherme de Moura Araujo, Farzaneh Khorsandi, 

Fadi Fathallah

All-Terrain Vehicles (ATVs) cause a distressing number of 

fatalities and injuries among children in rural communities 

in the U.S. From 2003 to 2010, the number of fatalities 

involving workers younger than 16 years old was consistently 

higher in agriculture than in all other industries combined. 

ATVs are one of the most frequent sources of incidents 

among youths in agriculture. For instance, since 2020, 20 

children have lost their lives, and 23 have been severely 

injured due to ATV-related incidents on U.S. farms. A 

number of studies demonstrated that youths are more 

vulnerable to injuries than adults because of their less 

developed physical, cognitive, and behavioral characteristics. 

Thus, it is hypothesized that youths are frequently involved 

in ATV incidents because of limitations in their physical 

capabilities, such as their anthropometric measures. There is 

a need to evaluate potential inconsistencies between youths’ 

anthropometry and the design characteristics of utility ATVs, 

commonly used to perform tasks in agricultural settings. 

This study aimed at evaluating potential inconsistencies 

between the operational requirements of utility ATVs and 

the anthropometric measures of youths through computer 

simulations. A numerical computing software (Matlab) was 

used to evaluate four youth-ATV fit criteria proposed by an 

ATV safety advocacy organization (National 4-H council). 

The selected criteria include evaluations about: 1) The 

distance between the handlebar and rider’s knee; 2) Rider’s 

hand size compared to ATV handlebar reach; 3) Relationship 

between the ATV brake pedal and the placement of the 

rider’s foot on the footrests; and 4) The rider’s ability to reach 

the ATV’s footrest. In total, 29 utility ATVs and children of 

two genders (males and females), three different ages (8, 12, 

and 16 years old), and three body-size percentiles (5th, 50th, 

and 95th) were evaluated. Preliminary results demonstrated a 

physical mismatch between utility ATV operational 

requirements and anthropometric measures of children. The 

simulations involving male children under the age of 9 

indicated that they could not properly reach the footrests of 

the evaluated ATVs. The results were even more striking for 

the simulations with females as a considerable percentage of 

the ATVs (38%) have a handlebar reach larger than the hand 

size of females 14-year-old and younger. The incompatibility 

between the riders’ hand size and the handlebar reach 

compromises riders’ ability to properly activate the 

handbrakes and thus control the vehicle. Such discrepancies 

compromise youths’ capability to operate utility ATVs, 

increasing their risk of injuries.
2022 NATIONAL OCCUPATIONAL INJURY RESEARCH SYMPOSIUM 86

Session G1

Occupational Injury Surveillance, Part 2

Moderator: Kitty Hendricks

G1.1

Title: A Time Series Analysis of Nonfatal Occupational Injuries 

Treated in United States Emergency Departments from 2012 to 

2019 

Authors: Eric Lundstrom, Scott Hendricks, Suzanne Marsh, 

Caroline P. Groth, Gordon Smith, Ruchi Bhandari

Background: Occupational injuries represent a significant 

source of morbidity in the United States. Despite this, 

time series analyses of nonfatal workplace injuries in the 

United States have been scarce in recent years. As 

temporal analyses of public health issues are critical for 

interpreting the impacts of targeted interventions and 

identifying emerging issues, this is an obvious gap within 

current occupational injury literature. Thus, the objective 

of this study was to analyze rates of nonfatal occupational 

injuries treated in United States emergency departments 

(EDs) from 2012 to 2019 using a time series approach.

Methods: Nonfatal occupational injury estimates from 

2012 to 2019 were generated using the National 

Emergency Injury Surveillance System - Occupational 

Supplement (NEISS-Work) dataset, a nationally stratified 

probability sample of hospital EDs. Injury rates per 10,000 

full-time equivalents (FTE) were calculated using the 

Bureau of Labor Statistics' Current Population Survey. 

Autoregressive Integrated Moving Average (ARIMA) 

modeling was used to analyze trends in monthly nonfatal 

injury rate estimates throughout the study period. Trends 

were assessed for the overall estimated injury rate and for 

injury rates by injury event type.

Results: An estimated 20,519,800 (95% CI = ±3,671,700) 

nonfatal occupational injuries were treated in United 

States EDs from 2012 to 2019; the rate of injuries treated 

during this time was estimated to be 180 (95% CI = ±31) 

per 10,000 FTE. Injury event types treated at the highest 

rates during this time included contact with foreign 

objects and equipment (59; 95% CI = ±11); overexertion 

and bodily reactions (49; 95% CI = ±11); falls, slips, and 

trips (28; 95% CI = ±4.9); exposure to harmful substances 

or environments (18; 95% CI = ±3.9); and violence and 

other injuries by persons or animals (16; 95% CI = ±3.5). 

A decreasing linear trend in monthly occupational injury 

rates from 2017 to 2019 was detected via visual inspection 

and found to be statistically significant (p = 0.002). 

Significant linear decreases were observed from 2017 to 

2019 for the estimated rate of injuries caused by falls, 

slips, and trips (p < 0.001); overexertion and bodily 

reaction (p < 0.001); exposure to harmful substances or 

environments (p = 0.010); transportation incidents (p = 

0.012); contact with foreign objects and equipment (p = 

0.044); and violence and other injuries by persons or 

animals (p = 0.046).

Discussion: These results demonstrate a significant, 

decreasing linear trend in the monthly rate of ED-treated 

occupational injuries from 2017 through 2019. A 

decreasing linear trend was also significant for injuries 

caused by falls, slips, and trips; overexertion and bodily 

reaction; exposure to harmful substances or 

environments; transportation incidents; contact with 

foreign objects and equipment; and violence and other 

injuries by persons or animals. Injuries caused by contact 

with foreign objects and equipment, and overexertion and 

bodily reactions, occurred at the highest rate across all 

time periods. While rates of injuries have decreased 

significantly in more recent years, nonfatal occupational 

injuries continue to be a serious public health problem.

G1.2

Title: Surveillance of Acute Nonfatal Occupational Inhalation 

Injuries Treated in U.S. Hospital Emergency Departments, 

2014-2017 

Authors: Kitty Hendricks, Larry Layne, Patricia Schleiff, 

Angela Javurek

Introduction: Acute nonfatal occupational inhalation 

injuries are caused by exposures to airborne toxicants and 

contaminants in the workplace. They can damage the 

respiratory system and affect other body systems.

Currently, there is no nationwide occupational health 

surveillance system that captures injuries resulting from 

exposures to airborne toxicants and contaminants. Efforts 

to identify these injuries have included the use of medical 

records, including those from poison control centers, 

physician reports, and hospital emergency departments 

(EDs). A study conducted in the 1990s found that U.S. ED 

treated inhalation injury rates, when compared to 

physician-reported rates in the United Kingdom and 

Canada, were significantly higher. The current study

examines four years of recent hospital ED data nearly two 

decades later.

Methods: Data from the National Electronic Injury 

Surveillance System Occupational Supplement (NEISSWork), a nationally stratified probability sample of 

hospital EDs, were used to identify nonfatal civilian 

occupational inhalation injuries treated in U.S. hospital 

EDs from 2014–2017. A workplace inhalation injury was 

defined as any worker who sought treatment in a hospital 
2022 NATIONAL OCCUPATIONAL INJURY RESEARCH SYMPOSIUM 87

ED as a result of inhaling a harmful substance from 

chemical, mineral, or organic sources at work. Due to the 

lack of a coding structure that would identify all 

inhalation cases, a three-step process was used to identify 

cases. First, cases were selected if they were coded with the 

Occupational Injury and Illness Classification System 

event/exposure code Inhalation of Harmful Substance 

‘552’; second, all cases with the nature of injury coded as 

Anoxia ‘65’ were manually reviewed by researchers; and 

third, a keyword search was performed on the narrative 

comment field of all remaining cases.

Results: From 2014 through 2017, an estimated 125,600 

(95% CI: 92,100–159,000) acute nonfatal occupational 

inhalation injury cases were treated in EDs, with an 

overall rate of 2.2 injuries per 10,000 full-time equivalents 

(FTE) (95% CI: 1.6–2.8). Firefighters comprised 6% 

(7,800; 95% CI: 5,000–10,600) of the total. Although males 

incurred 60% (95% CI: 56-64%) of the injuries, the overall 

injury rates for males and females were similar at 2.3 (95% 

CI: 1.7–2.9) and 2.1 (95% CI: 1.4–2.7) per 10,000 FTE, 

respectively. By age group, workers less than 25 years of 

age were at greater risk of injury at 4.1 injuries per 10,000 

FTE (95% CI: 2.8–5.3); this pattern held for both sexes. 

Thirty-five percent of injuries occurred in the service 

industry (43,800; 95% CI: 27,300-60,300), with females 

accounting for 61% (26,800; 95% CI: 16,200-37,500) of 

service injuries; followed by manufacturing (16,900; 95% 

CI: 10,500-23,300) and public administration (16,200; 

95% CI: 11,600-20,800), each with greater proportions of 

males (11,300 [95% CI: 6,900-15,700] and 13,600 [95% CI: 

9,500-17,700], respectively). Overall, the highest 

proportion of inhalation injuries (excluding firefighters) 

was due to chemical exposures (89,000; 95% CI: 65,800-

112,200). Injuries related to chlorine and chlorine 

compounds were more common among females (5,100; 

95% CI: 1,900-8,400), while injuries related to carbon 

monoxide (11,800; 95% CI: 7,600-15,900) exposure were 

most prevalent for males.

Conclusions: These results illustrate the burden of nonfatal 

occupational inhalation injuries and provide an 

understanding of how injuries are distributed based on 

age and sex. While inhalation injury rates have declined 

39% over the last two decades, they continue to be a 

serious occupational hazard that is likely underreported. 

The inclusion of industry and occupation coding on 

electronic health records would allow for a more 

comprehensive examination of the etiology of inhalation 

injuries, as well as provide the information necessary to 

develop targeted prevention efforts.

G1.3

Title: Severe Injuries in the Oil and Gas Industry: An Analysis of 

OSHA’s Severe Injury Reporting System from 2015-2020 

Authors: Vidisha Parasram, Harold Gomes, 

Christina Socias-Morales, James Collins, Audrey Reichard

Introduction: Work-related severe injuries occur across all 

industries. The Bureau of Labor Statistics (BLS) reports, in 

2019, US-private Oil and Gas industry recorded 1,840 lost 

workday injuries and illnesses. A 2014 study noted the 

lack of research into non-fatal occupational injuries in 

this sector. The Occupational Safety and Health 

Administration’s (OSHA) Severe Injury Report (SIR) 

database allows for in-depth analysis of risk factors to 

understand the occurrence of severe injuries in this sector. 

OSHA defines a severe injury as an in-patient 

hospitalization, amputation or loss of an eye. This study 

used SIR to describe occupational injuries and guide 

prevention efforts in the Oil and Gas sector.

Methods: We analyzed the SIR data that are publicly 

available on OSHA’s website. SIR contains incidents 

reported to OSHA under a 2015 reporting rule (29 CFR 

1904.39). Industries were stratified using 2, 5 and 6-digit 

North American Industry Classification System (NAICS) 

and analyzed by BLS Occupational Injury and Illness 

Classification System (OIICS) nature of injury, body part, 

event, and source codes. A subset database was created of 

NAICS codes describing the Oil and Gas Industry 

(NAICS 213112- Support Activities for Oil and Gas 

Operations and 213111-Drilling Oil and Gas Wells, and 

2111-Oil and Gas Extraction) to further access 

meaningful insights into severe injury occurrence.

Results: The SIR data recorded 61,540 severe injuries from 

2015-2020 and the Oil and Gas Industry experienced the 

largest number of these events, (N=1,701, 3%), closely 

followed by the General Medical and Surgical Hospitals, 

NAICS 622110 (N= 1,427, 2%) sector. Within the Oil and 

Gas Industry, Support Activities (NAICS 213112) 

accounted for 1,279 (2%) injuries, Drilling (NAICS 

213111) 417 (.7%) injuries and Extraction (NAICS 2111) 

accounted for 1 injury. The number of reports fluctuated 

from 2015 (N=295, 2016: N=218, 2017: N=350, 2018: 

N=369, 2019: N=334) to a notable decrease in 2020 

(N=135) likely due to the COVID-19 pandemic. The 

subset oil and gas database show 20% (N=342) of injuries 

involved oil drilling rigs and machinery but a majority 

included a variety of other equipment (pipes, ducts, 

tubing (N=88, 5%), machine and appliance parts, (N=55, 

3%), heat-environmental (N=48, 3%), hoses (N=35, 

2.06%) and metal pipes, tubing (N=35, 2%)). 

Approximately 6% of events involved equipment that was 
2022 NATIONAL OCCUPATIONAL INJURY RESEARCH SYMPOSIUM 88

unclassified. Amputations accounted for 29% (N=491) 

and fractures occurred in 28% (N=481) of severe injuries. 

Approximately 32% (N=547) involved fingers or 

fingernails (N=218, 13%), fingertips (N=201, 12%) or 

fingernails unspecified (N=128, 8%). Severe injuries 

tended to occur most frequently in January (N=180, 11%), 

July (N=174, 10%) and September (N=157, 9%) and on

Tuesdays (N=313, 18%), Wednesdays (N=292, 17%) and 

Thursdays (N=279, 16%).

Discussion: The OSHA SIR data are subject to significant 

underreporting. However, it is useful in that it expands on 

the understanding of non-fatal occupational injuries in 

the oil and gas sector and other industries by providing 

detailed insights into the source of the injury, body part 

affected and when injuries occur. These results can guide 

the development of strategic interventions addressing 

work arrangement issues and injury prevention in the oil 

and gas sector and can make valuable contributions to 

measure risk and assess potential gains to reduce such 

events. These data also provide opportunities to track 

changes in occupational injury trends moving forward.

Session G2

Ergonomics and Musculoskeletal Disorders

Moderator: Bradley Evanoff

G2.1

Title: Use of a Job Exposure Matrix to Study Both Recent and 

Past Work Exposures on the Incidence of Carpal Tunnel Release 

Surgery in the CONSTANCES Cohort

Authors: Bradley Evanoff, Alexis Descatha, Ann Marie Dale, 

Ryan Colvin

Introduction: Most studies of Carpal Tunnel Syndrome 

have examined only current workplace exposures as risk 

factors. We examined the effects of both recent and past 

work exposures on the incidence of surgery for carpal 

tunnel release (CTR).

Methods: Participants in a large prospective French 

general population study (CONSTANCES) were surveyed 

between 2012 and 2017. The survey included self-reported 

history of current and past jobs, allowing estimation of 

past and current workplace physical exposures using an 

existing job exposure matrix (JEM). CTR cases were 

ascertained through matching the surveys to national 

health insurance data for the 8-year period 2009-2016. 

Analyses were restricted to workers with some period of 

full-time work in 1999 or later. Poisson regression 

analyses (controlling for age, Body Mass Index (BMI), and 

sex) computed the relative risks (RR) of future CTR 

associated with different work exposures. Eleven 

exposures including physical force, repetition, posture, 

and keyboard use were categorized into quartiles, with the 

top quartile referenced on lower quartiles. Models 

included different time periods of exposure and/or 

different exposure lag times.

Results: 777 cases of CTR were observed among the 56,289 

person cohort. Those with CTR were more likely to be 

female, older, and to have a higher BMI. In both men and 

women, each of the 11 exposures was significantly 

associated with the incidence of CTR. In the cohort as a 

whole, RR of CTR per 5 years of exposure in the upper 

quartile included 1.19[1.13-1.25] for pressing with the 

base of the hand, 1.17[1.12-1.23] for use of vibrating tools, 

1.17 [1.12-1.22] for rotation of the forearm, and 0.88[0.84-

0.91] for keyboard use. Women showed larger effect sizes 

than men for some exposures, including repetition, use of 

vibrating tools, and pressing with the base of the hand. 

Higher effect sizes were seen among current workers than 

among those who had not worked in 5 or more years.

Lagging exposures by 3 and 5 years reduced the strengths 

of association.

Discussion: Use of a JEM in a large general population 

cohort allowed us to study the effects of work exposures 

on the incidence of carpal tunnel syndrome. While more 

recent exposures had stronger associations with CTR, 

some past exposures were also associated with future risk 

of CTR. Cumulative exposure to ten of eleven upper 

extremity physical exposures were associated with 

increased risk of CTR. Consistent with previous general 

population studies, duration of keyboard use was 

protective for CTR (and negatively associated with other 

exposures). Use of a population specific JEM allowed 

unbiased estimation of past exposures at the level of the 

job, and study of past exposures as well as current. The 

ability to estimate past exposures is even more important 

in the study of other musculoskeletal disorders such as 

osteoarthritis and degenerative tendon disorders, which 

develop over many years.

G2.2

Title: Iterative Design of Novel Aerosol Containment Hood Using 

Ergonomic Assessment

Authors: Katrina Cernucan, Erik Steenburgh, 

Andrew Merryweather, Rachael Jones

Introduction: The COVID-19 pandemic has been a 

dynamic situation resulting in rushed innovation and 

emergency measures implemented in hospital 

environments. One such measure is the use of aerosol 

containment hoods to protect healthcare providers 
2022 NATIONAL OCCUPATIONAL INJURY RESEARCH SYMPOSIUM 89

against COVID-19 exposure. Many of these devices were 

constructed with little research on their ergonomics. The 

goal of ergonomics is to provide more efficient and errorfree interactions between a human and the environment. 

A poorly designed device can interfere with physician 

performance, potentially putting the patient at risk. To 

maximize patient and provider safety, our aim was to 

perform an ergonomic assessment of the U-Cover, an 

aerosol containment hood designed at the University of 

Utah. We report the results from a 3D motion analysis 

study during simulated intubation using the U-Cover. 

Methods: We recruited seven physicians with experience 

performing intubations. Each participant signed an 

informed consent document approved by the University 

of Utah IRB (#00137408) and performed an intubation 

procedure. This was selected due to the time-sensitivity 

and the large space required. The procedure was 

performed with and without the U-Cover. A 12-camera 

motion capture system and Motive Body (NaturalPoint, 

OR) were used to collect subject 3D coordinates with a 

Conventional Upper Body Biomechanical passive 

markerset. Biomechanical modeling was performed in 

Visual3D (C-motion Inc, MD) to calculate procedure 

time and torso and neck angles. The data were filtered to 

only contain data points within 10 centimeters of the 

hood volume. 2D density plots, 95% confidence interval 

ellipses, and task durations were determined for all data 

points. To assess ergonomics, torso and neck angles were 

calculated and averaged for all trials. Statistical analyses 

were performed in R 4.0.3.

Results: In the hooded trials, the change in the range of 

95% of the position data of the endotracheal tube 

increased along the y-axis and decreased along the z-axis, 

(y-axis: +43%, z-axis: -15%). The physician is limited in 

their vertical motion and must use more of the horizontal 

space to complete the procedure. The mobility of each 

hand in the frontal plane was reduced in hooded trials 

compared to non-hooded trials. Changes in the range of 

95% of the position data for the wrist showed a reduction 

in mobility in the frontal plane (Left Wrist: x-axis: -45%, 

z-axis: -30%. Right Wrist: x-axis: -55%, y-axis: -41%). The 

average time to complete the procedure was significantly 

longer in hooded trials than non-hooded trials (p< 0.001). 

No significant differences were seen in mean torso angles 

and their corresponding standard deviations across 

hooded and non-hooded trials for flexion-extension (x̄: p 

= 0.804, σ: p = 0.521) and lateral flexion (x̄: p = 0.279, σ: p 

= 0.861). No significant differences were found between 

hooded and non-hooded trials for the mean neck angle 

and its standard deviations in flexion-extension (x̄: p = 

0.812, σ: p = 0.491) and lateral flexion (x̄: p = 0.243, σ: 

p = 0.278).

Discussion: The use of the U-Cover caused deviations in 

hand and endotracheal tube movements from the original 

procedure. Due to the longer duration of the procedure, 

the physician could be exposed to viral aerosols since the 

access ports are open during this time, and the patient will 

endure more time without oxygenation. For the next 

design iteration, 95% ellipses and density plots were used 

to modify the hood dimensions to better accommodate 

intubations. The neck and torso angles indicate there were 

only minor postural changes during the procedure, 

suggesting the initial U-Cover design did not significantly 

alter neck and torso posture. In the original design, the 

access ports were placed directly next to the aluminum 

frame, which limited the range of motion of the hands. In 

the next design phase, the frame will be moved away from 

the critical access points to enable more efficient patient 

interactions.

G2.3

Title: Occupational Demands Associated from a Novel Linkage 

of a Job-Exposure Matrix to the U.K. Biobank

Authors: Elizabeth Yanik, Jay Keener, Martin Stevens, 

Karen Walker-Bone, Ann Marie Dale, Graham Colditz, 

Rick Wright, Nancy Saccone, Nitin Jain, Bradley Evanoff

Introduction: Physically demanding occupations, 

particularly those with great upper extremity demands, 

may increase risk of rotator cuff disease (RCD) and need 

for surgical treatment. To investigate this, we linked a jobexposure matrix (JEM) to the UK Biobank to measure 

physical occupational exposures and estimate associations 

with incident RCD surgery.

Methods: In the UK Biobank, current job titles and UK 

Standard Occupational Classification (SOC) codes were 

recorded during a verbal interview at the baseline visit for 

UK Biobank participants. Lifetime job histories were 

captured through a web-based survey. UK SOC codes 

were linked to US SOC codes enabling use of a JEM based 

on the US O*NET database. O*NET-based scores for 

physical demands (static strength, dynamic strength, 

general physical activities, handling/moving objects (each 

range=1-7), time spent using hands, whole body 

vibration, and cramped/awkward positions (each 

range=1-5)) were assigned to jobs via US SOC codes. 

Incident RCD surgery cases were identified through 

linked national hospital episode statistics inpatient 

records. Cox regression was used to calculate hazard 

ratios (HRs) as estimates of associations with RCD 

surgery, accounting for confounders. Among those with 

lifetime job histories, associations were estimated in 

relation to duration of time with greatest exposure (above 
2022 NATIONAL OCCUPATIONAL INJURY RESEARCH SYMPOSIUM 90

cut-offs identifying approximately the top quartile of 

exposure). 

Results: We included 277,808 UK Biobank participants 

providing a current job title and reporting no chronic 

shoulder/neck pain at baseline. In this population, 1,345 

(0.5%) people had a subsequent inpatient RCD surgery.

After adjusting for age, sex, race, education, Townsend 

deprivation index, and body mass index, all O*NET 

variables considered were associated with risk of RCD 

surgery, including static strength (HR per point 

increase=1.13, 95%CI=1.09-1.18), dynamic strength 

(HR=1.20, 95%CI=1.13-1.28), general physical activities 

(HR=1.16, 95%CI=1.12-1.21), handling/moving objects 

(HR=1.12, 95%CI=1.08-1.16), time spent using hands 

(HR=1.10, 95%CI=1.04-1.17), whole body vibration 

(HR=1.45, 95%CI=1.30-1.61), and cramped/awkward 

positions (HR=1.25, 95%CI=1.16-1.33). More frequent 

exposure to heavy physical work self-reported in the UK 

Biobank verbal interview was also associated with RCD 

surgery (HR for ‘Always’ vs. ‘Never/rarely’=2.12; 

95%CI=1.79-2.50). Lifetime job histories were available 

for 100,929 people, in which greater exposures were 

significantly associated with RCD surgery after more than 

10 years of work (Ex. For dynamic strength score≥2 the 

HR for 11-20 years vs. 0 years=1.91, 95%CI=1.35-2.71, 

while HR for 1-10 years vs 0 years=1.08, 95%CI=0.83-

1.40).

Conclusion: Many different occupational physical 

exposures measured through a JEM were associated with 

incident RCD surgery. Associations were strongest in 

workers with more than a decade of greater exposure, 

highlighting the importance of cumulative exposure. 

Occupation should be recognized as an important 

contributor to the development of RCD, including 

atraumatic RCD which likely accounted for the vast 

majority of our cases.

Session G3

Efforts to Document and Address the Risk of Fatigue in 

the Agriculture, Forestry and Fishing Sector

Moderator: David Douphrate

Emerging Issue Problem and Session Description: The 

Agriculture, Forestry, and Fishing (AgFF) industry is 

often characterized as dangerous work in a dynamic 

environment that takes focus, good judgement, and often 

quick reflexes. AgFF workers average longer hours 

worked per week than those in other industries and may 

work 16 hours or more per shift during peak harvest 

periods. AgFF workers consistently have the highest 

fatality rate of any sector, while also experiencing high 

rates of non-fatal injury and illness. However, many 

federal and state OSH regulations have specific 

exemptions for AgFF work. Extended work hours, shift 

work, sleep deprivation, and fatigue have been described 

as a “significant safety issue” and a “cultural norm” within 

the sector, but little research or interventions have been 

developed for AgFF work settings.

However, addressing fatigue in AgFF using traditional 

approaches can be challenging. Several work 

organizational factors culturally and economically 

incentivize extended shifts and minimal staffing. 

Moreover, AgFF workers are older, less likely to have 

health insurance or paid leave, and live in rural and 

remote areas. Access to labor is also a factor in extended 

shifts, and the COVID-19 pandemic may have 

exacerbated ongoing labor shortages, especially in 

Agriculture which increasingly relies on H2A Visa 

workers. However, there is also no universally accepted 

objective measure of fatigue, and limited research has 

developed objective strategies to identify fatigue onset, 

quantified the extent to which fatigue contributes to 

adverse health outcomes or performance decrement, or 

developed work organization recommendations to 

mitigate fatigue in the sector.

This session will begin by exploring the unique socioecological contexts of AgFF work, which often makes 

current sleep hygiene best practices incompatible with the 

realities of work within the sector. Then the current state 

of shift work and fatigue research in AgFF will be 

discussed, highlighting new research projects, followed by 

a panel discussion of possible approaches for addressing 

current gaps in AgFF sleep and fatigue research and 

interventions.

Working Hours, Sleep, and Fatigue Across the Agriculture, 

Forestry, andFishing Sector: The Current State of the Science

Presenters: KC Elliott, NIOSH Office of Agriculture Safety and 

Health, and Jeff Levin, University of Texas Health Science Center 

at Tyler

Agriculture, forestry, and fishing industry (AgFF) workers 

often work extremely long hours during peak production 

seasons, resulting in sleep deprivation and fatigue. We 

conducted a scoping literature review to examine the 

extent and nature of research in this area. Article 

inclusion criteria included peer-reviewed journal articles 

written in English; published after 1989; covering AgFF 

workers in high-income countries; with data on working 

hours/schedules and sleep related to safety and health. 

Limited research has addressed long hours and sleep 

deprivation among AgFF workers. We identified 8,350 

articles for title and abstract review. Among those, 407 
2022 NATIONAL OCCUPATIONAL INJURY RESEARCH SYMPOSIUM 91

underwent full-text review and 96 met all inclusion 

criteria (67% agriculture, 25% fishing/seafood processing, 

8% forestry). The literature provided some evidence 

fatigue contributes to fatalities, injuries, and illnesses in 

AgFF. Older, new, young, foreign born, and female 

workers, as well as those who work in small organizations 

and/or work longer hours (40+) are at higher risk for 

fatigue-related injury and illness. Few studies have 

developed or evaluated interventions to control risks. 

Given that fatigue is believed to be a major factor in injury 

and illness for this sector, future AgFF surveillance and 

research should increase efforts to capture fatigue and 

sleep data, directly investigate the role of long hours and 

non-standard work schedules in these industries, and 

most importantly, create practical interventions to 

manage fatigue.

Fatigue and the Need for Recovery among Latino/a Immigrant 

Cattle Feedyard Workers

Presenter: Athena K. Ramos, University of Nebraska Medical 

Center, Central States Center for Agricultural Safety and Health 

(CS-CASH)

Cattle feedyards are animal feeding operations where beef 

cattle are finished to market weight on grain. Cattle 

feeding can be dirty, demanding, and dangerous work. 

This study sought to assess the predictors of fatigue and 

the need for recovery among Latino/a immigrant cattle 

feedyard workers in the United States. A path model was 

examined to explore direct and indirect relations among 

physical fatigue, mental fatigue, need for recovery, job 

characteristics, and health and sociodemographic 

covariates. Lower self-reported health, experiencing 

physical pain, not handling animals, and decreased 

decision latitude were directly related to increased 

physical fatigue. Shorter tenure working on cattle 

feedyards, lower educational level, experiencing physical 

pain, and increased job demands were directly related to 

heightened mental fatigue. Being female, experiencing 

physical pain, an elevated average of hours worked per 

day, increased job demands, and less decision latitude 

were directly related to an increased need for recovery and 

indirectly related to both physical and mental fatigue. 

Physical and mental fatigue have specific correlates, but 

job characteristics, including job demands and decision 

latitude, can directly and indirectly impact workers’ levels 

of physical and mental fatigue and their need for recovery. 

Both preventive measures and restructuring work 

operations may reduce the risk for fatigue and the need 

for recovery. Implications for cattle feedyard workers, 

supervisors, and employers are discussed. Finding ways to 

balance productivity and the well-being of workers should 

be a high priority for cattle feedyards across the country.

Documenting and Assessing Fatigue in the Northeast Forestry 

Industry

Presenter: Erika Scott, Northeast Center for Occupational Safety 

and Health

This presentation will describe recent efforts to document 

and characterize fatigue and fatigue management 

strategies in the Northeast Logging industry. Forestry 

industries are at high risk of injury and fatalities, and 

fatigue has been shown to be a factor in workplace injuries 

and near-miss incidents. However, there has been very 

little research directly examining the role of fatigue in the 

forestry industry, especially in the United States. 

Researchers from the Northeast Center in Occupational 

Health and Safety and Center for the Promotion of Health 

in the New England Workforce (CPH-NEW), a Total 

Worker Health Center of Excellence, have joined forces to 

investigate cardiovascular risk factors, including sleep, 

among Maine’s mechanized logging workforce. This 

presentation will review a logger field trial conducted in 

Maine, where a variety of wearable sensors including a 

custom-designed armband, Empatica E4 wristband and 

Hexoskin sensor shirt were used to measure a variety of 

health endpoints. Highlights will include logger comfort 

assessments, ease of use, data quality, and lessons learned 

from collecting such data in remote work settings.

Assessments of Sleep Deprivation and Associated Health 

Impacts in Commercial Fishermen

Presenters: Julie Sorensen, Northeast Center for Occupational 

Safety and Health, and Laurel Kincl, Oregon State University

Commercial fishing workers often suffer from sleep debt 

and fluctuating sleep schedules in an environment where 

the risk of injury or death is constantly present. U.S. Coast 

Guard reports of vessel sinkings have indicated a potential 

role of fatigue in vessel disasters, indicating that 

compromised reaction times or executive decisionmaking could be a hidden factor contributing to these 

events. Despite the recognized need to understand the 

impact of sleep debt, there is an almost complete lack of 

research on this phenomenon in commercial fishing. In 

particular, there is little that is known about the direct 

effects of sleep deprivation in commercial fishing and the 

risk of injury or the long-term, neuro-cognitive impact of 

repeated intermittent and limited sleep schedules.

Researchers from the U.S. East and West Coasts are 

currently collaborating on efforts to advance sleep studies 

research in commercial fishing, by laying the groundwork 

for future research in this realm. We will present 

preliminary data from qualitative interviews conducted 

with salmon, crab, lobster, and scallop fishing workers on 

the impact of work on sleep hygiene and the perceived 
2022 NATIONAL OCCUPATIONAL INJURY RESEARCH SYMPOSIUM 92

impacts of sleep debt on their health and well-being, as 

well as an overview of initial data from health surveys and 

assessments conducted with the commercial fishing fleet. 

Information learned in this study will be used to inform

future commercial fishing sleep debt studies.

Technology Considerations for Commercial Fishing Sleep 

Monitoring 

Presenters: Leigh McCue, George Mason University, and 

Julie Sorensen, Northeast Center for Occupational Safety and 

Health

Actigraphy is commonly viewed as the standard for sleep 

assessment in non-clinical settings. Commercially 

available actigraphy devices measure sleep based on 

accelerometer data and therefore capture motions of a 

moving platform, such as a commercial fishing vessel, in 

addition to test subject movements. Inspired by increasing 

researcher use of multi-sensor devices to measure sleep in 

various environments, in this presentation we share data 

collected by test subjects using Actigraph, Fitbit, Dreem, 

and Oura devices onboard small vessels. The presentation 

also includes discussion regarding safety and comfort of 

device wear while commercial fishing, as well as practical 

limitations on data acquisition and retrieval in the fishing

environment. Better understanding the accuracy and 

wearability of these sleep monitoring devices in a 

commercial fishing setting will serve as a technology 

enabler for large-scale study of sleep deprivation within 

the industry.
2022 NATIONAL OCCUPATIONAL INJURY RESEARCH SYMPOSIUM 93

NOIRS 2022 POSTER ABSTRACTS

(Presenters Underlined)

Although the abstracts in this publication were proofread to eliminate obvious errors 

in spelling, punctuation, and grammar, they were neither edited nor officially cleared 

by the National Institute for Occupational Safety and Health (NIOSH). Therefore, 

NIOSH is not responsible for the content, internal consistency, or editorial quality of 

the abstracts. That responsibility lies solely with the individual authors. Any use of 

company names and products throughout this publication does not imply 

endorsement by NIOSH, the Centers for Disease Control and Prevention, the Public 

Health Service, or the Department of Health and Human Services.
2022 NATIONAL OCCUPATIONAL INJURY RESEARCH SYMPOSIUM 94

POSTER SESSION

LIST OF FEATURED POSTERS

P1

Title: Response Time Following Local Vibration in Tasks 

Mimicking Truck Drivers Performance

Authors: Juan Manuel Castellote, Victor Selionov, 

Irina Solopova

Introduction: Some studies have shown that vibration 

applied for short periods of time do not show 

disturbances but others as with a general vibration 

exposure (common in truck drivers) may result in 

deleterious effects that may contribute to accidents. It is 

needed to understand the effects that repeated local 

vibration have in upper limb fast responses to conform a 

explanatory framework on truck drivers performance. 

Repeated exposure to mechanical vibration causes injuries 

that can be serious (South 2004) (Vartija et al. 2013). 

Exposure to the extremities contributes to the generation 

of lesions and local syndromes (e.g. carpal tunnel) 

(Bensefa-Colas and Choudat 2013) that require 

rehabilitation. These exposures are observed in works 

such as driving of freight vehicles by direct transmission 

through the steering wheel (Sekkay et al. 2018) (Kivekas et 

al. 1994) (Bovenzi et al. 1987) (Shahbazian et al. 2009) 

(Barregard 2003) (Rytkönen et al. 2006). The purpose of 

the present study is to differentiate responses to local 

vibration in muscles active in driving performance.

Methods: This study includes a pilot data set in subjects (n 

= 11) exposed to local vibration at biceps brachialis or 

extensor carpi radialis muscles in movements used for 

driving performance. Voluntary muscle responses and 

joint movement are explored after stimulation with 

different combinations of sustained vibration. For the 

experimental condition a local mechanical vibration 

stimulus is used following previous methodologies 

(Selionov et al. 2009) (Selionov et al. 2013) with low or 

high frequency. Three vibration durations have been used. 

Signals are collected by surface electromyography of 

agonist and antagonist muscles (Castellote and Valls-Solé 

2015) (Queralt et al. 2008) as well as by joint mobility 

electrogoniometry (elbow and wrist). For descriptive and 

inferential analyses SPSS-27 has been used.

Results: The sustained vibration causes changes in the 

motor response as well as in joint mobility in the 

stimulated muscles. Specifically, the voluntary response of 

joint mobility is seen in some cases slowed down in the 

face of different combinations of intensity * frequency, 

while in other cases the phenomenon is not observed. It is 

noteworthy that after the end of the stimulation and 

response periods, the final control assessment results in 

lower response figures than in the initial control, with 

shorter times (p <0.05). In the slowing down of the 

response during the evaluation periods, a relationship is 

observed between the increase in frequency and those 

cases with motor delayed response (p <0.05).

Discussion and Conclusions: We have explored the effects of 

sustained local vibration on upper limb motor responses, 

using different combinations of stimulus intensity * time. 

1. Based on the results, a delay in muscle activation and 

joint movement is observed after local vibration. 2. When 

the stimulation / response cycles have ended, a reduction 

is observed in the response times reflected in an 

anticipated joint mobility. 3. The fact that local vibration 

deteriorate voluntary responses may affect the 

performance in occupations such as truck drivers when 

they have to react fast to avoid an accident.

References: Castellote JM, Valls-Solé J. The StartReact 

effect in tasks requiring end-point accuracy. Clin 

Neurophysiol 126: 1879–1885, 2015. Selionov VA, 

Ivanenko YP, Solopova IA, Gurfinkel VS. Tonic central 

and sensory stimuli facilitate involuntary air-stepping in 

humans. J Neurophysiol 101: 2847–2858, 2009.

P2

Title: A Mixed-Methods Approach to Examining Safety Climate 

among Truck Drivers

Authors: Emily Yueng-Hsiang Huang, Yimin He, Jin Lee, 

Bailey Lytle, Ashan Senel Asmone, Yang Miang Goh

Presentation Brief Summary: Our project aims to provide 

safety researchers and practitioners with 

recommendations to promote organization- and groupsafety climate (SC) in the trucking industry. To do this we 

employ a mixed-methods approach using qualitative and 

quantitative methodologies with two goals in mind. The 

first is to understand the needs and concerns of truck 

drivers from their own perspectives, using trucking 

industry-specific SC scales as prompts; the second is to 

analyze and summarize how truck drivers view existing 
2022 NATIONAL OCCUPATIONAL INJURY RESEARCH SYMPOSIUM 95

policies, procedures, and practices to find ways to help 

promote trucking safety and health. Purpose/Objectives:

The purpose of the current study was to use a mixedmethods approach to understanding SC and the strategies 

to improve SC among truck drivers.

Background: According to the U.S. Bureau of Labor 

Statistics, transportation incidents remain the leading 

factor of fatal injuries among truck drivers (Bureau of 

Labor Statistics, 2020). SC is a key robust predictor of 

workplace safety. We sought to better understand which 

psycho-socio-cultural and managerial factors are most 

important for the designing and implementation of an 

occupational safety and health intervention programs for 

truck drivers. To do this we conducted interviews with 

truck drivers at truck stops to gather critical information 

for SC enhancement. 

Methods: Using both survey (N = 7246) and interview 

(N=18) responses provided by truck drivers regarding key 

SC items, we identified a number of positive and negative 

policies, procedures and practices that truck drivers 

perceived as the determinants of whether they thought 

their organizations were committed to promoting safety 

at work. Item response theory (IRT) analyses were 

conducted to analyze survey responses with regard to SC 

measures to identify the most discriminative items 

indicating which SC items were most sensitive to SC level 

and had the best potential for improvement.

Findings: Some common themes that emerged from the 

highest scoring scale items included compliance with 

regulations, strict speed limits, and autonomy among 

drivers. Themes from the lowest scoring scale item 

included discretion to take breaks, flexibility in 

rescheduling, and communication. Common themes from 

the scale items with the highest discrimination parameters 

included safety meetings, tools and equipment, and 

managers’ knowledge and experience. The analyses 

revealed several effective strategies to promote SC in the 

trucking industry: (1) Organization-level: prioritization of 

safety over customer needs, holding regular safety 

meetings, allowing drivers to take breaks when necessary, 

and conducting safety workshops, (2) Group-level: 

allowing drivers to make safety decisions for themselves, 

leadership acknowledging safe drivers, providing 

monetary bonuses, and offering positive and negative 

feedback to improve safety.

Discussion: Our hope is that organizations may use this 

information to promote safety and, ultimately, reduce 

occupational accidents and injuries. By using IRT 

analysis, such that items highest in discrimination 

parameters were most sensitive to the SC level, we could 

gauge and differentiate SC levels across trucking 

organizations; implementing strategies aligned with those 

items could make improvement in safety climate more 

substantial. Various themes emerging from interview 

responses allowed us to expand upon other potential 

contributing factors that help enhance SC within and 

across organizations. Conclusions: This study took the 

initial step of adopting a mixed-methods approach for 

understanding SC among truck drivers. Based on our 

results, we offer safety researchers and practitioners some 

recommendations on how to intervene in unsafe practices 

and promote organization and group SC in the trucking 

industry to reduce accidents and injuries in the 

workplace.

P3

Title: Accidents in the Truck Driver Sector and the Health 

Paradox of This Demanding Occupation

Authors: Juan Manuel Castellote, Miguel Del Pino

Introduction: It is known that some sectors in industry are 

more demanding with workers activity with high rates of 

injuries or illnesses that result in disability conditions. 

Some well know sectors are fishery and mining industries, 

and in most instances, societies facilitate either a shift to 

less demanding work or an early retirement. This is 

related to the reduction in physical and cognitive 

capacities that human beings have with age and 

demonstrates the sensibility of societies to the 

contribution of these professionals to the society. The case 

of truck drivers is special. It is an arduous work, with high 

risk for serious accidents, and additionally with some 

well-established factors that increase some illnesses. 

Sedentarism, turns, nutritional habits, and the frequent 

absence from home -mainly for long-haul drivers-, among 

other factors, reduce the health state of drivers with age. 

The increase in accidentability with age should be a result. 

However, that, it is not so evident unless an analysis is 

performed with adequate information from databases. 

Some studies suggest that the rates are increasing with 

age, but others show a reduction in accidentability, that 

may constitute a paradox. The present research shows an 

analysis with data from national databases and wants to 

clarify the accidentability in this work sector.

Methods: For the present study, National databases from 

the Government of Spain as well as from the European 

Union have been used, concerning morbidity, 

accidentability as well as degree of occupation in different 

sectors in order to establish rates of accidentability by age 

groups and analyzing the trend during a period covering 

consecutive years (2009-2018). Data have been 

normalized to the general population. For descriptive and 

inferencial analyses SPSS-27 has been used.
2022 NATIONAL OCCUPATIONAL INJURY RESEARCH SYMPOSIUM 96

Results: During the period of study (10 years) there is 

reduction of accidents in the road transport sector 

although not significant (p>0.05). There is a high increase 

in the accidentability with number of years at work, that is 

not seen in other high risk occupations such as fishery 

and mining industries (p<0.05). However, there is a 

reduction in accident rate with increase of the age of the 

worker in the truck driver sector, and a high significant 

reduction in those other sectors (fishery and mining 

industries) without changes in other activities (classif. 

ILO).

Discussion and Conclusions: The present study supports that 

workers that stay at work in the truck driving industry 

have more chance to have accidents. However, the 

calculated rates support that there is a reduction with age, 

and this may be due to the healthy worker effect, that 

means that those workers that follow in the sector are 

those that still are able to maintain activity in this 

strenuous activity. The conclusion is supported by data in 

other hard sectors, where there is also a significant trend 

for reduction of accidents with age, not easily explained 

by a learning curve. In these two last sectors, there is a 

difference from the truck sector because laws support 

early retirement of workers, as well as may facilitate shift 

to other less strenuous jobs with age. This explains, as a 

healthy work effect, the paradoxically reduction of 

accidents with age, not so evident in the truck drivers 

sector. It has been documented that the truck driving 

sector has reduced chances for workers to shift to other 

activities, aggravated by the advanced age of the worker. 

There should be some changes in legislation in order to 

either facilitate easier work for these workers or place a 

scenario where early retirement is facilitated.

P4

Title: A Hard Day’s Night: Shift Work, Fatigue and 

Cardiovascular Risk Factors Among Maine’s Logging Workforce

Authors: Erika Scott, Liane Hirabayashi, Judy Graham

Background: Logging is of the most hazardous industries in 

the United States (US), despite many workplace safety 

improvements made in the last decades. Currently, we 

know little about regional trends in health conditions of 

logging workers, especially in the Northeast.

Methods: This abstract reports on survey and health 

assessment data of a longitudinal cohort study involving 

Maine loggers. Specifically, data on work shift, commute 

time, sleep quality, and risk factors of obstructive sleep 

apnea are presented.

Results: Three hundred twenty-five (325) are included in 

the initial survey analyses, 246 mechanized loggers, and 79 

conventional. On average mechanized loggers worked 

longer days (11.8 hours vs. 9.7 hours) and had longer 

commutes from home to the woodlot (72.6 minutes. vs. 

40.7 minutes) than conventional loggers. Mechanized 

loggers were more likely than conventional loggers to 

begin their workday before 6:00 AM. Preliminary analysis 

of health screening data (sub-cohort of 81 loggers) 

identified several factors that require addition 

exploration: average body mass index (BMI) of 30.6, 

Mallampati scores of class 3 or 4 in 24%, along with 

average blood pressure of 138/83.

Conclusions: These factors contribute to a need to work 

with the logging community on cardiovascular risk and 

factors contributing to sleep quality. The ultimate goal is 

to make the industry a safer and healthier profession for 

the current workforce, as well as the workforce of the 

future. 

P5

Title: Investigation of a Fatality That Occurred When a Logging 

Processor Lost Traction and Rolled Down a Hillside

Authors: Jennifer E. Lincoln, Jeff R. Funke

Background: Between 2010 and 2019, the Bureau of Labor 

Statistics reported 723 fatalities in the forestry and logging 

industry. Research has shown that fatalities and injuries 

have declined due to an increased use of mechanized 

logging, but work-related hazards persist. These hazards 

include challenges in terrain, weather, and operating in 

remote areas. On January 25, 2019, a 32-year-old 

processor operator was fatally injured when his logging 

processor rolled down a previously logged (clear-cut) 

hillside. The processor operator was driving the 

equipment from a spur road to a main road. As the 

processor operator approached a narrow inside corner in 

the road near a log deck (a stack of logs), the tracks on the 

equipment slipped laterally on the outsloped road. While 

the processor operator was attempting to exit the cab, the 

equipment tumbled down the hillside, shearing the 

operator cab off the equipment and fatally crushing the 

operator. A logging industry association and the employer 

requested assistance from the National Institute for 

Occupational Safety and Health (NIOSH) to conduct an 

independent investigation of the incident.

Methods: The goal of the NIOSH Fatality Assessment 

Control and Evaluation (FACE) program is to prevent 

occupational fatalities across the nation by identifying and 

investigating work situations at high risk for injury and 

then formulating and disseminating prevention strategies 

to those who can intervene in the workplace. This 

programmatic goal is addressed by conducting 

surveillance to identify occupational fatalities; performing 
2022 NATIONAL OCCUPATIONAL INJURY RESEARCH SYMPOSIUM 97

investigations of specific types of events to identify injury 

risks; developing recommendations designed to control or 

eliminate identified risks; and making injury prevention 

information available to workers, employers, and safety 

and health professionals. In January 2020, investigators 

traveled to the location where the logging processor died 

to examine the worksite and collect facts from OSHA 

compliance officers, company officials, witnesses, and 

workers about what occurred before, during, and after the 

incident. NIOSH investigators obtained and reviewed 

training records, health and safety plans, incident scene 

photographs and drawings, and medical records.

Results: Findings are preliminary, as the investigation 

report is still in process. The report will be final by the 

time of the conference. FACE investigators identified the 

following hazards as key contributing factors: ice and 

snow had accumulated on the roadway; the roadway 

design was outsloped; during travel, the boom and 

processing head were positioned in a way that caused the 

equipment’s center of gravity to shift downhill; the 

processor head swung while the equipment moved, 

causing the equipment’s center of gravity to shift; the 

operator cab only had falling object protection design; and 

the ice bits for the equipment were not engineer designed.

Conclusions: To prevent similar occurrences, NIOSH 

investigators recommended the following.

• Road designers should limit outsloping on forest 

roads with potential winter travel;

• Employers should conduct a hazard assessment when 

working with forestry equipment in areas of steep 

terrain and provide worker training on hazard 

recognition as part of a comprehensive and sitespecific safety plan;

• Employers should develop, implement, and train 

operators on strategies for traveling forestry 

equipment over forest roads;

• Employers should select forestry equipment equipped 

with falling object protection (FOP) or falling object 

guard (FOG) and rollover protective structures 

(ROPS);

• Employers should consider participating in 

professional safety organizations to strengthen safety 

and health programs;

• Employers should develop a comprehensive health 

and safety program for manual and mechanical 

logging operations;

• Manufacturers should design stowing or sway control 

features for forestry attachments such as dangle head 

processors; and

• Manufacturers should provide engineer designed ice 

bits for forestry equipment operating during winter 

snow and ice conditions to reduce lateral slipping.

P6

Title: The NIOSH Fatality Assessment and Control Evaluation 

(FACE) Program – Law Enforcement Officer Motor Vehicle 

Fatality Investigations

Authors: Melanie Fowler, Nancy Romano 

Purpose: Motor vehicle-related incidents are a leading 

cause of line-of-duty deaths for law enforcement officers 

(LEO) in the United States – they are also preventable. 

Data from the National Law Enforcement Officers 

Memorial Fund indicates that from 2006-2019, 809 

officers died due to motor vehicle related incidents 

(struck-by and crashes) – 43% of all line-of-duty deaths. It 

is important to promote motor vehicle safety among 

officers so they can stay safe while working to protect 

communities. During 2010-2019, on average, one officer 

per week has been killed on our nation’s roads. Most 

years, motor vehicle-related incidents, including crashes 

and being struck by moving vehicles while on foot, are the 

main cause of death for officers. To address these deaths, 

the National Institute for Occupational Safety and 

Health’s (NIOSH) Fatality Assessment and Control 

Evaluation (FACE) Program studies LEO motor vehiclerelated fatalities and disseminates intervention 

recommendations to prevent similar deaths.

Methods: The NIOSH FACE Program conducts law 

enforcement officer (LEO) motor vehicle crash and 

struck-by fatality investigations. Investigations help us 

understand risks LEOs face on the job and identify ways 

to prevent similar LEO deaths. Through field 

investigations, FACE personnel collect agent, host, and 

environmental information from the pre-event, event, and 

post-event phases of the fatal incident. The investigative 

information is evaluated to identify contributing factors, 

which are addressed by recommendations aimed at 

controlling them. Each FACE LEO report includes a 

description of the incident with personal information 

removed, factors that contributed to the fatal event, and 

recommendations for the law enforcement community to 

prevent similar deaths. The reports do not place blame.

Results: The FACE team have completed 5 NIOSH FACE 

LEO reports to date, and 8 State FACE LEO reports are 

also published. In addition to the LEO reports, 

infographics have been created based on report findings 

as well as relationships built with stakeholders such as the 

National Police Foundation and the National Law 

Enforcement Memorial Fund. Reports and associated 

products are disseminated to targeted audiences and are 

available through the FACE webpage, NIOSH LEO motor 

vehicle safety webpage or the NIOSH internet homepage.
2022 NATIONAL OCCUPATIONAL INJURY RESEARCH SYMPOSIUM 98

Conclusions: The LEO investigations identify risk factors 

for fatal motor vehicle-related events that will be used to 

develop prevention recommendations. The 

recommendations are shared with law enforcement 

agencies across the United States with the goal of reducing 

LEO motor vehicle-related deaths.

P7

Title: Use of the CDC’s Social Vulnerability Index to Characterize 

Firefighters’ and Medical First Responders’ Potential Exposure 

to SARS-CoV-2 During Routine Emergency Responses

Authors: Alexa Furek, Katherine Yoon, Susan Moore, 

Megan Casey, Emily Haas

Background: Populations that are socially and/or 

economically marginalized face an increased risk for 

adverse health outcomes during hazardous events. The 

Centers for Disease Control and Prevention (CDC) 

created a social vulnerability index (SVI) to identify and 

map U.S. census tracts that may require additional 

assistance during hazardous events. Although the SVI has 

been used to inform resource allocation and community 

preparedness, it has not yet been used to examine calls in 

which fire departments and emergency medical service 

workers respond to emergencies. This research explores 

the association between potential SARS-CoV-2 exposures 

during routine emergency response calls in the context of 

social vulnerability across census tracts in three U.S. 

cities—Boston, MA; Columbus, OH; and New Rochelle, 

NY. 

Methods: The National Institute for Occupational Safety 

and Health received monthly, post-call emergency 

response operations data from the International Public 

Safety Data Institute's National Fire Operations Reporting 

System (NFORS). Department computer-aided dispatch 

(CAD) systems generated these data, including public 

health data such as potential exposure to SARS-CoV-2. 

We matched NFORS data by census tract to the CDC’s 

SVI data which ranks census tracts from 0 to 1, where 

higher percentile rankings indicate greater social 

vulnerability. We ranked individual census tracts on 15 

social factors grouped into four related themes: 

socioeconomic status (theme1), household 

composition/disability (theme2), minority status/language 

(theme3), and housing type/transportation (theme4). 

Controlling for total population, we examined the 

association of social vulnerability with SARS-CoV-2 

exposure during emergency response calls using a 

negative binomial regression model in R (version 4.0.3). 

Using GIS mapping technology (Quantum GIS, version 

3.16), we determined social vulnerability percentile 

rankings and aggregate SARS-CoV-2 exposures at the 

census tract level in three U.S cities.

Results: From March to September 2020, data from over 

160,000 emergency response calls were received, with 

13,198 potential SARS-CoV-2 exposures recorded and the 

highest percentage occurring in May 2020 (22.5%). For 

calls with potential SARS-CoV-2 exposures, the mean 

(SD) SVI rankings were overall, 0.611 (0.289); 

socioeconomic status, 0.610 (0.301); household 

composition/disability, 0.524 (0.347); minority 

status/language, 0.619 (0.228); and 

housing/transportation, 0.583 (0.272). Socioeconomic 

status and housing/transportation showed a significant 

association. For every 1-unit increase (1 percentile 

ranking=0.01) in socioeconomic vulnerability, the 

expected log count of response calls with potential SARSCoV-2 exposures increased by 1.8389 (Incidence rate ratio 

= 6.289, [3.186, 12.455], p-value <0.001). For every 1-unit 

increase (1 percentile ranking=0.01) in 

housing/transportation vulnerability, the expected log 

count of response calls with potential SARS-CoV-2 

exposures increased by 0.7338 (IRR=2.083, [1.277, 3.415], 

p-value <0.01).

Discussion: Our results identified an association between 

SARS-CoV-2 exposures during routine emergency 

response calls and higher SVI rankings at the census tract 

level, with socioeconomic status and 

housing/transportation both significantly associated with 

potential exposure to SARS-CoV-2. Although significant 

individually, household composition/disability and 

minority status/language were not significantly associated 

when adding other social vulnerability indices to the 

model. Our results complement previous findings on the 

association between SVI and COVID-19 incidence, 

showing that SVI can be examined at a more granular 

level to inform risk management decisions. Future efforts 

could further explore spatial trends in social vulnerability 

and COVID-19 emergency response call types reported by 

first responders across the U.S.

P8

Title: Reliability and Validity of a Safety Hazard and 

Management Assessment Questionnaire

Authors: Libby Moore, Steven Wurzelbacher, I-Chen Chen, 

Michael Lampl, Steven Naber

Introduction: Managing and improving occupational safety 

and health requires evaluating performance. Injury rates 

and costs have been among the most commonly used 

lagging indicators. Yet these metrics provide inadequate 

information on injury causes and offer little guidance for 
2022 NATIONAL OCCUPATIONAL INJURY RESEARCH SYMPOSIUM 99

improvement. For this reason, organizations are 

encouraged to use both lagging indicators and leading 

indicators (such as questionnaire-assessed safety hazards 

and management practices). However, the association 

between types of indicators over time can be complex.

Longitudinal data can assist in clarifying these 

associations and increasing indicator utility.

Method: Employer data were used to evaluate the 

reliability and predictive validity of a safety management 

questionnaire. Employers’ longitudinal questionnaire 

responses, including ratings of their safety and claims 

management system and hazard identifications, and 

workers’ compensation (WC) claims data were analyzed 

using a marginal model with time-dependent covariates.

Multivariable Poisson and linear regression analyses with 

claim rate and logarithmic cost, respectively, as dependent 

variables were carried out after adjusting for industry 

sector and size. Questionnaire data were used to evaluate 

questionnaire scaling properties and to assess 

generalizability of results.

Results: Four questionnaire scales were associated with 

better WC claim outcomes as predicted and two scales 

were unexpectedly associated with poorer WC claim 

outcomes. Analyses assisted in interpreting the latter 

results, suggesting that WC claim rates and costs, rather 

than being responses, were motivators for employer 

improvement in some cases. Thirteen hazards on the 

questionnaire, which were identified by employers as 

present in their organizations, were associated with 

poorer WC claim outcomes as predicted. In addition to 

predictive validity, the internal consistency reliability and 

convergent and discriminant validity of the questionnaire 

were supported.

Conclusions: This study extends leading indicator research 

using longitudinal questionnaire and WC claims data 

from employers it was designed to assist. It provides 

information on the potential usefulness of employer safety 

management scale ratings and hazard identifications for 

safety self-improvement. Analyses provided insight into 

associations between leading and lagging indicators, 

emphasizing the importance of using both for safety 

improvement. Safety management questionnaire scales 

were predictive of WC claim outcomes, although support 

for hazard assessments as leading indicators was stronger.

Practical Applications: This study supports the use of 

employer-completed hazard assessment questionnaires 

for targeting and prioritizing improvement efforts.

Employer-completed safety management scales may be 

useful for directing improvement efforts, although the 

conditions under which they are completed, including 

submission to insurers, require additional consideration.

P9

Title: Workplace Violence Training among Young Workers 

14–24 Years of Age in the US

Authors: Camryn Lopez, Kimberly Rauscher, Carri Casteel, 

Doug Myers, Corinne Peek-Asa 

Background/Introduction: Workplace violence effects all age 

groups. However, younger workers are at a greater risk 

due to high-risk employment environments. Because of 

their increased risk, training in avoiding and responding 

to workplace violence is essential yet we know little about 

the workplace violence training provided to young 

workers. Objectives: To understand more about the extent 

of workplace violence training received by young workers 

across the US and specifically, what are the workplace 

violence topics on which young people are given 

employer-provided training, the timing of that training, 

and the training format(s).

Methods: This analysis used data collected on 1,032 US 

workers ages 14–24 who were surveyed about their work 

experiences. We used descriptive statistics to analyze the 

prevalence of training received on each of fourteen 

training topics related to workplace violence. We also 

describe when respondents reported they were first 

trained (e.g. first week on the job) and the format of that 

training (e.g., watch a video).

Results/Findings: The most common topic with regard to

workplace violence prevention was how to properly 

interact with customers/clients (84%); followed by how to 

properly work with and communicate with 

coworkers/supervisors (77%). After these two topics, the 

prevalence of training on other preventative measures 

dropped significantly. Less than half were trained on how 

to recognize warning signs and situations to look for that 

may lead violence among customers/clients (40%) or 

coworkers or supervisors (31%), and only 8% were trained 

in using physical contact to deal with an incident of 

workplace violence. In terms of workplace violence 

response training, the most prevalent topic was how to 

report a violent event to the employer (59%); followed by 

use of emergency systems to call for assistance (55%). The 

least prevalent topic in terms of response was in selfdefense techniques to use during an attack (11%). 

Regarding the first instance of training, the majority 

reported they were trained during their first week on the 

job (65%); about 10% could not recall when they were first 

trained. The most common training format was in-person 

meeting(s) or discussion(s) (74%), then written handouts 

or other hard-copy materials to read (46%); followed by 

watching a video (37%) and taking an online course 

(31%).
2022 NATIONAL OCCUPATIONAL INJURY RESEARCH SYMPOSIUM 100

Discussion/Conclusions: This investigation shows that 

young workers lack employer-provided training in 

important workplace violence prevention and response 

topics. Most young workers are instructed on how to 

properly interact with coworkers and customers and 

receive this training in their first week on the job. While 

this is positive, knowing the importance of being 

respectful to others and acting professionally toward both 

co-workers and customers is only one aspect of 

preventing workplace violence. Other important 

information such as how to de-escalate a stressful or tense 

situation once it has arisen, how to escape a violent 

situation, or how to defend oneself during an attack were 

not commonly provided. While all workers should have 

workplace violence training, young people may need to be 

targeted for two reasons. One is their overrepresentation 

in the retail and service industries where workplace 

violence is more common. The other is their lack of work 

experience. A young person who is inexperienced may not 

be as equipped to handle violent or aggressive behavior as 

an older, more experienced worker. Their lack of 

experience combined with a lack of training makes young 

workers a particularly vulnerable population.

P10 

Title: Perceptions of Workplace Hazards in a Sample of 

West Virginia Sawmill Employees

Authors: Wayne Lundstrom, Eric Lundstrom, Patrick Donnelly, 

Mark Fuller

The forestry industry of West Virginia has a 

disproportionately high occupational injury rate in 

comparison to the rest of the country. Despite this, 

current literature is lacking regarding the state’s sawmill 

industry and how its workforce perceives occupational 

hazards. Thus, we sought to investigate hazard 

perceptions within the sawmill industry of West Virginia 

using a mixed-methods approach. A total of 93 sawmill 

workers across West Virginia completed paper surveys 

administered at their workplace; a subset of 9 participants 

volunteered to complete semi-structured telephone 

interviews. Of survey participants, the majority (75.2%) 

considered themselves “workers”, with the rest being 

“lower-level supervisors” (17.2%) or “upper-level 

supervisors” (7.5%). Survey participants agreed that 

injuries within the sawmill are often due to worker 

carelessness (65.6%) and that employees sometimes do 

not report injuries out of fear for being blamed (69.9%). 

Additionally, few participants (10.8%) agreed that the 

money they are paid is worth the risk of occupational 

injury. After controlling for age using logistic regression, 

no significant differences were detected between 

supervisors’ and workers’ responses. Thematic analysis of 

telephone interviews revealed that participants feel 

working with new and inexperienced workers is a barrier 

to safe work, as well as the idea that working with sawmill 

machinery is inherently dangerous. These results indicate 

that sawmill workers in West Virginia broadly agree that 

the industry is dangerous and present an opportunity to 

inform future jobsite safety interventions.

P11 

Title: Polypropylene Honeycomb in Industrial Safety Helmets

Authors: Shengke Zeng, Jinhua Guan, E.A. McKenzie, Jr., 

Bryan Wimer, Bradley Newbraugh, Bryan Williamson

Background: Industrial safety helmets protect the 

construction and other workers from traumatic brain 

injury (TBI) by attenuating impact acceleration through 

the helmet. The ANSI standard for industrial head 

protection (Z89.1-2014) requires that an industrial safety 

helmet should attenuate the impact acceleration to 150 g 

(g = 9.81 m/s2) or below as the helmet is impacted on a 

drop tower with Type II impact setup specified by the 

standard. A typical Type II industrial safety helmet could 

attenuate the head impact acceleration to ~110 g, but this 

acceleration level is still not effective for head protection.

A mild TBI usually could already occur at 61~144 g. To 

further attenuate the head impact acceleration, this study 

conducted helmet impact comparison tests to determine 

the feasibility of replacing the conventional expanded 

polystyrene (EPS) liner inside the industrial safety helmet 

shell with a polypropylene honeycomb layer, which is 

considered as an excellent impact energy absorber.

Method: In the comparison impact tests, two brands 

(Brands A and B) of the Type II safety helmets were 

modified by cutting a hole of 75 mm in diameter at the 

front of the EPS liner and inserting a circular 

polypropylene honeycomb pad with the same diameter 

and similar thickness of 17 mm (Brand A) or 15 mm 

(Brand B) into the hole. The hole center was 40 mm above 

the liner bottom. The individual honeycomb pad was 

loosely bonded with the EPS liner hole with hot glue dots 

to observe impact energy attenuation contributed mainly 

by the honeycomb pad. The density and the cell size of the 

honeycomb were 80 kg/m3 and 8 mm, respectively. The 

typical bare compression strength and modulus of the 

honeycomb were 1.89 MPa and 79.2 MPa, respectively.

The helmet impact tests on the original and modified 

helmets were conducted on a helmet drop tower with 

Type II test setup. In the first set of the comparison tests, 

20 Brand A and 20 Brand B helmets (10 original and 10 

modified helmets for each brand) were impacted at the 

front of the helmets with the standard impact velocity of 

3.5 m/s. In the second set of the tests, 50 Brand A helmets 
2022 NATIONAL OCCUPATIONAL INJURY RESEARCH SYMPOSIUM 101

were impacted at the same helmet location as that in the 

first set of the tests, with the impact velocity variated at 

2.5, 3.0, 3.5, 4.0 and 4.5 m/s. At each velocity, 10 helmets 

(five original and five modified) were impacted.

Results: The results of the first set of the comparison tests 

showed that the mean impact acceleration through the 20 

modified helmets with polypropylene honeycomb pad 

was 91.8 g which was 20.1% less than the impact 

acceleration through the 20 original helmets. The results 

of the second set of the comparison tests showed that the 

mean impact acceleration through the modified helmets 

were 53.6, 66.4, 86.6, 112.2 and 231.7 g, which were 9.7%, 

13.2%, 20.5%, 45.4% and 30.3% less than those through 

the original helmets at the impact velocities of 2.5, 3.0, 3.5, 

4.0 and 4.5 m/s, respectively. All reductions in impact 

acceleration were statistically significant except that in the 

2.5 m/s condition.

Discussion: With this polypropylene honeycomb material 

and structure, the plastic bending of the honeycomb cells 

and the circumferential stretching of the cell wall between 

the bending hinges attenuated more impact energy than 

the conventional EPS liner at the impact velocities ranged 

from 3.0 to 4.5 m/s. Since polypropylene honeycomb 

reached the boundary between plastic-deformation region 

and densification region at higher impact velocity than 

the EPS liner, the polypropylene honeycomb attenuated 

greater impact energy than the conventional EPS liner at 

higher impact velocities. Conclusions: The polypropylene 

honeycomb materials, with the physical properties 

mentioned above, are an effective substitute for the 

conventional EPS liner at the front of the industrial safety 

helmets. They can attenuate greater impact energy at 

impact velocities ranging from 3.0 to 4.5 m/s.

P12 

Title: What’s Stopping You? Organizational Constraints 

as a Multi-Facet Work Stressor

Authors: Nathan Bowling, Jesse Michel, Michael Rotch, 

Md Rashedul Islam, Stephen Wagner

Introduction: Considerable attention has been given to 

identifying various forms of work stressors—events or 

conditions within the workplace that impose adaptive 

demands on workers (Jex et al., 1992). Such research is 

important because stressors can undermine workers’ 

psychological and physical health, and thus present a risk 

for work injuries. The most widely studied stressors 

include role ambiguity and role conflict (Bowling et al., 

2017), workplace aggression (Hershcovis, 2011), and 

organizational constraints (Pindek & Spector, 2016). The

current research focuses on organizational constraints 

and describes the creation and validation of a self-report 

organizational constraints scale—the Multi-Facet 

Organizational Constraints Scale (MOCS).

Background: The organizational constraints construct 

subsumes the many factors within one’s workplace that 

interfere with effective job performance (Spector & Jex, 

1998). Examples include having inadequate equipment or 

training to do one’s work tasks and having to deal with 

frequent interruptions from coworkers (see Peters & 

O’Connor, 1980). Organizational constraints may 

produce work injuries via several mechanisms. First, some 

constraints (e.g., poor training, inadequate equipment, 

budget shortages) may create direct risks for work 

injuries. Second, constraints are related to psychological 

and physical symptoms—including anxiety, sleep 

disturbances, fatigue, and dizziness (Nixon et al., 2011; 

Pindek & Spector, 2016). These symptoms may contribute 

to engagement in unsafe work behavior. Finally, 

constraints are linked to engagement in various 

counterproductive work behaviors (CWBs; Pindek & 

Spector, 2016), which may include the failure to follow 

safety procedures.

Significance: Previous research has largely focused on 

overall organizational constraints rather than on its facets. 

In fact, one overall measure—Spector and Jex’s (1998) 

Organizational Constraints Scale (OCS)—has been used 

in most studies (see Pindek & Spector, 2016). Although 

the OCS yields high levels of reliability and construct 

validity, it does not provide facet scores. Different facets 

of constraints presumably have somewhat different sets of 

causes and effects. A multi-facet scale is needed to provide 

researchers and practitioners more specificity regarding 

aspects of work that pose the most risks to worker. Such 

information can be used as a basis for tailoring 

interventions to the unique needs of an organization or 

department. Method: The current research summarizes 

the MOCS’ development. We used standard scale 

development practices (see Hinkin, 1995, 1998) by first 

clearly defining the organizational constraints construct. 

Based on a thorough review of the literature and our own 

pilot studies, we identified 16 facets for inclusion in the 

MOCS (example MOCS facets include “poor training,” 

“physical conditions,” and “incorrect information”). We 

conducted three subsequent main studies (Study 1 N = 

324; Study 2 N = 400; Study 3 N = 79) to examine the 

reliability and construct validity of the MOCS.

Results: Collectively our studies provide evidence of the 

MOCS’s reliability and construct validity. Specifically, the 

MOCS facets consistently produce Cronbach’s αs > .85. 

Furthermore, the MOCS facets consistently predict 

important work-related criteria, including job 

dissatisfaction, work-related frustration, and CWB.
2022 NATIONAL OCCUPATIONAL INJURY RESEARCH SYMPOSIUM 102

Discussion: Given the undesirable effects organizational 

constraints may have on both individual workers and 

their employers, more research on this topic is needed. 

Using a multi-facet scale may aid in the scientific 

understanding of the conceptual nature of the constraints 

construct. Furthermore, information about which facets 

an organization scores high on can be used as a basis for 

developing tailored interventions to improve the health 

and well-being of all workers.
2022 NATIONAL OCCUPATIONAL INJURY RESEARCH SYMPOSIUM 103

DAY 3: THURSDAY, MAY 12, 2022

Session H1

Work-Related Vehicle Crashes

Moderator: Eva Shipp

H1.1 

Title: Driver Injuries in Heavy vs. Light and Medium Truck Local 

Crashes, 2010 - 2019 

Authors: Terry Bunn, Madison Liford, Michael Turner, 

Ashley Bush

Objective: Multiple research studies on driver injuries in 

heavy trucks have been conducted but relatively few 

studies have been performed on light and medium truck 

injuries. The objectives of this study were to use workers’ 

compensation (WC) first report of injury (FROI) data to 

1) compare demographic and injury characteristics 

between heavy truck drivers, and light and medium truck 

drivers involved in local crashes; 2) assess WC disposition 

and lost work time status associated with local heavy, 

medium, and light truck driver crashes; and 3) describe 

injury scenarios by specific vehicle type to obtain 

additional information on the crash circumstances.

Method: A cross-sectional study using WC FROI data for 

2010-2019 was performed, and quantitative and free text 

data were analyzed. Results: There were 800 total local 

crash FROIs; 451 were heavy truck crashes and 349 were 

light or medium weight truck crashes. The youngest (<25 

years) and oldest age groups (>65 years) were represented 

at higher proportions of local light and medium truck 

crash FROIs compared to the heavy truck group. Drivers 

in the light and medium truck local crash FROIs were 

employed primarily in the retail trade industry (47%), and 

wholesale trade industry (21%). The primary vehicle types 

identified in heavy truck local crashes were semi-trucks 

(13%), and dump trucks (11%). For light and medium 

trucks, the specific vehicle types identified were delivery 

trucks (30%). Heavy truck crashes involved rollovers due 

to the inability to stop in time when a vehicle was 

stopped/slowed in front of them, driving off narrow 

roadways and overcorrecting while bringing the vehicle 

back onto the pavement, and driving downhill and unable 

to downshift. Common injury scenarios for light and 

medium truck crashes involved being rear-ended, running 

red lights, and turning in front of other vehicles.

Conclusions: The utilization of WC data highlighted 

common injury scenarios by specific truck types for 

targeting driver safety training among light, medium, and 

heavy truck drivers. Future studies using linked WC data 

and crash data are needed to comprehensively identify 

specific industries, vehicle types, and circumstances 

surrounding light and medium vehicle crashes.

H1.2 

Title: Trends in Work-Related Fatalities Due to Motor Vehicle 

Crashes, United States, 2011–2019 

Authors: Srinivas Konda, Scott Hendricks, Stephanie Pratt, 

Rebecca Knuth, Rosa Rodriguez-Acosta, Eric Carbone

Introduction: Motor vehicle crashes (MVCs) are the 

leading cause of work-related deaths in the United States, 

yet little is known about how characteristics of MVC 

fatalities may have changed over time. The purpose of this 

study was to examine the trends in work-related MVC 

fatality rates from 2011–2019.

Methods: Data were obtained from the publicly available 

Census of Fatal Occupational Injuries database. The 

following Occupational Injury and Illness Classification 

System event codes were used to define MVCs: 24-

Pedestrian vehicular incidents; 26-Roadway incidents 

involving motorized land vehicle; 27-Nonroadway 

incidents involving motorized land vehicles. Fatality rates 

per 100,000 full-time equivalent (FTE) workers were 

calculated using employment data from the Current 

Population Survey. Poisson regression models accounting 

for serial correlation were used to calculate trends in rates, 

assuming a linear trend across the study period. Average 

annual percentage changes in work-related MVC fatality 

rates with 95% confidence intervals (CIs) were calculated. 

The average annual percentage change in the work-related 

MVC fatality rate for each subgroup was compared with 

the average annual percentage change in the overall workrelated MVC fatality rate.

Results: During 2011–2019, 15,802 workers died in MVCs 

in the United States (average: 1,756 per year), accounting 

for 36% of all work-related deaths (n=44,483). These 

fatalities were most often due to roadway incidents 

(n=10,873; 69%). The average annual MVC fatality rate of 

1.24 per 100,000 FTEs did not change significantly from 

2011–2019 (-0.04%; 95%CI: -0.63%, 0.57%). While the 

rate of fatalities due to nonroadway incidents significantly 

decreased by an average of 1.72% per year (95%CI: -

3.36%, -0.05%) and the rate of fatalities due to pedestrian 
2022 NATIONAL OCCUPATIONAL INJURY RESEARCH SYMPOSIUM 104

vehicular incidents decreased by an average of 0.35% 

(95%CI: -1.77%,1.07%), the rate of fatalities due to 

roadway incidents increased by an average of 0.38% per 

year (95%CI: -0.35%,1.13%). The MVC fatality rate for 

Black, non-Hispanics (1.09%; 95%CI: -0.72%,2.88%) and 

Hispanics (1.31%; 95%CI: -0.19%,2.88%) increased, 

whereas the average annual MVC fatality rate for whites 

decreased (-0.50%; 95%CI: -1.24%,0.24%). The average 

annual MVC fatality rate for workers aged ≥65 years 

increased significantly (1.61%; 95%CI: 0.03%,3.24%). The 

MVC fatality rate for driver/sales workers and truck 

drivers, who accounted for 39% of all work-related MVC 

deaths for 2011–2019, increased 0.72% per year on 

average (95%CI: -0.25%,1.76%). The average annual MVC 

fatality rate for installation, maintenance, and repair 

occupations showed a significant increase of 3.43% 

(95%CI: 0.61%,6.20%), which was significantly greater 

than the percentage change in overall MVC fatality rate 

(3.46%; 95%CI: 0.58%,6.35%). The average annual MVC 

fatality rates for construction and extraction occupations 

(-2.11%; 95%CI: -3.83%, -0.43%) and management 

occupations (-5.65%; 95%CI: -7.58%, -3.67%) declined 

significantly, and these declines were significantly greater 

than the percentage change in overall MVC fatality rate 

((-2.07%; 95%CI: -3.90%, -0.28%), (-5.61%; 95%CI: -

7.65%, -3.55%), respectively).

Discussion: While the overall work-related MVC fatality 

rate has not significantly changed over the 9-year study 

period, trends varied across incident types, demographics, 

and occupations. MVC fatality rates for those aged ≥65 

years and those working in installation, maintenance, and 

repair occupations increased significantly, while rates for 

those working in construction and extraction and 

management occupations and rates of nonroadway 

incidents across all occupations declined significantly. It is 

important to identify factors associated with the decline in 

rates for certain subgroups of the workforce and apply 

what is learned to other work settings. Research should 

continue to focus on reducing MVC fatalities across other 

subgroups where little or no decline occurred.

H1.3 

Title: Lessons Learned from Using Crash Records for Injury 

Surveillance in the AFF Sector

Authors: Eva Shipp, Amber Trueblood, Hye-Chung Kum, 

Shubhangi Vasudeo, Marcelina Perez, Lingtao Wu

Introduction: Fatal injuries in the agriculture, forestry, and 

fishing (AFF) sector are grossly overrepresented 

compared to the rate across all sectors in the U.S., based 

on the National Census of Fatal Occupational Injury 

(CFOI). CFOI data indicate that transportation-related 

injuries are among the top contributors to these fatal 

events. However, little is known about motor vehicle 

crashes in AFF, specifically events involving logging 

trucks and agricultural vehicles in the southwest (SW) 

region (Arkansas, Louisiana, New Mexico, Oklahoma, 

and Texas). The overarching goals of this ongoing project 

are (1) to develop an integrated database of AFF-related 

motor vehicle crashes that occurred on public roadways in 

the SW region and (2) use these data to conduct 

surveillance and research focused on identifying factors 

associated with higher injury severity events.

Methods: Each state in the U.S. maintains a database of 

crash records for events occurring on their public 

roadways. These records include structured fields 

pertaining to person, vehicle, roadway, and 

environmental factors related to crash events and 

resulting injuries. In addition to the structured fields, 

records include free-text crash narratives where law 

enforcement officers provide additional details on crash 

causation. The present project includes the structured 

fields for crash records from Arkansas, Louisiana, New 

Mexico, Oklahoma, and Texas for the years from 

approximately 2010 to 2020. Narratives were obtained for 

Texas and Louisiana. To the extent feasible, the structured 

data fields across the five states were mapped to the 

Minimum Model Uniform Crash Criteria published by 

the National Highway Traffic Safety Administration to 

facilitate their integration. Descriptive statistics and 

geographic information system methods are used to 

identify the distribution of variables and identify spatial 

and temporal crash patterns. Multiple logistic regression 

models were constructed to identify factors associated 

with higher severity crashes involving logging trucks and 

farm vehicles. Finally, text mining methods including 

natural language processing applied to crash narratives 

are being used to better classify and understand AFF 

crashes.

Results: At present, the surveillance system contains over 8 

million records with nearly 9,000 AFF-related crashes. 

Analysis of the crash records yielded a protocol for 

appropriately identifying AFF crashes while also 

quantifying potential misclassification as an AFF event. 

Analyses also reflect fields that differ markedly between 

states and how this impacts the interpretation of findings, 

including the comparison of crashes and their 

contributing factors across states. Strengths of crash 

records include their availability and details that are not 

included in traditional surveillance systems or clinical 

records. Key limitations of crash records include a lack of 

injury-specific information including diagnoses codes and 

specific fields to reflect industry and occupation.
2022 NATIONAL OCCUPATIONAL INJURY RESEARCH SYMPOSIUM 105

Discussion: Despite their inherent limitations, crash 

records can be an important component of injury 

surveillance involving AFF vehicles in the SW region. 

They also can be used to identify potential risk factors for 

higher severity crashes which can inform the selection of 

countermeasures designed to address these factors.

Session H2

Industrial Mobile Robots: Best Practices for Worker 

Safety 

Moderator: Carole Franklin

Mobile robots are changing the operation of industrial 

environments, and adjacent economic environments such 

as warehousing. Industrial robots were typically confined 

to fixed-in-place cells, to which human entry was 

prevented or controlled so as to maintain the safety of 

human workers. When the industrial robot was mounted 

to the capability of motion (e.g., gantry, hand-pushed cart, 

etc.), there was a well-defined or easily discernible range 

of motion. Historically, automated mobile machines in 

the industrial environment were confined to fixed 

guidepaths. Now, new technological advances are 

permitting mobile robots to navigate freely in the same 

spaces as human workers. However, with this new 

capability come new hazards and risks that must be 

evaluated for every deployment of mobile robots. This 

session will introduce concepts of mobile robotics in the 

industrial environment and how they are being used in 

industry, discuss the safety standards related to industrial 

mobile robots and systems of mobile robots, and how to 

evaluate and mitigate these new hazards related to 

industrial mobile robot systems.

The workshop will cover the following topics with respect 

to mobile robots in industry:

• Paradigm Shift in Industrial Robot Safety

• Introduction to Mobile Robots and Applications

• Safety Standards for Industrial Mobile Robots and 

Other Mobile Platforms

• Risk Assessment and Hazard Mitigation for 

Industrial Mobile Robot Systems

• Residual Risks for Industrial Mobile Robot Systems

Session Learning Objectives: Participants will learn what 

mobile robots are, how they differ from other mobile 

machines in the industrial environment, how they are 

being used in industry, what safety standards exist for 

mobile robots and mobile robot systems, and how to 

evaluate and mitigate hazards related to industrial mobile 

robot systems.

Paradigm Shift in Industrial Robot Safety

Presenter: Carole Franklin – Director ofStandards

Development, Robotics, Association for Advancing 

Automation (A3)

This presentation will describe how safety practices for 

mobile robotics requires a paradigm shift from fixed-inplace or defined-motion industrial robotics (whether 

collaborative or not).

Introduction to Mobile Robots and Applications

Presenter: Mark Lewandowski – Robotics Innovation Leader, 

Procter & Gamble

This presentation will discuss what industrial mobile 

robots are, and how mobile robots are being used in 

industry.

Safety Standards for Industrial Mobile Robots and Other Mobile 

Platforms

Presenter: Jeremy Marvel – Computer Scientist, National 

Institute for Standards and Technology (NIST) 

This presentation will discuss the industry standards for 

mobile robot safety and other forms of mobile machinery 

operating automatically or with degrees of autonomy in 

the industrial environment.

Risk Assessment and Hazard Mitigation for Industrial Mobile 

Robot Systems

Presenter: Aaron Prather – Senior Advisor, Technology 

Planning & Research, FedEx

This presentation will discuss the new hazards related to 

mobile robot systems and how to evaluate and mitigate 

these hazards.

Residual Risks for Industrial Mobile Robot Systems

Presenter: Federico Vicentini – Head of Product Safety, 

Boston Dynamics

This presentation will discuss approaches to a special 

topic of risk assessment, where some residual risks could 

be left unresolved due to the nature of the application, the 

environment, the user requirements, or the mobile robots 

themselves. 
2022 NATIONAL OCCUPATIONAL INJURY RESEARCH SYMPOSIUM 106

Session H3

Special Considerations for High-Risk Workers

Moderator: Tamara Small

H3.1 

Title: Promoting Safety and Well-Being Among Sheet Metal 

Worker Women Through Mentoring

Authors: Marissa Baker, Lily Monsey, Noah Seixas, 

Hendrika Meischke, Pranav Srikanth 

Background: Women are underrepresented in the 

construction industry, and research on their experiences 

reveals exposure to multiple safety hazards including illfitting personal protective equipment, less hands-on 

training with tools during their apprenticeship, physical 

overcompensation while proving themselves against sexist 

stereotypes, and sexual harassment. Mentorship has been 

shown to improve women's experiences and outcomes in 

the trades and increase their retention.

Methods: Utilizing a randomized control study design, we 

are longitudinally following apprentice sheet metal 

workers who were assigned a journey-level mentor and 

who were not assigned a mentor. To prepare the mentors, 

we developed an accessible and evidence-based 

mentorship training program, informed by industry 

stakeholders. The training included interactive online 

modules and synchronous Zoom sessions where mentors 

from across locals are able to build community and 

practice skills. We surveyed mentors, mentees, and 

control apprentices to gather baseline data on their 

experiences in the trades. This survey will be repeated 

every six months and supplemented with questions 

assessing the value of different aspects of the mentorship 

training for mentors.

Results: Twenty-three mentors from across the United 

States were trained and matched with 42 mentees. Control 

apprentices were also enrolled. Most mentors indicated 

they had not received formal mentorship training before, 

or formal training in skills such as active listening, goal 

setting, relationship building, problem solving or selfadvocacy, all of which are covered in our mentorship 

training. In post-training evaluations, the majority of 

mentors reported the training sessions to be valuable and 

prepared them to meet with their mentees. Amongst 

enrolled apprentices (both mentees and controls), 38% 

reported being bullied in the previous six months and 

45% reported having experienced discrimination based on 

their gender. Sixty-five percent of apprentices reported 

never receiving formal mentorship, indicating this is a 

needed intervention.

Discussion: Women still face gendered experiences in the 

construction trades. An appropriate, evidence-based, and 

accessible mentorship training may help to increase social 

support, develop leadership skills, and improve retention 

and experiences for women in construction. This skill 

development can, in turn, lead to decreased rates of injury 

amongst female construction workers.

H3.2 

Title: Evaluating the Accidents and Levels of Compliance 

in Construction Sites

Authors: Somendra Pal Rana, Rachna Dawar

Objectives: There has been an unprecedented growth in 

construction projects in India due to rapid 

industrialization and favorable environment. However, 

maximum fatal accidents take place in construction sector 

making the employment in the sector a risky affair. 

Employment of untrained migrant workers and constraint 

in time to complete the projects leads to several accidents 

at construction sites. Their socio-economic conditions 

sometimes contribute in unsafe acts at sites also. Ease of 

doing business has further made the workplace vulnerable 

to some extent as most of the initial work is done online 

without physical verification of the site. This results in 

giving rise to unsafe working conditions from the very 

beginning of the project.

Methods: The study was carried out to evaluate the 

accidents and level of compliances with a view to find the 

credible solutions. Inspections of the construction sites 

were carried out due to various accidents involving 

injuries and loss of valuable human lives. Since the 

construction site is dynamic in nature, it brings with it 

new challenges with change in worksite, machineries, 

height, depth and different type of work involved. The 

study tried to tap all such lacuna that are responsible in 

increase in accidents. Focus was given to the un-skilled 

workforce engaged in construction work, which 

aggravated the already grim situation at the workplace. 

Such migrated workforce coming from remote areas in a 

hope of searching livelihood were interviewed. Emphasis 

was given to know about their working conditions and 

familiarity with the jobs they were trusted upon at the 

sites.

Results: It was observed that more than fifty percent 

accidents took place due to fall from height. Excavated 

earth that was left without piling and shoring, was another 

cause of most of the accidents. Strict enforcement and 

regular training provided fruitful and desired results. It 
2022 NATIONAL OCCUPATIONAL INJURY RESEARCH SYMPOSIUM 107

was observed that proper OSH management and 

compliance to statutory requirement helped is reducing 

the accidents drastically. It was also found that legal 

actions against the managements acted as a deterrent but 

cannot be considered a viable solution. Lack of awareness 

and enthusiasm towards statutory compliances prevailed 

in employers, which can be addressed through proper 

communication and information.

Conclusions: The sites following the standard operations 

procedures and work instructions had fewer accidents and 

the severity of such accidents was also less. Proactive and 

persuasive approach by enforcement agencies inspired the 

employers to comply with the OSH laws and make the 

workplace safe. The top-level commitment for statutory 

compliances and care for lives, safety and welfare of 

workers is the key to raise awareness of OSH amongst the 

stakeholders.

H3.3 

Title: Revisiting Formative Research to Identify Gaps in Hazard 

Recognition Research for High-Risk Workers

Authors: Brianna Eiter, Mahiyar Nasarwanji

Background: To reduce risk of injury or illness, mine 

workers must be able to identify and mitigate hazards 

where they work. Hazard recognition is a critically 

important skill, and one that recent National Institute for 

Occupational Safety and Health (NIOSH) research 

indicates a need for improvement (Eiter et al., 2018). A 

review of the hazard recognition literature suggests 

previous research has focused primarily on safety-related 

hazards, e.g., slips and trips and rib and roof falls (Eiter et 

al. 2018; Kowalski-Trakofler & Barrett, 2003). One 

potential reason hazard recognition research has focused 

on these hazards is because of the data sources used to 

identify and select hazards. However, mine workers are 

vulnerable to other high-risk hazards such as, dust, noise, 

and heat but there continues to be limited research 

focused on mine worker recognition in these areas (Scott 

& Grayson, 2003). Therefore, the authors sought out to 

re-evaluate former panoramic scenes and distinguish 

between safety-related and health-related hazards and 

then re-examine gaps in research efforts to ascertain 

hazards that are consistently overlooked and how to 

address these hazards in future research.

Methods: In 2015, NIOSH conducted formative research 

to gather information to build an accurate and realistic set 

of stimuli that would be used as a part of a virtual reality 

laboratory research study. This formative research was 

derived from several methodologies including qualitative 

data collection where mine workers, health and safety 

professionals, and former Mine Safety and Health 

Administration (MSHA) inspectors were either 

interviewed or participated in focus groups, and an 

assessment of MSHA injury and fatality data and then 

used to create 32 panoramic scenes of a typical surface 

stone mine that included over 100 different hazards. The 

literature supports secondary analyses of qualitative and 

other formative data when the goal is to apply a new 

perspective or a new conceptual focus to that data 

(Heaton, 2000). The goal of this secondary analysis was to 

re-categorize hazards included in 32 panoramic scenes, 

re-assess interview and focus group data to identify 

whether and how health hazards were discussed by mine 

workers, H&S professionals, and subject matter experts 

(SMEs), and review data collection materials to determine 

why health hazards may have been overlooked during 

initial analyses.

Results: A review of the panoramic scenes indicated that 

hazards were largely safety-related (e.g., material on the 

walkway, small vehicles in larger vehicles blind spots, 

workers performing tasks without having locked and 

tagged out), though some health-related hazards were 

included (e.g., noise, welding fumes). This gap in hazard 

visualization is likely because the selected hazards were 

based in part on MSHA injury and fatality data. Based on 

the panoramic scenes developed, it is not surprising that a 

secondary analysis of the interview and focus group data 

also indicated that mine workers and H&S professionals 

primarily discussed safety hazards; however, healthrelated hazards such as dust and heat exposure were 

included. Additional analyses will be presented and 

discussed in the context of re-engaging with previous 

formative research with a new perspective to identify 

additional gaps to address with hazard recognition 

research. 

Discussion/Practical Applications: The purpose of this study 

was to revisit the formative research effort that preceded 

and informed a hazard recognition study and the creation 

of a set of panoramic scenes used as stimuli within a 

virtual reality laboratory environment. These results are 

being used to inform development and implementation of 

forthcoming hazard recognition research that will 

improve mine worker acknowledgement and behavior to 

reduce hazards that cause chronic outcomes.
2022 NATIONAL OCCUPATIONAL INJURY RESEARCH SYMPOSIUM 108

Session H4

Participatory Self-Management to Promote Safety 

Culture/Climate and Sustainability in Hazardous 

WorkEnvironments

Moderator: Ted Scharf

Abstract: Safety culture/climate continues to be a “hot 

topic” among safety professionals. But, on its own, the 

topic “safety culture/climate” is irrelevant, unless and 

until it is directly connected to the organization’s safety 

management system from which the safety 

culture/climate derives.

“The U.S. Occupational Safety and Health Administration 

(OSHA [3409, p.3]) recognizes that new strategies are 

needed to ensure that all workers return home safe, 

sound, and healthy from a day on the job. Workplace 

safety and health standards and their enforcement can 

have a huge impact on workers’ lives—but the OSHA 

standard setting process is slow and even full compliance 

with standards will not prevent all work injuries and 

illnesses. There is much untapped potential to leverage 

other movements that are big, proactive, diverse in 

audience and stakeholders, future-thinking, and 

innovative to advance worker safety and health. 

Sustainability is one such movement that provides the 

potential to go beyond the Agency’s traditional role and 

become a transformative force.”

Organizational sustainability extends far beyond the 

safety and health management system in a hazardous 

work environment. And there are many strategies and 

approaches that promote organizational sustainability 

(OSHA, 3409). With respect to a sustainable safety and 

health management system, one critical strategy is active, 

participatory engagement by every member of the 

workforce in that environment. This session will explore 

theoretical and practical approaches to developing and 

maintaining such engagement for a sustainable safety and 

health management system. Further, this session will 

connect these strategies to the creation of a strong safety 

culture/climate for the organization.

Presentation #1: A brief history of worker engagement in 

safety initiatives

Presenter: Lisa M. Kath, San Diego State University

The first presentation will provide the theoretical 

background and support from industrial/organizational 

psychology. Leading management theories will be briefly 

compared.

Presentation #2: “Non-compliance,” “complacency,” and 

other explanations for unsafe work practices that blame 

workers for systemic failures: one psychologist’s 

perspective 

Presenter: Ted Scharf, NIOSH, Cincinnati

The second presentation will examine a few of the – often 

untested, and incorrect – perspectives that are attributed 

to workers who appear to ignore or to short-cut safety 

guidelines.

Presentation #3: The promise of, and problems with, 

worker participation

Presenter: Scott Schneider, Laborers’ Health and Safety 

Fund 

of North America (retired)

The third presentation will address some of the available 

approaches to improve safety and safety culture/climate in 

hazardous work environments, with an emphasis on 

worker participation at all levels of management.

Presentation #4: Using close call reports to empower 

worker-led interventions

Presenter: Emily J. Haas, NIOSH, Pittsburgh

The final presentation will illustrate some of these 

approaches with results of interventions from the 

industrial construction and aggregates industries.

Discussion: David LeGrande, Communications Workers 

of America (retired)

The session will conclude with a discussion of the 

directions for future development of the ideas presented 

in this session.

Learning Objectives: Session participants will be able to:

1. Describe key components of the academic literature 

on organizational management related to worker 

participation.

2. Describe and assess this literature compared to 

popular descriptions that promote safety culture in the 

workplace. 

3. Evaluate possible methodological errors in the 

misinterpretation of this literature.

4. Suggest both theoretical and practical examples of 

worker self-management in hazardous work 

environments.
2022 NATIONAL OCCUPATIONAL INJURY RESEARCH SYMPOSIUM 109

Industries: Relevant to all industries with hazardous work 

environments. The presenters and discussant have 

research and intervention experience in agriculture, 

communications, construction, emergency response, and 

mining.

Reference: 

Occupational Safety and Health Administration (OSHA). 

U.S. Department of Labor. (2016, December). 

Sustainability in the Workplace: A New Approach for 

Advancing Worker Safety and Health. Washington, DC: 

OSHA 3409. 37p. Sustainability in the Workplace - 

Overview | Occupational Safety and Health 

Administration (osha.gov)

H4.1 

Title: A Brief History of Worker Engagement in Safety Initiatives

Author: Lisa Kath

Industrial-organizational psychology has a rich history of 

studying management theories and approaches that 

include worker engagement. This presentation (which 

needs to be virtual) reviews this history as a backdrop for 

the symposium that follows. This presentation will start 

off with a discussion of McGregor’s Theory X and Theory 

Y management (McGregor & Cutcher-Gershenfeld, 1960; 

Sorensen & Minahan, 2011). In this approach, Theory X 

managers hold the assumption that workers are 

inherently lazy and need to be supervised closely and 

motivated through external rewards or punishments to 

accomplish performance goals. Theory Y managers hold 

the assumption that workers are largely self-motivated to 

perform well, and that they need to be empowered to 

achieve performance goals. Only Theory Y managers are 

going to be inclined to include worker engagement (most 

notably, their participation in decision making).

There are other movements and approaches that 

inherently incorporate worker engagement. One such 

movement is what is commonly called kaizen, or 

“continuous improvement” (Kato & Smalley, 2010). In 

this approach, factory workers are empowered to make 

small changes necessary to improve the manufacturing 

process. This approach was a radical departure from 

historic time-and-motion studies, where workers were 

studied to determine the precise movements required, and 

they were not permitted to deviate from their 

standardized protocols. Another such approach is 

participatory ergonomics, which is the “involvement of 

people in planning and controlling a significant amount 

of their own work activities” (Burgess-Limerick, 2018).

The “ergonomics” part indicates a certain level of focus on 

the physical aspects of the job (tools, human-machine 

interaction), but it also emphasizes participation in 

decision making as a key element. More recently, 

particularly in the nursing field, there has been study of 

structural and psychological empowerment. (Laschinger 

& Havens, 1997; McDermott et al., 1996). This approach 

indicates that the structure of the organization needs to 

empower workers to have control over their own work to 

ensure quality and well-being.

There are several terms associated with teams who are 

empowered to be engaged in decision-making about work 

processes: quality circles (Lawler & Mohrman, 1987), 

Total Quality Management (Dahlgaard et al., 2008) and 

self-managed teams (Solansky, 2008). In these 

approaches, individual team members and the team as a 

whole are trained to identify areas where improvements 

can be made, and they are empowered to bring 

issues/concerns to the team for discussion about what 

needs to be changed. In all these approaches, there is 

strong evidence that including worker engagement in the 

improvement of processes is a powerful way to make 

significant strides toward better quality and safety. 

Understanding the long history of worker engagement 

and the notable empirical support worker engagement has 

enjoyed can be helpful in designing safety initiatives that 

are likely to be most effective.

References: Burgess-Limerick, R. (2018). Participatory 

ergonomics: Evidence and implementation lessons. 

Applied Ergonomics, 68, 289–293. Dahlgaard, J. J., 

Khanji, G. K., & Kristensen, K. (2008). Fundamentals of 

total quality management. Routledge. Kato, I., & Smalley, 

A. (2010). Toyota Kaizen Methods: Six Steps to 

Improvement. CRC Press. Laschinger, H. K. S., & Havens, 

D. S. (1997). The effect of workplace empowerment on 

staff nurses’ occupational mental health and work 

effectiveness. Journal of Nursing Administration, 27(6), 

42–50. Lawler, E. E., & Mohrman, S. A. (1987). Quality 

circles: After the honeymoon. Organizational Dynamics.

H4.2 

Title: “Non-compliance,” “Complacency,” and Other 

Explanations for Unsafe Work Practices That Blame Workers 

for Systemic Failures: One Psychologist’s Perspective

Author: Ted Scharf

Safety professionals often express their frustration 

regarding a failure in safety compliance by workers. 

Another common term is the “complacency” of workers 

with respect to workplace safety and health policies, 

procedures, and practices. This presentation will start 
2022 NATIONAL OCCUPATIONAL INJURY RESEARCH SYMPOSIUM 110

with the organization of work issues that may exert a 

profound impact on day-to-day workplace safety. For 

example, the provision of the number of workers, and/or 

the availability of the appropriate equipment to complete 

a task safely, are both key criteria with respect to safe work 

practices in an organization. But what happens when the 

number of staff are inadequate, and/or when safety 

equipment is unavailable? In short, safety and 

productivity often appear to be in conflict. Continuing, 

“non-compliance” and “complacency” are most often 

attributed to workers, and rarely, if ever, to the 

organization and management of the work processes. 

Examples that may be perceived as “non-compliance” or 

“complacency” will be offered from workers’ experiences 

on job-sites, and that derive from focus group interviews 

with Ironworkers. 1. These examples will be shown to be 

appropriate adaptations by workers to function effectively 

in hazardous work environments, and to accommodate to 

management rules. From a psychological perspective, 

adaption by each worker to a specific hazardous work 

environment is a key requirement to be able to function 

effectively. As one NIOSH colleague summarized the 

problem: miners are not working 300 feet underground 

because that is a safe place to be, they are working there to 

extract coal. 2. The challenge for safety professionals is to 

distinguish effective adaptation from dysfunctional 

adaptation and from habituation. Finally, it is incumbent 

on researchers and other safety professionals to examine, 

very closely, the actual physical and work organization 

conditions on a particular job-site, before they conclude 

that a worker is complacent or non-compliant. In many 

cases (Ironworker interviews), the worker has no control 

over staffing and other safety-related concerns on the jobsite. Yet, in the broader safety literature, we often see 

“non-compliance,” and “complacency” described as a 

relatively stable personality trait applied to individual 

workers. The purpose of this presentation is to challenge 

this judgment and description. This presentation will 

conclude with a practical example (again from the 

Ironworkers) regarding how unions and other 

organizations of workers might re-assert control over 

staffing and other organization of work issues that directly 

impact safety in hazardous work environments.

References: 1. Scharf, T., Hunt, J., III, McCann, M., 

Pierson, K., Repmann, R., Migliaccio, F., Limanowski, J., 

Creegan, J., Bowers, D., Happe, J., and Jones, A. (2011). 

Hazard Recognition for Ironworkers: Preventing Falls and 

Close Calls – Updated Findings. In, Hsaio, H., Keane, P. 

(Eds.). Research and Practice for Fall Injury Control in the 

Workplace: Proceedings of International Conference on 

Fall Prevention and Protection. Morgantown, WV., 

NIOSH. May 18-20, 2010. pp. 196-201. 

https://www.cdc.gov/niosh/docs/2012-103/pdfs/2012-

103.pdf 2. Wiehagen, Bill, (NIOSH, retired). Personal 

communication, 1997.

H4.3 

Title: The Promise of, and Problems With, Worker Participation

Author: Scott Schneider

Worker participation is key to an effective safety program 

and prevention. Workers are on the front lines and know 

where the problems are and how to fix them. But power 

imbalances in the workplace inhibit effective worker 

participation. This presentation will discuss ways to elicit 

effective participation and address these power 

imbalances through competent persons, rights to refuse 

unsafe work, joint safety committees and health and safety 

reps. 

H4.4 

Title: Using Close Call Reports to Empower Worker-Led 

Interventions 

Authors: Emily Haas, Joseph McGuire, Brendan Demich, 

Cassandra Hoebbel

Problem Statement: The National Safety Council (2013) 

discusses close calls as unplanned events that could have 

resulted in injury or damage but did not. Following a 

close call, workers complete reports to document these 

upstream risk indicators and initiate organizational and 

individual responses to mitigate hazards. However, it is 

unclear how these reports influence actions or controls to 

reduce risk. Some practitioners have argued that close call 

incidents should undergo risk assessments using the 

probability and consequences of occurrence. Based on the 

probability of a negative event occurring, risk assessments 

can help organizations determine whether the level of risk 

is acceptable, assess trends, and prioritize risk reduction 

strategies (McKinnon, 2012; Pinto et al., 2011; Ristic, 

2013). To that end, National Institute for Occupational 

Safety and Health (NIOSH) researchers took two activities 

often implemented separately (close call reports and risk 

assessments), to inform gaps in worksite interventions.

Methods: A collaboration with industrial construction and 

aggregate entities occurred in which 249 close call reports 

were content analyzed over a three-month period in 2018. 

Of these 249 reports, 167 were valid, work-related close 

calls. Researchers coded the reports using ANSI/ASSE’s 

(2011) qualitative 5×5 risk matrix in which close calls 

were analyzed for probability of occurrence (i.e., rare, 

unlikely, moderate, likely, almost certain) and 

consequence if the event happened (i.e., first aid, minor 

injuries, lost time, disability/fatality, multiple fatalities) to 
2022 NATIONAL OCCUPATIONAL INJURY RESEARCH SYMPOSIUM 111

calculate a risk rank (i.e., low, moderate, high, and 

critical). Additionally, NIOSH’s hierarchy of controls 

(2015) was used, if applicable, to categorize corrective 

actions taken in response to the close call. Researchers 

used these results to determine relationships among the 

risk type and the corrective action implemented.

Results: The risk matrix analyses suggested that 19% of the 

close calls were low risk, 25% moderate, 30% high, and 

26% critical risk. To determine a relationship between the 

risk type and the corrective action implemented by the 

organization or its employees, a nonparametric median 

test compared the proportion of scores within each 

category of corrective action that fell above the median 

risk type across all categories; risk types were ranked from 

1 (low risk) to 4 (critical risk). The results of the test were 

significant (chi-square=13.64, df = 4, p < .005), indicating 

that the relative frequency of levels of risk varied across 

types of corrective actions. For example, the action 

“Implement safe work procedures” was associated with a 

higher level of risk than the action “Not yet fixed” or 

“issue PPE.”

Practical applications: This study provides insight into ways 

that close calls can be used as a metric of safety 

management and improve worker engagement in risk 

management interventions. Notably, the results showed 

that the dominant corrective action in response to the 

close calls reported was an increased adherence to safe 

work practices on the job. Consequently, this presentation 

also discusses how one company, Cessford Construction, 

used results of their close call analyses to engage 

employees during onsite trainings to create tailored 

intervention materials including four leading indicator 

checklists – or scorecards – for use by the workforce 

during their shift (McGuire et al., 2019; Haas et al., 2019). 

The checklists provide workers with reminders about 

common causes that contribute to incidents and processes 

that could be utilized to prevent their occurrence. Because 

this program was developed by Cessford frontline 

employees it has been readily adopted, empowering them 

to take the lead in “fixing” identified hazards. These 

results provoke thoughts on organizational and 

communication gaps that might exist about safe work 

procedures as well as underlying reasons why certain 

work procedures are not always implemented as intended.

Session I1

Use of Workers’ Compensation Claims to Advance 

Safety 

Moderator: Steven Naber

I1.1

Title: The Impact of a State-Based Workers’ Compensation 

Insurer’s Risk Control Services on Employer Claim Frequency 

and Cost Rates

Authors: Steven Wurzelbacher, Stephen Bertke, Michael Lampl, 

P. Timothy Bushnell, David Robins, Steven Naber, 

Libby Moore

Objective: This study evaluated the impact of a state 

workers’ compensation (WC) insurer’s onsite risk control 

(RC) services on insured employers’ WC claim frequency 

and cost.

Methods: We used regression analyses to model 2004-2017 

claims data from 4,606 employer policies that received RC 

visits over time and compare this claims experience to 

matching policies that did not receive RC services.

Results: Relative total WC claim rates increased slightly 

after RC services, while relative lost-time claims rates and 

cost rates decreased. The impact of RC services was 

cumulative up to the fourth visit but diminished 

thereafter. 

Conclusions: The insurer RC consultation program was 

effective in reducing WC LT claim frequency and WC 

cost rate for serviced employers. This is consistent with 

the limited research conducted on insurer RC services and 

related regulatory visits.

I1.2

Title: Surveillance of Agricultural Injuries: Comparison of State 

Trauma and Workers' Compensation Data Sources

Authors: Marizen Ramirez, Carri Casteel, Daniel Boonstra, 

Fred Gerr, Joseph Cavanaugh, Christina Rosebush

Background: Although it is well-established that 

Agriculture is among the most dangerous industries in the 

US, surveillance of agricultural injuries is hampered by 

methodological challenges. The objectives of this study 

are to identify the types of agricultural injury data 

available from two administrative databases (trauma 

registry and workers' compensation) and characterize the 

cases most likely captured in one database versus another.
2022 NATIONAL OCCUPATIONAL INJURY RESEARCH SYMPOSIUM 112

Methods: Data were accessed from the Iowa Trauma 

Registry (ITR) and Iowa's statewide workers' 

compensation data from 2005-2014. The ITR collects data 

from injury cases that led to trauma response in all Level 

I, II, III and IV hospitals across the state. Data from the 

Iowa Division of Workers’ Compensation Data (WC) are 

submitted by agricultural operations across the state. Data 

were matched across these two state-level databases using 

deterministic and probabilistic linking procedures. 

Logistic regression models were then developed to 

identify predictors of capture in one or both of these 

databases. Predictors were identified using step-wise 

model selection procedures. The entry into the model and 

exit from the model criteria was a Wald p-value limit of 

0.2.

Results: A total of 2,508 agricultural injuries were reported 

in the ITR. Of these, 26% were caused by machinery, 18% 

from falls and 12% from being struck by or against 

objects. More than 90% of trauma cases were male; 32% 

were fractures; 16% were open wounds; and 8% were head 

injuries. The WC dataset contained a total of 3,529 

agricultural injury claims. A lower percentage of males 

were injured (83.2% out of 3,529 claims) in the WC 

dataset than in the ITR. For WC, the top causes of injury 

were falls (27.3%), overexertion (26.9%), and natural 

environments (including animal-related incidents) 

(10.4%). Sprains and strains were most prevalent at 36.7% 

followed by fractures at 17.2%. WC cases were just slightly 

younger (average age= 41) than ITR cases (average 

age=49). A total of 110 cases linked across both the 

trauma registry and workers’ compensation databases, 

representing only about 4.4% of the trauma registry and 

3.1% of the workers’ compensation cases. Age, sex, cause

of injury and nature of injury were identified as predictors 

of capture in either the ITR or WC data sources. Profiles 

of the cases with the highest probabilities of capture in the 

ITR and WC data sources will be generated.

Conclusion: From this study, we concluded that the trauma 

data and workers’ compensation data represent two 

unique surveillance sources for targeting different types of 

agricultural injuries.

I1.3

Title: Workers’ Compensation Claim Counts and Rates by Injury 

Event/Exposure Among State-Insured Private Employers in 

Ohio, 2007-2017 

Authors: Steven Wurzelbacher, Alysha R. Meyers, 

Michael Lampl, P. Timothy Bushnell, Stephen Bertke, 

David Robins, Chih-Yu Tseng, Steven Naber

Background: This study analyzed workers’ compensation 

(WC) claims among private employers insured by the 

Ohio state-based WC carrier to identity high-risk 

industries by detailed cause of injury.

Methods: A machine-learning algorithm was used to code 

each claim by US Bureau of Labor Statistics (BLS) 

event/exposure. The codes assigned to lost-time (LT) 

claims with lower algorithm probabilities of accurate 

classification or those LT claims with high costs were 

manually reviewed. WC data were linked with the state’s 

unemployment insurance (UI) data to identify the 

employer’s industry and number of employees. BLS data 

on hours worked per employee were used to estimate fulltime equivalents (FTE) and calculate rates of WC claims 

per 100 FTE.

Results: 140,780 LT claims and 633,373 medical-only 

claims were analyzed. Although counts and rates of LT 

WC claims declined from 2007-2017, the shares of leading 

LT injury event/exposures remained largely unchanged. 

LT claims due to Overexertion and Bodily Reaction 

(33.0%) were most common, followed by Falls, Slips, and 

Trips (31.4%), Contact with Objects and Equipment 

(22.5%), Transportation Incidents (7.0%), Exposure to 

Harmful Substances or Environments (2.8%), Violence 

and Other Injuries by Persons or Animals (2.5%), and 

Fires and Explosions (0.4%). These findings are consistent 

with other reported data. The proportions of injury 

event/exposures varied by industry, and high-risk 

industries were identified.

Conclusions: Injuries have been reduced, but prevention 

challenges remain in certain industries. Available 

evidence on intervention effectiveness was summarized 

and mapped to the analysis results to demonstrate how 

the results can guide prevention efforts. Practical 

Applications: Employers, safety/health practitioners, and 

researchers can use these data to understand industry 

differences in the level and mix of risks, as well as industry 

trends, and to tailor safety, health, and disability 

prevention services and research.
2022 NATIONAL OCCUPATIONAL INJURY RESEARCH SYMPOSIUM 113

Session I2

Measuring and Predicting Footwear Slip Risk

Moderator: Jennifer Bell

I2.1

Title: A Portable Device for Measuring Shoe-Floor Coefficient of 

Friction in Situ

Authors: Kurt Beschorner, Arnab Chanda, Brian Moyer, 

Alexander Reasinger, Sarah Griffin, Isaiah Johnston

Introduction: Friction performance of footwear is widely 

recognized to influence on the wearer’s risk of slipping 

[1]. Most modern devices for quantifying this friction are 

laboratory-based devices that cannot be easily used in 

environments where slips naturally occur (i.e., in situ) [2]. 

Portable measurements would enable end-users to 

identify high performance footwear for a particular work 

environment and could enable testing on walking surfaces 

that are difficult to simulate in a lab (ice, grass, etc.). Thus, 

a need exists for such technology.

Methods: A portable device (NextSTEPS, XRDS Systems) 

was developed that weighs 18 kg, is capable of testing 

whole shoes, and is battery powered. The device applies 

dynamic conditions (normal force of 250 N, sliding speed 

of 0.5 m/s, and shoe-floor angle of 17°) that are predictive 

of human slips [1]. The device is operated via a laptopbased user interface. The device has motors that generate 

horizontal and vertical motion, while force sensors 

measure friction and normal forces. A lockable hinge joint 

enables the user to set the shoe at the prescribed angle. 

The device determines coefficient of friction (COF) as a 

ratio of friction to normal force. The device was validated 

against the slip outcomes of 67 human exposures to 

liquid-contaminated flooring. Liquid contaminants 

included diluted glycerol and canola oil liquids and 

flooring materials included laminate and porcelain tile. 

Each participant was given a different pair of shoes for the 

tests. These shoes included a combination of shoes labeled 

as slip-resistant and shoes without this designation. 

Participants were categorized as slipping or not slipping 

based on whether their shoe slipping distance exceeded 3 

cm [1]. The COF for each shoe was measured under the 

same flooring and contaminant conditions as were 

present during the human exposure to the slipping. A 

logistic regression curve determined whether the observed 

COF values measured from the device were associated 

with slip outcome. Slip predictions were made using a 

training and validation set. To develop these predictions, 

a training data set was used that involved 9 shoe-floorcontaminant conditions and 124 human slip exposures 

(human slipping data set previously described in [1]). A 

receiver operating characteristic curve was developed to 

determine the COF cutoff that yielded the best sensitivity 

and specificity based on Youdin’s J parameter. This cutoff 

was then applied to the current data set to predict slips 

(COF values below the cutoff) and no slip outcomes (COF 

values above the cutoff). The odds ratio, sensitivity and 

specificity of these predictions were quantified.

Results: The COF values measured by the device were 

found to predict human slipping (p = 0.006) with fewer 

slips associated with higher COF values. The training data 

set yielded a cutoff of 0.122. The slip outcome predictions 

based on the training data set were sensitive (91%) and 

specific (62%) to the observed outcomes. An odds ratio of 

16.5 (95% confidence interval: 3.4-79.4) was observed for 

conditions where a slip was predicted relative to cases 

where a slip was not predicted.

Discussion: This study represents a significant step forward 

for developing portable technology to deliver footwear 

testing into natural working environments. Further 

research is needed to determine the capacity of the device 

to provide accurate and repeatable readings, particularly 

across different walking surfaces and on sloped surfaces.

Acknowledgements: Funding for this research was 

provided by the National Institute on Aging (R44 

AG059258). The authors thank David Williams for his 

assistance with collecting COF data. References 1. Iraqi, et 

al., Coefficient of friction testing parameters influence the 

prediction of human slips. Appl Ergo, 2018. 70: p. 118-

126. 2. Chang, et al., The role of friction in the 

measurement of slipperiness, Part 2: survey of friction 

measurement devices. Ergo, 2001. 44(13): p. 12.

I2.2

Title: Predicting Footwear Slip Risk Using a Low-Cost, Portable, 

Shoe Tread Scanner

Authors: Sarah Hemler, Kurt Beschorner

Occupational slips and falls are a major cause of injury in 

the U.S. Forty to 50 percent of all falls are due to slipping 

which is often caused by low friction at the shoe-floor 

interface [1]. Footwear is an important, modifiable risk 

factor for improving shoe-floor friction. Specifically, good 

practices in shoe outsole tread can improve shoe-floor 

friction and tread channels can drain fluid away from 

shoe-floor interface. When the tread on shoes becomes 

too worn, the fluid cannot be adequately dispersed, 

leading to under-shoe fluid pressurization and increased 

slip risk. Previous work in our group has shown that the 

size of the continuous worn region (WRS) on the shoe 

outsole is indicative of under-shoe traction performance 

and thus, shoe safety [2,3]. However, there is a need to 
2022 NATIONAL OCCUPATIONAL INJURY RESEARCH SYMPOSIUM 114

develop a low-cost, automated tool for assessing shoe 

wear and slip risk. The aim of this study was to develop 

and use a low-cost, portable, shoe tread scanner to predict 

slip risk based on the shoe outsole geometry. The scanner 

utilizes frustrated total internal reflection (FTIR) 

technology to image the heel of the shoe outsole. FTIR 

describes the process of shining light into a transparent 

plate (waveguide) such that the light is internally reflected. 

When an object with a larger refractive index than air 

touches the waveguide, the boundary condition changes 

and the light is transmitted out of the waveguide and can 

be detected by a camera. Slip outcome and the heel 

contact scans of 34 slip-resistant shoes used in a humanslipping study were determined. During the humanslipping study, participants unexpectedly walked over a 

contaminated surface in their own shoes. The peak slip 

speed (PSS) was calculated as the local maximum speed at 

least 50 ms after heel contact. A step was classified as a 

slip if the PSS exceeded 0.2 m/s [4]. On the scanner, the 

shoes were loaded (335 N) and the contact between the 

shoe and the waveguide was captured with a camera. An 

image processing procedure identified and quantified the 

size of the largest continuous worn region on the heel 

(WRS). The WRS across the shoes ranged from 1 to 1006 

mm2 with an average (standard deviation) WRS of 325 

(624) mm2. A univariate logistic regression was used to 

test the effect of WRS (identified from the scanner) on slip 

outcome (human slipping study). A larger WRS was 

significantly associated with an increase in slip outcome. 

This study showed that a low-cost, portable, shoe tread 

scanner was able to predict slip outcome based on shoe 

outsole geometry. The results are consistent with previous 

studies that have shown that using the size of the worn 

region on a shoe can be useful in predicting under-shoe 

traction performance [5]. Furthermore, this low-cost tool 

could be used to recommend replacement for shoes that 

reach a certain threshold on the logistic regressions. As 

such, the scanner shows promise as a practical tool for 

reducing occupational slip and fall risk.

Acknowledgments: This study was funded by the National 

Institute for Occupational Safety and Health (NIOSH R01 

OH 010940) and the National Science Foundation (NSF 

GRFP 174752). References: 1. Courtney, et al., 

Occupational slip, trip, and fall-related injuries–can the 

contribution of slipperiness be isolated? Ergonomics, 

2001. 44(13): p. 1118-1137. 2. Hemler, et al., Changes in 

under-shoe traction and fluid drainage for progressively 

worn shoe tread. Applied Ergonomics, 2019. 80: p. 35-42. 

3. Hemler, et al., Traction performance across the life of 

slip-resistant footwear: preliminary results from a 

longitudinal study. Journal of Safety Research, 2020. 4. 

Beschorner, et al., Fluid pressures at the shoe–floor–

contaminant interface during slips: Effects of tread & 

implications on slip severity. Journal of biomechanics, 

2014. 47(2): p. 458-463. 5. Beschorner, et al., An 

observational ergonomic tool for assessing the worn 

condition of slip-resistant shoes. Applied Ergonomics, 

2020. 88: p. 103140.

I2.3

Title: Predicting the Friction Performance of Footwear Based on 

Outsole Features

Authors: Kurt Beschorner, Arian Iraqi, Emily Meehan, 

Mahiyar Nasarwanji, Chris Deschler, Sarah Hemler, 

Claire Tushak, Natasa Vidic

Footwear with good frictional performance is widely 

recognized to prevent slips in fluid-contaminated 

conditions [1]. Friction performance of footwear is 

typically measured using expensive and specialized 

equipment [2]. This approach is inaccessible to many 

individuals. The purpose of this study was to predict 

friction performance of shoes based on inexpensively and 

simply measured outsole parameters. Footwear in the 

study was assessed through mechanical friction testing 

and through human-centered testing. Mechanical friction 

testing was conducted on fifty-eight shoes designated as 

slip-resistant (SR) [3] and fifteen shoes without this 

designation (NSR). An additional 36 SR shoes were 

assessed using human-centered methods. The key shoe 

features for predicting friction performance were the 

tread surface area, the presence of a bevel at the posterior 

region of the shoe, and the tread hardness. Friction 

performance was tested using biofidelic testing methods 

[4] with a canola oil contaminant. Flooring conditions 

included laminate flooring and ceramic tile. COF was 

measured as the average ratio of friction to normal force 

over a 200 ms period. For the NSR shoes, fluid pressures 

were also measured to determine the contribution of fluid 

drainage to these shoe designs. A statistical model was 

developed to predict COF for these shoes based on the 

tread surface area, bevel, hardness, flooring, and whether 

shoes were designated as slip-resistant by the 

manufacturer. Higher tread surface area, the presence of 

heel beveling, and lower hardness predicted an increase in 

shoe-floor COF for SR shoes, but not for NSR shoes. For 

NSR shoes, fluid pressure was negatively correlated with 

COF. NSR shoes with worse drainage (higher fluid 

pressure) had about a 50% reduction in friction 

performance than shoes with better drainage (lower fluid 

pressure). Thus, NSR shoes can improve friction 

performance by improving tread drainage whereas SR 

shoes can improve friction performance by targeting 

surface area, heel shape, and material hardness. The 

statistical model developed for SR shoes was validated 

using human exposures to an oily surface. Slip outcome 
2022 NATIONAL OCCUPATIONAL INJURY RESEARCH SYMPOSIUM 115

was determined based on slipping distance. Logistic 

regression methods were used to determine whether slip 

outcome was dependent on the predicted COF (calculated 

using the previously developed statistical model based on 

tread surface area, heel beveling, and hardness). A higher 

COF predicted by the statistical model was associated 

with a significant reduction in risk of slipping. This study 

demonstrates that the friction performance of slipresistant shoes can be predicted using tread features and 

that the friction performance of shoes that are not slipresistant can be predicted based on fluid drainage 

capacity. These results provide insight for designing and 

selecting shoes even when friction testing equipment is 

unavailable.

Acknowledgments: This study was funded by the National 

Institute for Occupational Safety and Health 

(R03OH011069). References: 1. Bell, J.L., J.W. Collins, 

and S. Chiou, Effectiveness of a no-cost-to-workers, slipresistant footwear program for reducing slipping-related 

injuries in food service workers: a cluster randomized 

trial. Scandinavian journal of work, environment & 

health, 2019. 45(2). 2. Chang, W.R., R. Gronqvist, S. 

Leclercq, R.J. Brungraber, U. Mattke, L. Strandberg, S.C. 

Thorpe, R. Myung, L. Makkonen, and T.K. Courtney, The 

role of friction in the measurement of slipperiness, Part 2: 

survey of friction measurement devices. Ergonomics, 

2001. 44(13): p. 1233-61. 3. Iraqi, A., N.S. Vidic, M.S. 

Redfern, and K.E. Beschorner, Prediction of coefficient of 

friction based on footwear outsole features. Applied 

ergonomics, 2020. 82: p. 102963. 4. Iraqi, A., R. Cham, 

M.S. Redfern, and K.E. Beschorner, Coefficient of friction 

testing parameters influence the prediction of human 

slips. Applied Ergonomics, 2018. 70: p. 118-126.

Session I3

The Role of Worker Age in Occupational Injuries

Moderator: James Collins

I3.1

Title: Risk of Work-Related Reinjury Among Older Workers With 

and Without a Work-Related Permanent Impairment: Are 

Work-Related Injury Rates Differentially Underestimated for 

Workers Aged 65 and Older?

Authors: Jeanne Sears, Deborah Fulton-Kehoe, 

Sheilah Hogg-Johnson 

Background: The workforce is aging; nearly 20% of 

Americans aged 65+ are employed. Work injuries among 

older workers are more severe, more costly, and more apt 

to result in permanent disability, early retirement, or 

death. Reports of lower injury rates for older workers are 

less than compelling, and evidence is scant for workers 

aged 65+. Work injury rates are often based on 

population size and calendar time, rather than on 

individual work-time at risk—differentially 

underestimating rates for older workers due to more parttime/intermittent work and retirement. Workers 65+ are 

also more likely to have health insurance or retirement 

alternatives to workers’ compensation (WC) and have 

markedly higher WC underfiling rates than those <65; 

work injuries are often billed to Medicare. To mitigate the 

impact of underfiling WC claims, we focused on reinjury 

among workers who previously filed WC claims. We 

assessed: (1) reinjury risk for workers aged 65+ vs. <65; 

(2) interaction between age and permanent impairment; 

(3) reinjury rates based on WC claims vs. self-report; (4) 

effect of denominator choice on age comparisons; and (5) 

age distribution of job strain, physical demands, and other 

injury risk factors.

Methods: Washington State WC claims for a retrospective 

cohort of 43,114 injured workers were linked to state wage 

files containing quarterly hours worked from injury date 

(2003-2017) through 2018. Reinjury was defined as 

reopened (aggravation/recurrence) or new injury claims. 

Two denominators were used: calendar quarters, and fulltime equivalent (FTE) quarters (cumulative work hours ÷ 

520). Reinjury risk by age was assessed using Cox 

proportional hazards regression, controlling for worker, 

injury, and job characteristics. Survey data were used to

assess associations between age and self-reported reinjury, 

health, and workplace factors. Workers with a workrelated permanent impairment were interviewed in 2019 

(N=599), about a year after claim closure. Reinjury rates 

per 100 worker-years were calculated using both calendar 

time and FTE time.

Results: Cohort: Using calendar time, the WC-based 

reinjury rate for workers aged 65+ (N=855) was 2.9 (2.4-

3.4) per 100 worker-years vs. 6.0 (95% CI: 5.8-6.1) for <65. 

Using FTE time, the reinjury rate was 11.2 (9.4-13.3) for 

65+ vs. 12.5 (95% CI: 12.3-12.7) for <65. In adjusted Cox 

models using calendar time, workers 65+ (vs. <65) had 

half the reinjury risk (HR: 0.50; 95% CI: 0.42-0.59); this 

gap narrowed substantially when using FTE time (HR: 

0.85; 95% CI: 0.72-1.01). Workers with (vs. without) 

permanent impairment had higher reinjury risk (HR: 

1.14; 95% CI: 1.09-1.19); there was no detected interaction 

with age. Survey: Using calendar time, the self-reported 

reinjury rate for workers 65+ (N=34) was 22.7 per 100 

worker-years (11.4-45.5) vs. 12.0 (95% CI: 9.5-15.1) for 

<65. Using self-reported FTE time, the reinjury rate was 

35.7 (17.8-71.3) for 65+ vs. 14.8 (95% CI: 11.7-18.6) for 

<65. Workers 65+ (vs. <65) were more likely to work 
2022 NATIONAL OCCUPATIONAL INJURY RESEARCH SYMPOSIUM 116

<100% FTE, be unemployed or retired, and have chronic 

conditions; they were similar regarding job strain, ability 

to handle physical job demands, comfort reporting an 

unsafe work situation or work injury, and comfort filing a 

WC claim.

Conclusions: Choice of denominator substantially affects 

reinjury comparisons by age, due to differential 

employment patterns. Workers aged 65+ appeared half as 

likely to be reinjured as workers <65 when using calendar 

time but did not significantly differ once rates were 

adjusted for work-time at risk. Survey data suggested that 

permanently impaired workers aged 65+ may have well 

over twice the reinjury risk of those <65—risk not 

explained by differences in physical demands, job strain, 

or various other work factors. Work injury incidence 

among workers aged 65+ is likely higher than previously 

appreciated. Continued aging of the workforce 

necessitates increased attention to injury surveillance and 

prevention for older workers.

I3.2

Title: Environmental Factors of Ladder Overreaching in Older 

Adults 

Authors: David Williams, Kurt Beschorner, Stephen Lord, 

Daina Sturnieks, Erika Pliner

Introduction: Ladder falls are the second most common 

cause of all falls [1], with people over 65 years having the 

highest hospital and intensive care admission rates due to 

falls from ladders [2]. In people presenting to an 

emergency department due to a ladder fall, 37% identified 

overreaching as a factor in their fall [3]. To better 

understand ladder fall risks for an aging working 

population, this study examined the role of environmental 

factors on reaching during ladder use in older adults.

Methods: A total of 104 healthy older participants were 

asked to complete a laboratory-based roof gutter clearing 

task on a straight ladder. The task required the 

participants to climb to the third step of a straight ladder 

and remove tennis balls from a gutter (5.8 m in length and 

2.1 m above the ground) until all the tennis balls were 

removed. Participants were allowed to move the ladder as 

many times as necessary to complete the task in a safe and 

quick manner. The maximum center of pressure (COP) 

location relative to the ladder center was used to quantify 

reach as this measure is highly correlated with maximum 

hand displacement during the gutter clearing task. The 

maximum COP was quantified for each reaching attempt 

on the ladder. A COP value that travelled outside the 

ladder base of support (199 mm from the ladder center) 

was classified as an overreach as the ladder would have 

likely tipped and resulted in a ladder fall if the ladder was 

not secured in this experiment. Extracted environmental 

factors were the percent of time into the ladder task (% 

time), ladder position (categories based on ladder 

location: left, middle left, middle, middle right, right), and 

whether the tennis balls extended so far from the ladder 

that they could not be removed without moving the 

ladder (remaining debris). The environmental factors 

were entered into a multivariate linear regression. Reach 

was the dependent variable as measured by the maximum 

COP of each reach.

Results: Environmental factors had a significant impact on 

reach (F6,827=6.40; p<0.001). Ladder position 

(F4,827=3.68; p=0.006) and remaining debris 

(F1,827=4.65; p=0.031) were both significant predictors of 

reach. The % time into the climb was not found to be a 

significant predictor of reach (F1,827=0.55; p=0.460). 

Maximum COP values were significantly farther from the 

ladder’s center when the ladder was positioned in the 

right middle of the gutter, compared to the right and left 

ends (Tukey HSD; p<0.05), and when there was 

remaining debris (i.e., tennis balls) after the reach. The 

right middle position (15%) and remaining debris (11%) 

conditions had the most reaches classified as overreaches.

Discussion/Conclusion: Our analysis found reach to be 

explained by environmental factors, that is, ladder 

position and remaining debris (tennis balls). Motivation 

can increase lateral reaching while on a ladder [4]. 

Remaining debris may act as a motivator to overreach. 

Ladder position may also prompt overreaching since the 

highest reach was observed at a position where many 

participants were on their last climb or second to last 

climb to complete the gutter clearing task. The results of 

this analysis draw important conclusions regarding the 

effects of environment on overreaching. These models 

help illustrate how the environment is associated with 

more dangerous decision making in terms of 

overreaching. These findings can help guide interventions 

to lower overreaching risk during ladder tasks.

References: 1. Webster, T. Compensation and Working 

Conditions. p. 28-38, 2000 2. Melmer, P., et al. The 

American Journal of Surgery. p. 1103-1107, 2020 3. 

Cabilan, C., et al. Emergency Medicine Australasia. p. 95-

102, 2018 4. DiDomenico, A., et al. Professional Safety. p. 

50-53, 2013. ACKNOWLEDGEMENTS: This work was 

supported by Whitaker International Fellowship Program 

and NIOSH R01OH011799.
2022 NATIONAL OCCUPATIONAL INJURY RESEARCH SYMPOSIUM 117

I3.3

Title: Traumatic Injuries and Fatalities Among Young Workers in 

Alaska: 2014-2018 

Authors: Richard Evoy, Devin Lucas, Samantha Case, 

Laura Syron

Background: Young workers (aged 15-24 years) experience 

higher rates of job-related injury compared with adult 

workers (aged 25-44 years) in the United States. Young 

workers may have limited or no prior work experience, as 

well as lack safety training, which can contribute to their 

risks of sustaining injuries. In 2018, Alaska had the second 

highest work-related fatality rate and 14th highest injury 

rate in the United States but there is a lack of literature on 

young worker injuries in Alaska. The study’s objective was 

to characterize occupational injuries and fatalities 

experienced by young workers in Alaska.

Methods: To describe patterns of traumatic injuries and 

fatalities among young workers, we used data from four 

datasets: Alaska Workers’ Compensation, Alaska 

Occupational Injury Surveillance System (AOISS), Alaska 

Trauma Registry, and Alaska Fishermen’s Fund. Cases 

were manually coded using the Occupational Injury and 

Illness Classification System (OIICS). Duplicates were 

manually identified between the datasets using the injury 

date, narrative, and location and the workers’ sex and age. 

Industry and occupation were coded using the North 

American Industry Classification System (NAICS) and 

Standard Occupational Classification System (SOC) codes 

based on workers’ job descriptions. The employee mailing 

address or their listed state of residence were used to 

identify Alaska residents. Descriptive analyses were 

performed. 

Results: Young workers represented ~14% of the nonfatal 

injuries and ~12% of the fatalities across the four datasets 

during 2014-2018. Young workers experienced twenty 

fatalities and 12,904 nonfatal injuries. Nonresidents of 

Alaska comprised 14.7% of nonfatal injuries and 30% of 

fatalities. Young workers in the Seafood Product 

Preparation and Packaging industry (NAICS 311710) had 

the most injuries (n=828, 6.42%) followed by the General 

Medical and Surgical Hospital industry (NAICS 622110) 

(n=651, 5.04%). Based on occupation, Laborers and 

Freight, Stock and Material Movers (SOC 53-7062) had 

the highest number of traumatic injuries (n=719, 5.57%) 

while Food Processing Workers, All Other (SOC 51-3099) 

had the second most injuries (n=611, 4.73%). The three 

most common events leading to injuries were injured by 

handheld object or equipment (n=904, 7.01%), 

overexertion in lifting/lowering (n=798, 6.18%), and 

struck against stationary object or equipment (n=657, 

5.09%). The three most common nature of injury codes 

were sprains/strains/tears (n=3,062, 23.73%), 

cuts/lacerations (n=2,479, 19.21%), and 

bruises/contusions (n=1,981, 15.35%).

Conclusion: Although progress has been made in reducing 

injuries among workers, Alaskan young workers still 

experience injuries and fatalities frequently. Based on

findings, there is a clear need for researchers, public 

health professionals, parents, employers, and young 

workers to prioritize young worker safety through an 

integrated approach, from education and training to 

adequate workplace supervision and support. 

Session I4

Connecting Safety Climate/Culture to Safety 

Management: A Brief Summary

Moderator: Ted Scharf

Presenters: Ted Scharf, Lisa M. Kath, Emily J. Haas

Workshop Description

Major goals:

1. Describe the complicated literature in safety climate & 

safety culture.

2. Summarize the current state of the art, including future 

directions for this research.

3. Connect this literature to OSH management systems in 

hazardous work environments.

This workshop will also consider:

a. The work organization context in which safety 

policies, procedures, & practices are implemented in a 

hazardous work environment.

b. Interventions to improve safety climate & culture in 

organizations.

Learning Objectives: Session participants will be able to:

1. Describe key components of the academic literature in 

safety climate and safety culture.

2. Assess the current state of the research and discuss 

promising future directions for research in this area.

3. Apply this literature to examples of occupational safety 

and health management systems.
2022 NATIONAL OCCUPATIONAL INJURY RESEARCH SYMPOSIUM 118

4. Compare potential interventions that address safety 

culture and safety climate by improving policies, 

procedures, and practices in hazardous work 

environments.

Industries: Relevant to all industries with hazardous work 

environments. The presenters have research and 

intervention experience in agriculture, construction, 

emergency response, and mining. Examples from these 

industries will be discussed.

Who should attend: Safety professionals, other 

practitioners, researchers, and students who would like to 

learn more about the burgeoning discipline of safety 

climate and safety culture are invited to attend this 

tutorial. Researchers who are considering teaching a class 

in safety climate and safety culture may also find it useful. 

Principal investigators with active research in this 

discipline are likely to find the material to be somewhat 

basic. No prerequisites are required. All those interested 

in this topic are invited to attend.

Please note: There is a great deal of material to cover to 

provide this overview and introduction. Consequently, 

there will not be extensive hands-on activities, as in a true 

workshop. We will provide a mental scaffold to help keep 

the information organized, and we will provide learning 

aids for you to refer to after the workshop is over.

Session Outline:

Organizing questions/issues for the session:

A. Why should anyone care about safety culture / climate 

in an organization?

SC & C have been shown to be valid, leading indicators 

of safety in hazardous work environments (e.g., Casey, 

Griffin, Harrison, and Neal, 2017; Schonfeld and 

Chang, 2017; Zohar, 2010, 2014). But so what? How 

does this connect to the organization?

1. Organizational (foundational) culture and climate

2. Safety culture and climate as a subset within 

organizations

3. Culture vs. climate

a. Underlying attitudes & beliefs, compared to a 

“snapshot in time”

b. Similarities across both domains

c. References for further study

4. Utility of safety climate assessments

a. Dx, early indicator:

1. Focused problem

2. Overall assessment of safety

b. Prioritizing or targeting 

interventions/improvements in safe work 

practices

c. Continuous improvement

d. Organizational sustainability

e. Connections to OSHMS’s

f. Business case

B. The overall context of safety in a hazardous work 

environment: National and International standards of 

sustainability and improved safety climate / culture in 

an organization: safety with productivity.

1. A few popular myths about safety climate/culture:

a. Safety culture/climate is just management talking 

to make themselves feel good. It doesn’t really 

matter.

b. Safety and productivity are at natural odds with 

one another

c. Safety C/C is too esoteric or ephemeral to be 

measured

d. Nothing can be done to change safety C/C.

2. The broader context within which safety 

climate/culture operates

a. Simplified models (Scharf, et al., in preparation)

b. Safety and health management systems

1. Hierarchy of controls in hazardous work 

environments

2. Process safety

3. High reliability organizations

c. Socio-technical systems

d. The complete organizational context: safety with 

productivity

3. Practical concerns in the workplace

a. Injury and illness outcomes

b. Reporting safety problems; psychological safety

c. Incentives for safety

d. Managing the transition period from coerced 

reporting to voluntary and proactive reporting

C. What is safety climate/culture, and how does it 

function in a hazardous work environment?
2022 NATIONAL OCCUPATIONAL INJURY RESEARCH SYMPOSIUM 119

1. Crew/group based aggregation of culture/climate

a. Level of aggregation is flexible, depending on 

organizational structure and function

b. A group-level phenomenon

c. Lone-worker is still part of a work group or team 

(Huang, et al.)

d. Zohar comparison between espousal and 

enactment (2010); “walking the talk,” and 

behavioral integrity (Simons, 2002)

2. Measurement of safety climate

a. Moss, Kath, McGonagle, and Bauerle, (2015, 

May); measurement decomposed into espousal 

and enactment

b. Individual level measurement of the interaction 

term, that is aggregated at the selected group level

c. Neal and Griffin (2006) individual “perceived 

safety climate” and “group safety climate.”

d. Safety climate “level” (mean) and “strength” 

(degree of coherence/variability)

3. Common first-order factors within the construct of 

safety climate (e.g. Hahn & Murphy, 2008)

a. Management commitment to safety

b. Supervisory performance/safety feedback

c. Worker involvement in safety

d. Coworker behavior norms

e. Guldenmund and many other references

4. Relevant empirical methods

a. Brief digression on exploratory factor analysis and 

confirmatory factor analysis, i.e. determining 

factor structure

b. Measurement equivalence across different 

demographic groups

c. Brief digression on HLM, contextual analysis, and 

ICC(1) and ICC(2), i.e. empirical analysis of 

group-level phenomena

5. Parallel or related constructs

a. Health climate

b. Psychosocial safety climate

c. Work-ownership climate

d. Psychological health and safety at work (Canada)

6. Antecedents, mediators, moderators, and other 

closely related phenomena to SC

a. Safety leadership

b. Supervisors – pretty much everything – a long list 

of potential elements here

c. Co-worker and crew-level attitudes and 

orientation 

d. Safety attitudes

e. Safety knowledge

f. Safety motivation and lack of same

g. Safety performance:

1. Safety compliance and lack of same

2. Safety participation and lack of same

D. Interventions to improve safety climate and culture:

1. Interventions and other examples of strong, positive 

safety climate training

a. CPWR

1. Safety Climate Assessment Tool (S-CAT), 2016, 

2018;

2. Foundations for Safety Leadership (FSL), 2017;

3. Safety Climate and Safety Management 

Information System, 2014.

b. AIHA “How To” Guides (Schneider, 2017)

c. IAFC: National Safety Culture Change Initiative

d. NRC: nine traits of a positive safety culture

e. Zohar and Polachek (2014)

National Institute for Occupational Safety and Health 

(NIOSH). (2006). Information Circular 9490: Job training 

analysis: a process for quickly developing a roadmap for 

teaching and evaluating job skills. By Wiehagen, W.J., 

Conrad, D.W., Baugher, J.M. Pittsburgh, PA: U.S. 

Department of Health and Human Services, Centers for 

Disease Control and Prevention, National Institute for 

Occupational Safety and Health, DHHS (NIOSH) 

Publication No. 2006–139.

(http://www.cdc.gov/niosh/mining/UserFiles/works/pdfs/

2006-139.pdf).
2022 NATIONAL OCCUPATIONAL INJURY RESEARCH SYMPOSIUM 120

Session J1

New Bureau of Labor Statistics Office of Safety and 

Health Program Methods and Approaches

Moderator: Elizabeth Rogers

Organizer: U.S. Bureau of Labor Statistics (BLS) Office of 

Safety and Health Statistics (OSHS)

BLS proposes an emerging issues session on new OSHS 

program methods and approaches with three detailed 

presentations on: 1) improvements to the secondary 

disclosure methodology and effects on data for the Census 

of Fatal Occupational Injuries and Illnesses, 2) changes in 

the next version of the Occupational Injury and Illness 

Classification System, and 3) results from the 2020 Survey 

of Occupational Injuries and Illnesses.

Improvements to Secondary Disclosure Methods in the Census 

of Fatal Occupational Injuries

Presenters: Daniel Frieland Julie Krautter, Bureau of Labor 

Statistics, Office of Safety and Health Statistics

The Census of Fatal Occupational Injuries (CFOI) at the 

Bureau of Labor Statistics (BLS) collects a complete 

census of all fatalities that occur during a calendar year as 

the result of workplace injuries. CFOI data present unique 

disclosure challenges because there are a small number of 

fatalities per year (5,333 in 2019) and many fatalities are 

reported publicly. For any information that BLS collects 

from confidential sources, it is required to protect the 

collected data. With the recognition that CFOI was not 

adequately protecting its confidential data, we set out to 

update the methodology. In this presentation, BLS will 

outline the options that we considered for disclosure 

limitation and the benefits and drawbacks of each, 

including reduction of publishable CFOI cells.

Occupational Injury and Illness Classification System (OIICS 3) 

for Data Users

Presenter: Christen Byler, MSPH, Bureau of Labor Statistics, 

Office of Safety and Health Statistics

The Occupational Injury and Illness Classification System 

(OIICS) was developed by the Bureau of Labor Statistics 

(BLS) and has been used to classify occupational safety 

and health surveillance data by nature, part of body, 

source, and event or exposure since 1992. Its second 

major revision, OIICS 3, is set for release in 2022. This 

presentation would orient OIICS stakeholders and data 

users to the changes they can expect and tips for how their 

organization can plan for a smooth transition in light of 

the series break. Some highlights of OIICS 3 include 

redesigning codes to anticipate technological changes in 

the workplace (e.g., robotics and autonomous vehicles), 

new codes to capture use and/or failure of safety 

interventions, and the addition of two classification 

structures to capture worker activity and location of 

incident. OIICS 3 also incorporates coding rules and 

examples into the new manual format for ease and 

consistency of coding.

Results from the 2020 Survey of Occupational Injuries and 

Illnesses (SOII)

Presenter: Imani Drayton-Hill, Bureau of Labor Statistics, 

Office of Safety and Health Statistics

Annually, the SOII collects occupational injuries and 

illnesses from approximately 230,000 US employers and 

publishes estimates of incidence rates and counts as well 

as detailed case and demographic data for cases that 

involve one or more days away from work. BLS will 

publish results of the 2020 SOII in November 2021. 

(These estimates are embargoed prior to the publication 

of results.) COVID-19 can be a recordable illness if a 

worker is infected as a result of performing their workrelated duties and meets OSHA criteria. The SOII relies 

on OSHA recordkeeping requirements, which mandate 

employers record certain work-related injuries and 

illnesses on their OSHA 300 log (29 CFR Part 1904). 

While the OIICS classification system used by SOII does 

not include a code specifically for COVID-19, these cases 

were included on the Nature code 3299 – “Other diseases 

due to viruses, not elsewhere classified.” This presentation 

will explore SOII collection challenges related to COVID19 cases, injury and illness estimates from the 2020 SOII, 

and the strengths and limitations in using SOII data to 

analyze COVID-19 in the workplace.

Session J2

Laboratory Studies to Reduce Work-Related Injuries

Moderator: Jennifer Bell

J2.1 

Title: Developing a Test for When Worn Shoes Should Be 

Replaced – Research to Practice

Authors: Kurt Beschorner, Sarah Hemler, Johanna Siegel, 

Vani Sundaram, Joel Haight, Mark Redfern

Occupational slips can be prevented through selecting 

slip-resistant footwear and replacing worn shoes [1]. We 

have conducted a series of experiments to understand 

shoe wear and determine when worn shoes should be 

replaced. This research was motivated by a gap in 
2022 NATIONAL OCCUPATIONAL INJURY RESEARCH SYMPOSIUM 121

knowledge around the surface mechanics of worn shoes 

and lack of guidance for when worn shoes should be 

replaced. The research involved three main components: 

friction testing of shoes that were exposed to accelerated 

wear under mechanically controlled conditions; friction 

testing of shoes that were worn by workers in 

occupational settings; and human slipping responses 

while wearing shoes with various levels of wear. The shoes 

were evaluated under liquid-contaminated conditions. A 

finding that was consistently observed was that shoe 

friction performance declined when a worn region 

formed on the outsole and the size of this worn region 

increased slip risk [2-4]. This resulted in an important 

paradigm shift from prior methods of characterizing shoe 

wear based on tread depth [5] or shoe age [1]. Thus, 

measuring the size of the worn region represents a 

promising new means of evaluating the worn condition of 

shoes and assessing whether these shoes should be 

replaced. Identifying the size of the worn region as a key 

metric formed the basis for new tests that empowered 

workers to assess the worn condition of their shoes. One 

test that emerged assessed the worn condition of the shoe 

using the base of an AA battery [6]. This test was validated 

across the accelerated wear, natural wear, and human 

slipping data sets. Shoes that failed this test had poorer 

fluid drainage, a 30% loss in friction performance, and an 

increase in slip risk. Therefore, this test was determined to 

be a valid method for assessing when worn shoes should 

be replaced. The “battery test” for shoes was disseminated 

through informational posters, dedicated websites, and a 

video. This research was incorporated into informational 

posters developed by the National Occupational Research 

Agenda (NORA) cross-sector on Traumatic Injuries. 

These posters were targeted at two sectors of interest: food 

service workers and hospital workers. Websites hosted by 

NORA and by the Human Movement and Balance Lab at 

the University of Pittsburgh were created to provide 

supplemental information on worn shoes. A video was 

produced that communicated this information and 

provided a tutorial for applying the test. Future research 

should aim to monitor the efficacy of the battery test in 

altering worker footwear replacement behavior and the 

resulting impact on their slip and fall risk. Furthermore, 

additional work may be needed to assess the human 

factors of utilizing the test and whether adaptations are 

desired by end users.

Acknowledgements: This research was funded by the 

United States National Institute for Occupational Safety 

and Health (R01OH010940).

References:

1. Verma, et al., Duration of slip-resistant shoe usage and 

the rate of slipping in limited-service restaurants: 

results from a prospective and crossover study. Ergon, 

2014. 57(12): p. 1919-1926.

2. Sundaram, et al., Worn Region Size of Shoe Soles 

Impacts Human Slips: Testing a Mechanistic Model. 

Journal of biomechanics, 2020: p. 109797.

3. Hemler, et al., Predicting hydrodynamic conditions 

under worn shoes using the tapered-wedge solution of 

Reynolds equation. Trib Int, 2020: p. 106161.

4. Hemler, et al., Traction performance across the life of 

slip-resistant footwear: preliminary results from a 

longitudinal study. J Safety Research, 2020. 74 p. 219-

225.

5. Li, et al., The effect of shoe sole tread groove depth on 

the friction coefficient with different tread groove 

widths, floors and contaminants. App Ergo, 2006. 

37(6): p. 743-748.

6. Beschorner, et al., An observational ergonomic tool for 

assessing the worn condition of slip-resistant shoes. 

App Ergo, 2020. 88: p. 103140.

J2.2 

Title: The Relationship Between Weight Shifts, Discomfort and 

Seated Breaks During Standing

Authors: Julie Rekant, ZacharyWiilson, April Chambers

Background: Sit-stand desks are increasingly a part of the 

office workplace. Their ability to improve physical activity 

and energy expenditure, as well as reduce discomfort is 

promising but unproven [1-3]. The potential for sit-stand 

desks to address discomfort likely depends on identifying 

correct usage: how much time sitting versus how much 

time standing is needed to prevent discomfort in both 

positions. Proposed ratios vary from 1:1 to 3:1. However, 

field research that has tried to impose set time limits have 

found workers indicating they prefer self-choice [4,5]. 

Weight shifting has been shown to be a powerful indicator 

of discomfort [6,7]. The long term goal of this research is 

to use technology to develop general dosage guidelines for 

sit-stand desks. As a first step towards this, the objective 

of this pilot study was to identify which aspects of weight 

shifting best predict discomfort and fatigue.

Methods: Healthy adults between the ages of 35-55 years 

old with no current orthopedic or muscular disorders 

were recruited to participate in this study. All research 

procedures were approved by the University of Pittsburgh 

Institutional Review Board. Subjects were asked to 

perform a computer task using a sit-stand desk in the 

standing position. Subjects stood on a force plate for 90 

minutes while center of pressure movements and ground 
2022 NATIONAL OCCUPATIONAL INJURY RESEARCH SYMPOSIUM 122

reaction forces were collected continuously. Subjective 

discomfort of body regions and overall fatigue surveys 

were measured on a visual analog scale at five-minute 

intervals. Each survey concluded by asking if the subject 

would like to take a seated break; after two consecutive 

“yes” answers the subject was given a short seated break.

Results: Participants demonstrated different weight 

distribution change patterns during standing. Participants 

who did not request seated breaks until later (after 60 

minutes of standing) or at all during the 90-minute visit 

demonstrated more sustained, alternating weight shifting. 

Those who requested seated rest breaks during the first 

hour demonstrated very little changes in medial-lateral 

center of pressure until right before they requested a 

seated break. Preliminary results show an increase in 

medial-lateral center of pressure excursions during the 

five-minute window prior to the participants receiving a 

seated break. Subjective ratings of discomfort in the lower 

body also increased in the ten-minute window prior to 

participants requesting seated breaks.

Discussion: This work reinforces previous prolonged 

standing research demonstrating increased weight shifting 

behavior with increased discomfort [6, 7]. Two different 

styles of standers were identified – those who move very 

little then demonstrate a specific pattern of quicker then 

slower large-amplitude movements and prefer to stand for 

less than an hour, and those who shift their weight 

consistently over time and prefer standing for longer 

periods of time. Finally, this pilot study shows the ability 

to use center of pressure changes during standing as a 

marker of discomfort, standing style, and sitting vs. 

standing preference when using a sit-stand desk.

References:

1. Chambers, Robertson, Baker. Applied Ergonomics. 

2019;78:37-53.

2. Agarwal, Steinmaus, Harris-Adamson. Ergonomics. 

2017:1-36.

3. Karakolis & Callaghan. Applied Ergonomics. 

2014;45(3):799-806.

4. Bao & Lin. Ergonomics. 2018;61(2):243-254.

5. Li, Mackey, Foley, et al. Journal of Occupational and 

Environmental Medicine. 2017;59(6):543-549.

6. Cham & Redfern. Human Factors. 2001;43(3):381-391.

7. Wiggermann & Keyserling. Human Factors. 

2013;55(4):764-775.

Session J3

Special Topics in Work-Related Injuries

Moderator: James Collins

J3.1 

Title: Work Schedules, Commutes, and Risky Driving Behaviors 

from a Cross-Sectional Survey of U.S. Oil and Gas Extraction 

Workers

Authors: Kait Wingate, Alejandra Ramirez-Cardenas

Background: Consisting of over 470,000 workers in 2019, 

the U.S. oil and gas extraction (OGE) workforce faces 

fatality rates higher than for all U.S. workers. The leading 

cause of death among OGE workers is transportation 

incidents, primarily due to motor vehicle crashes, and 

these fatalities are trending upwards. While the 

Occupational Safety and Health Administration (OSHA) 

regulates safety on oil and gas well sites, off-site motor 

vehicle crashes are outside of OSHA’s jurisdiction and 

motor vehicle safety (MVS) policies are the responsibility 

of each company. OGE workers often have long 

commutes and workdays; however, information about 

their driving behaviors, work schedules, and work 

environment is limited. This presentation will review the 

findings of a survey administered to U.S. OGE workers to 

characterize worker demographics and employment 

characteristics and examine the relationships between 

those characteristics and employer policies on risky 

driving behaviors and poor driving outcomes.

Methods: Researchers from the National Institute for 

Occupational Safety and Health administered a 

questionnaire and short interview to a sample of 500 OGE 

workers at worksites in Colorado, North Dakota, and 

Texas between 2017 and 2019. Questions included worker 

demographics, employer characteristics, work and 

commute schedules, worker health and exposures, safety 

culture, training, and driving behaviors. Statistical analysis 

and data management was performed using R and 

Microsoft Excel. Descriptive analyses, t-tests, and chisquare tests were performed as well as multivariable 

logistic regression to assess risky driving behaviors. 

Adjusted odds ratios were calculated for the final 

regression models.

Results: 498 workers completed the survey. The majority 

of respondents were male (96.8%) and white (70.7%), and 

over one-third were Hispanic (35.3%). Over half of 

respondents reported working for well servicing 

companies (54.4%), followed by drilling contractors 

(21.3%) and oil and gas operators (19.1%). Almost threequarters of respondents (72.9%) reported driving for 
2022 NATIONAL OCCUPATIONAL INJURY RESEARCH SYMPOSIUM 123

work. The mean total hours worked per day was 11.87, 

and the mean total daily commuting time was 1.82 hours. 

Company MVS policies that were almost universally 

reported included seat belt use and mandatory crash 

reporting. Less commonly reported MVS policies 

included journey management and fatigue management. 

The most frequently reported risky driving behavior was 

talking on a hands-free cell phone (always, often, or 

sometimes; 59.8%). About a quarter of respondents 

reported other behaviors such as ever having fallen asleep 

while driving a work vehicle (27.2%), feeling drowsy while 

driving a work vehicle (once per week or more, 26.1%), 

and driving 10 mph or more above the speed limit 

(always, often, or sometimes; 24.9%). Regression results 

identified the following variables to be significantly 

associated with poor driving outcomes: less sleep, longer 

daily commutes, longer work hours, alternative work 

schedules, working in North Dakota, no employer 

maximum work hours policy, in-vehicle monitoring 

systems, no ban on hands-free cell phones, and no 

employer fatigue management policy.

Discussion: While a large proportion of respondents 

reported driving as a part of their job, motor vehicle safety 

is often overlooked, as driving on the job is largely 

unregulated. OGE workers reported long daily commutes, 

long work hours, and limited sleep, all of which were 

significantly associated with risky driving behaviors and 

poor driving outcomes. Interventions such as alternative 

accommodations and modes of transportation are needed 

to help shorten commutes and allow sufficient sleep 

hours. Further research on commutes, work hours, and 

work schedules, and their impact on fatigue may help 

explain transportation injuries and fatalities among OGE 

workers. Additional evaluation on employer MVS policies 

and programs could help to identify gaps in risk 

management for work-related crashes.

J3.2 

Title: Demonstrating the Impact of Interventions to Prevent 

Work-Related Injuries

Authors: James Collins, Jennifer Bell, 

Cammie K. Chaumont Menendez, Hope Tiesman, 

Christina Socias-Morales, Guang Chen, Melody Gwilliam, 

Scott Hendricks, Harold Gomes, Srinivas Konda, 

Vidisha Parasram

Background: The public health approach to reducing workrelated injuries is an iterative process that utilizes 

surveillance data to characterize the injury burden, 

assesses risk factors to understand the underlying causes 

of injuries, and develops, implements, and evaluates 

interventions to address the problem. Researchers in the 

National Institute for Occupational Safety and Health’s 

(NIOSH), Division of Safety Research (DSR), Analysis 

and Field Evaluations Branch (AFEB) have collaborated 

with industry partners, employers, stakeholders, and other 

federal research agencies over the past 25 years to conduct 

intervention evaluation research. The purpose of our 

research is to demonstrate the impact of workplace 

interventions in populations of workers and communicate 

the findings regarding the effectiveness of successful 

interventions to stakeholders, industry partners and 

decision makers who can take action to create broad 

impact to benefit the overall workforce.

Methods: This presentation will examine a series of 

research studies that highlight the evolution of the NIOSH 

research branch to evaluate the efficacy of interventions to 

prevent work-related injuries. The values and skills of

rigorous inquiry, and methodological and practical 

considerations for conducting high quality intervention 

evaluation research will be discussed. The presentation 

will review the process of engaging industry partners and 

stakeholders, developing relevant research questions and 

specific methodological issues. More specifically, this 

presentation will examine the selection of the most 

appropriate study design, the development and 

implementation of interventions, establishment of study 

populations, length of follow-up, outcomes to measure, 

and economic assessments.

Results: Key findings from a range of intervention 

evaluation studies will be presented that have 

demonstrated statistically significant impacts on reducing 

motor vehicle crashes, falls from heights, falls on the same 

level, low back injuries, and violence in the workplace. 

These studies evaluated the efficacy of “best practices” 

interventions that addressed hazards across a range of 

occupations and industries including retail trade, 

healthcare, law enforcement, transportation, taxi drivers, 

food service workers, truck drivers and military personnel 

(Air Force and Navy). They also examined a range of 

interventions from multi-faceted programs to single 

interventions to prevent high priority injuries resulting 

from slips, trips, and falls, patient lifting, violence, and 

motor vehicle crashes.

Conclusions: The importance of demonstrating the impact 

of safety promoting ordinances and “best practices” injury 

prevention programs cannot be overstated. After 

demonstrating the effectiveness of successful municipal 

ordinances and workplace injury prevention programs, 

findings are disseminated widely to the research 

community, safety professionals, employers, unions, 

workers, and decision makers who can act on translating 

research to practice, reducing the risk of injury for the 

worker populations beyond the study population. The 
2022 NATIONAL OCCUPATIONAL INJURY RESEARCH SYMPOSIUM 124

future of workplace intervention evaluation will have to 

be adaptable to focus on the changing demographics of 

the US workforce, health inequities, underserved worker 

populations, changes in work organization and the rapid 

influx of technology to ensure that all workers have equal 

access to safe and healthy work environments to 

accomplish the NIOSH mission of preventing workrelated injuries.

J3.3 

Title: Occupational Injury in Group Homes

Author: Adam Moskowitz

Background and Objective: Residential care communities, 

commonly referred to as group homes, are a patchwork 

system of care and services for individuals who cannot 

live alone or with their families because of physical, 

emotional, and/or intellectual special needs. Residents live 

in small groups with 24-hour support from on-site staff, 

who also engage in cooking, cleaning, facilitating group 

activities, and driving for the residents. Group home 

employees are often young or part-time students, due to 

the flexibility of work hours and applicability of the 

experience to medical or care-focused careers. These 

workers face many of the same hazards as other clinical or 

medical workers, including patient-handling injuries, 

workplace violence, and biological exposures. However, 

little is known about injury trends or risks among group 

home employees. This project aims to describe 

occupational injury trends in group homes and identify 

risk factors for severe injury, patient-handling injury, and 

violence-related injury in the group home setting.

Methods: A dataset of workers’ compensation claims from 

group homes operating in the Upper Midwest from 2006-

2017 was analyzed. Incident descriptions were read by 

investigators and coded for violence and patient handlingrelated incidents. Log binomial regression was used to 

model risk factors for experiencing workplace violence, a 

patient-handling related injury, and lost-time injury.

Results: Of 4,365 injury claims, 13% resulted in lost time 

and 87% were medical only. Roughly 51% of all claims 

involved some form of violent incident or contact with a 

resident, 33% of all claims were specifically associated 

with violence, and 15% of all claims were related to 

patient-handling injuries. Claims involving violence were 

significantly associated with younger and male workers, 

while patient-handling related injuries were significantly 

associated with female workers. Common injury causes 

were lifting, falls, and absorption of noxious materials. 

Strains, contusions, and punctures were the most 

common injuries, with the lower back, finger, knee, and 

shoulder being the most commonly affected body parts. 

Patient handling-related injuries were a significant risk 

factor for having a lost-time claim.

Discussion and Conclusion: Group home employees are at 

high risk for injury, especially in younger age groups. A 

significant portion of injuries to group home employees 

involve contact with residents or incidents of violence. 

While workplace violence can have lasting psychological 

impacts on the victim, claims involving safe-patient 

handling injuries are generally more severe and carry 

higher risk for losing days of work. Safe Patient Handling 

policies from the medical field can be applied to group 

homes as an intervention to reduce injury risk from 

contact with residents. Verbal de-escalation should be 

prioritized over physical restraints when dealing with 

aggressive behavior. Because group homes operate out of 

residential houses and not regulated spaces like hospitals 

or medical facilities, extreme care should be taken to clear 

areas of debris and ice to prevent falls.
2022 NATIONAL OCCUPATIONAL INJURY RESEARCH SYMPOSIUM 125

NOIRS 2022 ABSTRACT AND SESSION PROPOSAL REVIEWERS

Jennifer L. Bell, PhD

NIOSH

Kurt Beschorner, PhD

University of Pittsburgh

Ruchi Bhandari, PhD

West Virginia University

Carri Casteel, PhD

University of Iowa

Dawn Castillo, MPH

NIOSH

Michelle Chervak, PhD, MPH

Army Public Health Center

HeeSun Choi, PhD

Texas Tech University

Jim Collins, PhD, MSME

NIOSH

Miranda Dally, MS

Colorado School of Public Health

Douglas Myers, ScD

Boise State University

MK Fletcher, MSPH

The American Federation of Labor and 

Congress of Industrial Organizations 

David Fosbroke, BS, MSF

NIOSH

Mark Fullen, EdD, CSP

West Virginia University

Susan Goodwin Gerberich, PhD, MSPH

University of Minnesota

Harold Gomes, PStat, CStat

NIOSH

Susan Gould, CSP, CHST, OHST

Board of Certified Safety Professionals

Kelly K. Gurka, PhD, MPH

University of Florida

Melody Gwilliam, PhDc, MSJ, MPH

NIOSH

Emily Haas, PhD

NIOSH

Thomas Hales, MD, MPH

NIOSH

Kitty Hendricks, MA

NIOSH

Hongwei Hsiao, PhD

NIOSH (Retired)

Emily Yueng-Hsiang Huang, PhD

Oregon Health & Science University

Jennifer E. Lincoln, MS 

NIOSH

Jennifer M. Lincoln, PhD, MS, CSP

NIOSH

Jennifer Marcum, DrPH, MS

Washington State

Suzanne M. Marsh, MPA

NIOSH

Cammie Chaumont Menendez, 

PhD, MS, MPH

NIOSH

Jack Ogutu, PhD, CSP

Millersville University 

Richard Olawoyin, PhD, CSP

Oakland University

Vidisha Parasram, DrPH, MPH

NIOSH

Keshia Pollack Porter, PhD, MPH

Johns Hopkins University 

Vaibhav Raj, PhD, MS

NIOSH

Audrey Reichard, MPH

NIOSH

Rosa L. Rodríguez-Acosta, PhD

NIOSH

Nancy Romano, MS, CSHM

NIOSH

Mahmood Ronaghi, MSAE, MSME, MBA

NIOSH

Ted Scharf, PhD

NIOSH

Christine Schuler, PhD

NIOSH

Natalie Schwatka, PhD

University of Colorado

Amee Schwitters, PhD

NIOSH

Eva Shipp, PhD

Texas A&M

Karl Sieber, PhD

NIOSH

Sergey Sinelnikov, MPH

National Safety Council

Tamara Small, PhD, MSN, APRN, FNP

DaVita

Gordon Smith, MD, MPH

West Virginia University

Christina Socias-Morales, DrPH

NIOSH

Veronica Stanley, MSPH, CIH, CSP, CESCP

American Industrial Hygiene Association

Lisa Steiner, PhD, CPE

NIOSH

Jon W. Williams, PhD

NIOSH
INDEX OF PRESENTERS

Adamson, Carisa Harris .....................................................................46

Alexander, Barbara ..............................................................................41

Baker, Marissa ....................................................................................106

Bernzweig, David.................................................................................60

Beschorner, Kurt...............................................................113, 114, 120

Bovbjerg, Viktor...................................................................................38

Bowling, Nathan ......................................................................... 63, 101

Brown, Samantha.................................................................................65

Bunn, Terry.........................................................................................103

Bunting, Jessica ....................................................................................37

Byler, Christen............................................................................. 34, 120

Canham-Chervak, Michelle ...............................................................69

Carson, Leslie .......................................................................................44

Case, Samantha ....................................................................................48

Castellote, Juan Manuel............................................................... 94, 95

Cernucan, Katrina ...............................................................................88

Chen, Guang.........................................................................................72

Cheng, Marvin......................................................................................32

Chiu, Sophia .........................................................................................35

Choi, HeeSun........................................................................................53

Chowdhury, Suman.............................................................................74

Collins, James.....................................................................................123

Dale, Ann Marie...................................................................................65

Dally, Miranda......................................................................................56

Davis, Jonathan ....................................................................................43

de Moura Araujo, Guilherme ............................................................85

Drayton-Hill, Imani ..........................................................................120

Dugdale, Zoe.........................................................................................71

Dyer, Michael .......................................................................................47

Eiter, Brianna......................................................................................107

Elliott, KC..............................................................................................90

Evanoff, Bradley ............................................................................ 82, 88

Evoy, Richard .....................................................................................117

Fetzer, Linda .........................................................................................47

Fowler, Melanie............................................................................. 50, 97

Franklin, Carole .................................................................................105

Friel, Daniel ........................................................................................120

Fullen, Mark .................................................................................. 46, 57

Funke, Jeff R. ........................................................................................96

Furek, Alexa..........................................................................................98

Garza, Elizabeth ...................................................................................36

Geczik, Ashley ......................................................................................60

Gibbs, Jenna..........................................................................................84

Gomes, Harold .....................................................................................78

Gorucu, Serap................................................................................ 39, 47

Gwilliam, Melody ................................................................................69

Gyawu, Eugene.....................................................................................33

Haas, Emily .................................................................................. 78, 110

Harris, William ....................................................................................64

Hayden, Marie......................................................................................67

Hemler, Sarah.....................................................................................113

Hendricks, Kitty...................................................................................86

Huang, Emily Yueng-Hsiang.............................................................94

Jeelani, Idris..........................................................................................32

Kath, Lisa.............................................................................................109

Khorsandi, Farzaneh ...........................................................................85

Kincl, Laurel................................................................................... 49, 91

Kline-Field, Karis.................................................................................49

Konda, Srinivas..................................................................................103

Krautter, Julie .....................................................................................120

Lee, Barbara ..........................................................................................76

Levin, Jeff...............................................................................................90

Lewandowski, Mark ..........................................................................105

Loflin, Murrey ......................................................................................81

Lopez, Camryn .....................................................................................99

Lundstrom, Eric ...................................................................................86

Lundstrom, Wayne............................................................................100

Marvel, Jeremy ...................................................................................105

McCue, Leigh........................................................................................92

Memarian, Babak.................................................................................45

Michael, Judd........................................................................................68

Miles, Stephen ......................................................................................35

Moore, Libby ........................................................................................98

Moskowitz, Adam..............................................................................124

Nam, Yoon-Sung .................................................................................51

Pan, Chris....................................................................................... 54, 73

Parasram, Vidisha................................................................................87

Prather, Aaron....................................................................................105

Quinn, Tyler.........................................................................................42

Ramirez, Marizen...............................................................................111

Ramos, Athena K. ................................................................................91

Rana, Somendra Pal...........................................................................106

Raymond, Benjamin............................................................................79

Rekant, Julie........................................................................................121

Rinehart, Richard.................................................................................83

Rowson, Steve.......................................................................................74

Rubin, Dennis L. ..................................................................................80

Rudolphi, Josie .....................................................................................51

Sarpy, Sue Ann .....................................................................................38

Scharf, Ted ..........................................................................................109

Schneider, Scott..................................................................................110

Schofield, Katherine ............................................................................55

Schuh-Renner, Anna...........................................................................70

Scott, Erika ............................................................................... 40, 91, 96

Sears, Jeanne .......................................................................................115

Shipp, Eva............................................................................................104

Smith, Todd ................................................................................... 61, 70

Socias-Morales, Christina............................................................ 42, 62

Sorensen, Julie ............................................................................... 91, 92

Steege, Andrea......................................................................................34

Swenson, Andrea .................................................................................77

Taylor, Jennifer ....................................................................................59

Trout, Douglas .....................................................................................52

VanWormer, Jeffrey............................................................................76

Vicentini, Federico ............................................................................105

Weaver, Darlene...................................................................................66

Williams, David..................................................................................116

Wimer, Bryan .......................................................................................83

Wingate, Kait......................................................................................122

Wu, John ...............................................................................................54

Wurzelbacher, Steven............................................................... 111, 112

Yanik, Elizabeth ...................................................................................89

Zeng, Shengke ....................................................................................100

2022 NATIONAL OCCUPATIONAL INJURY RESEARCH SYMPOSIUM 126

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