‘Take-Home’ Exposures Still PersistPosted on by
Occupational health has evolved into a largely technical field dedicated to identifying and eliminating the physical, chemical, and biologic hazards found at the workplace (Peckham et al, 2017). Central to this approach has been the distinction between work-related and non-work-related exposures, injuries, and illnesses which has become a line of demarcation between occupational safety and health and other disciplines within public health (Flynn 2018; Flynn and Wickramage 2017). However, there is growing recognition of the need for a more holistic and nuanced perspective on work and its impact on population health (Ahonen et al 2018; Schulte and Vainio 2010; WHO 2008). The take-home pathway, in which a worker contaminates shared family spaces with toxic exposures that have been tracked home from the workplace, illustrates the limitations of addressing issues only in the workplace or only in the community.
Lead has been at the center of research on the take-home pathway for many years. The Centers for Disease Control and Prevention (CDC) has played a critical role through the years to identify and document many children that have become lead poisoned because of the occupation of a household member (CDC/NCEH, 2020; CDC/NIOSH, 2020). Sadly, cases of childhood lead poisoning associated with an occupational origin persist and are common.
The work with take-home lead has expanded to include take-home exposures to other chemicals such as pesticides, asbestos, beryllium, and mercury (Suarez-Lopez et al., 2012; Fenske et al., 2013; Donovan et al., 2012; Sanderson et al., 1999; Wilson et al., 2018). More recently, NIOSH researchers have found an expanded version of the take-home exposure model useful in explaining the impact of work-related psycho-social factors, such as fatigue and stress on family health as well. Building on the concept of take-home exposures, we also consider how factors outside of work can have a significant impact (both positive and negative) on workplace exposures and prevention measures.
Using lead as an example, a recent review article in the Annals of Work Exposures and Health (Kalweit et al. 2020) calls for greater recognition of take-home exposures as a public health hazard. Besides summarizing the many industries where take home exposure cases have been documented and the many different type of contaminants that become take-home exposures, the review also identifies the many factors and pathways that contribute to this problem. The review emphasizes that those at greatest risk are often workers who experience various forms of structural vulnerability (i.e. racism, sexism, etc.) in their work as well as in the places where they live.
The article explains how take-home exposures are wrapped up in larger, systemic factors that create persistent health disparities. These include precarious employment, such as among contractors and immigrants, who often fear losing their jobs if they raise concerns about their working conditions. Vulnerable workers and their families are also more likely to face environmental injustices in housing and neighborhoods which can aggravate the impact of take-home exposures. Workers often experience more than one of these structural disadvantages simultaneously. These overlapping structural vulnerabilities have been described in recent publications on young immigrant workers in the construction industry. (Cunningham et al 2018; NIOSH/ASSE 2015).
To prevent the chronic, low-level, take-home exposures, both chemical and psycho-social, that are particularly harmful for developing children, a multi-tier intervention approach including interventions at the workplace, home, and community levels is needed. This serves as a reminder of the undeniable role that occupational health and safety has in community health and the need to adopt a more comprehensive understanding of the relationship between work and health.
How has your workplace or community addressed the issues surrounding take-home or spill-over exposures from work to home? Watch for upcoming blogs on take-home lead and the work-to-home spill-over of stress and fatigue.
Diana Ceballos, PhD, MS, CIH, is an Assistant Professor in the Department of Environmental Health at the Boston University School of Public Health. She was an industrial hygienist at the NIOSH HHE Program from 2010-2015.
Michael Flynn, MA, is the Coordinator of the Occupational Health Equity Program at the National Institute for Occupational Safety and Health.
Ahonen EQ, Fujishiro K, Cunningham TR, Flynn MA. (2018). Work as an Inclusive Part of Population Health Inequities Research and Prevention. American Journal of Public Health 108(3): 306-311. doi:10.2105/AJPH.2017.304214
Centers for Disease Control and Prevention, National Center for Environmental Health (CDC/NCEH). (2020). Childhood Lead Poisoning Prevention, At-risk Populations. Accessed on 16 March 2020 from https://www.cdc.gov/nceh/lead/prevention/populations.htm
Centers for Disease Control, National Institute for Occupational Safety and Health (CDC/NIOSH). Lead – Workplace Lead Publications. Accessed on 16 March 2020 from https://www.cdc.gov/niosh/topics/lead/publications.html#2
Cunningham, T. R., Guerin, R. J., Keller, B. M., Flynn, M. A., Salgado, C., & Hudson, D. (2018). Differences in safety training among smaller and larger construction firms with non-native workers: evidence of overlapping vulnerabilities. Safety science, 103, 62-69.
Donovan E.P., Donovan B.L., McKinley M.A., Cowan D.M., Paustenbach D.J. (2012). Evaluation of take home (para-occupational) exposure to asbestos and disease: a review of the literature. Crit Rev Toxicol, 42(9):703-31.
Fenske RA, Lu C, Negrete M, Galvin K. (2013). Breaking the take home pesticide exposure pathway for agricultural families: Workplace predictors of residential contamination. American Journal of Industrial Medicine; 56(9):1063-1071. doi:10.1002/ajim.22225.
Flynn, M. A. (2018). Im/migration, Work, and Health: Anthropology and the Occupational Health of Labor Im/migrants. Anthropology of Work Review, 39(2), 116-123. doi: 10.1111/awr.12151
Flynn MA, Wickramage K. (2017). Leveraging the Domain of Work to Improve Migrant Health. Int. J. Environ. Res. Public Health 14(10): 1248, doi: 10.3390/ijerph14101248.
Kalweit A, Herrick RF, Flynn MA, Spengler J, Berko K, Levy J, Ceballos DM. Eliminating Take-home Exposures: Recognizing the Role of Occupational Health and Safety in Broader Community Health. Annals of Work Exposures and Health. 2020. Epub.
National Institute for Occupational Safety and Health and American Society of Safety Engineers (NIOSH/ASSE). (2015) Overlapping vulnerabilities: the occupational safety and health of young workers in small construction firms. By Flynn MA, Cunningham TR, Guerin RJ, Keller B, Chapman LJ, Hudson D, Salgado C. DHHS NIOSH Publication No. 2015-178. Cincinnati, OH: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention.
Peckham, Trevor K, Marissa G Baker, Janice E Camp, Joel D Kaufman, Noah S Seixas 2017. “Creating a Future for Occupational Health.” Ann Work Expo Health 61:3–15.
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Schulte Paul, Harri Vainio. 2010 “Well-being at Work – Overview and Perspective.” Scandinavian Journal of Work, Environment & Health 36:422-29.
Suarez-Lopez JR, Jacobs DR, Himes JH, Alexander BH, Lazovich D, Gunnar M. (2012). Lower acetylcholinesterase activity among children living with flower plantation workers. Environmental Research; 114:53-59. doi:10.1016/j.envres.2012.01.007.
Wilson E, Lafferty J.S., Thiboldeaux R, Tomasallo C, Grajewski B, Wozniak R, Meiman J. (2018) Occupational Mercury Exposure at a Fluorescent Lamp Recycling Facility – Wisconsin, 2017. MMWR 67(27):763-766.
11 comments on “‘Take-Home’ Exposures Still Persist”
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In depth but a good read
I could see how the points could valid, a lot of other facts need to be considered
Fm: LTC Kevin Jones, US Army/WAARNG (Ret)
I have been following the COVID-19 news, discussion, and statistics in great detail for the past few months. After leaving the Military, I spent 20 years working at the Hanford Nuclear Reservation in security, which quite often required Radiation Contamination Area (RCA) entrance. I am concerned with the “taking home” aspect as discussed in regard to lead, asbestos, beryllium, mercury, ect, and especially with COVID-19 as it pertains to our medical professionals, but more so with the high incidence of infection OF our medical professionals as reported in the news. I wonder if an asset that is not being properly exploited in the prevention of virus transfer from patient to Med Staff, and then to Med Staff families, is our nuclear industry.
I would imagine that “spread by contact” with regard to COVID-19 would be quite similar to the spread of radioactive contamination. In an RCA, a worker,s PPE can pick up surface contamination on the outside of the PPE by contact with a contaminated surface. Proper removal of the PPE, a procedure that is constantly monitored and strictly enforced, has been very effective in preventing the transfer of radioactive contamination from the outer surface of the PPE to the workers clothing and skin, and thus preventing the “taking home” aspect of contamination spread. Any missed step in the PPE Removal Procedure could potentially allow a contamination/viral exposure to the “worker’.
I would thus wonder if DOE, or more specifically their Radialogical Control organization could be contacted to see if they have any information or suggestions that may be of benefit to our Medical Community.
I have additional information I would like to discuss in more detail and can be contacted by e-mail. Thank you for your time.
Thank you for your comment. Indeed, both biological and radiation hazards can be take home contaminants. You are correct that proper donning and doffing of respirators, change-out or decontamination of gloves, protective clothing, and footwear are all important to prevent biological contamination of workers as well as the environment, including taking the contamination home. Because biological contamination is not immediately detectable, as some radiological contamination is using field survey meters (e.g., Geiger Counter), careful attention to donning, doffing and decontamination procedures is even more important. NIOSH does benefit from the knowledge of radiological decontamination techniques since we use radionuclides in our laboratories and have a Radiation Safety Officer at our laboratories that use NRC-licensed materials; in addition to a number of CHPs that participate in our other occupational safety and health research programs.
well write. its very important article. everyone should to know it, thanks for share it. i want to see more article like this.
thank you for such an exhaustive and quality article
have been following the COVID-19 news, discussion, and statistics in great detail for the past few months. After leaving the Military, I spent 20 years working at the Hanford Nuclear Reservation in security, which quite often required Radiation Contamination Area (RCA) entrance. I am concerned with the “taking home” aspect as discussed in regard to lead, asbestos, beryllium, mercury, ect, and especially with COVID-19 as it pertains to our medical professionals, but more so with the high incidence of infection OF our medical professionals as reported in the news. I wonder if an asset that is not being properly exploited in the prevention of virus transfer from patient to Med Staff, and then to Med Staff families, is our nuclear industry
Thank you, this article is very inspiring and increases knowledge
I hope the writer and the team will be more successful.
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