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Introduction: Injuries at work may negatively influence mental health due to lost or reduced working hours and financial burden of treatment. Our objective was to investigate, in U.S. workers (a) the prevalence of serious psychological distress (SPD) by injury status (occupational, non-occupational, and no injury) and injury characteristics, and (b) the association between injury status and SPD. Methods: Self-reported injuries within the previous three months were collected annually for 225,331 U.S. workers in the National Health Interview Survey (2004–2016). Psychological distress during the past 30 days was assessed using the Kessler 6 (K6) questions with Likert-type scale (0–4, total score range: 0–24). SPD was defined as K6 ≥ 13. Prevalence ratios (PR) from fitted logistic regression models were used to assess relationships between injury and SPD after controlling for covariates. Results: The prevalence of SPD was 4.74%, 3.58%, and 1.56% in workers reporting occupational injury (OI), non-occupational injury (NOI), and no injury, respectively. Workers with head and neck injury had the highest prevalence of SPD (Prevalence: OI = 7.71%, NOI = 6.17%), followed by workers with scrape/bruise/burn/bite (6.32% for those with OI). Workers reporting OI were two times more likely to have SPD compared to those without injury (PR = 2.19, 95%CI: 1.62–2.96). However, there was no significant difference in SPD between workers with OI and workers with NOI (PR = 0.98, 95%CI: 0.65–1.48). Conclusion: The prevalence of SPD varied by injury status with the highest being among workers reporting OI. We found that the workers reporting OI were significantly more likely to have SPD than those without injury, but not more than those with NOI. Practical Applications: Mental health management programs by employers are necessary for workers who are injured in the workplace.

Introduction: Symptoms of depression and anxiety are a common consequence of occupational injury regardless of its cause and type. Nevertheless, mental health care is rarely covered by workers’ compensation systems. The aim of this study was to assess the use of mental health care post-injury. Methods: We used a subsample of patient-care workers from the Boston Hospital Workers Health Study (BHWHS). We matched one injured worker with three uninjured workers during the period of 2012–2014 based on age and job title (nurse or patient-care associate) and looked at their mental health care use pre- and post-injury using medical claims data from the employer sponsored health plan. We used logistic regression analysis to assess the likelihood of mental health care use three and six months post-injury controlling for any pre-injury visits. Analyses were repeated separately by job title. Results: There were 556 injured workers between 2012 and 2014 that were matched with three uninjured workers at the time of injury (n = 1,649). Injured workers had a higher likelihood of seeking mental health care services than their uninjured counterparts during the six months after injury (OR = 1.646, 95% CI: 1.23–2.20), but not three months post-injury (OR = 0.825, 95% CI: 0.57–1.19). Patient-care associates had a higher likelihood to seek mental health care post-injury, than nurses (OR: 2.133 vs OR: 1.556) during the six months period. Conclusions: Injured workers have a higher likelihood to experience symptoms of depression and anxiety based on their use of mental health care post-injury and use is more predominant among patient-care associates; however, our sample has a small number of patient-care associates. Practical Applications: Treating depression and anxiety as part of the workers’ compensation system has the potential of preventing further physical ailment and improving the return to work process regardless of nature of injury.

About NOIRS 2018: The National Occupational Injury Research Symposium (NOIRS) is the only regularly held research forum in the United States dedicated to occupational injury research and prevention. The 7th NOIRS, sponsored by the National Institute for Occupational Safety and Health (NIOSH) and several partners, was held October 16–18, 2018 in Morgantown, West Virginia. The symposium theme was “Advancing Worker Safety in the 21st Century through Research and Practice.” Article selection: This special issue of the Journal of Safety Research highlights exemplary research presented at the symposium, making it available to those who did not attend. The articles included in this issue address leading causes of occupational injury, cross-cutting issues such as organization-based prevention, and emerging issues associated with advancements in technology. The articles draw from public health, the social sciences, and engineering disciplines. Concluding remarks: Research presented at NOIRS over the years has expanded beyond describing occupational injuries and developing and evaluating intervention approaches, to studying how to ensure that research is put into practice. While there has been progress in advancing the prevention of occupational injuries, there is more to be done, and attention is needed to projected transformations in workplaces, work and the workforce. NIOSH looks forward to working with partners to co-sponsor the 8th NOIRS, tentatively planned for the fall of 2021, to present state-of-the art research to advance worker safety.

Objectives: To determine coders’ agreement level for the Occupational Injury and Illness Classification System (OIICS) source of injury and injury event codes, and the Farm and Agricultural Injury Classification (FAIC) code in the AgInjuryNews.org and to determine the effects of supplemental information and follow-up discussion in final code assignments. Methods: Two independent researchers initially coded 1304 injury cases from AgInjurynews.org using the OIICS and the FAIC coding schemes. Code agreement levels for injury source, event, and FAIC and the effect of supplemental information and follow-up discussions on final coding was assessed. Results: Coders’ agreement levels were almost perfect for OIICS source and event categories at the 3-digit level, with lower agreement at the 4-digit level. By using supplemental information and follow-up discussion, coders improved the coding accuracy by an average 20% for FAIC. Supplemental information and follow-up discussions had helped finalize the disagreed codes 55% of the time for OIICS source coding assignments and 40% of time for OIICS event coding assignments for most detailed 4-digit levels. Five key themes emerged regarding accurate and consistent coding of the agricultural injuries: inclusion/exclusion based on industry classification system; inconsistent/discrepant reports; incomplete/nonspecific reports; effects of supplemental information on coding; and differing interpretations of code selection rules. Practical applications: Quantifying the level of agreement for agricultural injuries will lead to a better understanding of coding discrepancies and may uncover areas for improvement to coding scheme itself. High level of initial and final agreement with FAIC and OIICS codes suggest that these coding schemes are user-friendly and amenable to widespread use.

INTRODUCTION: The National Occupational Injury Research Symposium (NOIRS) is the only national forum focused on occupational injury research findings, data and methods, and prevention strategies; it has been convened every 3–5 years since 1997. The theme of the sixth symposium, held in May 2015, was “Advancing Occupational Injury Research through Integration and Partnership.” Organizers requested that attendees complete a post-meeting evaluation to assess meeting impact, and gather information useful in planning subsequent meetings and activities. SURVEY INSTRUMENT/METHODS: The questionnaire was publicized via a quick response (QR) code and link to the survey on symposium book cover, and mentioned at each scientific session. The online survey was designed to be completed in about 15 minutes; no identifying information was collected. Survey link remained open for seven days post-symposium. SURVEY RESULTS: About 50% of registered attendees responded. Almost half were attending their first NOIRS. Most were researchers (69%); 45% were affiliated with government and 38% with university or research institute. Five of six reported that the symposium mostly or completely met expectations. Reasons for attending included gaining exposure to new areas of research (87%), sharing their research (80%), and to develop new ideas for conducting research (79%). The majority (90%) reported that the symposium provided adequate networking opportunities. The conference venue was reported as good or better by 69%, more so among repeat attendees (77%) compared to first-timers (61%). DISCUSSION: The evaluation demonstrated that NOIRS was valuable to attendees, and provided a forum for sharing research results, developing new research ideas, and networking. Respondents provided input on different aspects of NOIRS and suggestions useful in planning next NOIRS, tentatively scheduled for 2018. NOIRS 2015 objectives for integration across disciplines and partnership with industry and safety professionals were partially met. In planning NOIRS 2018, more attention should be paid to attracting and engaging a broader spectrum of attendees.

Introduction More than 5,000 fatalities and eight million injuries occurred in the workplace in 2007 at a cost of $6 billion and $186 billion, respectively. Neurotoxic chemicals are known to affect central nervous system functions among workers, which include balance and hearing disorders. However, it is not known if there is an association between exposure to noise and solvents and acute injuries. Method: A thorough review was conducted of the literature on the relationship between noise or solvent exposures and hearing loss with various health outcomes. Results: The search resulted in 41 studies. Health outcomes included: hearing loss, workplace injuries, absence from work due to sickness, fatalities, hospital admissions due to workplace accidents, traffic accidents, hypertension, balance, slip, trips, or falls, cognitive measures, or disability retirement. Important covariates in these studies were age of employee, type of industry or occupation, or length of employment. Discussion: Most authors that evaluated noise exposure concluded that higher exposure to noise resulted in more of the chosen health effect but the relationship is not well understood. Studies that evaluated hearing loss found that hearing loss was related to occupational injury, disability retirement, or traffic accidents. Studies that assessed both noise exposure and hearing loss as risk factors for occupational injuries reported that hearing loss was related to occupational injuries as much or more than noise exposure. Evidence suggests that solvent exposure is likely to be related to accidents or other health consequences such balance disorders. Conclusions: Many authors reported that noise exposures and hearing loss, respectively, are likely to be related to occupational accidents. Practical applications: The potential significance of the study is that findings could be used by managers to reduce injuries and the costs associated with those injures.

Introduction: Despite the rich tradition of research on predictors of workplace injury, most studies rely on cross-sectional, between-person designs. Furthermore, prior research has often overlooked the possibility that factors outside the work domain can influence the occurrence of actual injuries at work. To address these limitations, the current study examined the effects of work and family demands on the occurrence of workplace injury. Drawing on the intuition of the work-home resources model (W-HR), we investigated how within-person level changes in demands and resources from both domains influence work injuries over a 12-year period. Method: We used 12 years of longitudinal data (N = 7,820) to study the long-term within-person changes in work and family domains and to capture the event of low frequency incidence such as workplace injury. Specifically, we conducted multilevel analyses to study the links between within-person change in time and energy resources both in work and family domains and within-person change in the likelihood of experiencing a workplace injury. Results and conclusion: The findings showed that within-person changes in work hours, spousal work hours, income and number of children, were significantly associated with changes in the likelihood of experiencing a workplace injury. We conclude with a discussion of implications for theory and future research of workplace injuries. Practical application: The research provided useful insights on the intimate association between work and family domains in the context of safety management.

Introduction: Employers engaged in similar business activities demonstrate a range of workers' compensation claim rates. Workplace injuries and illnesses could be prevented if employers with high claim rates achieved the claim rates of their safer peers. Methods: We used Washington workers' compensation claims data for years 2013–2015 to calculate rates of compensable claims (eligible for disability or time loss benefits, if unable to work four days after injury) and total accepted claims (compensable plus medical-aid only claims) for each employer. We estimated the number and cost of claims to occur if employers with high claim rates reduced them to the rates of employers at the 25th percentile, adjusted for insurance risk class, employer size, and injury type. To evaluate the impact of setting more or less ambitious goals, we also estimated reductions based on claim rates at the 10th and 50th percentiles. Results: Over 43% of claims and claim costs would be prevented if employers with higher claim rates lowered them to the 25th percentile using either total accepted or compensable claim rates as the benchmark outcome. The estimated claim cost savings from benchmarking to compensable claims was nearly as great as the estimate based on benchmarking to total accepted claims ($308.5 mil annually based on compensable claims vs. $332.4 mil based on total accepted claims). Restaurants and Taverns had the greatest number of potentially prevented compensable claims. Colleges and Universities and Wood Frame and Building Construction had the greatest potential reduction in compensable claim costs among larger and smaller employers, respectively. Conclusion: Substantial reductions in workers' compensation claims and costs are possible if employers achieve the injury rates experienced by their safer peers. Practical application: Evaluating the range of workplace injury rates among employers within industry groups identifies opportunities for injury prevention and offers another approach to resource allocation.

Introduction Little is known about the effects of employee assistance programs (EAPs) on occupational injuries. Materials and methods Multivariate regressions probed a unique data set that linked establishment information about workplace anti-drug programs in 1988 with occupational injury rates for 1405 establishments. Results EAPs were associated with a significant reduction in both no-lost-work and lost-work injuries, especially in the manufacturing and transportation, communication and public utilities industries (TCPU). Lost-work injuries were more responsive to specific EAP characteristics, with lower rates associated with EAPs staffed by company employees (most likely onsite). Telephone hotline services were associated with reduced rates of lost-work injuries in manufacturing and TCPU. Drug testing was associated with reductions in the rate of minor injuries with no lost work, but had no significant relationship with lost-work injuries. Practical applications This associational study suggests that EAPs, especially ones that are company-staffed and ones that include telephone hotlines, may prevent workplace injuries.

Introduction The U.S. Coast Guard and Federal Occupational Safety and Health Administration have identified the Alaskan offshore seafood processing industry as high-risk. This study used Coast Guard injury reports to describe patterns of traumatic injury among offshore seafood processors, as well as identify modifiable hazards. Methods From the reports, we manually reviewed and abstracted information on the incident circumstances, injury characteristics and circumstances, and vessel. Traumatic injury cases were coded using the Occupational Injury and Illness Classification System, and a Work Process Classification System. Descriptive statistics characterized worker demographics, injuries, and fleets. Results One fatal and 304 nonfatal injuries among processors were reported to the Coast Guard during 2010–2015 across multiple fleets of catcher-processor and mothership vessels. The most frequently occurring injuries were: by nature of injury, sprains/strains/tears (75, 25%), contusions (50, 16%), and fractures (45, 15%); by body part affected, upper extremities (121, 40%), and trunk (75, 25%); by event/exposure resulting in injury, contact with objects and equipment (150, 49%), and overexertion and bodily reaction (76, 25%); and by source of injury, processing equipment and machinery (85, 28%). The work processes most frequently associated with injuries were: processing seafood on the production line (68, 22%); stacking blocks/bags of frozen product (50, 17%); and repairing/maintaining/cleaning factory equipment (28, 9%). Conclusions Preventing musculoskeletal injuries, particularly to workers' upper extremities and trunks, is paramount. Some injuries, such as serious back injuries, intracranial injuries, and finger crushing or amputations, had the potential to lead to disability. Practical applications Safety professionals and researchers can use the study findings to inform future intervention efforts in this industry. Hazard control measures should target: (a) overexertion from lifting and lowering objects and equipment; (b) equipment and boxes falling and striking workers; (c) workers being caught in running machinery during regular operations; and (d) slips, trips, and falls.

Introduction An increasing number of ethnic minorities (EMs) have been employed in the construction industry to alleviate severe labor shortages in many countries. Unfortunately, statistics show that EMs have higher fatal and non-fatal occupational injury rates than their local counterparts. However, EMs are often underrepresented in safety climate (SC) research as they are difficult to reach and gauge their perception. A positive relationship has been widely found between SC and safety performance. Understanding the safety perceptions of EMs helps to reduce injuries and improve their safety performance. Method Based on a sample of 320 EMs from 20 companies in the construction industry, exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were used to identify the SC factors of EMs, and validate the extracted factors, respectively. Multivariate analysis of variance was undertaken to examine mean differences in perceptions of SC by personal characteristics. Results Three SC factors for EMs encapsulating 16 variables were identified through EFA. The hypothesized CFA model for a three-factor structure derived from EFA showed a satisfactory goodness-of-fit, composite reliability, and construct validity. Conclusions Three SC factors were identified, namely: (a) safety management commitment, safety resources, and safety communication; (b) employee's involvement and workmate's influence; and (c) perception of safety rules, procedures and risks. The perceptions of SC differed significantly by nationality, marital status, the number of family members support, and drinking habit. Practical applications This study reveals the perception of EMs toward SC. The findings highlight the areas for safety improvement and provide leading indicators for safety performance of EMs. The findings are also enlightening for countries with a number of EMs, such as the United Sates, the United Kingdom, Australia, Singapore, and the Middle East.

Introduction The National Occupational Injury Research Symposium (NOIRS) is the only regularly held forum exclusively dedicated to occupational injury research and prevention. Method The 2015 conference theme, advancing occupational injury research through integration and partnership, shaped the conference and is reflected in articles selected for this special issue. Results' Conclusion The 6th NOIRS, held May 19–21, 2015, brought together more than 250 researchers, occupational safety practitioners and students to share and discuss occupational injury research. Articles in this special issue highlight some of the research presented at the conference, reflect multiple scientific disciplines and approaches, cover a breadth of occupational injury causes and worker populations, and provide examples of research advanced by partnerships. Practical Applications The next NOIRS, tentatively scheduled for 2018, will build upon the theme of integration and partnership as well as feedback from conference attendees.

Objectives The aim of this study was to examine utility of appending International Classification of Diseases (ICD) codes from Vital Statistics Mortality (VSM) data to Bureau of Labor Statistics (BLS) Census of Fatal Occupational Injuries (CFOI), and compare occupational event characteristics based on ICD external cause and BLS Occupational Injury and Illness Classification System (OIICS) event codes. Methods We linked VSM records with CFOI records for 2003 and 2004. Results Ninety-five percent of approximately 11,000 CFOI cases were linked to VSM cases. Linked data suggest that CFOI OIICS event and VSM ICD codes identified similar leading events. However, VSM data were generally less specific. Conclusion Lack of detail inherent in ICD codes and death narratives limits specificity of injury characteristics in VSM data. Appending ICD codes to CFOI appears to offer little value. Research comparing work- and non-work-related events may be better served by having a defined framework to crosswalk both coding schemes to facilitate comparisons. Impact on industry Over the last two decades, both ICD and OIICS have been used to characterize occupational injury circumstances; however, this is the first study to use linked case comparisons of the OIICS and ICD codes at a detailed level. This study confirmed that multiple source data systems provide more detail surrounding an incident than a single source data system does. Our results suggest that OIICS-coded CFOI data are a better source for occupational injury research and prevention purposes. For future comparison studies requiring ICD, it would be advantageous to have a defined framework that could easily be used to map both coding schemes (OIICS and ICD).

Objective This study describes injury characteristics and costs of work-related traumatic brain injury (WRTBI) among 16-24 year olds in Washington State between 1998 and 2008. Methods WRTBIs were identified in the Washington Trauma Registry (WTR) and linked to workers' compensation (WC) claims data. Medical and time-loss compensation costs were compared between workers with isolated TBI and TBI with other trauma. Results Of 273 WRTBI cases identified, most (61.5%) were TBI with other trauma. One-third of WRTBI did not link to a WC claim. Medical costs averaged $88,307 (median $16,426) for isolated TBI cases, compared to $73,669 (median $41,167) for TBI with other trauma. Conclusions Results highlight the financial impact of WRTBI among young workers. Multiple data sources provided a more comprehensive picture than a single data source alone. This linked-data approach holds great potential for future traumatic occupational injury research. Impact on Industry TBI among young workers not only involves long-term health and psychological impacts, but is costly as well.

Introduction Many non-battle injuries among deployed soldiers are due to occupational-related tasks. Given that non-battle injuries are a significant cause of morbidity and mortality, occupational safety and health are of great concern to the military. Some of the leading causes of non-battle injuries in the military are also common in non-military occupational settings. Nationally, falls and motor-vehicle accidents are leading causes of non-fatal occupational injuries in the civilian workforce. The objective of this research is to identify the leading causes, types, and anatomic locations of non-fatal non-battle injuries in Afghanistan and Iraq. Methods Non-battle injuries were identified from medical air evacuation records. Causes of air evacuated injuries were identified and coded using the diagnosis and narrative patient history in the air evacuation records. Descriptive statistics were used to report the air evacuated non-battle injury rates, causes, injury types, and anatomic locations. Results Between 2001 and 2013, there were 68,349 medical air evacuations from Afghanistan and Iraq. Non-battle injuries accounted for 31% of air evacuations from Afghanistan and 34% from Iraq. These injuries were the leading diagnosis category for air evacuations. The three leading causes of injury for Afghanistan and Iraq, respectively, were sports/physical training (23% and 24%), falls/jumps (19% and 16%), and military vehicle-related accidents (8% and 11%). The leading injury types were fractures (21%), overuse pain and inflammation (16%), and dislocations (11%). Practical applications Given that over 30% of medical evacuations of soldiers result from non-battle injuries, prevention of such conditions would substantially enhance military readiness during combat.

Introduction Workers in the electric power industry face many risks of injury due to the high diversity of work tasks performed in potentially hazardous and unpredictable work environments. Method We calculated injury rates by age, sex, occupational group, and injury type among workers in the Electric Power Research Institute’s (EPRI) Occupational Health and Safety Database (OHSD), which contains recordable injury, medical claims, and personnel data from 18 participating electric power companies from 1995 to 2013. Results The OHSD includes a total of 63,193 injuries over 1,977,436 employee-years of follow-up, for an overall injury rate of 3.20 injuries per 100 employee-years. Annual injury rates steadily decreased from 1995 to 2000, increased sharply in 2001, and subsequently decreased to their lowest rate of 1.31 injuries per 100 employee-years in 2013. Occupations with the highest injury rates were welders (13.56 per 100 employee-years, 95% CI 12.74–14.37), meter readers (12.04 per 100 employee-years, 95% CI 11.77–12.31), and line workers (10.37 per 100 employee-years, 95% CI 10.19–10.56). Males had an overall higher injury rate compared to females (2.74 vs. 1.61 per 100 employee-years) although some occupations, such as meter reader, had higher injury rates for females. For all workers, injury rates were highest for those in the 21 to 30 age group (3.70 per 100 employee-years) and decreased with age. Welders and machinists did not follow this trend and had higher injury rates in the 65 + age group. There were 63 fatalities over the 1995 to 2013 period, with 21 fatalities (33.3%) occurring among line workers. Conclusions Although injury rates have decreased over time, certain high-risk groups remain (i.e., line workers, mechanics, young males, older welders and machinists, and female meter readers). Practical applications Protective measures and targeted safety programs may be warranted to ensure the safety of electric power workers.

Occupational injuries are a relevant research and practical issue. However, intervention studies evaluating the effectiveness of workplace injury prevention programs are seldom performed.The effectiveness of a multifaceted intervention aimed at reducing occupational injury rates (incidence/employment-based=IR, frequency/hours-based=FR, severity=SR) was evaluated between 2008 and 2013 in 29 Italian foundries (22 ferrous; 7 non-ferrous; 3,460 male blue collar workers/year) of varying sizes. Each foundry established an internal multidisciplinary prevention team for risk assessment, monitoring and prevention of occupational injuries, involving employers, occupational physicians, safety personnel, workers' representatives, supervisors. Targets of intervention were workers, equipment, organization, workplace, job tasks. An interrupted time series (ITS) design was applied.4,604 occupational injuries and 83,156 lost workdays were registered between 2003 and 2013. Statistical analysis showed, after intervention, a reduction of all injury rates (-26% IR, -15% FR, -18% SR) in ferrous foundries and of SR (-4%) in non-ferrous foundries. A significant (p=0.021) 'step-effect' was shown for IR in ferrous foundries, independent of secular trends (p0.001). Sector-specific benchmarks for all injury rates were developed separately for ferrous and non-ferrous foundries.Strengths of the study were: ITS design, according to standardized quality criteria (i.e., at least three data points before and three data points after intervention; clearly defined intervention point); pragmatic approach, with good external validity; promotion of effective good practices. Main limitations were the non-randomized nature and a medium length post-intervention period. In conclusion, a multifaceted, pragmatic and accountable intervention is effective in reducing the burden of occupational injuries in small-, medium- and large-sized foundries. Practical Applications: The study poses the basis for feasible good practice guidelines to be implemented to prevent occupational injuries, by means of sector-specific numerical benchmarks, with potentially relevant impacts on workers, companies, occupational health professionals and society at large.

Introduction A 2009 Government Accounting Office (GAO) report, along with numerous published studies, documented that many workplace injuries are not recorded on employers' recordkeeping logs required by the Occupational Safety and Health Administration (OSHA) and consequently are under-reported to the Bureau of Labor Statistics (BLS), resulting in a substantial undercount of occupational injuries in the United States. Methods OSHA conducted a Recordkeeping National Emphasis Program (NEP) from 2009 to 2012 to identify the extent and causes of unrecorded and incorrectly recorded occupational injuries and illnesses. Results OSHA found recordkeeping violations in close to half of all facilities inspected. Employee interviews identified workers' fear of reprisal and employer disciplinary programs as the most important causes of under-reporting. Subsequent inspections in the poultry industry identified employer medical management policies that fostered both under-reporting and under-recording of workplace injuries and illnesses. Conclusions OSHA corroborated previous research findings and identified onsite medical units as a potential new cause of both under-reporting and under-recording. Research is needed to better characterize and eliminate obstacles to the compilation of accurate occupational injury and illness data. Practical applications Occupational health professionals who work with high hazard industries where low injury rates are being recorded may wish to scrutinize recordkeeping practices carefully. This work suggests that, although many high-risk establishments manage recordkeeping with integrity, the lower the reported injury rate, the greater the likelihood of under-recording and under-reporting of work-related injuries and illnesses.

Problem Although parking facilities are a common feature of the landscape in the United States, little is known about their safety. Method A dataset of parking lot fatalities for 1993–2002, created from the Census of Fatal Occupational Injury (CFOI) research file, was analyzed. Results The most common events in parking lots were contact with objects (15%), pedestrian fatalities (13%), homicides (36%), and suicides (11%). The perpetrators of parking lot fatalities, compared to all workplace homicides, were more likely to be known to the victim. Conclusion The 206 work–related fatalities per year in parking lots present challenges to the safety community. Although much of the risk results from the usage of motor vehicles, violent acts are even more prominent. Impact on industry Because homicides are most prevalent in parking lots, both administrative and environmental measures may lower the risk of homicide. Although difficult to assess, various elements of the design of parking facilities may have an influence on the occurrence of injuries.

Background Commercial fishing is carried out worldwide, often in non-industrialized forms, and is associated with high rates of fatal and non-fatal occupational injury. Problem Fishermen who work independently in non-industrialized settings do not have access to union or industry sponsored safety services and must make their own decisions about safety practices. Learning the meaning of safety for them and the safety measures they employ is important before developing interventions. Methods Two fieldworkers conducted in-depth ethnographic interviews with 31 commercial fishermen in North Carolina. Interviews and fieldnotes were analyzed using QSR N5. Results Fishermen primarily related staying safe to work practices and attitudes. They identified specific safety measures, appropriate gear and boat maintenance, weather decisions, and working cooperatively when ocean fishing. Discussion The ethnographic research process can produce information about a group's norms of preventive behavior and safety concerns. Knowledge of workers' concepts and practices will inform researchers' inquiries.

For 2-1/2 days in October, 2011, more than 200 researchers convened at the 5th National Occupational Injury Research Symposium (NOIRS) to celebrate advances and successes in the field, to learn from each other about recent and ongoing occupational injury research, and to network and establish new professional relationships to advance occupational injury research in the future. This special issue highlights some of the research presented at that meeting. There has been considerable progress in research and worker safety since the first NOIRS in 1997, with demonstrated reductions in worker deaths and injury, an increased depth and breadth of research, and the development and validation of prevention strategies. Despite this progress, occupational injuries continue to exert too high a toll on workers, employers and society, and there are numerous challenges that need to be addressed to continue advancements in worker safety.

Problem: The study examined risk factors for fatal versus serious injuries of construction workers' falls through roofs. Method: Fatal injury falls ( N =10) were matched against serious injury falls ( N =10), and descriptive analyses were carried out retrospectively of investigation reports. Results: Fatal injuries occurred predominantly on farms, in the afternoon, and without the use of passive personal fall protective equipment (PPFPE; safety net, lifeline, etc.). In contrast, serious injuries disproportionately occurred in the morning hours, and were likely due to decreased risk perceptions and less safe behavior, possibly as the result of the greater use of PPFPE. Summary: Risk factors for fatal and serious roof fall injury incidents differ in terms of farm/nonfarm location, time of day, and use of PPFPE. Impact on industry: Occupational injury incident surveillance systems need to collect data systematically regarding the status and role of personal protective equipment (PPE).

Problem: The U.S. government's annual workers' compensation tab for work-related injuries and illnesses incurred by its civilian labor force has been substantial, totaling US$2 billion in 2000. To control these costs, federal agencies rely primarily on annual or prevalence-based cost accounting to evaluate the effectiveness of injury prevention efforts. Since most of the annual bill is for the older, persistent and costlier cases, this approach may obscure recent safety trends and can lead to faulty assumptions. Solution: Researchers analyzed Department of the Navy workers' compensation costs using an incidence-based approach. This method considers only new injuries and illnesses occurring in a given year and projects their likely course, duration, and long-term associated costs, providing the truest measure of the costs of that year's operation. Discussion: We trace the history of workers' compensation cost estimation in the federal government, discuss the drawbacks of using annual instead of projected long-term costs to evaluate work site prevention and control efforts, present health economics and insurance industry alternatives, and make a case for adopting an incidence approach. Impact on Government and Industry: The incidence approach promotes fiscal accountability and cost containment in both public and private sectors, allowing managers to accurately evaluate the impact of prevention and return-to-work programs. By identifying the actual costs of new mishaps, this technique allows organizations to hold managers accountable for the costs incurred specifically during their tenure and is the most suitable technique for assessing performance.

This study is concerned with the longitudinal representation of injury risk obtained using alternative injury-rate denominators—hours worked and production volume. It investigates injury risks at the underground extraction phase in a Swedish iron-ore mine. Six stages of mining development are defined, and three risk measures are employed: average injury rates (AIRs) by stage, injury rate ratios (IRRs) by stage, and annual injury rates (AnIRs). The two denominators give a quite different representation of injury risk at the early stages of the development of the mine, but tend increasingly to provide a similar picture (similar ratios) at later stages. It is concluded that automated production processes, as opposed to mechanized ones, tend to make hours worked and production volume interchangeable denominators. Choice of appropriate denominator may depend upon whether the individual or the production process is in focus.

When studying occupational agricultural injury death, it is necessary to use a case definition that includes occupational exposure in an agricultural environment. Of 504 total deaths identified using the three different definitions, only 36 cases were captured by all three. This study shows that using three different definitions (a. Externally caused death with place listed as farm; b. Injury at Work box checked yes or unknown, agricultural industry or occupation, and external cause of death; and, c. E-code 919.0) similar demographic profiles are produced. However, the external cause, the location of the worker at time of injury, and the occupation of the injured varied depending upon the definition used. If the goal is preventing all injury deaths related to agriculture, it may be necessary to consider a broad definition of occupational injury when analyzing death certificate data. It may be necessary to include deaths of people who were exposed (but not working with) agricultural hazards, in addition to only using deaths identified through the injury at work box.

Injuries both on the job and off cost employers about $200 billion annually, or $1,700 per employee. Injuries to workers and their families generate an estimated 29% of employers' health-related fringe-benefit costs, including 19% of health-care costs and 46% of disability costs. Occupational injuries cost employers around $155 billion, three-fourths of the total, and over $1,400 per injury. Non-work injuries cause one-fourth of employer injury costs and 42% of injury fringe-benefit costs. Annually they cost employers $45 billion, or $380 per employee. Highway crashes cost employers $56 billion per year—$38 billion from occupational crash injuries, $15 billion from off-the-job crash injuries to employees and their families, and over $3 billion in property damage and repair costs. Highway crash injuries account for nearly one-fourth of occupational injury costs to employers. Occupational crashes cost employers $80,000 per million vehicle-miles of travel, or $23,000 per crash.

Attempts to evaluate occupational injury surveillance systems have centered on employer compliance. Surveillance systems also rely on employees reporting injuries, and the reliability of such reporting is unknown. In this study of hospital environmental service workers, 29.2% (108 of 372) recalled having been injured in the previous year, and of these, 38.9% (42 of 108) had not reported one or more injuries. Among those injured, older workers (mean age 40.6 years vs. 36.2 years; p = 0.024) and those having worked longer at the same job (mean duration 6.7 years vs. 4.3 years; p = 0.032) were more likely to not report an injury. The most frequently cited reason for not reporting was that the injury had seemed too minor, though 64.4% of unreported injuries required medical care and 44.1% resulted in lost work time.

Problem Non-fatal type II violence experienced by hospital workers (patient/visitor-on-worker violence) is not well described. Methods Hospital administration data (2004-2009) were examined for purposes of calculating rates of type II violent events experienced by workers. We also conducted a review of the hospital-based literature (2000-2010) and summarized findings associated with type II violence. Results 484 physical assaults were identified in the data, with a rate of 1.75 events/100 full-time equivalents. Only few details about events were captured, while non-physical events were not captured. The literature yielded 17 studies, with a range proportion of verbal abuse (22%–90%), physical threats (12%–64%) and assaults (2%–32%) reported. The literature lacked rigorous methods for examining incidence and circumstances surrounding events or rates of events over time. Discussion For purposes of examining the impact of type II violence on worker safety, satisfaction and retention, rigorous surveillance efforts by hospital employers and researchers are warranted.

Introduction Although much is known about the distribution of occupational injury in terms of various job and employment factors, considerably less is known about other possible risk factors, particularly those involving psychosocial and organizational factors. These factors have not been emphasized in most injury surveillance systems or large scale, population based surveys. Method In this study, data from the 2002 General Social Survey (GSS) and NIOSH Quality of Work Life (QWL) module were used to examine the risk of occupational injury in terms of socio-demographic factors, employment characteristics, and organizational factors. Results The most informative results were obtained from Poisson regression analyses, which identified race, occupational category, and work-family interference as risk factors, and safety climate and organizational effectiveness as protective factors for occupational injury. These results provide guidance for targeting interventions and protective measures to curtail occupational injury in the United States.

Problem Construction risk management is challenging. Method We combined data on injuries, costs, and hours worked, obtained through a Rolling Owner-Controlled Insurance Program (ROCIP), with data from focus groups, interviews, and field observations, to prospectively study injuries and hazard control on a large university construction project. Results Lost-time injury rates (1.0/200,000 hours worked) were considerably lower than reported for the industry, and there were no serious falls from height. Safety was considered in the awarding of contracts and project timeline development; hazard management was iterative. A top-down management commitment to safety was clearly communicated to, and embraced by, workers throughout the site. Discussion and Impact A better understanding of how contracting relationships, workers' compensation, and liability insurance arrangements influence safety could shift risk management efforts from worker behaviors to a broader focus on how these programs and relationships affect incentives and disincentives for workplace safety and health.

While agricultural injury has been identified among the major causes of occupational injury mortality and morbidity, data have been limited pertinent to the magnitude, consequences, and potential risk factors for animal-related injuries -- a major source of morbidity among agricultural operations.Demographics, exposure, and injury data were collected for 1999 and 2001 among agricultural households in a five-state region. Causal models facilitated survey design, data analyses, and interpretation of results; directed acyclic graphs guided multivariate modeling.From 7,420 households (84% response of eligible), a total of 5,045 injury events were reported; 1,016 (20.1%) were animal-related. Multivariate analyses revealed increased risks for those20 years; residents of all states compared to Minnesota; all age groups compared to 0-4 years;0 hours worked; and prior agricultural injury history. For those 20+ years, increased risks were identified for: South Dakota residents; males;0 hours worked; and prior agricultural injury history. For those cases20 and 20+ years of age, 58% and 46%, respectively, resulted in lost work time on their agricultural operations (31% and 50%, one week or more).Animal-related injury has a major impact on the agricultural industry. Results serve as a basis for interventions and further research.The impact of animal-related injuries on the agricultural industry appears significant; among age groups20 and 20+, 85% and 82%, respectively, had some resulting restriction. For all events combined, 29% and 30%, respectively, involved restriction from one week to 3+ months; 12% and 15% involved restriction for one month or more. Among those20 and 20+ years of age, 58% and 46%, respectively, lost work time on their own agricultural operation as a result of injuries associated with their own operation; 22% and 15% lost one week or more. Moreover, of the non-agriculture-related injuries, 31% and 50% resulted in lost work time on their own operation; 15% and 28%, respectively, lost one week or more. Restrictions such as these can affect the productivity of the operation, resulting in financial impacts, especially on small operations that have few people to manage the required tasks.

Problem National occupational injury prevention goals often prioritize the reduction of serious injuries. This study analyzed whether this prioritization is credible in respect to lost-time injuries and short and long term work absence, and the implications this has for injury severity-based versus injury absence-based prevention approaches. Method The data consisted of national and work-site specific injury and absence data from construction workers in Denmark, including workers from the Copenhagen Metro construction sites, during the period 2000–2001. Results and impact on industry and government Absence length was significantly dependent on the type of injury. Sprains and strains were most prevalent and accounted for approximately one third of injuries and absence. Fractures accounted for one sixth of injuries and the greatest proportion of long-term absence. The results give credibility to the need for targeting sprains and strains in injury and absence prevention initiatives.

Problem: Two questions were posed in this global literature review: Do young workers have a higher occupational injury rate? Are the injuries of young workers more often fatal than those of older workers? Method: The studies of nonfatal and fatal injuries were collected based on the following criteria: (a) published in peer-reviewed journals; (b) the young workers were under 25 years of age; (c) the injury rate or fatality rate of young workers and the overall rate was published; and (d) description of the population and the number of injuries was presented. Results: The majority of 63 nonfatal studies reported showed that young workers had a higher injury rate than older workers. Twenty-nine out of 45 studies on fatal occupational injuries indicated that young workers had a lower fatality rate than older workers. These results are clearer for men than for women. Impact on industry: The results showed that young men were a risk group for occupational injuries. However, the injuries of young workers were reported as less often fatal than those of older workers.

INTRODUCTION: Using different methods, two national systems compile fatal occupational injury data in the United States: the National Institute for Occupational Safety and Health (NIOSH) National Traumatic Occupational Fatalities (NTOF) surveillance system, and the Bureau of Labor Statistics (BLS) Census of Fatal Occupational Injuries (CFOI). The NTOF uses only death certificates, while CFOI uses multiple sources for case ascertainment. METHODS: Through overall and case-by-case comparisons, this study compares these systems and evaluates counts for the nation and by state for worker and case characteristics. RESULTS: From 1992 through 1994, NTOF reported an average of 84% of the number of traumatic occupational fatalities reported in CFOI. This percentage changed somewhat when a case-by-case comparison was conducted--88% of the NTOF cases were matched directly to the CFOI cases. Although CFOI captured a larger number of fatalities annually, the additional fatalities did not follow a discernable pattern. IMPACT ON INDUSTRY: By understanding the distribution of fatalities, targeted efforts to reduce them will benefit all industries.

Method: A 24-week experiment was conducted to assess how first aid training affects the motivation of small business construction industry employees in avoiding occupational injuries and illnesses and its effect on their occupational health and safety behavior. A simplified multiple baseline design across workplace settings was used to evaluate the effects of first aid training. Participants' motivation to control occupational safety and health risks was explored during in-depth interviews before and after receipt of first aid training. Objective measurement of occupational safety and health behavior was conducted by a researcher directly observing the workplace before and after participants received first aid training. Results: The observations at participants' worksites suggested that, for the most part, the first aid training had a positive effect on the occupational safety and health behavior of participants. First aid training appeared to reduce participants' “self–other” bias, making them more aware that their own experience of occupational safety and health risks is not beyond their control but that their own behavior is an important factor in the avoidance of occupational injury and illness. First aid training also appeared to reduce participants' willingness to accept prevailing levels of occupational safety and health risk and increase the perceived probability that they would suffer a work-related injury or illness. Participants expressed greater concern about taking risks at work after receiving first aid training. Impact on Industry: It appears that first aid training enhances participants' motivation to avoid occupational injuries and illnesses and improves their risk control behavior. The implications of this are that first aid training can have a positive preventive effect and could complement traditional occupational health and safety training programs. As such, there may be benefit in providing first aid training to all employees rather than limiting this training to a small number of designated “first aiders.”

This report describes an analysis of existing occupational injury data concerning stairway-related falls. Injury data based on reports obtained from the Ohio and California workers' compensation agencies were analyzed to identify common stair injury patterns. Frequency tabulations are provided for the following factors: (a) location (indoors vs. outdoors, on vs. off employer's premises, site category); (b) task (ascending vs. descending, body movement on the stair, task being attempted); and (c) events (precipitating actions and conditions). One of the most outstanding findings is that 92 % of the injuries occurred when the worker was descending the stair, i.e., 636 of the 688 cases in which direction of travel was indicated. Additionally, injury records from the New York and Ohio workers' compensation agencies were used to rank industries in terms of combined frequency and severity rates of stairway-related injuries.

A generalized power model is proposed as a description of the relationship between the frequencies of different classes of accidents and their rank order. In order to test the validity of this model, empirical analyses have been made of reported statistics for total accidents and home accidents as well as for occupational injury or illness. On the basis of these analyses, the proposed frequency-rank relationship appears to be an appropriate empirical model, which provides highly respectable fits to the great majority of the analyzed data. Two of the model parameters account for the frequency variations between ranks and are related to the notion of accident variety (diversity) for which some quantitative measures are proposed. The values of the variety measures are calculated for each set of accident data and some explanations and interpretations are offered.