If we want more evidence-based practice, we need more practice-based evidence.*

Chapter 16
Residential, Occupational, and
Other Environments

 Table of Contents


REFERENCES - since publication of 8th edition



Communities can organize their programs and environmental standards and controls most efficiently around settings in which people live, work and play. Housing and worksites remain private preserves in most societies, but community, state and national governments have as much responsibility to assure their safety in construction and structural maintenance as they do for public recreational environments and open roads. The objective of this chapter, besides those stated at the beginning of the chapter, is to understand the commonalities and differences among and between environmental settings as they must be regulated to protect health.


Our look at epidemiology of housing and health leads to the conclusion that crowding and lead paint are less problematic today than in the past, but indoor pollution and homelessness are greater problems than in past decades. The section on occupational health identifies the epidemiology of workplace hazards and various strategies for their reduction, including educational, technological, legislative, regulatory, economic, and health service measures. The issues in recreational environments center on smoking in public places, swimming pool and boat safety, and the sanitation of hot tubs.


Employers offering more smoking cessation support following CMS decision. Wall Street Journal, Apr 26, 2005.

Senator Harkin introduces Healthy Workforce bill. Apr 22, 2005. congressvote.html

W.Va. Health Workers Report Most Serious On-Job Injuries.  July 16, 2003

Rhode Island to Press Its Lawsuit on Lead Paint. 

Off-the-Job Drinking Predicts Later On-the-Job Injury.  Sept. 16, 2002

California Needle Safety Law Will Go Into Effect July 1. SAN FRANCISCO (SF Chronicle, June 18, 1999). The California state Occupational Safety and Health Standards Board approved the first US state regulation requiring the use of safety needles to protect health care workers from potentially deadly infections.

OSHA to Consider New Needle Rules. WASHINGTON (AP, May 21, 1999) – The Occupational Safety and Health Administration will consider requiring hospitals and health care facilities to use safety devices that could reduce needlestick injuries to workers. OSHA Administrator Charles N. Jeffress said Thursday that the agency, this fall, will being considering whether new requirements on safety devices are necessary to reduce potentially dangerous needlestick injuries to the nation's 5.6 million health care workers. The announcement coincided with the release of an OSHA report, based on comments from 400 health care workers and facilities, that said safety devices aren't being used widely enough to substantially reduce the 590,000 needlestick injuries each year.

New Mosquito Killer Hitting Market. EAST GREENWICH, R.I. (AP, Mar 16, 1999) - Bruce Wigton was swatting mosquitoes during a fishing trip in 1990 when he began to plot his revenge against the bloodsucking bugs. Nine years later, Wigton has come up with the Mosquito Magnet, a device that lures mosquitoes to what they think is a hemoglobin snack, but instead sucks them into a bag where they die. American Biophysics, which has worked with the U.S. Department of Agriculture in developing the product, is selling the Mosquito Magnet to resorts in Florida and the Caribbean. The next step is completing the design of a smaller, cheaper unit that "the average person can get into his back yard," said Wigton, chairman and director of research and development at the East Greenwich-based company. See full story:

CDC: Foodborne Illnesses Declining. ATLANTA (AP, March 12, 1999) - Cases of foodborne illness caused by certain germs, including salmonella, declined sharply last year, the government said. Although E. coli cases increased, the Centers for Disease Control and Prevention said the decreases in some foodborne illnesses were attributable to changes in meat and poultry processing under a Department of Agriculture program implemented in January 1998. The rate of salmonella infections, rarely fatal but can cause food poisoning, decreased 14% over the last two years - from 14.5 per 100,000 people in 1996 to 12.4 per 100,000 in 1998, the CDC said. See full story in the CDC Morbidity and Mortality Weekly Reports, March 12, 1999/Vol. 48/No. 9:
* Incidence of Foodborne Illnesses: Preliminary Data from the Foodborne Diseases Active Surveillance Network (FoodNet) --- United States, 1998

Report: Salad Bar Spawned E. Coli. OMAHA, Neb. (AP, Mar. 10, 1999) - An E. coli bacteria outbreak that sickened 10 people has been traced to a restaurant salad bar, health officials said. At least eight additional cases may be linked to the Golden Corral restaurant in Kearney, 185 miles west of Omaha. Five people, including a 79-year-old woman and a 6-year-old boy, were hospitalized, although none was critically ill. The confirmed cases all involved E. coli O157:H7, state health department spokeswoman Marla Augustine said Tuesday. That particular strain attacks the digestive tract and, in severe cases, can cause kidney failure and death. The suspected source was contaminated lettuce in the salad bar, said Mike Kutch, president of Tri-Golden Management of Evergreen, Colo., which owns the restaurant. "Once (the outbreak) was brought to our attention, we've been cooperating with the health department," said Kutch. "It's a bad thing to happen." State Epidemiologist Thomas Safranek said all those sickened were in the Kearney area during the weekend of Feb. 26-28.

Is Big Better When It Comes to Housing (Universal Press Syndicate March 14, 1998).
Over the past 30 years families have gotten smaller while homes have become larger.

What's in a Number? Demographics Tell a Multifold Investing Tale. (International Herald Tribune April 6,1997). Basis statistics tell tales of what is going on in the work-force. The number of working women has stalled in the 1990s and this has an impact on the economy.

All the Comforts of Home. (AARP Bulletin October 1996). More and more people are working at home. It is difficult to estimate how many people are spending more work time at home, but experts agree that the number is growing fast.

For earlier news stories, please click here. 


The American College of Occupational and Environmental Medicine (ACOEM)

55 W. Seegers Road, Arlington Heights, IL 60005;

(800) 226-3626.


ACOEM has released a set of comprehensive guidelines for protecting health care workers from the resurgence of active pulmonary tuberculosis (TB). The guidelines are based on those of the Centers for Disease Control and Prevention (CDC), National Institute of Occupational Safety and Health (NIOSH), and those proposed by the Occupational Safety and Health Administration (OSHA).  

Operation Life Safety
International Association of Fire Chiefs

4025 Fir Ridge Drive
Fairfax, VA 22033
Phone: (703) 273-0911

Promotes programs of public awareness and education about the importance of sprinklers in buildings and to pass local sprinkler ordinances.

National Institute of Env. Health Sciences
Department of HHS

PO Box 12233
Research Triangle Park, NC 27709
Phone: (919) 541-3345

Publishes directories of its research programs, bibliographies and monographs, e.g., chemical pollutants in the environment. Environmental Health Perspectives, bimonthly, includes conference papers, articles and state-of-the-art reviews.

National Institute for Occupational Safety & Health Department of HHS
Building 1, Room 3106
1600 Clifton Road, NE
Atlanta, GA 30333
Phone: (404) 639-3534; (404) 639-3061

Answers questions of a non-technical nature in the occupational safety and health field and provides single copies of NIOSH publications to visitors. Inquiries of a technical nature are referred to the Clearinghouse for Occupational Safety and Health in Cincinnati, Ohio.

Industrial Health Foundation
34 Penn Circle West
Pittsburgh, PA 15206
Phone: (412) 363-6600

Trade association of industrial firms seeking to advance healthful working conditions in industry. Publication list available.

National Safety Council
444 North Michigan Avenue
Chicago, IL 60611
Phone: (800) 621-7619; (312) 527-4800

Public service organization with training programs and extensive publications catalog of print and audiovisual materials available.

Society for Occupational and Environmental Health
P.O. Box 42360
Washington, DC 20015-0360
Phone: (703) 556-9225

Seeks to improve quality of both working and living places and to focus public attention on scientific and regulatory concerns. Publications on diseases of specific occupations.

Women's Occupational Health Resource Center
117 St. Johns Place
Brooklyn, NY 11217
Phone: (718) 230-8822

Source of information and assistance for workers, public, professionals, and employers. Publishes fact sheets and information packets on topics such as stress, video display terminals. Publications list available.

Habitat for Humanity International
121 Habitat street
Americas, GA 31709 USA
Phone: (912) 924 –6935

This organization brings people and communities together to provide accessible housing for all.

National Resource Center on Worksite Health Promotion
777 N. Capitol Street, NW, Rm.800
Washington, DC 20002
Phone: (202) 408-9320

Studies and reports on health-related issues of interest to employers and the business community, including health and work issues, occupational hazards, and health promotion.

Lyme Disease Prevention 

To obtain a copy of the ALDF report, please call 914-277-6970. For more information on ALDF, please visit their website at  www.aldf.com.

The American Lyme Disease Foundation (ALDF) has published a new report entitled "Lyme Disease and Other Tick-Borne Infections: What Public and Other Health Professionals Need to Know" urging public health officials to rethink lyme disease prevention. The report recommends new prevention strategies such as tick control, modifications on case surveillance and expanded consumer and professional education. 

Status of Smoking Bans on International Flights, June 1999. http://ostpxweb.dot.gov/policy/safety/smoke.htm

Japan, one of the last countries to resist the bans, has banned smoking on all of its domestic and international flights. In the USA, smoking has been banned on all domestic and international flights, as well. Now that Tower Air, the last hold out announced smoking bans on all its flights, some 95 percent of all international passenger flights are now smoke-free and it now appears realistic to expect a complete ban world-wide.

Preparing their homes for future weather-related natural disasters




Marsalek, Jiri; Sztruhar, Daniel; Giulianelli, Mario; Urbonas, Ben (Eds.). Enhancing Urban Environment by Environmental Upgrading and Restoration. New York, Springer, 2005.

Cullen, M. R. (1999). Personal Reflections on Occupational Health in the Twentieth Century: Spiraling to the Future. ANNUAL REVIEW OF PUBLIC HEALTH 20: 1-14.
    ABSTRACT/Full-Text: Abstract.

Geyer, S., & Peter, R. (1999). Occupational health. Occupational status and all-cause mortality. A study with health insurance data from Nordrhein-Westfalen, Germany. EUROPEAN JOURNAL OF PUBLIC HEALTH 9 (2): 114-118.
http://www3.oup.co.uk/eurpub/hdb/Volume_09/Issue_02 .

Farm Worker Illness Following Exposure to Carbofuran and Other Pesticides --- Fresno County, California, 1998. MORBIDITY AND MORTALITY WEEKLY REPORTS, February 19, 1999/Vol. 48/No. 6. Go to: http://www.cdc.gob/mmwr/preview/mmwrhtml/00056485.htm

Spira, A. & Multigner, L. (August 1998).  Debate. Environmental factors and male infertility. The effect of industrial and agricultural pollution on human spermatogenesis, HUMAN REPRODUCTION, 13(8):2041-2042.

Thonneau, P, Bujan, L, Multigner L. & Mieusset, R. (August 1998). Occupational Heat Exposure And Male Fertility: A Review. HUMAN REPRODUCTION.  , 13(8): 2122-2125.

Tisdale, J.A., Sofge, C.W. Observations from the CDC: Women and Work: Highlights of NIOSH Research. JOURNAL OF WOMEN’S HEALTH. AUG 01 1998 v 7 n 6: 651-59.

Wynn, M. & Wynn, A. Fortification of Grain Products with Folate: Should Britain Follow the American Example. NUTRITION AND HEALTH.  1998 v 12 n 3, 147.

When Cancer Comes To WorkBusiness & Health.  JUL 01 1998 v 16 n 7,  34.
Medical advances mean more workers are staying on the job while they undergo treatment. Does your company brand them as sick people or offer support?

Book Review

Diamond, Jared. (2005). Collapse: How Societies Choose to Fail or Succeed. New York: Viking Books, 560 pp. $29.95. 

    The review by Troy Jollimore in the San Francisco Chronicle, Jan. 9, 2005, p. E1, is titled: "How societies commit suicide," and features the book author's "guided tour of failed human societies that will motivate us, he hopes, not only to try to save our own society from catastrophic collapse, but will also provide us with the knowledge and insight to succeed." Diamond is also the author of the Pulitzer Prize-winning best seller, "Guns, Germs and Steel." This book reviews the collapse of societies such as the failed societies of Easter, Henderson, and Pitcairn islands, the Norse population of Greenland, and the most recent societal collapse of Rwanda. He points to the ecological collapse the precedes and accompanies the societal collapse, and how some other societies are at a crossroad in their own survival ecologically and socially, namely China, Australia, and Haiti, which contrasts starkly from the success of the Dominican Republic at the other end of the same island of Hispanola. 

Wallace, R., & Wallace, D. (1999). A Plague on Your Houses: How New York Was Burned Down and National Public Health Crumbled. New York & London: Verso Press.
    During the 1970's, poor neighborhoods in the old industrial cities suffered massive housing destruction. These cities lost much population to the suburbs and to boomtowns in the West and South. "A Plague on Your Houses" provides the details of how public policies such as benign neglect and planned shrinkage destroyed poor minority neighborhoods in New York City both physically and socially. The authors suggest that the Rand Corporation provided substandard mathematical models that blamed the closing of fire companies for the fire epidemics, but they argue that this was only at best a symptom of the broader policies antagonistic to inner-city development.
    Mass migrations, shifting patterns of housing overcrowding, and loss of social control and support unleashed a crisis in public health and public order. Infectious diseases such as tuberculosis, measles, and AIDS flared up; contagious behaviors such as violence, substance abuse, and multiple-partner sexual activity also became epidemic. Even the life expectancy of elderly African-Americans was affected and declined between 1970 and 1980 after decades of increase.
    Most of the city was touched by one or more of the consequences of the disaster. The contagious diseases and behaviors gradually spilled over into the suburban counties of the New York City metro region (24 counties). Eventually, the abused big metro regions (New York, Los Angeles, Miami) entrained the whole national network of metro regions into epidemics of violent crime and AIDS.


Other References

Frankish, C.J., & Green, L.W. (1999). Worksite Smoking Cessation Interventions. Chap. 6 in Green, L.W., Frankish, C.J., McGowan, P., Ratner, P., Bottorff, J., Lovato, C.Y., Shoveller, J., Johnson, J., Williamson, D. (Eds.), SMOKING CESSATION: A SYNTHESIS OF THE LITERATURE ON PROGRAM EFFECTIVENESS. Vancouver: University of British Columbia Institute of Health Promotion Research, for the BC Ministry of Health.
    A systematic review of the research literature on effectiveness of smoking cessation methods applied in occupational settings.

Achievements in Public Health, 1900--1999: Improvements in Workplace Safety --- United States, 1900--1999. Morbidity and Mortality Weekly Reports 48(22), June 11, 1999.
    At the beginning of this century, workers in the United States faced remarkably high health and safety risks on the job. Through efforts by individual workers, unions, employers, government agencies, scientists such as Dr. Alice Hamilton (see box, page 462), and others, considerable progress has been made in improving these conditions. Despite these successes, much work remains, with the goal for all workers being a productive and safe working life and a retirement free from long-term consequences of occupational disease and injury. Using the limited data available, this report documents large declines in fatal occupational injuries during the 1900s, highlights the mining industry as an example of improvements in worker safety, and discusses new challenges in occupational safety and health. References cited:
1. Eastman C. Work-accidents and the law. New York, New York: Russell Sage Foundation, Charities Publications Committee, 1910.
2. Bureau of Labor Statistics, US Department of Labor. Table A-1. Fatal occupational injuries by industry and event or exposure, 1997. Available at http://www.bls.gov/cfoi/cfb0103.pdf . Accessed June 9, 1999.
3. National Safety Council. Accident facts, 1998 edition. Itasca, Illinois: National Safety Council, 1998.
4. Corn JK. Response to occupational health hazards: a historical perspective. New York, New York: Nostrand Reinhold, 1992.
5. CDC. Fatal occupational injuries--United States, 1980-1994. MMWR 1998;47:297-302.
6. Stout NA, Jenkins EL, Pizatella TJ. Occupational injury mortality rates in the United States: changes from 1980 to 1989. AmJ Public Health 1996;86:73-7.
7. Skow ML, Kim AG, Duel M. Creating a safer environment in U.S. coal mines: the Bureau of Mines methane control program, 1964-79. Washington, DC: US Department of the Interior, Bureau of Mines, May 1981 (report no. 5-81).
8. Bonnie RJ, Fulco CE, Liverman CT, eds. Reducing the burden of injury: advancing prevention and treatment. Washington, DC:Institute of Medicine, National Academy Press, 1999.
9. National Institute for Occupational Safety and Health. Assessing occupational safety and health training: a literature review. Cincinnati, Ohio: US Department of Health and Human Services, CDC, 1998; DHHS publication no. (NIOSH)98-145.
10. National Institute for Occupational Safety and Health. Preventing homicide in the workplace. Cincinnati, Ohio: US Department of Health and Human Services, CDC, 1993; DHHS publication no. (NIOSH)93-109.
11. National Institute for Occupational Safety and Health. Traumatic occupational injury research needs and priorities. Cincinnati, Ohio: US Department of Health and Human Services, CDC, 1998; DHHS publication no. (NIOSH)98-134.

Foodborne Botulism Associated With Home-Canned Bamboo Shoots -- Thailand, 1998. Morbidity and Mortality Weekly Report 48 (21), June 4, 1999 http://www.cdc.gov/epo/mmwr/preview/mmwrhtml/mm4821a1.htm
    On April 13, 1998, the Field Epidemiology Training Program in the Thailand Ministry of Public Health (TMPH) was informed of six persons with sudden onset of cranial nerve palsies suggestive of botulism who were admitted to a provincial hospital in northern Thailand. To determine the cause of the cluster, TMPH initiated an investigation on April 14. This report summarizes the results of the investigation, which indicate that the outbreak was caused by foodborne botulism from home-canned bamboo shoots.
References cited:
1. Shapiro RL, Hatheway C, Swerdlow DL. Botulism in the United States:a clinical and epidemiologic review. Ann Intern Med 1998;129:221-8.
2. St. Louis ME. Botulism. In: Evans AS, Brachman PS, eds. Bacterial infections of humans: epidemiology and control. 2nd ed. New York, New York: Plenum Medical, 1991:115-26.
3. Villar RG, Shapiro RL, Busto S, et al. Outbreak of type A botulism and development of a botulism surveillance and antitoxin release system in Argentina. JAMA 1999;281:1334-8,1340.
4. Shapiro RL, Hatheway C, Becher J, Swerdlow DL. Botulism surveillance and emergency response: a public health strategy for a global challenge. JAMA 1997;278:433-5.



1. Indoor pollution. Plan a community program to address the problems of a) inadequate ventilation in well insulated homes, and b) improper indoor storage of household and garden chemicals. In addition to the list of indoor pollutants listed in the first boxed issue, consider others like diesel and gasoline fumes, car exhaust and carbon monoxide from attached garages, lawn and garden pesticides, bleaches and cleaning materials, pest strips, insecticides, and chemicals for jacuzzis and swimming pools.

2. Deinstitutionalized mental patients. Determine the incidence and prevalence of homelessness in your community and then identify available shelters, half-way houses, and referral services. Does your community provide adequate housing for battered women? abused children? the elderly? the migrant worker? What recreational facilities are there for children and adults?

3. The economics of housing. What kind of housing is provided in your community for the poor and those without shelter? Who manages low-income housing and shelters? What is the lived experience of these places? What are the qualifications to live in them? Contacting an organization such as Habitat for Humanity (information at the end of this chapter) to explore other kinds of housing alternatives.

4. Housing and preparedness. Natural and human causes of building destruction can be explored to better understand safety features of homes, offices and other structures. Where are the safest places to be indoors in the event of an earthquake, tornado or hurricane? Why? Where should smoke detectors be placed in homes to be most effective? Locate smoke detectors at home to determine if there is adequate placement.

5. Occupational environments. What are the major employers in your community and the kinds of occupational health concerns that result? Contact the occupational health and safety officer at one of these organizations to understand how occupational health is assured at their organization.

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