2
Hispanic/Latino Occupational Health and Safety: Available Information and Information Gaps

National census and household surveys such as the Current Population Survey, which over-sample1 for minorities including Hispanics, provide critical demographic data for improving our understanding of shifts in the Hispanic population. In 2000, there were 35.3 million Hispanics in the United States, a 58-percent increase over the 22.4 million recorded in the 1990 census. This compares with a population increase of less than 9 percent among non-Hispanics during the same time period (U.S. Census Bureau, 2001). By 2050 it is projected that one out of every four persons in the United States will characterize themselves as Hispanic, compared with about one in eight today. While extremely valuable for tracking changes in our population, these datasets face a variety of challenges in their interpretation and in considering priorities for future efforts. Workshop discussion related to the white paper prepared by Scott Richardson et al. (see Appendix D) included several concerns about interpretation of Census data in driving development of information and educational outreach. They noted that the census methodology results in differential undercounts of Hispanics and the correlates of undercount are those most closely linked to risk for occupational injury. Therefore, the census population profile underestimates the size of the at-risk population. However, these data clearly document the rapid growth of the Hispanic worker and employer populations in the United States and demonstrate the need to consider health education and communication strategies that can more effectively reach these communities. Such demographic characteristics as location, education, country of origin, and language spoken at home are valuable tools in developing materials and public health interventions to serve at-risk populations more effectively. The adequacy of existing datasets and their potential use in assessing the impacts of future interventions on Hispanic worker occupational injury and illness were discussed. Key aspects of that discussion follow.

CENSUS PARAMETERS

Census methodologies do not always capture the detail needed for the types of analyses which are useful in assessing a specific population, as for this report. The section below discusses some of the data and data constraints in the most recent census.

Population Classifications

Recent reports from the Institute of Medicine (NRC, 2000, 2002) and the Centers for Disease Control and Prevention (CDC, 1993; Hahn, 1992, 1999; Hahn and Stroup, 1994) have

1  

Sampling is based on calculations of the number of randomly selected people needed to represent a population for the data analyses planned. At times, it is necessary to include more members of a specific group in the sample in order to have enough members of that group to be able to draw valid conclusions about that group from the data.



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Safety is Seguridad: A Workshop Summary 2 Hispanic/Latino Occupational Health and Safety: Available Information and Information Gaps National census and household surveys such as the Current Population Survey, which over-sample1 for minorities including Hispanics, provide critical demographic data for improving our understanding of shifts in the Hispanic population. In 2000, there were 35.3 million Hispanics in the United States, a 58-percent increase over the 22.4 million recorded in the 1990 census. This compares with a population increase of less than 9 percent among non-Hispanics during the same time period (U.S. Census Bureau, 2001). By 2050 it is projected that one out of every four persons in the United States will characterize themselves as Hispanic, compared with about one in eight today. While extremely valuable for tracking changes in our population, these datasets face a variety of challenges in their interpretation and in considering priorities for future efforts. Workshop discussion related to the white paper prepared by Scott Richardson et al. (see Appendix D) included several concerns about interpretation of Census data in driving development of information and educational outreach. They noted that the census methodology results in differential undercounts of Hispanics and the correlates of undercount are those most closely linked to risk for occupational injury. Therefore, the census population profile underestimates the size of the at-risk population. However, these data clearly document the rapid growth of the Hispanic worker and employer populations in the United States and demonstrate the need to consider health education and communication strategies that can more effectively reach these communities. Such demographic characteristics as location, education, country of origin, and language spoken at home are valuable tools in developing materials and public health interventions to serve at-risk populations more effectively. The adequacy of existing datasets and their potential use in assessing the impacts of future interventions on Hispanic worker occupational injury and illness were discussed. Key aspects of that discussion follow. CENSUS PARAMETERS Census methodologies do not always capture the detail needed for the types of analyses which are useful in assessing a specific population, as for this report. The section below discusses some of the data and data constraints in the most recent census. Population Classifications Recent reports from the Institute of Medicine (NRC, 2000, 2002) and the Centers for Disease Control and Prevention (CDC, 1993; Hahn, 1992, 1999; Hahn and Stroup, 1994) have 1   Sampling is based on calculations of the number of randomly selected people needed to represent a population for the data analyses planned. At times, it is necessary to include more members of a specific group in the sample in order to have enough members of that group to be able to draw valid conclusions about that group from the data.

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Safety is Seguridad: A Workshop Summary criticized conventional categories used to classify populations in the United States. Indeed, even the Office of Management and Budget has noted that these classifications should not be interpreted as being scientific or anthropological in nature, nor should they be viewed as determinants of eligibility for participation in any Federal program. They have been developed in response to needs expressed by both the executive branch and the Congress to provide for the collection and use of compatible, non-duplicated, exchangeable racial and ethnic data by Federal agencies.2 The workshop attendees agreed that there are multiple subcategories of Hispanics/Latinos. These include countries of origin from Spain to Mexico to Argentina, and length of residency from recent arrivals to multiple generations in the United States These groups and subgroups do not constitute a “racial” or even an “ethnic” group. As described in the sources mentioned above, there are variations in language, behavior, and other cultural aspects within and among these groups, as the groups and the individuals in them have different cultural experiences or cultural processes that shape and influence them (NRC, 2002). The workshop participants noted the change that occurred between the 1990 and 2000 censuses to allow designation of multiple racial groups may affect comparisons with non-Hispanic black and non-Hispanic white populations but should not affect the fraction of Hispanics of any race compared with non-Hispanics of any race. The workshop participants agreed that a sensible public health agenda would give priority to addressing high-risk groups of workers. While absolute numbers of workers in various occupations or industry sectors should be given due consideration, groups with high fatality rates were deemed the highest-priority target populations. Defining such priorities using existing datasets is challenging. Using the Census of Fatal Occupational Injuries combined with denominator employment information from the Current Population Survey, it is possible to calculate fatality rates of Hispanics and non-Hispanics in various occupations and industry sectors. Non-fatal injury rates among Hispanics by occupation or industry can also be calculated. This provides valuable targeting information for defining high-priority occupations and industries with elevated Hispanic fatality or injury rates. During the workshop several cautions when using such data to target health education initiatives were discussed. This included concerns about the statistical validity of fatality rates in very small populations. If there are only two Hispanic elephant trainers and one dies in a given year, the calculated rate may be very high but may not reflect real relative risk of the occupation or be statistically meaningful. Similarly, if there are no fatalities in a given year, this may not accurately reflect risk. Therefore, strictly targeting the highest-risk or highest-relative-risk occupations or industry sectors could lead to misallocation of effort. The workshop participants agreed that it would be more appropriate to focus priorities on larger high-risk occupations or industry sectors where sample sizes are adequate to provide reliable results. Self-Employed The self-employed are exempt from most occupational safety and health regulations, including fatality, injury, and illness data collection and reporting requirements. As a result the Occupational Safety and Health Administration (OSHA) reports far fewer occupational fatalities than the Bureau of Labor Statistics’ Census of Fatal Occupational Injuries, since the Census of 2   See <http://www.nih.gov/od/ocpl/resources/ombclearance/directive15.pdf>. Date accessed November 5, 2002.

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Safety is Seguridad: A Workshop Summary Fatal Occupational Injuries includes the self-employed and public sector workers. Small establishments (under 10 employees) have been excluded from reporting injuries. This may skew Hispanic injury and fatality data somewhat, although exactly how is unclear. Because barriers to entry into the labor market are likely to be lower with small establishments than large ones, this may disproportionately affect Hispanic employers and employees. Reportedly, individual workers are increasingly hired as self-employed subcontractors rather than as employees to avoid withholding of payroll taxes. This excludes them from protections such as workers’ compensation insurance as well as occupational safety and health regulations. This is likely to be most common in workforces with limited economic opportunities or limited knowledge of U.S. and state legal protections. Although true self-employment can provide a path to economic opportunity, contract labor may lack such opportunities and yet be classified as self-employed in these datasets. There is no current research to verify that Hispanics are at increased risk of these sorts of employment practices. Such misclassifications of employment would skew reported injury and employment rates to the extent that such practices exist. Workshop participants agreed that further research to better characterize such organization of work factors and their impact on injury and illness reporting as well as actual injury rates would be valuable. Personal services such as domestic help, home health care, and similar occupations present unique outreach challenges, since there are no concentrations of similarly at-risk employees. Self-employment and at-home businesses are a significant fraction of total employment that presents health education challenges and are likely to be undercounted in existing national datasets. Industrial and Occupational Classifications It should be noted that while the mining sector as a whole is identified as a high-risk sector for Hispanic fatalities, the majority of these Hispanic fatalities are in fact in the subcategory of petroleum exploration and production. Petroleum and gas exploration and production are covered under the Occupational Safety and Health Administration’s general industry regulations (or similar state plans), rather than under safety and health regulations administered by the Mine Safety and Health Administration. Neither the U.S. Standard Industrial Classification system nor the North American Industrial Classification system nor the Standard Occupation Classification system (see Sidebar 1), which code occupations, use definitions that align with legislative and regulatory boundaries. The Mine Safety and Health Administration regulations may apply to a worker during the execution of some tasks, while OSHA regulations may apply while performing other tasks. Similarly there are different regulatory boundaries that affect occupational safety and health under the Railway Labor Act, Longshore and Harborworkers Act, Jones Act (maritime), and others. Employers in the same U.S. Standard Industrial Classification system or North American Industrial Classification system may have employees who work under a variety of occupational safety and health regulatory schemes. For example, an electrician may work under OSHA construction regulations, Mine Safety and Health Administration regulations, OSHA general industry regulations, Harborworkers Act, various state OSHA plans, or have no regulatory protection at all if the electrician is self-employed or works in the public sector in a state without an OSHA-approved state plan. The industry and occupation classification systems do not consider these legislative or regulatory boundaries, so to the extent that health education interventions address workers and employers in a given sector it may be important to communicate more than one regulatory scheme. This is also an important consideration in policy analysis research considering possible impacts on public health of legislative or regulatory actions or employer organizational changes. This presents challenges in defining relevant comparisons with national data.

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Safety is Seguridad: A Workshop Summary SIDEBAR 1 Industry and Occupation Classification Systems The Standard Occupational Classification system is the U.S. federal government’s standard occupational classification system. An occupation is the kind of work a person does to earn a living. The Standard Occupational Classification system classifies workers according to the work performed into categories for the purpose of collecting and analyzing data. Each broad occupation category includes detailed occupation(s) requiring similar job duties, skills, education, and experience. The Standard Industrial Classification codes were developed to facilitate the collection and analysis of census data. An industry is the type of activity at a person’s place of work. The Standard Industrial Classification codes classify business establishments by the types of products or services they make available. Establishments engaged in the same activity, whatever their size or type of ownership, are assigned the same code. In 1997 the North American Industry Classification system replaced the Standard Industrial Classification. This revision not only provides for newer industries but also reorganizes the categories according to production or process. The North American Industry Classification system is used for statistical reporting of all economic activities of the United States, Canada, and Mexico. SOURCE: U.S. Census Bureau at <http://www.census.gov/hhes/www/ioindex/faqs.html#Q2>, date accessed: November 5, 2002. The coding systems for both industry type and occupation are in the process of changing in order to achieve comparable classification systems across Mexico, the United States, and Canada and to improve comparability with the International Standard Industrial Classification system. The North American Industrial Classification system will replace the U.S. Standard Industrial Classification system and the Standard Occupational system will be adopted in 2003 for the Current Population Survey. Early versions of these systems were used in the 1997 Economic Census. These coding changes will result in shifts in populations in some categories. Categories with the same name under the U.S. Standard Industrial Classification system and North American Industrial Classification system may in fact have different contents under the new system due to significant differences in how establishments are classified (Walker and Murphy, 2001). For example, the construction sector will include approximately 3 percent more employees under the North American Industrial Classification system (Hiles, 2001) by incorporating construction laborers and helpers, landscaping, rental of construction equipment, and management occupations such as land subdivision, which were not included in construction under the U.S. Standard Industrial Classification. Residential remodelers is also a new listing in the 2002 version of the North American Industrial Classification system that is likely to have significant Hispanic employment but not have a comparable category in historical data. Exactly how this change in the coding systems will affect the reporting of Hispanic fatality rates by industry and occupation is unclear. Interpretation of trends and changes from historical rates may be difficult to interpret based on these national data sources during the transition period. Whether observed fatality or injury rate changes are the result of coding changes or actual changes in Hispanic fatality rates in targeted occupations or industries will be difficult to assess using national datasets. Workshop participants thought this should be considered in developing evaluation mechanisms for assessing public health interventions among Hispanic employers and employees. Most industrial classification and occupation codes are by necessity broad enough to include diverse tasks, diverse levels of risk, and diverse work processes. In some cases these classifications may have inadequate detail to target particular high-risk tasks or processes.

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Safety is Seguridad: A Workshop Summary Identification of a high-risk task, high-risk exposure to a hazardous material, or high-risk process cannot necessarily be used to define an exposed or at-risk population of businesses or employees using existing datasets. For example, laborers and helpers and non-construction may include a wide range of tasks and practices that present diverse risks of occupational injury or fatality. Public health interventions targeting specific tasks may have to incorporate evaluation mechanisms independent of national or state datasets in order to assess impacts. In another example, the work of cleaning a poultry or meat slaughterhouse falls under Building Cleaning and Maintenance Services, which includes office building cleaning services and janitorial services. The rate of injury for this industrial classification code is low because of the overwhelming number of cleaners in relatively safe, non-hazardous jobs compared to the slaughterhouses, which have very different exposures and risks. The cleaning of slaughterhouses is very dangerous and primarily employs Hispanic, non-English-speaking, new immigrants. Temporary Employment Agencies New entrants into the U.S. labor market are likely to be observed in employment sectors and settings with low barriers to entry. These include sectors with direct foreign recruitment, temporary employment agencies, casual or informal sector labor, day labor, and contract labor. While precarious employment often provides low barriers to new labor market entrants, it also makes demographic data collection, communication of health and safety risks, and dissemination of public health information particularly challenging. Similarly such industry structures are likely to result in increased part-time work, seasonal work, frequent new employers, and multiple simultaneous employers. Among small employers and the self-employed these factors may result in short-lived businesses, multiple sources of income (including self-employment), and intermittent contracts or business income. This sector of the Hispanic population offers unique public health intervention and health communication opportunities. Temporary agencies and personnel services are a rapidly growing industry sector While employees of such services perform diverse tasks in occupations from construction and manufacturing to office clerical and janitorial services, these are all reported in a single industry category based on the principal activity of the establishment. It is, therefore, not clear which occupations are represented within this industry classification. The workshop participants were concerned that workers are reported in this single industrial classification and yet may perform work in any industry sector from custodial services and clerical to construction trades. There is further concern that Hispanics may disproportionately participate in the informal cash economy, which may not be accurately reflected in national statistics. UNDERREPORTING These datasets face serious challenges of underreporting among Hispanics in both the census (McKay, 1992) and in the Current Population Survey, particularly with mobile or migrant populations, populations without telephones (Current Population Survey is a telephone survey) or stable residences, and illegal immigrants who may not respond to surveys for fear of being identified. Illegal and low-visibility housing units, where the recently arrived, poorest, and limited-English Latino immigrants live, are disproportionately missed during mail surveys as well. There is a strong indication of underreporting of injuries among Hispanics reflected in the disparity between increasing fatality rates and higher than average occupational fatality rates combined with lower than average reported lost work time injury rates (see Appendix D; Center to Protect Workers’ Rights, 2002).

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Safety is Seguridad: A Workshop Summary The workshop participants discussed the issues of underreporting of injuries and undersampling and agreed that despite the remarkable changes documented in the formal statistics, there is a significant group of Hispanics that are not adequately sampled. However, because of the multiple data sources used in the Census of Fatal Occupational Injuries, the expectation is that recorded Hispanic occupational fatalities are relatively complete and are more accurately characterized than basic demographic shifts, occupational injuries, or occupational illnesses. Workshop participants generally agreed that economic, cultural, and personal pressures were commonly exerted on employees to limit reporting of workplace injuries. Low-income Hispanics in precarious employment settings may be particularly susceptible to such pressures when they face economic uncertainty. Reporting of injuries results in direct costs to the employer in terms of Workers’ Compensation costs and insurance experience modification ratings that affect future insurance premiums. Research to quantify the extent of injury underreporting and to define the impacts of economic and cultural incentives and disincentives would allow more effective dissemination of Occupational Safety and Health Administration information using injury data. Given reporting concerns for injuries and illness, current targeting of high-risk occupations and industries can best be achieved using occupational fatality data. Workshop participants believed that immigration status is likely to have a significant impact on injury reporting behavior. Illegal workers who are recent immigrants may be unfamiliar with injury reporting practices and state Workers’ Compensation systems, or may not want to risk dismissal as a result of any behavior that may not be viewed positively by the employer or supervisor. Illegal immigrants are likely to be in the most economically precarious situations making them responsive to any reporting disincentives. In addition, illegal immigrants may be unaware of the OSHA provisions and procedures for reporting unsafe conditions. Workers in low-skill jobs where there is a ready supply of replacement workers may be particularly responsive to pressures to underreport injuries and illness. This may also influence the workers’ willingness to perform tasks, question high-risk practices, and report violations. Workshop participants thought that employer attitudes and the impact of direct discrimination should be the subject of further research. It may be that Hispanic worker injuries are less likely to be reported based on a variety of factors that may impact employer and supervisory attitudes on various worksites. To what extent can higher relative risk among Hispanics be explained by differences in occupation, age, education, and other demographic characteristics? For low-income workers in precarious employment there is significant economic pressure to work even when injured or ill. Paid sick leave is unlikely to exist in such settings, and workers may be unaware of Workers’ Compensation systems. Even if they are aware of Workers’ Compensation systems, the systems may require multiple days out of work before any compensation is provided. Although failure to report injuries may result in long-term economic damage due to later medical complications or the result of repeated cumulative injuries or exposures, workers in economically fragile positions may focus largely on immediate income to meet immediate life needs. Research on such low-income workers is limited and presents researchers with serious challenges compared to research in stable employment settings. Although workers involved in the informal setting (e.g., handywork, gardening, construction, construction cleanup, auto repair, gleaning fields) could conceivably be included in household surveys such as the Current Population Survey, they may be less likely to report such employment. Employers who answer this survey would be very unlikely to be included in the Economic census or other employer survey. Workers who are paid cash without withholding are not eligible for unemployment insurance payments, Workers’ Compensation payments, health insurance payments of medical expenditures, or social security disability payments. These and similar economic disincentives are likely to affect reporting of occupational injuries. A quantitative assessment of the U.S. informal economy (i.e., economic transactions that avoid

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Safety is Seguridad: A Workshop Summary existing tax structures) would likely show that recent and illegal immigrants of any ethnicity are disproportionately involved in this cash economy. Although the Current Population Survey allows the comparison of union and non-union workers, it is likely that economic incentives to report injuries and illness and undersampling in household surveys are quite different between these groups. Unions may offer valuable public health outreach capabilities for Hispanic workers in some sectors. Union status and other organization of work factors are important research variables in evaluating the effectiveness of public health interventions to prevent occupational injury and illness. Undersampling is likely to be more severe in a mobile workforce. Typically the Current Population Survey requires a defined address (not a shared hotel room) to administer the survey. As mobility increases, including regular migration as in agricultural workers, it would be expected that undersampling would increase in any structured survey. This is a major concern in construction and agriculture, which are industry sectors with the highest fraction of Hispanic employment. The Current Population Survey is a telephone survey that depends on having not only an address but also an active residential telephone (not a pay phone or hotel phone). This is likely to lead to undersampling the lowest income and most mobile sectors of the workforce. The Current Population Survey is administered in Spanish as well as English. ENFORCEMENT DATA OSHA datasets such as the integrated management information system citation data, occupational fatality investigation data, and injury-reporting surveys provide potentially valuable additional datasets, although these datasets do not exist solely for research purposes. Injury-reporting surveys involve submission of OSHA injury logs from a sample of approximately 50,000 establishments (excluding construction, government, and the self-employed). With the exception of recent changes in the OSHA 170 fatality investigation report form, these datasets do not typically include ethnicity, race, or language information. Analysis is difficult when this information is included as part of some narrative components of these datasets. In terms of regulatory enforcement as an intervention to prevent injury and disease, workshop participants thought that further research is needed to assess the awareness of Hispanic employers and employees regarding OSHA requirements and penalties, and whether they constitute a significant incentive for improved practices. While OSHA provides many materials in Spanish and has a hiring priority to expand the number of Spanish-speaking compliance officers, it is unclear how effective these initiatives are at informing the Hispanic employer and employee communities. More effective coordination and sharing of Spanish-language documents across OSHA and among various state plans would be valuable, as would research evaluating the effectiveness of these materials at reaching various segments of the Hispanic community. Awareness of injury record keeping requirements may also affect the quality of data collected from Hispanic employers as a group. It was also noted at the workshop that OSHA spends most of its resources on large industries in heavily unionized workplaces. However, the greatest risk is with small businesses in non-unionized environments. OSHA interventions could be better targeted by focusing on the high-risk sectors. SURVEILLANCE DATA Serious challenges are faced by surveillance efforts, such as the NIOSH-supported Adult Blood Lead Survey and other state disease registries, state Workers’ Compensation research, and injury and fatality data. There are several initiatives that could make it illegal to collect race and

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Safety is Seguridad: A Workshop Summary ethnicity data, and this may make continuity of data for future comparisons difficult. NIOSH-supported efforts such as the Adult Blood Lead Survey for adult blood lead concentrations, OSHA’s new initiatives to add ethnicity and primary language questions to the OSHA Form 170 for fatality investigations, and similar long-term surveillance of injury and disease, which are critical for establishing baselines and tracking the impact of future public health interventions. Current trends within NIOSH and Center for Disease Control and Prevention (CDC) to convert cooperative agreements for state surveillance programs into contracts may create obstacles to recruiting additional state participants in existing surveillance programs or initiating new programs. Harmonization of core data across state boundaries is critical in characterizing illness or injury rates among ethnic or racial minorities where the small number of cases in some states may not allow reliable analysis and may raise confidentiality and privacy concerns. Note that for the purposes of the Current Population Survey, both ethnicity (Hispanic, non-Hispanic) and race (e.g., black, white, Asian, Native American) are independently categorized. This requires caution when comparing Hispanic rates with black or white since these categories overlap. Comparisons with non-Hispanic whites or non-Hispanic blacks or with population averages are required for clarity. Further, a response of Hispanic, Chicano, Mexican American, or Latino does not necessarily equate with Spanish as a primary language or the language spoken in the home; rather, some fraction of self-designated Hispanics speak Spanish as the primary language in their homes. Another important issue is that there are households where the primary language spoken at home is an indigenous one and Spanish is the second language. Workers in these households may have limited ability to understand even orally presented occupational health and safety information in Spanish. This is an important issue in regions where there are higher levels of immigration of indigenous origin workers (e.g., California, Oregon, Florida) but not so important in other areas. DATA PRIORITIES The general view of the workshop participants was that for most high-risk activities, industry sectors and occupations the demographic and fatality data is adequate, and public health professionals know enough about the problems (e.g., causes of injury) and effective controls to provide the basis for developing interventions. Data on occupational illnesses remains inadequate not only for Hispanic workers but for all workers. Data on non-fatal injuries, although they are likely to be impacted by a variety of factors as outlined above, may provide the basis for useful comparisons in narrowly defined research initiatives and for prioritizing the most serious injuries where underreporting is expected to be less severe than for minor injuries. Use of these data is constrained by the fact that injuries are also likely to be underreported. The influence of social, economic, and cultural factors on reporting behaviors is critical before existing injury data can be effectively interpreted. In the opinion of workshop participants, research that further quantifies and characterizes specific risks is not the principal barrier to preventing occupational injury and disease among Hispanic workers. Rather, research should focus on the effectiveness of specific field interventions with the goal of national or targeted dissemination of those interventions that are found to be efficacious in pilot projects, combined with research to evaluate the effectiveness on the health and safety of targeted populations. How can we reduce occupational injury and illness among Hispanics, starting with known hazards, among high-risk groups of employers and employees? Improved communication and improved knowledge of the organization of work, economics of occupational injury, and work culture is clearly an aspect of such a research and public health agenda.

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Safety is Seguridad: A Workshop Summary There was concern at the workshop that research on safety culture, organization and sociology of work, and the economics of injury may be perceived as blaming Hispanic victims. Despite the potential difficulties, the workshop participants encouraged NIOSH to expand research on the organization of work and industry structures that are faced by Hispanic workers and employers. Participants also encouraged the development of experimental or quasi-experimental approaches in order to define and evaluate effective interventions to improve awareness, change organizational incentives and disincentives, and change high-risk behaviors. A major concern of the workshop participants was the lack of appropriate long-term funding mechanisms for such interventions. Current NIOSH research funding, both internally and extramurally, focus on one- to three-year awards. The exceptions are a few five-year cooperative agreements. The current trend within NIOSH and the Centers for Disease Control and Prevention is reportedly to eliminate cooperative agreements in favor of shorter-term grants and contracts. This may not provide realistic funding mechanisms for developing, piloting, national or regional dissemination, and evaluation of public health interventions to prevent fatalities, injuries, and illness among Hispanic workers. Hispanic employers may be hesitant to allocate their limited resources to implement injury and illness prevention programs that have not been demonstrated to be effective in such field research. Mechanisms for planning, managing, and funding for applied intervention research on a 5- to 10-year time frame is critical. Public health interventions focusing on changing individual behaviors such as tobacco smoking and seatbelt use have required long-term perspectives, and there is every indication that organizations may be even slower to change. It is essential that those individuals be influenced and implement organizational change. Workshop participants agreed that such long-term funding mechanisms as cooperative research agreements are crucial as an administrative priority for more effectively conducting field research on evaluating interventions to prevent injuries and fatalities. FUTURE DATA NEEDS A recent addition of questions on principal language to the OSHA 170 fatality investigation form should provide some additional information for evaluating the extent to which communication problems may contribute to fatal injuries and development of injury prevention interventions. Workshop participants agreed that improved occupational illness data is critical. This might be developed through various pilot initiatives targeting states, geographic areas, or high-risk groups. Priority could be given to at least one pilot program targeting a population that includes a significant Hispanic workforce. Improved injury data and research to further define individual and employer incentives and disincentives to report injuries are critical to understanding apparent disparities between Hispanic fatality and injury rates. Marketing campaigns for disseminating public health information and interventions have been developed for such topics as prevention and cessation of tobacco smoking and seatbelt use. The occupational health community has limited knowledge of these interventions and how they might be adapted to fatality or injury prevention interventions targeting Hispanic employers or employees. During workshop discussions participants noted that multi-disciplinary research initiatives related to social marketing or models of effective intervention dissemination mechanisms are a critical area for future research. Data structure design and determination of reasonable metrics for defining changes from baseline present major challenges and may drive changes in the current datasets. Workshop participants were not aware of any exposure databases that distinguish Hispanic workers. It is possible that existing exposure databases do not include ethnicity. Worksite data can also be problematic, since it is often poorly defined when dealing with some of the multi-employer worksites, multi-site employers, and transient contract employers.

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Safety is Seguridad: A Workshop Summary Similar problems exist with task data. Workshop participants could not identify task inventories to compare Hispanic and non-Hispanic workers. For example, it would be of interest to know whether actual work practices are different among Mexican-trained workers who are recent immigrants. Particularly with very-low-wage workers, task inventories may be different with a higher fraction of manual and hand tool work, and fewer capital-intensive processes. A significant concern raised by the workshop participants was youth employment (under 18 years old) when it places young workers at unacceptable levels of risk and limits their opportunities for education and future employment. Recent NIOSH recommendations on Department of Labor Hazardous Orders define allowable employment for youthful workers in the United States. These may be of particular value to Hispanic youth who may face high-risk work processes with reduced benefit from training and supervision that is often provided only in English. Other areas where participants identified data gaps included longitudinal data on new immigrants, information on the informal economy, and workers in the cash economy. SUMMARY OF INTERVENTION PRIORITIES Participants agreed on several priorities for NIOSH to consider in targeting health education campaigns, public health interventions, and occupational safety and health information to best address the elevated rate of Hispanic occupational fatalities. These priorities include: workers and employers who speak and write little or no English; recent immigrants as opposed to established populations; workers with low literacy levels in both English and Spanish; and workers with high-risk occupations and industry sectors. High-risk industry sectors (based on fatality rates) include agriculture, construction, food processing, and health care. Workshop participants suggested several additional priorities for intervention criteria. Although data resources and workforce characteristics almost certainly vary by state it may be difficult to get state-by-state data. Typically Current Population Survey public datasets can be used only for assessing regional variations due to confidentiality requirements and small datasets in some states. Another priority for intervention is differences by country of origin in popular vocabulary for terms important for worker safety, such as names of equipment or tools, and cultural variations in perceptions of risk and need for protection. Development of strategies for moving toward a more common vocabulary related to safety and health is an important consideration, but the issue was not seen as the primary barrier to preventing injury and illness. As described in the NIOSH National Occupational Research Agenda priorities related to organization of work, understanding the barriers and context within which public health interventions can be effective should be a priority in targeting Spanish-language materials, as it is in targeting English language public health interventions (NIOSH, 1996). In addition to language differences that can be addressed by translation, recognition of cultural differences may modify the nature of an effective public health intervention, even when addressing the same occupational health hazard in the same industry sector as an English-language counterpart. Effective interventions that extend beyond simple translation are important to address diversity within the Hispanic workforce and differences from the non-Hispanic workforce. Existing data to target, prioritize, and provide metrics for evaluation of the effectiveness of interventions is not currently limiting initial public health interventions but has considerable weaknesses. Workshop participants thought that major long-term initiatives should be developed by NIOSH, the Bureau of Labor Statistics, and OSHA to improve public datasets, and that several high-priority Hispanic target populations can be distinguished with relative confidence using current data.