Community Health Aides, Industrial Hygiene, Volatile Organic Compounds
Conditions
Brief summary
This project aims to reduce negative health outcomes in small businesses that primarily employ high-risk Latino workers by characterizing their exposures to hazardous chemicals and assessing if a community health worker (CHW) intervention is effective at decreasing these exposures. Although preventable by definition, occupational disease and injuries are leading causes of death in the United States, with a disproportionate burden faced by Latinos. Small businesses pose a particular risk. They are more likely to employ low-wage Latino workers, and often use hazardous solvents including volatile organic chemicals that can cause asthma, cancer, cardiovascular, and neurological disease; yet their workers lack access to culturally and linguistically appropriate occupational health and pollution prevention information due to economic, physical, and social barriers. CHW-led interventions and outreach in Latino communities have documented increased access to health care and health education and reduced workplace exposures among farmworkers. CHWs are an innovative method to bridge the gap between these small business communities and other stakeholders. The proposed project will capitalize on established partnerships between the University of Arizona, the Sonora Environmental Research Institute, Inc. and the El Rio Community Health Center. A community-engaged research framework will be used to complete the following specific aims: 1) quantify and identify exposures to hazardous chemicals in the two high risk small business sectors common in our target area (i.e., auto repair shops and beauty salons); 2) work collaboratively with business owners, trade groups, workers and CHWs to design an industrial hygiene - enhanced CHW intervention tailored for each small business sector; and 3) conduct a cluster randomized trial to evaluate the effectiveness of the CHW intervention at reducing workplace exposures to volatile organic compounds and assess which factors led to successful utilization of exposure control strategies in both male and female-dominated businesses. Businesses will be randomized to either an intervention or delayed intervention group, both of which will receive incentives to participate including worksite health screenings. CHWs will work closely with business owners and employees to select and implement exposure-strategies appropriate for their worksite using a menu of complementary strategies of varying complexity and cost. This innovative project has the potential to directly reduce occupational health disparities through a CHW intervention that moves beyond providing occupational health education. The intervention will overcome current barriers by helping marginalized Latino workers and small business owners who may have limited education, literacy, and computer skills to understand the hazards associated with their work, and will empower them to have greater control over their occupational exposures, with the ultimate goal of preventing occupational disease and reducing health disparities.
Interventions
The intervention will be derived from audits and exposure assessments and focus groups with workers and owners in the same business types (excluded from the trial) conducted in an earlier part of the study, as well as a community advisory group (e.g., Hispanic Chamber of Commerce) . From this, we will generate educational materials specific for each small business sector. We will provide the CHWs with a list of industry-specific control options along with potential cost savings and benefits. For example, EPA estimates a cost saving of $13,000 per year for auto body shops that switch to the high-velocity low-pressure spray guns. Each list will be a comprehensive menu of options that contain multiple control measures including simple controls, such as keeping the lids on the solvent containers.
Sponsors
Study design
Masking description
Data collection will be conducted by research staff blinded to the intervention condition. CHWs will only be present at the first baseline-assessment prior to data collection.
Intervention model description
Both groups will receive a baseline exposure assessment and health screenings from El Rio Community Health Center. Then, the intervention group will receive the industrial hygiene (IH)-enhanced community health worker (CHW) intervention. After the second exposure assessment, the delayed group will receive the intervention. A third exposure assessment will be obtained to determine if exposure levels and controls are maintained in the intervention group, and to assess the intervention in the delayed group. This will help us assess sustainability of the intervention. CHWs will accompany evaluators during the first assessment but leave before data collection begins. We anticipate that the CHW intervention will be completed over a 60-day time period (range: 30-90 days).
Eligibility
Inclusion criteria
* workers or owners of small businesses in select sectors (e.g., beauty salons, auto shops) in target zip codes in southern metropolitan Tucson, Arizona
Exclusion criteria
* age less than 18 years or people not employed in targeted sectors
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in Volatile Organic Chemical Concentrations From Pre- to Post-Intervention | 6 months | The primary outcome is the change in average total volatile organic chemical exposures for each business from pre- to post- intervention. |
Countries
United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Intervention Group - Beauty Salon The intervention group will receive the IH-enhanced CHW intervention before (\
3 months) the other arm (Delayed Intervention Group).
Industrial Hygiene-Enhance Community Health Worker Intervention: The intervention will be derived from audits and exposure assessments and focus groups with workers and owners in the same business types (excluded from the trial) conducted in an earlier part of the study, as well as a community advisory group (e.g., Hispanic Chamber of Commerce) . From this, we will generate educational materials specific for each small business sector. We will provide the CHWs with a list of industry-specific control options along with potential cost savings and benefits. For example, EPA estimates a cost saving of $13,000 per year for auto body shops that switch to the high-velocity low-pressure spray guns. Each list will be a comprehensive menu of options that contain multiple control measures including simple controls, such as keeping the lids on the solvent containers. | 77 |
| Delayed Intervention Group - Beauty Salon The delayed intervention group will receive the IH-enhanced CHW intervention after (\
3 months) the other arm (Intervention Group).
Industrial Hygiene-Enhance Community Health Worker Intervention: The intervention will be derived from audits and exposure assessments and focus groups with workers and owners in the same business types (excluded from the trial) conducted in an earlier part of the study, as well as a community advisory group (e.g., Hispanic Chamber of Commerce) . From this, we will generate educational materials specific for each small business sector. We will provide the CHWs with a list of industry-specific control options along with potential cost savings and benefits. For example, EPA estimates a cost saving of $13,000 per year for auto body shops that switch to the high-velocity low-pressure spray guns. Each list will be a comprehensive menu of options that contain multiple control measures including simple controls, such as keeping the lids on the solvent containers. | 70 |
| Intervention Group - Auto Shop The intervention group will receive the IH-enhanced CHW intervention before (\
3 months) the other arm (Delayed Intervention Group).
Industrial Hygiene-Enhance Community Health Worker Intervention: The intervention will be derived from audits and exposure assessments and focus groups with workers and owners in the same business types (excluded from the trial) conducted in an earlier part of the study, as well as a community advisory group (e.g., Hispanic Chamber of Commerce) . From this, we will generate educational materials specific for each small business sector. We will provide the CHWs with a list of industry-specific control options along with potential cost savings and benefits. For example, EPA estimates a cost saving of $13,000 per year for auto body shops that switch to the high-velocity low-pressure spray guns. Each list will be a comprehensive menu of options that contain multiple control measures including simple controls, such as keeping the lids on the solvent containers. | 69 |
| Delayed Intervention Group - Auto Shop The delayed intervention group will receive the IH-enhanced CHW intervention after (\
3 months) the other arm (Intervention Group).
Industrial Hygiene-Enhance Community Health Worker Intervention: The intervention will be derived from audits and exposure assessments and focus groups with workers and owners in the same business types (excluded from the trial) conducted in an earlier part of the study, as well as a community advisory group (e.g., Hispanic Chamber of Commerce) . From this, we will generate educational materials specific for each small business sector. We will provide the CHWs with a list of industry-specific control options along with potential cost savings and benefits. For example, EPA estimates a cost saving of $13,000 per year for auto body shops that switch to the high-velocity low-pressure spray guns. Each list will be a comprehensive menu of options that contain multiple control measures including simple controls, such as keeping the lids on the solvent containers. | 52 |
| Total | 268 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 | FG002 | FG003 |
|---|---|---|---|---|---|
| Overall Study | Withdrawal by Subject | 9 | 1 | 3 | 3 |
Baseline characteristics
| Characteristic | Intervention Group - Beauty Salon | Delayed Intervention Group - Beauty Salon | Intervention Group - Auto Shop | Delayed Intervention Group - Auto Shop | Total |
|---|---|---|---|---|---|
| Age, Continuous | 44 years STANDARD_DEVIATION 12 | 47 years STANDARD_DEVIATION 14 | 40 years STANDARD_DEVIATION 12 | 38 years STANDARD_DEVIATION 11 | 42.4 years STANDARD_DEVIATION 12.4 |
| Ethnicity (NIH/OMB) Hispanic or Latino | 54 Participants | 52 Participants | 47 Participants | 37 Participants | 190 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 21 Participants | 15 Participants | 21 Participants | 14 Participants | 71 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 2 Participants | 3 Participants | 1 Participants | 1 Participants | 7 Participants |
| Region of Enrollment United States | 77 participants | 70 participants | 69 participants | 52 participants | 268 participants |
| Sex/Gender, Customized Female | 68 Participants | 62 Participants | 4 Participants | 3 Participants | 137 Participants |
| Sex/Gender, Customized Male | 7 Participants | 7 Participants | 64 Participants | 48 Participants | 126 Participants |
| Sex/Gender, Customized Unknown | 2 Participants | 1 Participants | 1 Participants | 1 Participants | 5 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk | EG003 affected / at risk |
|---|---|---|---|---|
| deaths Total, all-cause mortality | 0 / 77 | 0 / 70 | 0 / 69 | 0 / 52 |
| other Total, other adverse events | 0 / 77 | 0 / 70 | 0 / 69 | 0 / 52 |
| serious Total, serious adverse events | 0 / 77 | 0 / 70 | 0 / 69 | 0 / 52 |
Outcome results
Change in Volatile Organic Chemical Concentrations From Pre- to Post-Intervention
The primary outcome is the change in average total volatile organic chemical exposures for each business from pre- to post- intervention.
Time frame: 6 months
Population: This is a cluster-randomized trial where the clusters were small businesses. There were 1-4 workers at each shop per assessment. The unit of analysis here is the average total volatile organic chemicals exposures for each business at each analysis.
| Arm | Measure | Value (GEOMETRIC_MEAN) |
|---|---|---|
| Intervention Group - Beauty Salon | Change in Volatile Organic Chemical Concentrations From Pre- to Post-Intervention | 2738 ppb |
| Delayed Intervention Group - Beauty Salon | Change in Volatile Organic Chemical Concentrations From Pre- to Post-Intervention | 3875 ppb |
| Intervention Group - Auto Shops | Change in Volatile Organic Chemical Concentrations From Pre- to Post-Intervention | 523 ppb |
| Delayed Intervention - Auto Shops | Change in Volatile Organic Chemical Concentrations From Pre- to Post-Intervention | 225 ppb |