Womens Occupations and Risks from Chemicals (WORC) Robert - - PowerPoint PPT Presentation

Women’s Occupations and Risks from Chemicals (WORC)

Robert Harrison, MD and Peggy Reynolds, PhD

California Depart ment of Public Healt h and Cancer Prevent ion Inst it ut e of California

California Breast Cancer Research Council Meet ing – March 9, 2018 Funded by CBCRP #21ZB0901

Background

• Funded by California Breast Cancer Research Program (CBCRP

, Grant#21ZB-0901; Co-PIs=Robert Harrison, Peggy Reynolds)

• Response to CBCRP’s California Breast Cancer Prevention Initiative

(CBCPI) RFP on “ Occupat ional Chemical Exposures in Calif ornia and Breast Cancer Risk”

• 5-year proj ect (2016-2020), 3 phases
• Overarching obj ective: advance our understanding of the degree to

which workplace chemical exposures may increase breast cancer risk among California working women

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Phase I (Y ear 1)

• Identify where women are employed in California.
• Identify workplace chemicals of concern (CoC) for breast cancer risk.
• Identify the overlap between where women are employed in California

and workplace exposures to groupings of CoC for breast cancer risk.

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Phase 2 (Y ear 2)

• Identify key available data and any gaps in occupational chemical

exposures for women working in California.

• Create a database and data visualization tool of women’s occupational

exposures to known and suspected mammary gland carcinogens, mammary gland toxicants, and/ or endocrine disrupting chemicals in California.

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Phase 3 (Y ears 3-5)

Conduct a more in-depth pilot investigation into one or more key industries in California that appear to pose the greatest breast cancer risk to women, based on the findings of Phase 2.

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Community Engagement: WORC Advisory Commit t ee

Knowledge

Gap

WORC Research S taff

• Robert Harrison (Co-PI, OHB/ CDPH)
• Peggy Reynolds (Co-PI, CPIC)
• S

usan Hurley (Proj ect Manager/ Epidemiologist, CPIC)

• S

tella Beckman (Environmental Health S cientist, CPIC)

• Jackie Chan (Industrial Hygienist, OHB/ CDPH)
• Matt Frederick (Data S

pecialist, OHB/ CDPH)

• Paula Johnson (Epidemiologist, OHB/ CDPH)
• Minhthu Le (Administrative Assistant, CPIC)
• Thu Quach (Consultant/ Epidemiologist, CPIC/ Asian Health S

ervices)

• Marcel Reynolds (Communications S

pecialist, OHB/ CDPH)

• Elana S

ilver (Epidemiologist/ Data Visualization Liaison, Consultant)

• Julie Von Behren (Epidemiologist, CPIC)
• Justine Weinberg (Industrial Hygienist, OHB/ CDPH)
• Carmela Lomonaco/ Judy Thai/ S

enaida Poole (CBCRP)

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Phase I Methods – where women work

Reviewed variety of data sources for California workforce

• American Community S

urvey (ACS ) data from US Census identified as most complete

S ummarized and compiled data on ~ 8 million women employed in CA

• For all industries and occupations (~ 500 occupations)
• Includes sociodemographic characterist ics (age, race/ ethnicity,

education, income, citizenship, language, presence/ age of children in home)

• Based on compilation of 2010 ACS

data from US Census

• Included approximate estimates of informal workforce derived by

modeling data

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Phase I Results – where women work

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California Women: Top Ten Largest Occupations

Occupation Number

• f Women

Secretaries & administrative assistants 310,470 Cashiers 282,052 Elementary & middle school teachers 252,404 Registered nurses 243,053 Retails salespersons 220,713 Personal care aides 205,666 Maids and housekeeping cleaners 197,778 Customer service representatives 173,840 Managers 157,700 Accountants and auditors 154,899

Source: ACS 2010-2014 US Census data.

Phase I Results – where women work

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Methods: Estimating Informal Workforce

• Not documented in existing data resources
• Methods to generate estimates using existing data resources
• S
• me researchers have developed methods for limited geographic areas but

these are:

• Quite variable depending on assumptions
• Not well-suited to statewide estimations
• Adapting these methods, we generated two estimates of informal workers:
• estimate X –

based on self-employed in ACS data

• estimate Y - based on non-citizens in ACS

data

• Input from Advisory Committee
• Given these limitations, caution for interpretation from the Data

Visualization Tool

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Phase I Results – Informal Workforce

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Chemical Concerns for Occupations with Informal Employment from WORC AC

Workforce Chemical Concerns Domestic Workers Chemicals in cleaning products Restaurant Workers Disinfectants, indoor air pollutants (e.g. P AHs) Agriculture Workers Pesticides Makeup Artists and Hairdressers Chemicals in cosmetics Janitors and Custodians Chemicals in cleaning products Day Laborers Formaldehyde, wood preservatives, paints, pesticides Garment Workers Flame retardants and fabric preservatives Artists S

• lvents, paints

S treet Vendors Air pollutants from traffic

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Phase I – Chemicals of Concern

• Evaluated multiple data resources, final list based primarily on:
• S

ilent S pring Institute’s list of mammary gland carcinogens and mammary gland toxicants

• TEDX list of endocrine disruptors
• Created a list of 1,000+ chemicals-of-concern (CoC) for breast

cancer

• Includes indicators for mammary gland carcinogens, endocrine disruptors,

mammary gland toxicants, and high production volume chemicals

• Categorized in 27 groups based on chemical properties and/ or usage
• Constructed another dataset summarizing workplace sampling data

(OS HA) – data sparse by chemical and industry

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Phase I Results: Chemicals-of-Concern

Chemicals-of-concern (n=1,082) in 27 categories

Category # Chemicals Alkyphenols/ethoxylates 15 Antimicrobials 32 Biogenic substances 54 Combustion products 62 Dioxins 121 Dyes 34 Flame retardants 52 Food constituents and additives 49 Fragrance ingredients 62 Household products 28 Industrial chemicals 172 Metabolites and degradates 20 Metals 27 Natural hormones 5 Other 6 Parabens 12 Perfluorinated compounds 13 Personal care products 74 Pesticides 308 Pharmaceuticals - antineoplastic 20 Pharmaceuticals - other 57 Phthalates 16 Plastics 61 Research chemicals 58 Solvents 31 Synthetic hormones 13 Unclassified 70

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Phase I – Estimating Chemical Exposures

• Created Job Exposure Matrix (JEM) to identify overlap of
• ccupations with exposures to Chemicals-of-Concern for:
• 145 occupations (representing ~ 85%
• f CA female workforce)
• 9 broad occupational groups identified by our AC as likely to have high

proportion of informal workers (domestic workers, restaurant workers, agricultural workers, make-up artists and hairdressers, day laborers, garment workers, artists, street vendors)

• Based on expert review by two industrial hygienists
• Tie-breaking review by Dr. Harrison

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Progress: Phase II (Data Visualization Tool)

• Obj ective  to create an interactive online tool to:
• Characterize the California female workforce:
• By occupation, race/ ethnicity, age group
• S

ummarize groups of chemicals of concern

• Identify potential chemical exposures by occupation
• Highlight data gaps
• Be useful to multiple stakeholder groups
• Contract with external vendor
• Will be hosted on CBCRP website
• Work is in progress  goal for completion in S

pring 2018

NOTE: still in draft form!

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Phase II: Data Gaps – where women work

• Capturing Informal Workforce
• Low income, limited literacy and English proficiency
• More likely to be exposed to workplace chemicals (?

)

• More vulnerable to health effects associated with exposures (?

)

• S

OC codes used by US Census – heterogeneous mix of j obs, difficult to estimate probabilities of chemical exposures by industry/ occupation

• Lack of information on occupational history –

limits ability to characterize exposures by industry/ occupation

• Chronic exposures
• Exposures during windows of susceptibility

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Phase II: Data Gaps – workplace chemicals

Lack of systematically-collected quantitative chemical exposure data:

• in contemporary workplaces that represent current patterns of

employment

• for occupations that employ many women, especially in the informal

sectors

• include exposure assessments that consider specific j obs (not j ust broad
• ccupational groups), in conj unction with industry
• data on chemicals-of-concern for breast cancer, particularly endocrine

disruptors

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Phase II: Data Gaps –

• ther
• Incomplete and inaccurate information on occupation and industry

in cancer surveillance databases (e.g. CCR, S EER)

• Dearth of simultaneously-collected information on cancer and
• ccupation/ industry in national and statewide population surveys
• Limited biomonitoring data from nationally-representative

workforces

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Recommendations to fill gaps – research

• Exploratory analyses that link existing cancer outcome data,
• ccupation/ industry data, sociodemographic data, national and

statewide survey data, and biomonitoring data

• Expand and improve WORC-JEM
• S

pecific chemicals, rather than categories

• More detailed targeted occupations/ industries (rather than ACS
• defined)
• Apply JEM approach to identify & prioritize
• ccupations/ industries for targeted exposure surveillance and/ or

biomonitoring

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Recommendations to fill gaps – policy

• Enhance statewide population-based surveys (e.g. BRFS

S , CHIS ) to include more detailed survey information on occupation/ industry, informal work, and health indicators (e.g., cancer outcomes)

• Expand statewide population-based surveys (e.g. BRFS

S , CHIS ) to include a biomonitoring component to measure markers of chemical exposures

• Improve the completeness and accuracy of occupation and industry

reporting in cancer surveillance systems (CCR, S EER)

• Continue collection of detailed industry and occupation information in

NHANES and NHIS

• Expand California Biomonitoring Program to include more occupational

cohorts

• Develop systematic workplace chemical monitoring programs for

targeted occupations of concern for breast cancer risk

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Phase III (Pilot Exposure S tudy)

Domestic household cleaners and hotel housekeepers:

• Represent a large segment of the workforce
• Include a substantial number of informal workers
• 80%

Latina

• Considerable opportunity for chemical exposures from cleaning

products

• Understudied for breast cancer risks

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Pilot Exposure S tudy in Cleaners

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Obj ectives

• Overarching Goal:
• Further our understanding of the role of occupational chemical exposures in

the risk of breast cancer among women working in the cleaning industry

• Obj ectives:
• Build relationships with key stakeholders
• Collect preliminary qualitative and quant it at ive exposure data
• Provide foundation for future research, intervention, advocacy

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S tudy Population

Domestic Household Cleaners & Hotel Housekeepers

• Informal and formal workers
• Conventional cleaning and green cleaning practices
• Union and non-union
• Focused in greater S

F Bay Area

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S pecific Aims:

• 1. Engage Stakeholders

Identify key stakeholders and engage their input to refine the direction, scope, and implementation of other study aims

• 2. Qualitative Assessment

Conduct focus groups to collect information from members of the cleaning workforce on their use of cleaning products, self-reported health and exposure concerns, and perceived challenges and

• pportunities to reduce chemical exposures in the workplace
• 3. Field Observations

Conduct worksite field observations to collect information on cleaning product use in the workplace and to select targeted priority chemicals for quantitative measurement study

• 4. Personal Measurements

Conduct quantitative measurement study of targeted priority chemicals among a small sample of workforce based on personal monitoring data collected while performing j ob tasks

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Phase III Timeline

• Start: Spring 2018
• 3-year study

−Y

ear 1: Formation of S takeholder Group, conduct focus groups

−Y

ear 2: Worksite field observations by industrial hygienists

−Y

ear 3: Quantitative measurement study (personal monitoring)

• Partnering with LOHP (Laura Stock and Suzanne Teran)

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