Hazard Evaluation

A Hazard Evaluation in the Apple Warehouse Industry (NIOSH/CDC, 1997-2000)

During the past decade, the apple warehouse industry in Washington state has grown considerably, both in production and technology. Up to 15,000 employees work in warehouses with a large percentage of women. Approximately two-thirds of these workers are of Mexican descent. Both management and labor have identified health and safety concerns in the industry, such as musculoskeletal diseases, carbon monoxide poisoning, and slips and falls. Reported occupational health and safety research and evaluations have, for the most part, taken place in the more traditional and hazardous food processing plants, such as meat packing facilities and canneries. No studies evaluating the hazards associated with manually packing fresh fruit for market and cold room storage have been identified. Our project was designed to characterize and better understand the health, ergonomic, and safety hazards in the Washington apple warehouse industry, and to identify any controls currently in use that are designed to reduce worker injury and illness.

Additional Hazard Evaluation Publications

Rohlman DS, Lucchini R, Anger WK, Bellinger DC, van Thriel C. Neurobehavioral testing in human risk assessment. Neurotoxicoloy. 2008 May;29(3):556-67.

Phung DT, Nguyen HT, Mock C, Keifer M. Occupational injuries reported in a population-based injury survey in Vietnam. Int J Occup Environ Health. 2008 Jan-Mar;14(1): 35-44. PMID: 18320730.

Thepaksorn P, Daniell WE, Padungtod C, Keifer MC. Occupational accidents and injuries in Thailand. Int J Occup Environ Health. 2007 Jul-Sep;13(3):290-4. PMID: 17915543.

Hofmann J, Snyder K, Keifer M. A descriptive study of workers' compensation claims in Washington State orchards. Occup Med (Lond). 2006 Jun;56(4):251-7. Epub 2006 Apr 20. PMID: 16627546.

Salazar MK, Keifer M, Negrete M, Estrada F, Synder K. Occupational risk among orchard workers: a descriptive study. Fam Community Health. 2005 Jul-Sep;28(3):239-52. PMID: 15958882

Fenske RA, Hidy A, Morris SL, Harrington MJ, Keifer MC. Health and safety hazards in Northwest agriculture: setting an occupational research agenda. Am J Ind Med. 2002;2:62-7.

Murphy HH, Hoan NP, Matteson P, Morales Abubakar ALC. Farmers’ Self-surveillance of Pesticide Poisoning: A 12-month Pilot in Northern Vietnam. IJOEH 2002 Jul-Sept; 8;3: 201.

Fenske RA, Harrington M. Forest Safety: Developing an occupational research agenda for Northwest forestlands. Proceedings of the summit 2000: Washington Private Forest Forum. University of Washington College of Forest Resources, Seattle WA, 2000. Available by Request

Assessment of Job-related Exposures for Diarrheal Illness in Farmworker Families (NIOSH/CDC 2006-2011)

This two-year exploratory project investigated a probable cause of Yakima County’s high rates of diarrheal illness – bacterial pathogens from livestock, taken home or in well water. It is hypothesized that occupational and environmental exposure pathways from livestock operations pose a significant risk of exposure to zoonotic bacterial contamination for farmworkers and their families. This study demonstrates the effectiveness of currently available methods for recovery of example bacteria from various surfaces. These methods are available to exposure science researchers. Additionally this study examines the roles of organism die-off and the experimental design of validation studies in the reported efficacy for surface sampling methods.

Confronting the Health Risks of Climate Change: Integrating Science and Public Health Practice to Improve Preparedness for Worsening Heat Events, Air Pollution and Environmental Degradation in the NW (CDC, 2009-2012)

Climate change will have serious and long-term consequences for public health. The greatest impacts will be in cities with milder summers, less air conditioning and higher population density, which are characteristic of the Pacific Northwest. A multi-disciplinary team of UW scientists  evaluated the impact of climate change on human health in the Pacific Northwest, worked with local communities to study health risks that will likely occur in the next 35 years and uncovered how communities might mitigate those risks. This 3-year project  developed an evidence-based forecast of health impacts for different communities. This evidence will enable public health officials to develop specific plans of action to prevent health risks associated with climate change.

Read the UW News Article: UW researchers to study impacts of climate change on health in the Pacific Northwest

Development of a Surveillance Strategy to Guide Injury Prevention Efforts in the Washington Commercial Fishing Industry (MAAF, 2011-2013)

Dr. June Spector addressed a pressing information need – surveillance of non-fatal injuries. In collaboration with commercial fishing leaders and researchers at NIOSH, PNASH conducted an exploratory project to build new agreements with a variety of data sources (insurers, clinics, hospitals) and develop a system to characterize nonfatal injuries and intervention opportunities. Two data sources offered the UW researchers enough information to analyze: the US Coast Guard’s (USCG) database (termed MISLE) and the database of a Seattle-based insurance claims adjustor. They were able to use these sources to describe non-fatal injury data for Washington-based commercial fishers.

In this exploratory review, analysts found:

  • The most common injuries occur to workers on deck.
  • Wrists and hands were the most common anatomical sites of injury in both data sources.
  • Wrist and hand injuries frequently appear to be due to crush injuries, particularly during cargo handling operations, particularly when moving cases of frozen fish.

These findings suggest that hand-crush protection may prevent significant numbers of injuries, but specifics about the activities leading to injury were not available.

“We hope our results will motivate stakeholders in commercial fishing to organize a central database for non-fatal injury collection” – June Spector, PI.


Feasibility Project: Risk Factors for Heat-Related Illness among Oregon Farmworkers (PNASH Small Grants 2012-2013)

Complementing our HRI pilot in Washington State, this one-year pilot conducted by Oregon State University (OSU) surveyed a farmworker community in Oregon, collaborating with our UW PNASH HRI project on the computer- based survey instrument. OSU researchers and students conducted personal interviews with 100 Latino migrant or seasonal workers engaging in outdoor crop production work during the data collection period. Nearly 30% of participants reported experiencing ≥2 HRI symptoms previous week. There was a low level of knowledge about working in the heat and concern about HRI, but moderate comfort level taking breaks. Nearly 75% drank water ≥1x per hour, 65% consumed soda while working, and 40% worked at a site in which no cooling measures were provided (e.g. shade, trees, rest stations). Results from this study provide the foundation from which a culturally competent intervention can be developed to reduce the incidence of HRI. Results from the project demonstrate that heat-related illness is an important health topic for agricultural workers and that hydration and cooling measures need to be emphasized to workers as well as growers as a way to decrease heat-related illness.

Hazard Priority Ranking in Farming, Fishing, and Forestry 
(NIOSH/CDC, 1996-2001)

The extent and severity of agricultural health and safety hazards are largely unknown in the Pacific Northwest region. This project was designed to engage various constituencies familiar with agricultural health and safety throughout Region X. This process aimed to look broadly and long-term at the issues of farming, fishing, and forestry occupational safety and health in our regions, including technical, social, and economic dimensions involve a diverse group of stakeholders in identifying issues that can be addressed by occupational safety and health research; establish a priority list, or agenda, of occupational safety and health research topics relevant to Northwest farming, fishing, and forestry; and provide a continuing forum for discussion of key health and safety issues for the region.

Publication List

Occupational Skin Disorders in Region X Farming, Fishing, and Forestry (NIOSH/CDC, 1996-2002)

The objectives of this project were to: quantify the impact of dermatitis on the farming and forestry work force; characterize the most important causes; and develop interventions to control the major causes of farming and forestry workplace dermatitis in Region X.

This project also explored pre-collected data systems for use in characterizing dermatitis in commercial fishing.

Vegetation was the leading cause of agricultural dermatitis but "unknown" was the second leading cause followed by "unspecified chemicals," "insecticides," and "soaps and detergents." Farm workers were the category of workers who were represented most frequently among agricultural dermatitis claims, representing 58.7% of all agricultural dermatoses claims. The majority of funds supporting this project derived from the Washington Medical Aid and Accident Fund through the Center.

Pilot Project: Agricultural Work and Injuries in Teenagers (NIOSH/CDC, 1999-2000)

Direct assessment of the proportion of teenagers working in agriculture and the percent injured is sparsely reported in the literature and has not been performed in the Northwest United States. This project estimated the proportion of teenage children who work for pay in agriculturally related jobs in a rural town in Washington's Yakima Valley. Secondary goals were to estimate the injury rate among the teenage workers in the sample, to identify the patterns of work in relationship to school, and to characterize the treatment and outcome of these work related injuries. A random digit dialing survey targeted to a rural town composed of non-migratory agriculture workers of Mexican descent was employed to obtain these estimates.

Pilot Project: Assessing Agricultural Safety and Health among Hmong Farmers (NIOSH/CDC 2011-2013)

Hmong refugees are increasingly being resettled throughout the U.S., and are frequently engaging in small, family-owned farm operations. This pilot project was important in taking a preliminary, foundational step towards fully investigating agricultural work hazards among refugees operating small-scale farms. Considering the significant challenges that refugees endure during the resettlement process, examining how life circumstances, in particular work, determine health status during this transition is a worthwhile undertaking. Working in a partnership with Washington State University’s (WSU) Small Farm Program, we assessed safety and health issues among Hmong refugee farmers in Washington State. The project explored novel participatory approaches: the participatory rural appraisal process as well as integrated Photovoice and farm worksite observational exposure assessments. Additionally, we successfully established a working relationship with the Hmong community in the Skagit Valley. This is a regional stakeholder group that PNASH had not engaged previously. Our findings are in press and available for use is a Facilitator’s Participatory Rural Appraisal Guide.

R Neitzel, J Krenz, A de Castro. Safety and health hazard observations in Hmong farming operations. J Agromedicine. (Accepted 2014)

Pilot Project: Occupational Safety and Health of Forest Workers (NIOSH 2010-2011)

This project documented occupational injuries and illnesses and related medical treatment among immigrant, Spanish-speaking forest workers in southern Oregon. In addition the project informed the development of a pilot job health and safety promotora program for these workers that The Alliance of Forest Workers and Harvesters-Labor Occupational Health Program at the University of California, Berkeley- Lomakatsi Restoration Project partnership will be initiating with separate funding.

With a small grant from PNASH, this partnership piloted a job health and safety promotora program for these workers. Alliance staff recruited and trained promotores to staff the program as well as to collaborate in developing and conducting a sample survey among forest services workers.

Contacting workers through snowball sampling, the promotoras administered the questionnaire to 150 workers, representing a response rate of 75%. Principal findings show that injury rates among forest workers are much higher than rates reported by the Bureau of Labor Statistics, and that forest workers and employers fail to report on-the-job injuries at rates consistent with other studies. The forest workers surveyed reported specific concerns about safety training and working conditions.  The needs raised by workers will help this partnership in developing a promotora program.

Final Report, Educational Materials

Pilot Project: Study of Risk Factors for Heat-Related Illness in Agricultural Workers (NIOSH/CDC 2011-2013)

This two-year pilot, completed in FY2013, successfully generated baseline data and set the stage for future study of the association between potential Heat Related Illness (HRI) risk factors and heat effects as well as the development of interventions to reduce HRI. Heat exposure has been identified as an important cause of non-fatal illness and death in agricultural workers. Few studies have focused on HRI in hired crop workers, who are largely seasonal, foreign-born, Spanish-speaking workers. There is currently little known about how cultural beliefs and practices related to hydration and HRI may affect the prevention and treatment of HRI in these workers.

The overall goal of this study was to identify potential risk factors for HRI and to determine the feasibility of quantifying the physiological effects of heat exposure in agricultural workers. To accomplish our aims, we: 1) conducted Participatory Rural Appraisal (PRA) workshops to engage our study population and facilitate identification of cultural beliefs and practices that may pose barriers to HRI prevention; 2) developed and validated an interactive computer-based survey instrument to characterize potential HRI risk factors; and 3) measured heat exposure and heat strain in a small sample of workers in the fields. Major observations regarding farmworkers’ HRI-relevant beliefs and attitudes included: 1) farmworkers subscribe to varying degrees to the belief that cooling treatments should be avoided after heat exposure, with some believing that such treatments should be avoided after heat exposure, and others encouraging the use of such treatments; 2) the desire to lose weight may be reflected in behaviors that promote increased sweating; 3) highly caffeinated energy drinks are preferred to increase work efficiency and maintain alertness; and 4) the location of drinking water at work (e.g. next to restrooms) and whether water is clean, but not necessarily chemically-treated, are important considerations in deciding whether to drink the water provided at worksites. All findings are currently being published and incorporated into HRI educational materials. The resulting materials will be disseminated regionally to workers and employers through PNASH’s Outreach and Education Core.

Further study of potential knowledge-behavior gaps may uncover opportunities for additional HRI prevention strategies. Farmworkers and employers should be included in the development and evaluation of interventions to prevent HRI. A KO1 (new investigator) project proposal has been submitted by Dr. June Spector to investigate the association between heat stress, injury risk, and productivity in agricultural workers. We are also exploring a new project integrating a heat alert for the agricultural community on Washington State University's Ag Weather Net website.



M Lam, J Krenz, P Palmández, M Negrete, M Perla, H Murphy-Robinson and JT Spector. Identification of barriers to the prevention and treatment of heat-related illness in Latino farmworkers using activity-oriented, participatory rural appraisal focus group methods. BMC Public Health 2013, 13:1004-1015. See: http://www.biomedcentral.com/1471-2458/13/1004

Pilot: Transmission of Microorganisms in Dairy Farms (PNASH Pilot 2013-2014)

Dairy farming requires close contact between people and animals with transmissions that can be a source of zoonotic disease. In this small pilot a multidisciplinary team will survey work practices to provide insight into modifiable risk factors for microbial transmission with implications for the health of workers, dairy cows and the environment in a “One Health” model.

Prevention of Agricultural Injuries Resulting from Ladder Falls (NIOSH/CDC, 2000-2001)

Researchers evaluated a Washington State Department of Labor and Industries’ accident prevention program implemented by their Yakima regional office in Kittitas, Grant, and Adams counties. The three-year injury prevention program aimed to reduce the frequency and cost of claims that are related to falls from ladders in the orchard and to eye injuries. Researchers conducted semi-structured interviews with farm workers who were injured on the job following a fall from a ladder and who filed a claim prior to the L&I implementation of the prevention program. Information was collected on the circumstances of the injury, prior training, knowledge of and barriers to the use of preventive practices, and the injured worker’s perception of what could have been done to prevent the accident and related injury. Investigators then conducted field assessments of the level of program implementation and analyzed pre- and post-program claims data among intervention and non-intervention growers to determine the degree of program effectiveness.

Purse Seiner Survey (NIOSH/CDC, 1997-2000)

The objectives of this cross-sectional questionnaire study were to: estimate the frequency of injuries among Washington state purse seiners; identify major injury patterns among seiners; characterize the most hazardous tasks and potential methods for intervention among the purse seiner fleet.

Self-reporting and self-mailing questionnaires were distributed to the purse seiner fleet during the fishing season in southeast Alaska. The vast majority of these boats are owned and operated by Washington state residents.