Bang, K.M. et al., Prevalence of asthma by industry in the US population: a study of 2001 NHIS data.
   American Journal of Industrial Medicine 47: 500-508. June 2005

education services workers accounted for 9 percent of all SENSOR-recorded occupational asthma cases between 1993 and 2000.  Nearly 70 percent of these asthma cases were new-onset, 31 percent were work-aggravated, and 8 percent were RADS.  The study’s authors note: “The number of WRA cases among teachers and reported from elementary and secondary schools indicate that asthma in educational settings is an occupational health problem.  Workers in this industry are primarily public sector employees, and in half of the states Occupational Safety and Health Administration (OSHA) provisions do not apply.”

Work-related asthma and exposures

The NIOSH Worker Health Chartbook 2004 (all workers) indicates significant associations between work-related asthma (WRA) and exposures: “During 1993 –1999, the largest proportion of WRA cases was associated with miscellaneous chemicals (19.7%).  This category of agents includes many exposures that are not easily classified (for example, perfumes, odors, and glues).”  Other exposures associated with work-related asthma reported in the NIOSH Chartbook were indoor air pollutants (9.9 percent), cleaning materials (11.6 percent), solvents not otherwise specified (8.2 percent) and polymers (5.3 percent).

As noted above, regardless of the cause, once asthma is present, it must be managed appropriately in the workplace, for the health and productivity of the worker.  Identification of troublesome exposures — those that incite asthmatic responses — and mitigation or elimination of such sources, are part of good practice in asthma management, and prudent practice in workplace health.    The exposures listed in the Chartbook as associated with work-related asthma are strikingly similar to those about which nurses and teachers have expressed concern.

Occupational health and nursing

“Hospitals have led the list of industries reporting 100,000 or more cases [of occupational illnesses] for the past two years. The rate of illnesses experienced by workers in the hospital industry was 72.9 cases per 10,000 full-time workers, compared to 27.9 cases for private industry as a whole,” according to the Bureau of Labor Statistics.

Research on nurses’ occupational health has focused on task-related exposures (latex, glutaraldehyde, needle sticks, lifting) but has been scant in focus on other workplace-related exposures.  In 2001, the American Nurses Association conducted an online health and safety survey, which gathered nearly 5000 responses in about a month.  Over 70 percent of respondents had been nurses for 10 years or more, and more than half worked in acute care hospitals.  Nearly 80 percent reported that they do not feel entirely safe in their workplaces. Nearly half reported a work-related illness, or illness exacerbation, in the year previous to taking the survey.  Over 30 percent reported little information from employer about workplace health hazards, and an additional eight percent reported receiving no hazard information at all from employers. Three-quarters of the respondents indicated that unsafe work conditions interfered with delivery of patient care.  Nearly 88 percent said that health and safety considerations influence their decision to remain in the profession.

In March 2005, the Massachusetts Department of Health reported that among Massachusetts workers in healthcare settings, “Cleaning products were the agents most frequently reported by [asthma] cases (74/305, 24%), but the exposures that triggered asthma varied by occupation.  Nurses most commonly reported latex, followed by cleaning products then aldehydes (glutaraldehyde and formaldehyde).  Office workers in health care settings most often identified miscellaneous chemicals, paints, solvents and glues, followed by cleaning products and new carpet, dust (including renovation), molds, smoke and perfume.  Laboratory workers and technicians reported aldehydes (glutaraldehyde and formaldehyde) most often and dental workers reported latex.”    The substances identified as problematic are allergens, sensitizers and irritants, all of which have potential to cause or contribute to exacerbations of worker asthma.

The increasing need for additional nurses in the U.S. workforce, plus the high rate of occupational illnesses in nursing professionals, point to the need to make workplace health in healthcare facilities a national health priority.  Work-related asthma alone may be having a significant negative current impact on worker productivity, retention and recruitment in both healthcare and education occupations.  Unless addressed in a timely fashion, conditions contributing to these high rates of work-related illness could have serious negative impacts in the future.  Prevention of workplace illness exacerbations is indicated by both the nature of the substances reported as present in the work environment, and the association between these substances and work-related asthma exacerbations.

Occupational health and teaching

Education initiatives have been a Bush administration priority: After passage of the No Child Left Behind Act in 2002, the White House announced its program, “A Quality Teacher in Every Classroom,” saying, “This program represents the largest and most comprehensive Federal investment in preparing, training and recruiting teachers and principals.  Nearly $3 billion will be made available to States through formula grants to prepare, train, and recruit high-quality teachers.”  The program is authorized under the Elementary and Secondary Education Act as amended by No Child Left Behind: Title II, Part A (P.L.107-110) 2002. About $44.5 million was appropriated for the Transition to Teaching portion of the program in the FY 2006 budget, along with $14.7 million for the Troops to Teachers portion.

However, the program contains no funds for ensuring that schools are healthy workplaces. Teacher health is clearly important to teacher retention, and this in turn is clearly necessary to achieve administration education quality goals.  However, nationwide, about one in four beginning teachers leaves the profession within four years.   At the end of the 1999-2000 school year, the teacher workforce lost about eight percent of its personnel, including two percent to retirement, and four percent to other occupations. The rate of teacher loss to other occupations was double the rate found at the end of the 1987-88 and 1990-91 school years; losses to retirement were double the rate at the end of the 1987-88 school year.    Though an estimated 700,000 teachers will retire by 2010, those losses will account for less than 30 percent of the projected teacher losses during the period 2002-2010; non-retirement reasons are anticipated to outnumber retirement reasons by three to one.

Although there is widespread recognition that environmental conditions in schools can affect student health and performance, particularly for those with asthma, data is sparse on teacher work-related health and related concerns.  However, a 1999 survey conducted by the U.S. National Center for Education Statistics found that the majority of complaints about unsatisfactory environmental conditions in U.S. public schools were related to ventilation (26 percent nationwide) and indoor air quality (18 percent nationwide).  Nationwide, 29 percent of schools reported inadequate ventilation systems.

In a recent analysis of SENSOR data for work-related asthma 1993-2000, researchers found that the agents most frequently reported as associated with work-related asthma in teachers and teachers’ aides were indoor air pollutants (28%), cleaning products (19%), mold (18%), and mineral and inorganic dusts (18%).

A 2003 study that surveyed teachers in Chicago and Washington D.C. found that many respondents reported health problems related to the work environment (Chicago over 25 percent; D.C. over 30 percent), with respiratory symptoms predominating.  The author of this report notes
that the teacher-reported rates of health problems in this study far exceed OSHA reports of such problems (4 percent), but adds that the OSHA figures are derived from employer reports.  About half the teachers surveyed in this report rated their schools’ condition at “C” or lower, and of these, 40 percent were considering changing workplaces, with 30 percent of those contemplating change considering leaving the profession altogether.   In a subsequent study of teacher retention in Washington D.C., a study found that good school quality was nearly as important as pay scale in teacher retention.

Teacher dissatisfaction with facility quality is also reflected in recent a Canadian survey. Sixty percent of all respondents to this (very small) Canadian online survey about school indoor air quality were teachers, and teachers reported 41 percent of the indoor air concerns expressed in the survey.  In all respondents, health problems related to school indoor air quality were reported by 16 percent, and dissatisfaction with ventilation was reported by 24 percent.  Health problems reported were “headaches, nausea, asthma, allergies, chronic throat problems, severe sinus infections, respiratory illness, skin rashes, eye infections, watery eyes, cold-like symptoms, drowsiness, and mental confusion.”

Problem exposures identified in this survey were poor ventilation; biological contaminants (mold, dust, bacteria); thermal discomfort; “fumes from vehicles; perfume; air fresheners; Volatile Organic Compounds (VOCs) from wallboard, furniture, and building materials; smelly markers; chlorine smell in water; sewer smells; musty stale air; photocopier ink; furnace fumes; cafeteria odours; smoke and gas smells; laundry soap smells on clothing; cleaning product fumes; floor wax;” CO2; CO; carpet (emissions from new; mold/dust/bacteria from old); asbestos building materials; pesticides; rodent excrement; leaking roofs and foundations.    Many of these are allergens and irritants having the potential to exacerbate existing respiratory conditions.