California Occupational Safety Research Articles

Nonfatal Violence Involving Days Away From Work Following California's 2017 Workplace Violence Prevention in Health Care Safety Standard.

Objectives. To examine the impact of the California Occupational Safety and Health Administration's (Cal/OSHA's) 2017 workplace violence (WPV) prevention in health care safety standard on nonfatal violent injuries among health care workers (HCWs). Methods. We accessed estimated counts of WPV from the survey of occupational injuries and illness from 2011 to 2019 specific to HCWs. We used the Current Population Survey estimates of HCWs to create rates per 10 000. We conducted a longitudinal panel analysis and a comparative interrupted time-series analysis to examine the change in incidence and in rates associated with California's new standard. Results. Adoption of the 2017 safety standard led to an additional 3.48 reported WPV injuries per 10 000 HCWs in California, or an additional 473 injuries. Sensitivity analyses suggest other injuries did not change in the same period. Conclusions. It appears that the Cal/OSHA standard increased reporting of WPV injuries among HCWs in the first year of its adoption compared with the United States. Mandating reporting of all WPV incidents in the health care setting may be a means to ensure a more complete understanding of this public health problem. (Am J Public Health. 2022;112(11):1668-1675. https://doi.org/10.2105/AJPH.2022.307029).

A descriptive analysis of 2020 California Occupational Safety and Health Administration covid-19-related complaints

COVID-19 mortality has disproportionately affected specific occupations and industries. The Occupational Safety and Health Administration (OSHA) protects the health and safety of workers by setting and enforcing standards for working conditions. Workers may file OSHA complaints about unsafe conditions. Complaints may indicate poor workplace safety during the pandemic. We evaluated COVID-19-related complaints filed with California (Cal)/OSHA between January 1, 2020 and December 14, 2020 across seven industries. To assess whether workers in occupations with high COVID-19-related mortality were also most likely to file Cal/OSHA complaints, we compared industry-specific per-capita COVID-19 confirmed deaths from the California Department of Public Health with COVID-19-related complaints. Although 7820 COVID-19-related complaints were deemed valid by Cal/OSHA, only 627 onsite inspections occurred, and 32 citations were issued. Agricultural workers had the highest per-capita COVID-19 death rates (402 per 100,000 workers) but were least represented among workplace complaints (44 per 100,000 workers). Health Care workers had the highest complaint rates (81 per 100,000 workers) but the second lowest COVID-19 death rate (81 per 100,000 workers). Industries with the highest inspection rates also had high COVID-19 mortality. Our findings suggest complaints are not proportional to COVID-19 risk. Instead, higher complaint rates may reflect worker groups with greater empowerment, resources, or capacity to advocate for better protections. This capacity to advocate for safe workplaces may account for relatively low mortality rates in potentially high-risk occupations. Future research should examine factors determining worker complaints and complaint systems to promote participation of those with the greatest need of protection.

Factors associated with physical injury or police involvement during incidents of workplace violence in hospitals: Findings from the first year of California's new standard.

Workplace violence in healthcare settings is known to be a costly and often underreported problem. In California, hospitals are required to report incidents of violence towards workers to the California Occupational Safety and Health Administration (CalOSHA) using an online reporting system that went into effect in 2017. Reports submitted to CalOSHA from July 2017 to September 2018 pursuant to this new requirement were analyzed using descriptive methods and logistic regression. Four hundred eight hospitals submitted reports using the new incident reporting system. Behavioral health units had 1.82 times the odds of the reported incident resulting in physical injury compared to inpatient medical units, and investor-owned facilities had 2.43 times the odds of the reported incident resulting in physical injury compared to city or county-owned facilities. Inpatient and behavioral health units had significantly reduced odds of a reported incident resulting in police involvement when compared to other locations within the hospital. These findings indicate that protections for healthcare workers deserve ongoing attention from stakeholders and legislators and provide insight into how healthcare facilities report incidents of violence towards workers.

DiSCO — Department Safety Coordinators and Officers: Building Safety Culture

At the University of California, Davis, Colleges/Departments, Organized Research Units, and Administrative units are required to appoint a Department Safety Coordinator (DSC). DSCs share information from the campus’ Safety Services/EH&S organization to their departments and facilitate compliance with California Occupational Safety and Health Administration (Cal/OSHA) standards and other regulatory programs. The DSC role, however, is often part-time, assigned at seemingly arbitrary percentages to people who do not, necessarily, have professional safety backgrounds. The role can be overwhelming, isolating, conflicting, and lead to burn-out, especially as the role often competes with other non-safety responsibilities. We introduce a grass roots effort to connect and support DSCs across the campus and how this effort has evolved into a thriving online safety community, with an impact beyond its own activity.

Hospital Workplace Violence Prevention in California: New Regulations.

In response to startling statistics in the increasing number of workplace violence (WPV) incidents against health care workers, California employers across the continuum of care are preparing their organizations to comply with California Occupational Safety and Health Administration (CAL/OSHA) regulation SB 1299. This groundbreaking legislation requires hospitals and other health care settings to implement written strategic prevention plans and broaden the identification and reporting of incidents related to WPV. Also included in the law is a minimum staff education requirement and formal risk identification and mitigation plans. The occupational health nurse will play a critical role in preparing health care organizations and staff in this endeavor.

GRUDZEN ET AL. RESPOND

We would like to thank Silvera et. al. for their thoughtful response to our research article. We agree that there appears to be a recent rise in the production of “bareback” pornography, and we are similarly concerned by the reemergence of intentional unsafe sexual practices by men who have sex with men (MSM) both in adult films and in the community. We would also like to emphasize the important difference between an individual who chooses to engage in unsafe sexual practices and unsafe workplace practices imposed on an employee by an employer. Our aim was to compare the safety practices for workers in a legal industry after the California Occupational Safety and Health Administration (CalOSHA) issued a model Exposure Control Plan and Industry Illness and Prevention Plan for the adult film industry after an HIV outbreak in 2004.1 We were chiefly concerned with workers’ rights and safety, and our study was not designed to determine the preferences of viewers, or effects on their behavior, though we believe these are important and understudied topics. We concluded that both industries are out of compliance with CalOSHA requirements but that the homosexual adult film industry is in comparatively better compliance. Though it has not been rigorously studied, key informant interviews suggest that “bareback” pornography has increased in the last few years, making our findings of 80% condom use in homosexual films more likely out of date than because of our choice of sampling frame. Nonetheless, this is further proof that neither industry is complying with CalOSHA regulations. We also agree that adult film is increasingly being sold as video on demand rather than as a DVD. However, we know from in-depth interviews with adult film performers that, at least at the time of our study, adult content was typically recycled from DVD to the Internet.2 The most important message from our manuscript and Silvera et al.’s letter is that serious risk of occupational exposure to HIV and sexually transmitted infections is ongoing in both the heterosexual and homosexual adult film industry and that both segments of the industry are out of compliance with worker safety requirements. This is not only negligent, but illegal.

The Adult Film Industry: Time to Regulate?

The United States adult film industry produces 4,000–11,000 films and earns an estimated $9–$13 billion in gross revenues annually [1]. An estimated 200 production companies employ 1,200–1,500 performers [2]. Performers typically earn $400–$1,000 per shoot and are not compensated based on distribution or sales. Los Angeles County is the largest center for adult film production worldwide. In 1988 the California Supreme Court, in People v. Freeman, found adult film production to be protected as free speech under the First Amendment, since such films were not considered obscene based on prevailing community standards. Unlike other legal but highly regulated activities such as gambling and commercial sex work in Nevada, the adult film industry was legalized in California through case law, not by statute, and has for the most part escaped governmental oversight. Regulation of the industry has been limited to prevention of child pornography. Title 18, Section 2257 of the United States Code of Regulations explicitly prohibits performers under age 18 and provides for civil and criminal prosecutions for any violation [3]. Adult film production companies are required to have a Custodian of Records to document and retain records of the age of all performers, to enforce the age entry restriction. Adult film performers engage in prolonged and repeated sexual acts with multiple sexual partners over short periods of time, creating ideal conditions for transmission of HIV and other sexually transmitted diseases (STDs). All the more concerning, high-risk practices are on the rise [4]. These practices include sex acts that involve simultaneous double penetration (double-anal and vaginal–anal intercourse) and repeated facial ejaculations. At the same time, condom use is reportedly low in heterosexual adult films—approximately 17% for adult performers [5]. In 2004, only two of the 200 adult film companies required the use of condoms for all penile–anal and penile–vaginal penetration [2]. Performers report that they are required to work without condoms to maintain employment. These practices lead to high transmission rates of STDs and occasionally HIV among performers. After four performers contracted HIV in 1998, Sharon Mitchell, a former adult film performer, founded Adult Industry Medical (http://www.aim-med.org), a clinic to counsel and screen performers monthly for HIV using a PCR test (Figure 1). It was expanded later to include other STD testing. The testing program began as an effort to reduce transmission of infections through early diagnosis, treatment, and “quarantine” should a performer test positive for HIV. Performers are required in most cases to pay for all screening tests, and to sign a consent form that permits disclosure of their test results to other performers and producers before filming. Both of these practices are explicitly prohibited under California Occupational Safety and Health Administration (Cal/OSHA) regulations. HIV-positive female performers are permanently excluded from participating in adult films. Figure 1 Screenshot of the Web site of Adult Industry Medical Health Care Foundation

Epidemiologic investigation of a cluster of workplace HIV infections in the adult film industry: Los Angeles, California, 2004.

Adult film production is a legal, multibillion dollar industry in California. In response to reports of human immunodeficiency virus (HIV) transmission by an adult film worker, we sought to determine the extent of HIV infection among exposed workers and to identify means of improving worker safety. The Los Angeles County Department of Health Services initiated an outbreak investigation that included interviews of infected workers to elicit information about recent sex partners, review of the testing agency's medical records and laboratory results, molecular analysis of HIV isolates from the 4 infected workers, and a risk assessment of HIV transmission in the adult film industry. Many adult film workers participate in a monthly program of screening for HIV infection by means of polymerase chain reaction-based technology to detect HIV DNA in blood. A male performer tested negative for HIV on 12 February 2004 and 17 March 2004, then tested positive for HIV on 9 April 2004. During the period between the negative test results, he experienced a flulike illness after performing unprotected vaginal and anal intercourse for an adult film produced outside the United States by a US company. After returning to California, he performed unprotected sex acts for adult films with 13 female partners who had all tested negative for HIV in the preceding 30 days; 3 subsequently tested positive for HIV (a 23% attack rate). Contact tracing identified no reasonable sources of infection other than the male index patient. Although current testing methods may shorten the window period to diagnosis of new HIV infection, they fail to prevent occupational acquisition of HIV in this setting. A California Occupational Safety and Health Administration-approved written health and safety program that emphasizes primary prevention is needed for this industry.

Shiny Science: A New Substitute for Hexavalent Chromium

Although perhaps more familiar to those of us of a certain age who remember when all cars had sparkling mirror-finish bumpers, chromium still plays a big part in industry. Chromium is valued for its brightness, durability, resistance to corrosion, and hardness. It is used as a pigment in paint, inks, and plastics, as an anticorrosion agent in protective coatings, and in chrome plating on such things as aircraft engine components, tool and die parts, railroad wheel bearings, and, of course, the “brightwork” that trims motorcycles, cars, and trucks. As more and more scientific studies have revealed, however, chromium also has a darker side. The chromium used in the plating industry is primarily hexavalent chromium, which is a very different animal from the trivalent form required by the human body. Hexavalent chromium is a potent human carcinogen, and can also cause dermal irritation and kidney and liver damage. Now, in an effort to find safer alternatives, researchers are looking at tailored nanostructures that offer the appearance and durability of hexavalent chromium without the hazards.

Labor Law Enforcement in California, 1970-2000

This chapter examines the record of two state agencies within the California Department of Industrial Relations, the Division of Labor Standards Enforcement (DLSE) and the California Occupational Safety and Health Program (Cal/OSHA), over the 1970-2000 period. Although the data available on the performance of these agencies are severely limited - in most cases consisting only of enforcement activity measures, without any valid measures of enforcement outcomes, it is possible to draw some conclusions. The analysis shows that the agencies' budget and staffing allocations have generally not kept pace with the growth in the size of the state's workforce, nor with the agencies' increased responsibilities. Despite recent improvements, the agencies are still funded and staffed at 1989 levels. Moreover, several key activity measures, such as the number of investigations, citations, and penalties assessed, have failed to increase in proportion to the expansion of funding and staffing that has occurred. The chapter highlights the urgent need for these agencies to collect data on outcomes, so that any future progress in their work can be measured and evaluated in a rigorous manner.

Lead use in California Industry: Its Prevalence and Health Implications

An estimated 230 000 workers were reported to work in lead- using activities as a result of a 1986 statistical survey of employers in California. However, 68% of these workers worked in activities of relatively low hazard. This included 114000 workers engaged in electronic soldering. Over 1800 workers were reported to work in battery manufacture, a relatively high-hazard activity, but with consistent monitoring and protection. In contrast, over 4300 workers were involved in radiator repair activities, a high-hazard activity with inconsistent monitoring and protection. Over 8% of construction workers were reported to work in lead-using processes. This sector is exempt from federal Occupational Safety and Health Administration (Fed/OSHA) and California Occupational Safety and Health (Cal/OSHA) lead standards, yet some of the most hazardous activities (welding, grinding, and cutting, etc.) occurred here. Comparison of projections from the National Occupational Hazard Survey of potential lead exposure in California with these survey results suggests consistent and reliable assessment of the major sources of potential occupational exposure to lead.

LEAD USE IN CALIFORNIA INDUSTRY: ITS PREVALENCE AND HEALTH IMPLICATIONS

An estimated 230,000 workers were reported to work in lead-using activities as a result of a 1986 statistical survey of employers in California. However, 68% of these workers worked in activities of relatively low hazard. This included 114,000 workers engaged in electronic soldering. Over 1800 workers were reported to work in battery manufacture, a relatively high-hazard activity, but with consistent monitoring and protection. In contrast, over 4300 workers were involved in radiator repair activities, a high-hazard activity with inconsistent monitoring and protection. Over 8% of construction workers were reported to work in lead-using processes. This sector is exempt from federal Occupational Safety and Health Administration (Fed/OSHA) and California Occupational Safety and Health (Cal/OSHA) lead standards, yet some of the most hazardous activities (welding, grinding, and cutting, etc.) occurred here. Comparison of projections from the National Occupational Hazard Survey of potential lead exposure in California with these survey results suggests consistent and reliable assessment of the major sources of potential occupational exposure to lead.

Fatal Injuries at Work in California

We examined deaths due to injury on the job reported from three readily accessible data sources in California for a 1-year period. Of 682 deaths identified as of February 1990 as having occurred on the job in 1983, county coroners identified 607 (89.0%), workers' compensation records identified 294 (43.1%), and the California Occupational Safety and Health Administration investigated 141 (20.7%). Most fatal injuries at work resulted from events that are not covered by current California Occupational Safety and Health Administration standards: transportation vehicle accidents and homicides. Demographic patterns suggest that fatal injuries on the job are nonrandom events, which may be prevented by additions to existing standards or increased enforcement of workplace safety standards and by efforts to target groups at highest risk. Improved surveillance of fatal occupational injuries will require changes in existing reporting mechanisms, similar to those proposed by the US Bureau of Labor Statistics.

Determination of sialic acid using 2-thiobarbituric acid in the absence of hazardous sodium arsenite

Sialic acid (SA) is a component of many glycoproteins and glycolipids. Unusual levels of SA have been observed in a variety of cancerous tissues. Recent evidence indicates that serum SA can be an indicator of tumour burden and prognosis [l-4]. The commonly used thiobarbituric acid (TBA) calorimetric [5,6] and fluorometric [7] assays for SA employ sodium arsenite as a reducing agent. The United States Occupational Safety and Health Administration [8] and the State of California Occupational Safety and Health Act [9] have classified all inorganic arsenic salts as carcinogens, and the latter has established rigid standards for their use. This ban on the use of sodium arsenite without special facilities had led us to find an alternative reducing agent for the TBA assay of SA.

Hazards in the hospital: educating the workforce through its union.

The hospital workforce is exposed to many occupational hazards of which most hospital workers are unaware. The author and another health educator, both employed with the California State Department of Health, conducted occupational health and safety educational sessions for the membership of a hospital workers' union. These sessions taught nonprofessional workers how to recognize hospital hazards, how to eliminate or minimize these hazards, and informed workers of their legal rights under the California Occupational Safety and Health Act. We first had to convince the union health and safety officer that we had skills and information which would be of benefit to the union. Once that hurdle was crossed, we encountered some difficulty conducting an adequate needs assessment and including the target population in the planning of the educationals. Two series of educational sessions for rank-and-file members were conducted and were enthusiastically received by those attending, with a request for more sessions.