Experts say chronic health problems don't have to be part of the construction worker's job and offer preventive measures for musculoskeletal, skin and other hazards.

More than 7.5 million U.S. workers are employed in construction, an industry where high rates of work-related illness have always been accepted as part of the job. Compared to other industries, the rate of work-related illnesses among construction is one of the highest.

"One of the things we say about construction is that the major causes of death are falls, electrocution and caught between," said Susan Moir of the University of Massachusetts at Lowell. "In fact, the major causes of death in construction are health-related." Moir, director of the school's Construction Occupational Health Project, said most construction workers will eventually die of the wear and tear of the industry and the health exposures they are subjected to every day.

Work-related illnesses that construction workers suffer from are much less dramatic than traumatic injuries or deaths, but they are no less harmful. Construction workers die at a greater rate than the general public from chronic diseases and are at a higher risk for musculoskeletal disorders, noise-induced hearing loss, respiratory disease and skin disorders -- all of which are preventable.

Musculoskeletal disorders among construction workers account for 22.5 percent of injuries resulting in lost work days. Construction has the highest rate of back injuries of any industry, except transportation.

Most of the back problems are low-back injuries, common in most construction trades and highest among roofers, floor layers and scaffold erectors.

Most back injuries are sprains and strains from lifting, lowering, carrying, pushing and pulling materials, explained Marie Haring-Sweeney, a branch chief with the National Institute for Occupational Safety and Health (NIOSH) who also sits on OSHA's construction safety and health advisory committee. "If you must twist while carrying heavy loads, work bent over or stay in other awkward postures, you are at risk for injuries."

Also common are shoulder problems, particularly in trades that require extensive overhead work, such as sheet metal work or painting. "There's a lot of rotator cuff and shoulder impingement," Haring-Sweeney said. "There are a lot of sheetworkers who have to go on early disability because of shoulder disorders."

Vibration is another pervasive hazard in construction. "When you talk to construction workers," explained Don Garvey, CIH, CSP, "a common phrase that you hear is, 'the guys just wear out.' You never hear of that in general industry, but it's common in construction." Garvey, a senior construction industrial hygienist with St. Paul Fire & Marine Insurance and chairman of the American Industrial Hygiene Association's Construction Committee, believes the sentiment stems from the vibration exposure to which construction workers are subjected. Hand-arm vibration from powered hand tools and cold temperatures that cause loss of feeling and the need to hold onto tools more tightly pose significant risks to workers.

Katherine Hunting, an associate professor of occupational and environmental health at George Washington University, offered a number of measures to prevent musculoskeletal problems. "One of the best ways to cope with these issues is to get mechanical help in moving materials around on the work site." She suggested using carts or wheelbarrows to move things so the workers are not carrying heavy loads themselves. Hunting also advised relying on teamwork to move heavy items. "Often, though, the work is so hurried, and there's so much time pressure that workers don't want to ask for help," she acknowledged.

Hunting suggested workers position their work at the correct height, if possible. "You want to keep the work between your knees and your chest. Doing so helps avoid low bends and high reaches. It's one of the best prevention methods out there."

When it comes to tools, Hunting advised using those that provide cushioning and are the right size for a worker's grip. "There are a lot of tools out there that claim to be ergonomic that aren't really, so it's difficult to find the right ones," she warned.

Finally, Hunting suggested that workers who spend a lot of time on their knees sit down rather than kneel. "If people are putting in electrical fixtures 12 inches off the floor, they're going to do a lot better sitting on an overturned drywall bucket than they will working on their knees. As a general rule, if it makes you more comfortable, it's going to be better ergonomically."

"Noise is one of the biggest across-the-board health risks in construction," Garvey said. Noise comes not only from the tasks individual workers are performing, but also from high ambient levels at many sites. In addition to impairing the quality of life on and off the job, hearing loss puts workers at high risk for injuries. "It's a safety hazard, as well, when workers can't hear what's going on around them," Moir pointed out.

According to Mark Stephenson, audiologist with NIOSH, the typical construction worker already has, or is acquiring, a debilitating, permanent hearing loss. "The average carpenter, by the time he's 25, has 50-year-old ears. The sad thing is, no construction worker needs to lose his hearing. Noise-induced hearing loss is 100 percent preventable," Stephenson said.

Despite the ubiquitous levels of hazardous noise at construction sites, little data exist to quantify construction workers' noise exposures and their associated risk of occupational hearing loss. Unlike the hearing loss prevention measures required in the manufacturing sector, OSHA does not require similar measures in construction.

Experts insist the best approaches to hazardous noise involve engineering or administrative controls to limit exposures. "If they have the ability to isolate the noise, that would be ideal; but, in construction work, that's not very practical," said Carol Merry, health education researcher with NIOSH. When engineering and administrative controls are not feasible, hearing protection can be an effective tool to prevent noise-induced hearing loss. The trick, according to Merry, is getting workers to wear it.

"In lots of cases, we find that construction workers are not wearing hearing protection," Merry said, citing reasons from not knowing where to get it to lack of awareness of the severity of the problem. Also, workers who are not in constant noise often feel they don't need to wear protection.

Merry emphasized that hearing protection will only be effective when workers are taught how to select, fit and wear it. "Training is really the key. Without training, workers are very likely to get only a fraction of the protection the device offers." Merry further underscores comfort and fit. "The best hearing protector is one that fits well, because if it fits, a worker will wear it," she said. Failure to fit hearing protection properly and to wear it consistently is probably the leading cause of noise-induced hearing loss, Merry added.

Construction workers develop and die from respiratory or lung diseases at a higher rate than the general population. Moreover, Moir said, "there are significant indications of respiratory disease in large numbers of construction workers at a very young age." Work-related chronic lung diseases such as silicosis and asbestosis usually take many years to develop and are often diagnosed after the worker has retired.

Silicosis is a respiratory disease resulting from breathing in crystalline silica dust that is deposited in the lungs. The most common source of silica is from quartz (sand, an integral component of concrete, can be nearly pure quartz). When silica is freshly fractured, said Moir, it "looks like dust, but it's extremely hazardous."

Construction workers can be exposed to silica in many ways, including rock drilling, hauling and dumping. The possibility of silica exposure may exist whenever concrete is disturbed, as well. "In all kinds of work with concrete dust, we have discovered surprisingly high levels of silica exposure," Moir said.

Lead poisoning is also a problem for construction workers, particularly those repairing or demolishing old bridges and other steel structures coated with lead paint. "We're doing a lot of repair on bridges, and every bridge in the history of the universe has been painted with lead-based paint," Garvey said. Workers welding, burning, torch-cutting or sandblasting lead paint-coated structures are at risk. Lead can damage the nervous system, kidneys and reproductive organs.

Asbestos remains a threat to construction workers. Massive exposures to asbestos occurred among construction workers installing it between 1940 and the mid-1970s and removing it since then. Asbestos is often in old fireproofing, roofing, vinyl flooring, pipe and boiler insulation and some roads and cement-sheet products. Exposure can lead to asbestosis (a disabling lung disease), lung cancer and mesothelioma, a usually fatal cancer of the chest or abdominal cavity lining. Asbestos-related cancers usually do not appear until 20 to 30 years after exposure.

Inhalation hazards are among the most difficult of health hazards to deal with because they threaten the workers and those around them. One of the best ways to limit exposure, according to Moir, is through mitigation. "Mitigation usually means addressing health and safety problems at the perimeter of the sight to protect those who are outside the site," Moir explained. "Still, we would like the industry to consider beginning its mitigation efforts at the center of the site. In protecting the workers, the bystanders will be protected." She admits, though, that mitigation is expensive, and there are economic disincentives to taking this approach.

Another alternative Moir suggested is the wet method. "There has been some research done to show that wetting the dust down is pretty effective." The problem, she said, is that it is often done episodically. "What we would like to see is people preplanning for the dust so that the prevention method is built into the design of the operation."

Local exhaust is another option. "We have done studies that show, when you use local exhaust ventilation or mechanical ventilation, exposures are reduced by 30 (percent) to 50 percent," said Pam Susi of CPWR – Center for Construction Research and Training. Ideally, a local exhaust vacuum system should be built into the equipment, Moir said. "For your ordinary construction contractor (85 percent of the industry is very small operations), this equipment can be very expensive."

Roughly 12 percent to 15 percent of all occupational illnesses involve the skin. In 1996, more than 2,000 construction workers reported a work-related skin disorder. Despite their frequency, occupational skin diseases and disorders are not well-recognized as health problems associated with the construction industry.

"The big culprits in terms of exposures include cement and cement products, as well as epoxies and epoxy resins that are utilized in different settings -- stucco-type work, for example, or any kind of cement production or cement work," said Boris Lushniak, dermatologist with NIOSH. Contact dermatitis is the most common skin hazard, comprising between 90 percent and 95 percent of all occupational skin diseases. About four-fifths of all cases of contact dermatitis are due to irritation caused by chemicals. The remaining one-fifth are caused by allergic reactions.

Chemical and allergic reactions are the result of direct contact with materials, according to Lushniak. He said a worker may start off not having a problem but, because of constant contact with a substance, become sensitized and ultimately allergic to it over time.

Excessive ultraviolet radiation exposure from sunlight is another little-known hazard facing construction workers. While there is little data as to rates and numbers of cases, occupational exposure to sunlight can have health effects on the skin, including increasing the risk of skin cancers.

Lushniak supports a combination of strategies to prevent occupational skin diseases:

1. Identify irritants and allergens in the workplace;
2. Substitute chemicals that are less irritating or allergenic, when feasible;
3. Establish engineering controls to reduce skin exposure;
4. Use personal protective equipment;
5. Practice personal and occupational hygiene;
6. Establish educational programs to increase employee and employer awareness; and
7. Provide a system for the evaluation, reporting and surveillance of dermatoligical disease.

Lushniak advocates using a combination of these preventive measures. "One thing tends not to work well used alone," Lushniak said. He cautioned against a common attitude that skin problems are simply "part of the job" in construction. "The reality is that you do have potential health effects from having stuff on you all the time, but it shouldn't be part of the job. It shouldn't be taken for granted."

Until companies begin to focus more on prevention, construction will continue to rank with mining and agriculture as an industry with the highest rate of occupational health problems, Moir said. She argued that construction heath and safety personnel often find themselves tailing behind the problems at busy, often far-flung construction sites. "We need to build health and safety prevention right into production, so that it's not something that's not thought of until the problem is already there."