JOURNAL REVIEWS

Peek-Asa C, Erickson R, Kraus JF. Traumatic occupational fatalities in the retail industry, United States 1992-1996. Am J Ind Med 1999; 35:189-191.

People working in the retail industry have a lower risk of most types of workplace deaths than other workers, but they are at dramatically increased risk of violent death on the job, according this study. These researchers from the University of California-Los Angeles reviewed 3,692 occupational deaths among retail industry workers for the years 1992 through 1996, using data from the federal Department of Labor’s Census of Fatal Occupational Injuries.

They found that liquor stores had the highest work-related fatality rates in the retail industry. The two leading causes of death in the retail industry were violence, accounting for 69.5%, and motor vehicle crashes, accounting for 19.3%. Females, younger, minority, and foreign-born workers were more likely to be killed in retail than other industries. The researchers determined that deaths in retail industry were more likely to be in small businesses, after normal business hours, and in urban settings.

The work-related fatality rate ranged between 2.97 and 3.27 per 100,000 workers. Of the 2,411 retail workers killed at work in the study period, 2,017 were shot, 215 were stabbed, and 90 were hit or kicked to death. Another 89 were killed in other ways.

"The greatest increase in deaths over the five-year period was in drinking establishments, in which work-related deaths increased by 50% from 1995 to 1996," the researchers note. "The causes of this increase have not yet been explained."

Death rates and the proportion of deaths due to violence were lower for general merchandise, home furnishing, and drug stores. The researchers surmise that the risk is lower in general merchandise and home furnishing stores because they usually are not open late and often are in shopping malls.

Fenster L, Waller K, Chen J, et al. Psychological stress in the workplace and menstrual function. Am J Epidemiol 1999; 149:127-134.

Stressful jobs can cause an abnormal shortening of the menstrual cycle in some women, according this study from the Department of Health Services in Emeryville, CA. The research involved 276 healthy premenopausal women who were asked to keep a daily diary and provide daily urine samples. The women provided information on an average of five menstrual cycles, and they also participated in a telephone interview.

Metabolites of estrogen and progesterone were measured in the urine, and computer algorithms were developed to characterize each cycle as ovulatory or anovulatory and to select a probably day of ovulation. The telephone interview was used to collect information about psychological stress at work as well as other occupational, demographic, lifestyle, and environmental factors. The researchers found that stressful work, defined as high demands with little control, was not strongly associated with an increased risk for anovulation, cycle variability, short luteal phase, long follicular phase, long menses, or long cycle.

However, the researchers found that women in stressful jobs had a more than doubled risk for short cycle length, less than 24 days, compared with women not working in stressful jobs. One possible explanation for the connection is that luteinizing hormone secretion has been inhibited by an increase in corticotropin-releasing hormone or glucocorticoid.

"Menstrual outcomes are important as they may be intervening mechanisms or markers for other health outcomes such as fertility, osteoporosis, and breast cancer," the researchers write. "For example, breast cancer may be increased among women with shorter menstrual cycle lengths, because it is thought that breast cancer risk may be decreased among women with fewer total lifetime ovulatory menstrual cycles."

Glazner JE, Borgerding J, Bondy J, et al. Contractor safety practices and injury rates in construction of the Denver International Airport. Am J Ind Med 1999; 35:175-185.

This study involved a number of contractors and subcontractors who participated in the construction of the Denver International Airport, seeking to explain the variation in injury rates. The researchers found that certain factors could be associated with a lower incidence of lost-time injuries, but there also were some surprising results suggesting that some accepted safety practices did not have such a positive effect.

The authors conducted 213 telephone interviews with representatives of contractors and obtained information about certain safety policies and practices, comparing that information with available data on lost-time and non-lost-time injury rates. They identified several factors that were significantly associated with a lower rate of injury on the job.

Regarding lost-time injuries, lower rates were associated with a policy requiring disciplinary action whenever safety rules were violated, and selecting subcontractors who had better experience modification ratings. With non-lost-time injuries, three actions were identified as leading to lower injury rates: management always establishing safety goals for supervisors, conducting drug testing at times other than badging and after accidents, and completing the contract on budget.

The data analysis also showed that contractors who consistently followed a number of safety practices actually had higher injury rates, a finding that the researchers found difficult to explain. They hypothesize that the result may have been a methodological fault, attributable to the fact that many of the interviews took place a year or more after work on the airport was complete. It is possible, they say, that the contractors had improved safety practices since the airport work, possibly in response to a high number of injuries in the airport project. If so, the contractors may have mistakenly reported that they followed certain practices during the airport work when they actually adopted them later.

Melhorn JM. The impact of workplace screening on the occurrence of cumulative trauma disorders and workers’ compensation claims. J Occ Envir Med 1999; 2:84-89.

Education programs that include individual risk screening can have a positive effect on the incidence of cumulative trauma disorders and related workers’ compensation claims, according to these researchers.

The study was prompted by the concerns of employers that close monitoring of musculoskeletal disorders and workplace risks will cause a sharp increase in the number of OSHA 200 events and workers’ comp claims. Such fears appear to be unfounded, the researchers say.

Employers have been encouraged to establish ergonomic prevention programs, but the researchers say many employers resist because they fear the costly side effects of such a program. The potential effects were studied at a financial institution with 82 employees in six branch offices.

Records from a four-year period were studied to determine the incidence of cumulative trauma disorders and workers’ comp claims, then those results were compared to the same figures after the employees were educated about musculoskeletal risks using a program approved by the federal Occupational Safety and Health Administration in Washington, DC. The program included an assessment of the risk for the individual workers.

The researchers found that there was no increase in the number of OSHA 200 events and no increase in the incidence of workers’ compensation claims after completion of the education program and risk assessment.

"Incidence of cumulative trauma disorders has been most effectively reduced by use of individual risk-screening programs," the researchers note. "Therefore, employers should be encouraged to develop and implement prevention programs that include individual risk screening." t

Repace JL, Jinot J, Bayard S, et al. Air nicotine and saliva cotinine as indicators of workplace passive smoking exposure and risk. Risk Analysis 1998; 18:71-82.

Measurements of nicotine in the air and saliva of nonsmoking workers can determine how much increased risk of cancer is faced by workers exposed to the smoking of co-workers, according to this study.

The authors suggest that the study results could be used to counter claims by the tobacco industry that exposure to tobacco in the workplace poses little risk.

The federal Occupational Safety and Health Administration (OSHA) in Washington, DC, has proposed a rule to eliminate nonsmokers’ exposure to environmental tobacco smoke in the workplace, but the tobacco industry has challenged the proposal by asserting that tobacco exposures in the workplace are very low and that any risk is not significant enough to warrant control with an OSHA rule.

The authors measured the nicotine levels in the air in a number of workplace settings and also the saliva cotinine in nonsmoking workers to determine how much nicotine they had ingested. Their findings suggest that workers often are exposed to significant levels of tobacco in the workplace.

They estimate that an average salivary cotinine level of 0.4 ng/ml corresponds to an increased lifetime mortality risk of 1/1,000 for lung cancer and 1/100 for heart disease. More than 95% of workers exposed to environmental tobacco smoke in the workplace exceeded OSHA’s significant risk level for heart disease mortality, and 60% exceed the significant risk level for lung cancer mortality.

"Our model suggests that at the current 28% prevalence of unrestricted smoking in the office workplace, passive smoking creates a significant risk, causing an estimated 4,000 heart disease deaths and 400 lung cancer deaths annually among nonsmoking office workers," the researchers conclude.