PUBLIC HEALTH BRIEFS
Identification of Hawaii's Occupational Health Hazards: A Preliminary Study J. MARC ROSEN, MPH, AND SHERRY J. HANEN, MPH
Introduction There is insufficient information about the incidence, prevalence, nature, and distribution of occupational illness and disease both nationally and in Hawaii, with report rates ranging from four cases/1,000 workers/year' to a recently reported rate of 284 cases/1,000 workers/year.2 Overall rates do not provide information which can be utilized to delineate the health hazard target areas. Tabulations are needed concerning the relationship between the worker, the type of work performed, the hazard, and the subsequent illness. The purpose of this study was to obtain data which could be utilized in planning occupational health activities in Hawaii, as the State was preparing to assume Occupational Safety and Health responsibility from the federal Occupational Safety and Health Administration. The project was begun in March 1973 and completed in October 1973; the data continue to be used by Hawaii's Division of Occupational Safety and Health. Unfortunately, current records kept for occupational illness cases in Hawaii are of little or no value. The Worker's Compensation Division of the Department of Labor and Industrial Relations (DLIR) regularly collects all WC claim forms and the Research and Statistics Office compiles and tabulates the gathered data. The problem lies in the lack of attention given the illness/disease data. The illness/diseases are coded as one of the 20 ill-defined and often esoteric groupings, such as antibiotics, undulant fever, anthrax, etc. Display of this coded data is limited to one simple table per calendar year.
study. The major task, then, was to return to the original source documents (WC-I Forms for the year 1972) and individually recode each case according to the most effective format as an expedient means of characterizing the employee, his work, and related illness. Once the WC-1 forms were obtained, they were coded according to the following major categories: location, industry, occupation, hazard, and resulting illness. The industry code used was Standard Industrial Classification (SIC); occupations were from Dictionary of Occupational Titles (DOT); hazard and illness codes were adopted from California's Division of Labor Statistics and Research and based on the International Classification of Diseases (ICDA). Following this hand-coding, the cases were key punched onto cards, several computer programs were written (using SPSS-Statistical Package for Social Sciences) and the data (1326 cases) tabulated and cross-tabulated accordingly.
Results By island, the predominantly agricultural islands of Lanai and Molokai had the highest incidence of occupational illnesses with a combined rate of 15.52 cases/1,000 employees/year. Hawaii reported a rate of 7.31, while Maui, Oahu, and Kauai reported rates of 5.34, 4.00, and 3.66, respectively. The overall State rate was 4.43. Classified according to SIC, the construction industry contributed 24.4 per cent of the total illnesses with a rate of 13.98. Durable manufacturing and agriculture followed with rates of 10.50 and 7.25 (see Table 1). Occupationally, laborers (mainly construction workers) and farm workers had ex-
Methodology It was recognized that data directly pertinent to the entire workforce must be utilized in order to anticipate and meet the industrial hygiene needs of Hawaii's employees. The Worker's Compensation Division of the DLIR was the only agency collecting such data, although, their illness coding was less than optimally useful. It was impossible, with no funds available for this project, to conduct a data-gathering Address reprint requests to J. Marc Rosen, MPH, Public Health Analyst, Stanford Research Institute, 1611 N. Kent Street, Arlington, VA 22209. Ms. Hanen is a Public Health Analyst with the Institute. At the time the research was conducted, the authors were with the State of Hawaii, Department of Labor and Industrial Relations, Division of Occupational Safety and Health, Honolulu, HI. This paper, which was presented at APHA's 103rd Annual Meeting in Chicago, November, 1975, was revised and accepted for publication in the Journal on February 16, 1976. AJPH May, 1976, Vol. 66, No. 5
TABLE 1-Occupational Illness by Industry n
Construction Durable Manufacturing Nondurable Manufacturing Transportation, Communication, Utilities Wholesale Trade Retail Trade Finance, Real Estate,
323 50 89
13.98 10.50 4.43
98 84 151
4.03 5.33 2.62
Insurance Hotels Other Services Government
41 117 127 166 80
2.08 6.56 2.71 2.85 7.25
*Illness cases per 1,000 employees durng 1972.
PUBLIC HEALTH BRIEFS
tremely high rates of 20.06 and 14.55. These two groups of employees are Hawaii's target population in terms of industrial hygiene needs. As for reported illnesses, eye conditions (primarily conjunctivitis) contributed 46.6 per cent of all cases. Dermatitis and all other dermal infections accounted for 34.4 per cent of the total. Bursitis and other conditions involving repeated motion, with 4.7 per cent of the cases, were the most common conditions after eye and skin problems. The combination of organic and inorganic dusts ranked as the most prevalent occupational hazard, comprising 14.2 per cent of the total. Detergents-cleaners was next, being involved in 12.7 per cent of the cases. Organic chemicals followed with 11.2 per cent (see Table 2). The possible cross-tabulations and further calculations in this study are almost infinite, and only a portion of the results can be outlined in this paper. A brief probable causation chain of three of the most obvious and direct illness relationships is given below: OCC/S.I.C.
Construction Hotel & Service Farming
These findings are primarily useful as initial indicators of Hawaii's occupational illness target areas. The delineation of certain occupations and industries as illness-prone can be quite useful by the Division of Occupational Safety and Health. It is expected that the data will be used for educational, informational, and enforcement activities. The prime recipient of these data is the recently operational Occupational Health Branch. Ongoing c6llection and evaluation will allow the Branch to develop an effective Inspection Scheduling System and to plan and conduct industrial hygiene inspections efficiently. These statistics and target areas are presently being used by the Division's staff to educate the employees working in the high-risk fields through classroom presentations and workshops. Through the media of television, radio, trade papers, daily newspapers, and Division publications many more affected employees may be reached and at least informed of hazards. Also, additional detailed material about specific situations can be developed and distributed as the need and/or demand arises. It is imperative to recognize the inherent shortcomings in utilizing data drawn from Worker's Compensation files. A major problem is the severe under-reporting of compensable claims because of employer pressure to avoid economic loss. Also, employee reluctance to file for compensation biases the reported rates. The fact that the data used in this study are "first reports" of injury/illness reflects a lack of certainty concerning occupational causation. Further, many occupational illnesses are not recognized because of (1) lack of char-
188 99 23 66 38 52 49 30 149 29 169 101 43 98 54 137 142 47
Dust Inorganic Organic Other and Unclassified Gases Pesticides Other Agricultural Chemicals Metals Organic Chemicals Inorganic Chemicals Detergents and Cleaners Cement, Paint, etc. Plant & Animal Products Food Products Infectious Agents Environment Miscellaneous Unknown
HAZARD Foreign Bodies/Dust Detergents & Cleaners Fruit & Nut/Chemicals -
TABLE 2-Occupational Hazards
Per cent of Total
14.2 7.5 1.7 5.0 2.9 3.9 3.7 2.3 11.2 2.2 12.7 7.6 3.2 7.4 4.1 10.3 10.7 3.5
ILLNESS Conjunctivitis Contact Dermatitis Contact Dermatitis
acteristic symptoms, (2) long period of exposure required, (3) long latency period between exposure and illness, and (4) unfamiliarity of most physicians with the industrial conditions under which their patients are exposed. The problem of reliable and valid coding of the data will be partially overcome as the Hawaii Department of Labor personnel become familiar with the data and coding procedures. For example, although the reporting of 46.6 per cent of all cases of conjunctival in nature is formally accurate, most cases can be better classified as safety problems-that is, eye protection would have in most cases prevented the foreign body from entering the eye, hence, no "illness" would have resulted. This distinction between safety and health is not at all clear, and therefore some discrepancies in these data will always be present. It is our intention to report as illnesses those cases which are not usually preventable by traditional "safety" measures. A final encouraging note is that this preliminary study is being used as a model from which to plan a computer-based occupational safety and health information system which will regularly generate statistics for utilization by the Division of Occupational Safety and Health. In this way, current statistics will be the basis for planning the Division's program.
REFERENCES 1. State of Hawaii. 1973 Occupational Injuries and Illnesses Survey. pg. 2, 1975. 2. Discher, D. P. Pilot Study for Development of an Occupational Disease Surveillance Method. U.S. Department of Health, Education, and Welfare. pg. 41-42, 1975.
AJPH May, 1976, Vol. 66, No. 5