AMERICAN JOURNAL OF INDUSTRIAL MEDICINE 53:179–187 (2010)
Latino Worker Perceptions of Construction Risks Nancy Nivison Menzel,
PhD, RN
1 ,{
and Antonio P. Gutierrez,
MS
2{
Background Construction is a hazardous occupation, with Latino (Hispanic) workers at a greater risk for death than other ethnicities/races. Latinos accounted for over half of construction injuries involving days away from work in Nevada in 2006. Methods This study recruited 30 Latino construction workers from three Southern Nevada trade unions to participate in four focus groups conducted in Spanish to determine their perceived risks for injury. Audiotapes were transcribed into English transcripts, which were analyzed for themes. Results Themes included language/communication difficulties, traditional Latino values, construction trade skill level differences, and health literacy. Participants were unfamiliar with the workers’ compensation system. Conclusions Small contractors in particular should provide more effective safety training in Spanish and appropriate safety equipment. Unions should offer English language training using simulation and more information about workers’ compensation rights. Occupational health providers should consider Latino beliefs and communication needs when assessing health status or providing care. Am. J. Ind. Med. 53:179–187, 2010. ß 2009 Wiley-Liss, Inc. KEY WORDS: construction worker; Latino; health disparities; occupational safety; occupational injury; vulnerable population
INTRODUCTION The conceptual model of health disparities in the US described by Lipscomb et al. [2006] conceives of work as a complex yet often overlooked determinant of health. In the model, work is viewed as influencing individual, family, and community health, not only due to the fact that work is associated with occupational exposures but also due to its link with income level, health insurance benefits, and
1
School of Nursing, University of Nevada, Las Vegas, Las Vegas, Nevada School of Nursing, University of Nevada, Las Vegas, Las Vegas, Nevada The authors have no conflicts of interest to report. { Associate Professor. { Faculty Researcher. Contract grant sponsor: University of Nevada, Las Vegas School of Nursing. *Correspondence to: Nancy Nivison Menzel, School of Nursing, University of Nevada, Las Vegas, 4505 S. Maryland Parkway, Box 453025, Las Vegas, NV 89154. E-mail:
[email protected] 2
Accepted 23 June 2009 DOI 10.1002/ajim.20735. Published online in Wiley InterScience (www.interscience.wiley.com)
2009 Wiley-Liss, Inc.
psychosocial functioning. The long history in the US of racial and ethnic minorities holding the most hazardous jobs continues today, with minorities over-represented in jobs with more dangerous exposures, lower wages, and fewer benefits, all of which are associated with health disparities [Lipscomb et al., 2006]. Construction is one of the high-hazard, low benefit industries that employs ethnic/racial minorities, particularly Latinos (Hispanics) [CPWR, 2007]. From 2003 until the late 2007 slump in the housing market [Pew Hispanic Center, 2008b], the construction industry was responsible for a high rate of job growth for Latinos, particularly those who were foreign-born [Pew Hispanic Center, 2006, 2007]. In 2005, there were an estimated 2.6 million Latino construction workers [CPWR, 2007] constituting about 40% of the construction workforce of 6.4 million the same year [Hajiha, 2007]. Along with this job growth came an increased exposure to construction occupational hazards and disproportionate fatality rates [CPWR, 2007; Centers for Disease Control and Prevention, 2008]. Laborers, the entry construction occupation for most foreign-born Latinos [Brunette, 2005], have one of the highest risks of death
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[Dong and Platner, 2004; Bureau of Labor Statistics, 2009]. However, the reported rate of occupational injuries among Latino construction workers is slightly lower than other ethnic/racial groups [CPWR, 2007]. Latinos under-report occupational injuries [Buchanan et al., 2005] and may do so over and above the under-reporting of all injuries inherent in the US Department of Labor Bureau of Labor Statistics’ methodology [Rosenman et al., 2006; Boden and Ozonoff, 2007], possibly due to insecurities related to immigration status and job security [Bhatt, 2006; Aizenman, 2008]. Between 2005 and 2007, Southern Nevada experienced a residential and commercial construction boom [Berzon, 2008b], but with the boom came an increase over 2004 in the number of lost workday injuries among construction workers. In 2006, Nevada Latinos accounted for over half of those injuries (Table I) [Nevada Department of Labor and Industries, 2004, 2005, 2006b]. This article reports findings from a focus group-based study of unionized Latino construction workers in Southern Nevada in late 2007 to identify their perceptions of construction risks. The authors initiated the study not only due to the proportion of injuries among Latinos, but also due to reports of exploitation of undocumented Latino immigrants in Southern Nevada construction work [Pratt, 2006; Saucedo, 2007]. Recognized hazards of construction work include lifting heavy loads; maintaining awkward postures; working at heights; experiencing pressure to work quickly; and exposure to chemicals, outside elements, noise, and radiation [Dong, 2005; Levy et al., 2006; Seixas et al., 2008; National Institute for Occupational Safety and Health, 2009]. To protect workers from these hazards, the US Department of Labor’s Occupational Safety and Health Administration (OSHA) is responsible for enforcing the Occupational Safety and Health Act of 1970, which requires employers to ‘‘furnish to each of his employees employment and a place of employment which are free from recognized hazards that are causing or are likely to cause death or serious physical harm to his employees’’ [Public Law 91-596, 1970]. In Nevada, rates for construction worker injuries higher than the national average indicated that employers were not providing sufficient protection for workers. For private industry construction in 2006, the non-fatal occupational injury and illness incidence rate per 10,000 full-time workers in Nevada was 8.5 [Nevada Department of Labor and Industries, 2006a], compared to 5.9 in the US overall [Bureau of Labor Statistics, 2007].
Subsequent to this study, an investigative newspaper reporter found evidence that Nevada OSHA was neither enforcing regulations nor providing penalties at the level needed to force construction contractors to improve job safety [Berzon, 2008c], which triggered a review by federal OSHA [Berzon, 2008a]. The reporter received a Pulitzer Prize for Public Service in journalism for her series of articles on Southern Nevada construction safety [The Pulitzer Prizes, 2009]. Improving safety for Latino construction workers is of public health importance due to their high representation in the construction workforce [CPWR, 2007] and the greater chance that they may become permanently impaired and disabled for future work if injured [Anderson et al., 2000; Goodrum and Dai, 2005]. Those adverse outcomes may be attributed in part to the lower health literacy often observed in the Latino population [Schillinger et al., 2002; Committee on Health Literacy et al., 2004; Pew Hispanic Center, 2008a], an inability to navigate the US healthcare system for injuries requiring workers’ compensation payments [Dong et al., 2007], and lack of health insurance coverage, including workers’ compensation [Nicholson et al., 2008]. Occupational injuries and deaths among Latino construction workers have an adverse effect on families and communities as well, as noted by Lipscomb et al. [2006]. Because Latinos represent the largest racial/ethnic group in Southern Nevada (and the US) without health insurance [Southern Nevada Health District, 2007], Latino construction workers and their families can create taxpayer burdens if they present themselves for uncompensated medical care at publicly funded emergency departments. Employers and workers’ compensation insurers suffer economic losses whenever a workplace accident is reported as well. They pass these losses along to consumers in the form of higher prices. Despite the severe consequences of construction-related injuries and the large number of injured Latino workers, there have been relatively few studies of Latino construction worker perceptions of their risks for occupational injury. To the extent that Latino construction workers’ perceived risks differ from those of other ethnic/racial groups, such information will assist in designing targeted interventions. Previous studies have generated only limited data on which to design interventions. One large study analyzed
TABLE I. Number (%) of Construction InjuriesWith Days Away FromWork in Nevada by Race/Ethnicity Year
White
Latino
Black
Other/not reported
Total
2004 2005 2006
830 (28) 1,180 (31) 880 (26)
1,240 (42) 1,470 (39) 1,710 (51)
20 (
