AMERICAN JOURNAL OF INDUSTRIAL MEDICINE
Work Safety Climate, Personal Protection Use, and Injuries Among Latino Residential Roofers Thomas A. Arcury, PhD,1,2 Phillip Summers, MPH,1,2 Julia Rushing, MS,3 Joseph G. Grzywacz, PhD,4,5 Dana C. Mora, MPH,2,6 Sara A. Quandt, PhD,2,6 Wei Lang, PhD,3 and Thomas H. Mills III, MS7,8
Background This analysis describes work safety climate, personal protective equipment (PPE) use, and injuries among Latino residential roofers, and examines the associations of work safety climate with PPE use and injuries. Methods Eighty-nine North Carolina residential roofers completed a baseline interview and daily logs about perceptions and use of PPE, occurrence of injuries in last 12 months, and work safety climate. Results The mean work safety climate score was 26.5 (SD ¼ 5.6). In the baseline interview, participants reported that the majority of employers provided PPE and that they used it most or all of the time; daily log data indicated that PPE was used for half or fewer of hours worked. 39.9% reported any injury in the last 12 months. Work safety climate was significantly correlated with the provision and use of most types of PPE, and was inversely associated with injury. Conclusions Supervisors promoting safety may increase the PPE use and decrease injuries. Am. J. Ind. Med. ß 2014 Wiley Periodicals, Inc. KEY WORDS: occupational health; immigrant health; health disparities; minority health; construction workers
INTRODUCTION
1
DepartmentofFamilyandCommunityMedicine,WakeForestSchoolofMedicine,Winston-Salem, North Carolina 2 Center for Worker Health, Wake Forest School of Medicine, Winston-Salem, North Carolina 3 DepartmentofBiostatisticalSciences,DivisionofPublicHealthSciences,WakeForest School of Medicine,Winston-Salem, North Carolina 4 Department of Human Development and Family Science, Oklahoma State University, Stillwater, Oklahoma 5 Center for Family Resilience, Oklahoma State University, Stillwater, Oklahoma 6 DepartmentofEpidemiologyand Prevention,Division of Public Health Sciences,Wake Forest School of Medicine,Winston-Salem, North Carolina 7 Myers-Lawson School of Construction,Virginia Polytechnic Institute and State University,Wake Forest School of Medicine,Winston-Salem, North Carolina 8 Occupational Safety and Health Research Center, Virginia Polytechnic Institute and State University, Blacksburg,Virginia Correspondence to: Thomas A. Arcury, PhD, Department of Family and Community Medicine, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157-1084. E-mail: [email protected] Accepted12 October 2014 DOI10.1002/ajim.22404. Published online in Wiley Online Library (wileyonlinelibrary.com).
ß 2014 Wiley Periodicals, Inc.
Construction workers experience high rates of injury and fatality [Bureau of Labor Statistics, 2012]. Rates of injury and fatality are greater among immigrant and Latino construction workers than among native and non-Hispanic white construction workers [Dong and Platner, 2004; Center for Construction Research and Training, 2013]. Roofers are particularly susceptible to injury and fatality, particularly from falls [Bureau of Labor Statistics, 2012]. Latino immigrant workers are a vulnerable population. Latino construction workers are typically young, speak Spanish, have little formal education, and are employed in low-skill, high-risk occupations [Dong et al., 2009]. However, research on risk factors for occupational injuries among Latino construction workers, including residential roofers, is limited. Menzel and colleagues [Menzel and Gutierrez, 2010; Menzel and Shrestha, 2012] and Roelofs and colleagues [Roelofs et al., 2011] have examined safety issues among general Latino construction workers using
2
Arcury et al.
qualitative methods. They report that Latino construction workers are willing to tolerate unsafe conditions and to work quickly due to their need for employment, their perceptions that employers feel workers are disposable, and their fear of retaliation if they complain about unsafe conditions. These are beliefs that the Latino construction workers share with immigrant workers in other industries [Quandt et al., 2006; Grzywacz et al., 2007; Keifer et al., 2009; Arcury et al., 2012a]. Two qualitative studies have focused on the safety beliefs of Latino residential roofers. Hung and colleagues [Hung et al., 2013] examine beliefs about fall-prevention training and report that the “safety status quo” among Latino roofers is perpetuated by workers’ perception that they already know about safety, and that the workers do not value working safely due to their overconfidence. Arcury and colleagues [2014] discuss the value that Latino roofers place on productivity over safety. This differential value of productivity results in less use of personal protective equipment (PPE) and greater unsafe behaviors when PPE use and safe behaviors are perceived to lessen productivity. Work safety climate, worker perceptions of how much their supervisors value safety over production [Zohar, 1980], is particularly important for the safety of immigrant Latino construction workers. Positive work safety climate is associated with occupational safety performance and reduced occupational injuries [Neal and Griffin, 2002; Zohar, 2010]. Work safety climate is related to work demands, and to the frequency and severity of injuries among construction workers [Gillen et al., 2002; Shoji and Egawa, 2006; Choudhry et al., 2007, 2009]. Immigrant Latino construction workers’ beliefs about the importance of high productivity to maintain employment and about the importance of loyalty to supervisors [Arcury et al., 2014], together with the understanding that men should accept risk [Arcury et al., 2012b], indicates that their evaluation of the value a supervisor places on safety will strongly influence their behavior. Arcury and colleagues [2012] examine the associations of work safety climate with safety practices among Latino residential construction workers from three trades, including roofers. Roofers reported the worst work safety climate; for all of the Latino construction workers, work safety climate was positively associated with safety practices. Although they constitute a large part of the construction industry and experience high rates of injury, few research data exist on Latino construction workers in specific trades. The aims for this analysis are to describe the perceived work safety climate among Latino residential roofers working in North Carolina, to describe the perceptions and use of PPE among these roofers, and examine the associations of perceived work safety climate with perceptions and use of PPE and experience of injuries among these roofers.
METHODS The data for this study were collected as baseline information for the test of an educational intervention to improve fall safety among Latino residential roofers [Lane et al., 2012]. The project was approved by the Wake Forest School of Medicine IRB, and all participants provided signed informed consent.
Participant Recruitment Participants for this study were required to be aged 18 years or older, self-identified as Latino or Hispanic, currently employed 30 or more hours per week as a roofer in the residential construction industry, expected to continue employment as a roofer in residential construction for at least 3 months, and have a working telephone (cell phone or landline). No lists of Latino roofers or the companies that employ them exist. Several procedures were used to identify and recruit participants. First, project staff used their personal networks and familiarity with the Latino community to identify individuals who they thought met the inclusion criteria. Second, project staff contacted local organizations serving the Latino community and asked organization staff to identify individuals who met the inclusion criteria. Finally, project staff generated a list of community sites and locations frequented by immigrant Latino residential construction workers such as tiendas (Mexican stores), labor sites, laundromats, and churches. Project staff visited these sites and asked the site managers and patrons to identify themselves or others who met the inclusion criteria. Of those who met the inclusion criteria, 89 agreed to participate and 26 declined, for a participation rate of 77%. The actual participation rate may be lower as individuals not wanting to participate could have avoided project staff. The common reasons given for declining participation were that the intervention would require too much time, high telephone charges, and fear of offending their employers. When an individual agreed to participate, project staff reviewed the intervention and data collection program with the participant, answered any questions, and obtained informed consent.
Data Collection Two procedures were used to collect the data used in this analysis. First, participants completed an intervieweradministered questionnaire that addressed participant personal and work characteristics, work safety climate, whether PPE was provided and used, and occupational injuries experienced in the previous 12 months. The questionnaire was completed at the time the participant gave informed consent. Interviewers were fluent Spanish speakers who were trained by the investigators. Second, the participants
Work Safety Climate Among Latino Residential Roofers
completed a series of daily logs using interactive voice response (IVR) technology [Abu-Hasaballah et al., 2007; Grzywacz et al., 2014]. IVR technology uses stored, prerecorded questions or Voice Extensible Markup Language to deliver audible questions to study participants over the telephone. Participants respond to questions by entering a number as a text response on their telephone’s keypad or by responding verbally. Participants completed daily logs for a period of up to seven days after the baseline interview. The daily logs provided information on the percent of working days the participant used specific types of PPE. Participants received an incentive of $15 for completing the baseline interview, and an incentive of $20 plus $10 for telephone costs for completing the daily logs.
Measures Personal and work characteristics were based on items in the baseline questionnaire. They included age in years, years lived in the United States, years lived in North Carolina, years of education, years working as roofer, weeks in the last year working as a roofer, and hours per week in the last year working as a roofer. Other items addressed country of origin (Mexico or other), language spoken as a child (Spanish or indigenous), pay schedule (hour, day, week, or roof), and number of contractors worked for in past year (one, more than one). Finally, participants indicated if they had ever received formal training in roofing, roofing safety, or ladder safety. Work safety climate was evaluated with the 10-item scale developed by Gillen and colleagues [2002]. Nine of the items in this scale used a four-point Likert format (strongly agree, agree, disagree, strongly disagree). The 10th item included three response categories. Values for the scale ranged from 9 to 39, with higher values indicating better work safety climate. The mean score in this study was 26.5, with a standard deviation of 5.6 (a ¼ 0.73). The Spanish translation of this scale has been used in several previous analyses with workers in construction, manufacturing, and agriculture [Arcury et al., 2012a,b, 2013]. Two sets of PPE use measures were based on items collected in the baseline interviews and used in previous research with Latino construction workers [Grzywacz et al., 2012a]. For the items eye protection, hearing protection, cut-resistant gloves, abrasion-resistant gloves, hard hat and harness, participants reported whether it was provided by their employer (yes/no) and if they used it none/ some of the time versus most/all of the time. Two other sets of PPE measures were based on items collected in the daily logs. For the items eye protection, hearing protection, gloves, hard hat and harness, participants reported if they believe their use was not important versus important. These measures were based on a set of true-false statements in
3
which participants were asked to judge the overall value of each item (e.g., “Hard hats are not really needed for roofers”; “It is important for Roofers to wear safety glasses while working.”). They also reported the hours they wore the items; based on the hours worked for the days they completed the daily logs and the hours they reported wearing the item, the percent of time used was calculated for each item. Participants reported whether they had sustained each of a set of injuries in the previous 12 months in the baseline interview. A series of dichotomous measures was constructed from these responses. These measures included, first, whether participants had experienced a fall while working in roofing. Second, these measures included whether participants had experienced a cut or laceration, bruise or contusion, strain or sprain, flame or chemical burn, head injury like a concussion or knocked unconscious, dislocated join, broken or fractured bone, electrical shock, or any other injury. A measure of Any Injury was recreated based on the occurrence of any of the specific injuries.
Analysis Summary statistics (means, standard deviations, and percentages) are used to describe participant characteristics, work safety climate, use of personal protective equipment, and injuries during the previous year. The association between the work safety climate score and PPE use was evaluated using Spearman correlation coefficients. T-tests were used to compare the work safety climate score among those with and without injuries. All tests were considered significant at alpha
Work Safety Climate, Personal Protection Use, and Injuries Among Latino Residential Roofers Thomas A. Arcury, PhD,1,2 Phillip Summers, MPH,1,2 Julia Rushing, MS,3 Joseph G. Grzywacz, PhD,4,5 Dana C. Mora, MPH,2,6 Sara A. Quandt, PhD,2,6 Wei Lang, PhD,3 and Thomas H. Mills III, MS7,8
Background This analysis describes work safety climate, personal protective equipment (PPE) use, and injuries among Latino residential roofers, and examines the associations of work safety climate with PPE use and injuries. Methods Eighty-nine North Carolina residential roofers completed a baseline interview and daily logs about perceptions and use of PPE, occurrence of injuries in last 12 months, and work safety climate. Results The mean work safety climate score was 26.5 (SD ¼ 5.6). In the baseline interview, participants reported that the majority of employers provided PPE and that they used it most or all of the time; daily log data indicated that PPE was used for half or fewer of hours worked. 39.9% reported any injury in the last 12 months. Work safety climate was significantly correlated with the provision and use of most types of PPE, and was inversely associated with injury. Conclusions Supervisors promoting safety may increase the PPE use and decrease injuries. Am. J. Ind. Med. ß 2014 Wiley Periodicals, Inc. KEY WORDS: occupational health; immigrant health; health disparities; minority health; construction workers
INTRODUCTION
1
DepartmentofFamilyandCommunityMedicine,WakeForestSchoolofMedicine,Winston-Salem, North Carolina 2 Center for Worker Health, Wake Forest School of Medicine, Winston-Salem, North Carolina 3 DepartmentofBiostatisticalSciences,DivisionofPublicHealthSciences,WakeForest School of Medicine,Winston-Salem, North Carolina 4 Department of Human Development and Family Science, Oklahoma State University, Stillwater, Oklahoma 5 Center for Family Resilience, Oklahoma State University, Stillwater, Oklahoma 6 DepartmentofEpidemiologyand Prevention,Division of Public Health Sciences,Wake Forest School of Medicine,Winston-Salem, North Carolina 7 Myers-Lawson School of Construction,Virginia Polytechnic Institute and State University,Wake Forest School of Medicine,Winston-Salem, North Carolina 8 Occupational Safety and Health Research Center, Virginia Polytechnic Institute and State University, Blacksburg,Virginia Correspondence to: Thomas A. Arcury, PhD, Department of Family and Community Medicine, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157-1084. E-mail: [email protected] Accepted12 October 2014 DOI10.1002/ajim.22404. Published online in Wiley Online Library (wileyonlinelibrary.com).
ß 2014 Wiley Periodicals, Inc.
Construction workers experience high rates of injury and fatality [Bureau of Labor Statistics, 2012]. Rates of injury and fatality are greater among immigrant and Latino construction workers than among native and non-Hispanic white construction workers [Dong and Platner, 2004; Center for Construction Research and Training, 2013]. Roofers are particularly susceptible to injury and fatality, particularly from falls [Bureau of Labor Statistics, 2012]. Latino immigrant workers are a vulnerable population. Latino construction workers are typically young, speak Spanish, have little formal education, and are employed in low-skill, high-risk occupations [Dong et al., 2009]. However, research on risk factors for occupational injuries among Latino construction workers, including residential roofers, is limited. Menzel and colleagues [Menzel and Gutierrez, 2010; Menzel and Shrestha, 2012] and Roelofs and colleagues [Roelofs et al., 2011] have examined safety issues among general Latino construction workers using
2
Arcury et al.
qualitative methods. They report that Latino construction workers are willing to tolerate unsafe conditions and to work quickly due to their need for employment, their perceptions that employers feel workers are disposable, and their fear of retaliation if they complain about unsafe conditions. These are beliefs that the Latino construction workers share with immigrant workers in other industries [Quandt et al., 2006; Grzywacz et al., 2007; Keifer et al., 2009; Arcury et al., 2012a]. Two qualitative studies have focused on the safety beliefs of Latino residential roofers. Hung and colleagues [Hung et al., 2013] examine beliefs about fall-prevention training and report that the “safety status quo” among Latino roofers is perpetuated by workers’ perception that they already know about safety, and that the workers do not value working safely due to their overconfidence. Arcury and colleagues [2014] discuss the value that Latino roofers place on productivity over safety. This differential value of productivity results in less use of personal protective equipment (PPE) and greater unsafe behaviors when PPE use and safe behaviors are perceived to lessen productivity. Work safety climate, worker perceptions of how much their supervisors value safety over production [Zohar, 1980], is particularly important for the safety of immigrant Latino construction workers. Positive work safety climate is associated with occupational safety performance and reduced occupational injuries [Neal and Griffin, 2002; Zohar, 2010]. Work safety climate is related to work demands, and to the frequency and severity of injuries among construction workers [Gillen et al., 2002; Shoji and Egawa, 2006; Choudhry et al., 2007, 2009]. Immigrant Latino construction workers’ beliefs about the importance of high productivity to maintain employment and about the importance of loyalty to supervisors [Arcury et al., 2014], together with the understanding that men should accept risk [Arcury et al., 2012b], indicates that their evaluation of the value a supervisor places on safety will strongly influence their behavior. Arcury and colleagues [2012] examine the associations of work safety climate with safety practices among Latino residential construction workers from three trades, including roofers. Roofers reported the worst work safety climate; for all of the Latino construction workers, work safety climate was positively associated with safety practices. Although they constitute a large part of the construction industry and experience high rates of injury, few research data exist on Latino construction workers in specific trades. The aims for this analysis are to describe the perceived work safety climate among Latino residential roofers working in North Carolina, to describe the perceptions and use of PPE among these roofers, and examine the associations of perceived work safety climate with perceptions and use of PPE and experience of injuries among these roofers.
METHODS The data for this study were collected as baseline information for the test of an educational intervention to improve fall safety among Latino residential roofers [Lane et al., 2012]. The project was approved by the Wake Forest School of Medicine IRB, and all participants provided signed informed consent.
Participant Recruitment Participants for this study were required to be aged 18 years or older, self-identified as Latino or Hispanic, currently employed 30 or more hours per week as a roofer in the residential construction industry, expected to continue employment as a roofer in residential construction for at least 3 months, and have a working telephone (cell phone or landline). No lists of Latino roofers or the companies that employ them exist. Several procedures were used to identify and recruit participants. First, project staff used their personal networks and familiarity with the Latino community to identify individuals who they thought met the inclusion criteria. Second, project staff contacted local organizations serving the Latino community and asked organization staff to identify individuals who met the inclusion criteria. Finally, project staff generated a list of community sites and locations frequented by immigrant Latino residential construction workers such as tiendas (Mexican stores), labor sites, laundromats, and churches. Project staff visited these sites and asked the site managers and patrons to identify themselves or others who met the inclusion criteria. Of those who met the inclusion criteria, 89 agreed to participate and 26 declined, for a participation rate of 77%. The actual participation rate may be lower as individuals not wanting to participate could have avoided project staff. The common reasons given for declining participation were that the intervention would require too much time, high telephone charges, and fear of offending their employers. When an individual agreed to participate, project staff reviewed the intervention and data collection program with the participant, answered any questions, and obtained informed consent.
Data Collection Two procedures were used to collect the data used in this analysis. First, participants completed an intervieweradministered questionnaire that addressed participant personal and work characteristics, work safety climate, whether PPE was provided and used, and occupational injuries experienced in the previous 12 months. The questionnaire was completed at the time the participant gave informed consent. Interviewers were fluent Spanish speakers who were trained by the investigators. Second, the participants
Work Safety Climate Among Latino Residential Roofers
completed a series of daily logs using interactive voice response (IVR) technology [Abu-Hasaballah et al., 2007; Grzywacz et al., 2014]. IVR technology uses stored, prerecorded questions or Voice Extensible Markup Language to deliver audible questions to study participants over the telephone. Participants respond to questions by entering a number as a text response on their telephone’s keypad or by responding verbally. Participants completed daily logs for a period of up to seven days after the baseline interview. The daily logs provided information on the percent of working days the participant used specific types of PPE. Participants received an incentive of $15 for completing the baseline interview, and an incentive of $20 plus $10 for telephone costs for completing the daily logs.
Measures Personal and work characteristics were based on items in the baseline questionnaire. They included age in years, years lived in the United States, years lived in North Carolina, years of education, years working as roofer, weeks in the last year working as a roofer, and hours per week in the last year working as a roofer. Other items addressed country of origin (Mexico or other), language spoken as a child (Spanish or indigenous), pay schedule (hour, day, week, or roof), and number of contractors worked for in past year (one, more than one). Finally, participants indicated if they had ever received formal training in roofing, roofing safety, or ladder safety. Work safety climate was evaluated with the 10-item scale developed by Gillen and colleagues [2002]. Nine of the items in this scale used a four-point Likert format (strongly agree, agree, disagree, strongly disagree). The 10th item included three response categories. Values for the scale ranged from 9 to 39, with higher values indicating better work safety climate. The mean score in this study was 26.5, with a standard deviation of 5.6 (a ¼ 0.73). The Spanish translation of this scale has been used in several previous analyses with workers in construction, manufacturing, and agriculture [Arcury et al., 2012a,b, 2013]. Two sets of PPE use measures were based on items collected in the baseline interviews and used in previous research with Latino construction workers [Grzywacz et al., 2012a]. For the items eye protection, hearing protection, cut-resistant gloves, abrasion-resistant gloves, hard hat and harness, participants reported whether it was provided by their employer (yes/no) and if they used it none/ some of the time versus most/all of the time. Two other sets of PPE measures were based on items collected in the daily logs. For the items eye protection, hearing protection, gloves, hard hat and harness, participants reported if they believe their use was not important versus important. These measures were based on a set of true-false statements in
3
which participants were asked to judge the overall value of each item (e.g., “Hard hats are not really needed for roofers”; “It is important for Roofers to wear safety glasses while working.”). They also reported the hours they wore the items; based on the hours worked for the days they completed the daily logs and the hours they reported wearing the item, the percent of time used was calculated for each item. Participants reported whether they had sustained each of a set of injuries in the previous 12 months in the baseline interview. A series of dichotomous measures was constructed from these responses. These measures included, first, whether participants had experienced a fall while working in roofing. Second, these measures included whether participants had experienced a cut or laceration, bruise or contusion, strain or sprain, flame or chemical burn, head injury like a concussion or knocked unconscious, dislocated join, broken or fractured bone, electrical shock, or any other injury. A measure of Any Injury was recreated based on the occurrence of any of the specific injuries.
Analysis Summary statistics (means, standard deviations, and percentages) are used to describe participant characteristics, work safety climate, use of personal protective equipment, and injuries during the previous year. The association between the work safety climate score and PPE use was evaluated using Spearman correlation coefficients. T-tests were used to compare the work safety climate score among those with and without injuries. All tests were considered significant at alpha
