The overall aims of the project of the California Fundamental Program are to:

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1 CALIFORNIA OCCUPATIONAL HEALTH AND SAFETY SURVEILLANCE: FUNDAMENTAL PROGRAM CALIFORNIA DEPARTMENT OF PUBLIC HEALTH ANNUAL PERFORMANCE REPORT August 1, 2008 Robert Harrison, MD, MPH Principal Investigator Occupational Health Branch, 850 Marina Bay Pkwy., Bldg. P, Third Floor; Richmond CA Tel: ; Fax: ; Barbara Materna, PhD, CIH Co-Investigator Tel: ; Fax: ; The overall aims of the project of the California Fundamental Program are to: Collect Occupational Health Indicators annually and conduct selected in-depth analysis to guide future work. Expand assessment of the Workers Compensation Information System (WCIS) as a useful data source for surveillance. Enhance relationships with stakeholders inside and outside California to guide and support program work, and increase the use of our work by others to improve workplace conditions. Increase dissemination of surveillance data, project findings, and public health recommendations. Perform annual program review/evaluation. MAJOR ACCOMPLISHMENTS AND OUTPUTS Injury and illness data The Fundamental Program has conducted an in-depth analysis of selected Indicators and major occupational health problems using multi-year data from hospital discharges, Emergency Department visits, Bureau of Labor Statistics annual survey, Census of Fatal Occupational Injuries, and WCIS. See below for plans regarding broad dissemination of data. Teen injury and illness data We have assisted planning efforts of the California Partnership for Young Workers Health and Safety by providing requested data on injury and illness for young workers, analyzed to match the specific age sets (14-15, 16-17, and 18-20) that correspond to rules restricting permitted work activities/occupations. The Partnership will use these data to publicize the special risks to young workers. Heat illness A statewide tracking system has been established for occupational heat illness using WCIS and other data sources. We analyzed data and presented at the June 2008 Council of State and Territorial Epidemiologists (CSTE) meeting. Findings are valuable for evaluation of the impact of California s heat illness prevention standard for outdoor workers and consideration of the need for a similar standard for indoor workers. Heat illness data have also been discussed in the public health community within the context of the health impacts of global warming and

2 climate change. Flavorings and lung disease In response to the identification of several flavor manufacturing workers with severe lung disease, we continued a public health investigation and developed a guidance document for providers of worker medical surveillance programs: Medical Surveillance for Flavorings-related Lung Disease Among Flavor Manufacturing Workers in California. ( Stakeholder outreach and data dissemination The publication Occupational Health Watch August 2007 ( a 12-page program newsletter, was distributed to over 3500 stakeholders. We initiated plans to replace OHW with a shorter, less resource-intensive electronic newsletter to be distributed on a more frequent basis. Program evaluation Logic models were developed for all four components of the California surveillance program (Fundamental, asthma, pesticide illness, fatalities) to engage staff in discussion of intended outcomes/impacts and serve as a basis for program planning and evaluation. PLANS FOR THE NEXT YEAR The Fundamental program will continue to accomplish its specific aims with the following activities: Prepare, disseminate, and discuss with stakeholders a report on the scope and cost of worker injury and illness in California. The report will highlight the issue of underreporting and include Occupational Health Indicators and analyses from multiple data sources. Implement a focused effort on establishing and enhancing relationships with key stakeholders with an interest in safer chemicals policies to protect workers, communities, and the environment. We will host a conference to present our work in this area and obtain input on future directions. Increase activities to share data, findings, and public health recommendations from multiple projects with affected worker and employer groups through enhancements to our website, materials dissemination, face-to-face meetings, and development of an electronic newsletter.

3 WORK-RELATED ASTHMA SURVEILLANCE AND PREVENTION CALIFORNIA DEPARTMENT OF PUBLIC HEALTH ANNUAL PERFORMANCE REPORT August 1, 2008 Robert Harrison, MD, MPH Principal Investigator Occupational Health Branch, 850 Marina Bay Pkwy., Bldg. P, Third Floor; Richmond CA Tel: ; Fax: ; Jennifer Flattery, MPH Co-Investigator Tel: ; Fax: ; The overall aims of the project are to identify, characterize and prevent work-related asthma in California by: 1. Expanding case ascertainment using multiple data sources 2. Performing case-based field investigations and developing prevention strategies 3. Collaborating with local and state agencies 4. Disseminating results generated from project activities; and 5. Evaluating surveillance activities on an ongoing basis MAJOR ACCOMPLISHMENTS AND OUTPUTS Case Ascertainment The Work-Related Asthma Prevention Program has identified approximately 4,000 cases over 15 years. Up until this year, cases have largely been identified through Doctors First Reports of Occupational Injury or Illness, a statewide reporting mechanism. However this year, Workers Compensation Data, Emergency Department Data, and Patient Discharge Data were added to the system and evaluated. Follow-up was attempted for all identified cases through telephone interview, or medical record retrieval if an interview was not possible. Outputs include data summaries based on multi-year analysis, including calculation of rates. Data summaries have been inserted into a variety of contexts, including reports, publications, and presentations for wide distribution. Specific outputs are listed below. Case-based Field Investigations, Prevention Strategies, and Dissemination Work-related asthma program staff conducted several industrial hygiene worksite evaluations over the past year. These included: a pilot evaluation of general cleaning methods and asthmagenic exposures in three hospitals; an evaluation of the asthmagenic potential of cleaning agents and processes in schools; and a follow-up investigation of glutaraldehyde exposures in the manufacturing of bio-prosthetic heart valves. All investigations generated prevention recommendations, and follow-up of glutaraldehyde levels in the heart valve manufacturing plants demonstrated a significant reduction in exposures. Results of data analysis and strategies for prevention were presented in a variety of contexts, including seven presentations at meetings and conferences of unions, local asthma coalitions, health care providers, and national public health organizations. Several important publications and journal articles were generated by the program. Peerreviewed journal articles were published in scientific journals with program staff as either

4 primary or co-authors on: regulating substances that can cause work-related asthma; summarizing results from worksite investigations of glutaraldehyde exposures in heart valve manufacturing; and work-related asthma in the educational services industry. The program also contributed work-related asthma chapters to two large Department asthma documents, one summarizing asthma surveillance data statewide and the other providing an updated Strategic Plan to Address Asthma in California for the years The program also provided data to the California Thoracic Society to be included in its Guide to Occupational Respiratory Disease in California. Collaborations with Local and State Agencies We continue to work collaboratively with a wide variety of state, local, and national agencies to foster successful approaches to asthma prevention. Program staff collaborated extensively with California s NCEH asthma grant recipient program (CA Breathing) on several major projects, including finalizing and disseminating an updated Strategic Plan, planning for a statewide asthma research summit, reviewing an RFP for asthma prevention activities, and contributing to criteria for a statewide asthma-safe school award. Staff also collaborated on statewide and national policy and guideline development regarding asthma-safe cleaning in schools, thirdparty certification of asthma-safe cleaning chemicals, and electronic reporting of workers compensation information. In addition, examples of organizations staff have collaborated with include: California EPA, University of California, Regional Asthma Management and Prevention Initiative (RAMP), local American Lung Association, CA Thoracic Society, Health Care without Harm, Green Schools Initiative, Green Purchasing Institute, California Teachers Association, SEIU, Local School Districts, including San Francisco, West Contra Costa and Los Angeles unified, San Francisco County, US EPA, and the Cal/OSHA airborne contaminant sensitizer committee. Evaluation of surveillance activities We continue to conduct quality assurance and quality control in our project activities. We conduct ongoing evaluation of our case ascertainment activities through capture-recapture analysis, and conduct targeted follow-up assessments to determine if prevention recommendations have been effective. PLANS FOR THE NEXT YEAR Our Work-related Asthma Prevention Program will continue to accomplish its specific aims with the following activities: Perform formal capture-recapture analysis of emergency department, patient discharge, Doctor s First Reports, and electronic workers compensation data. Promote asthma-safe cleaning practices in hospitals and schools. Investigate recently identified additional cases of asthma associated with glutaraldehyde exposures in heart valve manufacturing. Investigate one other cluster of cases and issue prevention recommendations.

5 PESTICIDE-RELATED ILLNESS CALIFORNIA DEPARTMENT OF PUBLIC HEALTH ANNUAL PERFORMANCE REPORT August 1, 2008 Robert Harrison, MD, MPH Principal Investigator Occupational Health Branch, 850 Marina Bay Pkwy., Bldg. P, Third Floor; Richmond CA Tel: ; Fax: ; Rupali Das, MD, MPH Co-Investigator Tel: ; Fax: ; The overall aims of the project are to identify, characterize and prevent and occupational pesticide illness in California by: 1. Expanding case ascertainment using multiple data sources 2. Performing case-based field investigations and developing prevention strategies 3. Collaborating with local and state agencies 4. Disseminating results generated from project activities; and 5. Evaluating surveillance activities on an ongoing basis MAJOR ACCOMPLISHMENTS AND OUTPUTS Case Ascertainment The Occupational Pesticide Illness Prevention Project has identified over 3,500 case reports over approximately 10 years. We continued to identify incidents through Pesticide Episode Transmittal Reports, and individual cases through Doctors First Reports of Occupational Injury or Illness, Pesticide Illness Reports, and reports from the California Poison Control System. In 2007, we added and evaluated Workers Compensation Data, Emergency Department Data, and Patient Discharge Data as sources for identifying additional pesticide illness cases. Medical records were requested for all reported cases. For selected incidents, we utilize investigation reports from respective California Agricultural Commissioners as additional data sources. Data collected from this multi-year surveillance effort includes calculations of rates, industry, occupation, type of pesticide involved, how exposure occurred, and type of health effect. We have utilized data summaries in various ways, including reports, publications, and presentations for wide distribution. In addition to documenting the significant scope of this important public health problem, we have used the data to characterize the conditions under which pesticide illness occurs so that appropriate prevention strategies can be developed and implemented. Case-based Field Investigation, Prevention Strategies, and Dissemination Occupational Pesticide Illness Prevention Project staff conducted several industrial hygiene worksite evaluations over the past year. These included visits to two nurseries and a dark house (mushroom growing facility) to assess best practices during indoor pesticide applications; an investigation of an illness incident due to phosphine gas in an almond processing facility; and an assessment of health hazards to utility workers following structural fumigation. As a followup to an illness investigation conducted in 2005 and to pursue our goal of promoting safer alternatives, we evaluated less toxic methods of pest control in the citrus industry. Investigations included interviews with workers, employers, and regulatory agencies. Written reports and oral presentations were issued following the conclusion of all investigations.

6 Information generated from surveillance and investigation activities were presented to a variety of audiences, including the California Agricultural Commissioners annual conference, the US EPA Worker Safety and Health Conference, health care practitioners, unions, and national public health conferences. Several important publications and journal articles were generated by the program. We issued a report on alternatives to some pesticides in the citrus industry and incorporated the information into several presentations; we plan to disseminate it widely. We published peer-reviewed journal articles in scientific journals with program staff as either primary or co-authors on pesticide illness among flight attendants and pesticide poisoning in the retail industry. We collaborated with California EPA and Vector Borne Diseases Branch staff to revise a fact sheet addressing the safety of pesticides used to control the West Nile Virus. Collaborations with Local and State Agencies We continue to collaborate with partners in labor unions (Association of Flight Attendants, Utility Workers Union) our own department (on infectious diseases, environmental health, and border health issues), federal agencies (NIOSH, US Environmental Protection Agency), state agencies (California Department of Pesticide Illness Worker Health Branch, the Office of Environmental Health Hazard Assessment), and community based organizations who are interested in the prevention of work-related pesticide illness (California Rural Legal Assistance, Pesticide Action Network, Migrant Clinicians Network). In addition, project staff continue to contribute to specific reviews of health effects of pesticides and analysis of work-related pesticide regulatory issues, and collaborate with the UC Berkeley Center for Occupational and Environmental Health on physician education activities. Evaluation of surveillance activities We continue to conduct quality assurance and quality control in all our project activities. We conduct ongoing evaluation of our case ascertainment activities through capture-recapture analysis, and conduct targeted follow-up assessments to determine if prevention recommendations have been effective. PLANS FOR THE NEXT YEAR Our Occupational Pesticide Illness Prevention Project will continue to accomplish its specific aims with the following activities: Plan and hold a conference for agricultural stakeholders examining the public health impacts of pesticides and the link to the need for safer alternatives Incorporate the surveillance of disinfectant-related illnesses to our existing program Based on site visits and research, assess and issue a report on the best practices in nurseries to reduce pesticide exposure to workers

7 WORK-RELATED INJURY FATALITIES CALIFORNIA DEPARTMENT OF PUBLIC HEALTH ANNUAL PERFORMANCE REPORT August 1, 2008 Robert Harrison, MD, MPH Principal Investigator Occupational Health Branch, 850 Marina Bay Pkwy., Bldg. P, Third Floor; Richmond CA Tel: ; Fax: ; Laura Styles, MPH Co-Investigator Tel: ; Fax: ; The overall aims of the project are to identify, characterize and prevent work-related injury fatalities in California by: 1. Expanding case ascertainment using multiple data sources 2. Performing case-based field investigations and developing prevention strategies 3. Collaborating with local and state agencies 4. Disseminating results generated from project activities; and 5. Evaluating surveillance and dissemination activities on an ongoing basis MAJOR ACCOMPLISHMENTS AND OUTPUTS Case Ascertainment The Work-Related Injury Fatality Program (WRIF) has identified 1,997 cases from January 1, 1992 through June 30, Fatalities have been coded so that all cases have 5 codes each (NAICS, SIC, 1990 COC, 2000 COC, ICD-9). In preparation for a more comprehensive data analysis and mapping project, 4 additional variables were identified and entered into the WRIF database. Securing efficient access to files at the Coroner s office, and monitoring media reports and blogs on a daily basis have resulted in more timely case ascertainment. Data summaries based on multi-year analysis have been included in reports, publications and presentations. Case-based Field Investigation, Prevention Strategies, and Dissemination WRIF program staff conducted 10 worksite investigations, including: collapsed paper bale, unsecured pipe, an unprotected lighting circuit, vertical milling machine, warping machine, fall off a ladder, through a skylight and a floor opening, and a backing dump truck. A Spanishlanguage translator accompanied the WRIF investigator to the worksite to eliminate language barriers. Twelve investigation reports were approved and published, resulting in 23 prevention recommendations. WRIF case examples from investigation reports were used as part of worker training train the trainer curriculums on construction hazards and general health and safety. Results of data analysis and recommendations for preventions were presented at national public health conferences, the NIOSH WRIF annual meeting, industry trade association meetings, Worker s Memorial Day event, and State government agency meetings. Program staff contributed to the June 6 th MMWR report: Work-Related Injury Deaths Among Hispanics United States A California WRIF investigation was highlighted in Safety and Health Magazine, National Safety Council, July 2008, FACE Value, Laborer Crushed by Falling Paper Bales

8 Two new FACE fact sheets were published, bringing the total number of fact sheets to 18. All have been translated into Spanish, and will be printed in August A total of 1,195 fact sheets and brochures were distributed at conferences, meetings, worksites, or mailed to individuals requesting them. Our website received an average of 3,256 visits per month. Collaborations with Local and State Agencies We continue to collaborate with a variety of local, state, and national agencies to prevent workrelated injury fatalities, including: NIOSH, Division of Occupational Safety and Health (Cal/OSHA), California Department of Transportation (Caltrans), UCLA Labor Occupational Safety and Health (LOSH) Program, UC Berkeley Labor Occupational Health Program (LOHP) and Center for Occupational and Environmental Health (COEH), State Building Trades Council, unions, career and vocational schools, trade associations, consulates, and labor centers. Evaluation of surveillance activities Quality control of our case ascertainment and data coding is ongoing. Evaluation of WRIF publications and reports are available online and printed at the bottom of each fact sheet. In addition, follow-up interviews at investigated worksites determine if prevention recommendations have been implemented. PLANS FOR THE NEXT YEAR Our WRIF program will continue to accomplish its specific aims with the following activities: Publish in-depth family impact stories Develop a WRIF instruction supplement for instructors in vocational schools, ESL courses, and apprenticeship programs. Write manuscript for peer-reviewed publication highlighting 15 years of surveillance data. Post a map of fatality locations on the California WRIF website. Develop a photo scenario on lockout/tagout for low-literacy Hispanic workers.