Injuries Among Working Youth : Results of School Based Surveys in North Carolina and South Carolina Janet Abboud Dal Santo J.Michael Bowling Funding from: The National Institute of Occupational Safety and Health

Introduction Young workers are at increased risk of injury than adult workers. Descriptive data on occupational injuries among young workers is scarce. Almost all serious injuries to young workers are preventable. Studying relationships of injuries with safety training, issuance of work permits, and use of protective equipment is important for designing targeted injury prevention interventions.

Methods School-based surveys Conducted in 16 randomly selected high schools in North Carolina Oct–Nov 2005) and 16 randomly selected high schools in South Carolina (Oct–Dec 2008) Teens who had worked in any paid job outside the home during the last two years completed the entire questionnaire Excludes: domestic and agricultural employment Anonymous 15–20 minute questionnaire Non-working students provided only sociodemographics Descriptive statistics and cross tabulations were used to describe injuries and assess their relationships with safety training, protective clothing and equipment, and issuance of work permits. Protective measures were specific to the type of job and place of employment.

Survey Response Using CASRO definition response rate is 73.8–86.6% for North Carolina survey and 82.2–91.1% for South Carolina In North Carolina survey 844 working teens completed the whole questionnaire and 1094 non-working students completed socio-demographic section only In South Carolina survey 811 working teens completed the whole questionnaire and 995 non-working students completed socio-demographic section only Data was weighted and SAS version 8.2 was used for analyses.

Selected Characteristics of the Sample in North Carolina Working Teens % Frequency Urban 50.9 429.5 Race   White 60.3 492.1 Black/African American 26.9 219.3 Other 12.1  99.1 Male 48.8 405.3 Age at Survey (≥16) 85.8 711.4 Age when started working (≥16) 60.8 464.5 Grades 11 and 12 78.4 651.8 Mother education above high school 57.4 387.7 Father education above high school 47.5 Employed mother 78.2 627.9 Employed father 78.8 598.6

Selected Characteristics of the Sample in South Carolina Working Teens % Frequency Urban 68.0 551.8 Race   White 53.4 426.8 Black/African American 37.5 300.2 Other 8.8 70.0 Male 48.8 405.3 Age at Survey ( ≥16 ) 87.9 688.7 Age when started working ( ≥16 ) 63.1 463.0 Grades 11 and 12 79.7 641.9 Mother education above high school 62.5 242.9 Father education above high school 51.3 403.6 Employed mother 78.8 608.1 Employed father 80.0 584.6

Characteristics of Working Teens North Carolina South Carolina % Frequency Worked in multiple jobs 38.7 244.3 43.9 355.9 Worked during the school year 77.9 655.1 80.8 650.9 Still working at the time of survey 56.9 477.5 55.7 443.4 Family ownership of business 11.1 92.3 10.4 82.7 Types of jobs Sales and cashiers 25.9 205.0 21.8 159.3 Services 54.4 430.2 63.7 465.8 Managers/professionals/admin 7.1 56.2 4.2 30.9 Laborers 11.6 91.4 8.1 63

Distribution of Employed Youth by Occupation in North Carolina Food preparation, food services 30% Cashiers 11% Sales Occupations 15% Administrative Support 4% Managerial, professional, and technical work 3% Precision production, operations, transportation, laborers 12% Other services 25% 8

Distribution of Employed Youth by Occupation in South Carolina Precision production, operations, transportation, laborers 8.7% Food preparation, food services 39% Managerial, professional, and technical 1.9% Sales occupations 14.7% Cashiers 7.1% Other services 24.8% 9

Reported Types of Injuries Among Working Youth in North Carolina and South Carolina % Frequency Back pain 9.4 5 8.5 2 Deep cuts  18.3  9  15.9  4 Sprained ankle 7.0 3 3.8 1 Fainting 2.0 0.0 Broken bones 29.5 14 12.0 Falls 5.8 Burns 11.2 20.4 Other 6.2 29.2 7 Multiple injuries 10.7 10.2 Most common injuries in both states are: deep cuts, broken bones, burns and multiple injuries. Other injuries included: puncture, insect sting, animal bite, hurt thumb, burn in eyes, heavy stuff dropped on body.

Places of Employment Where Injuries Occurred in North Carolina Majority of injuries occurred in construction sites, fast food restaurants and recreational sites. Broken bone injuries occurred mainly in recreational facilities and construction sites. Deep cut injuries occurred in fast food restaurants and in construction sites. Multiple injuries occurred mainly in construction sites . Burns, falls and back pain occurred mainly in fast food restaurants. 52% of youth who reported having an injury had a work permit in reference job. No significant association between work permit issuance and reported injuries. About two thirds (66%) of injured teens reported having safety training. No significant association between injuries and age of working youth in North Carolina as well as South Carolina.

Places of Employment Where Injuries Occurred in South Carolina Majority of injuries occurred in grocery stores and in fast food restaurants. Broken bone injuries and deep cuts occurred mainly in grocery stores and in fast food restaurants. Multiple injuries occurred in fast food places and in food preparation services All burn injuries were reported to have occurred in fast food restaurants. Over two thirds (72%) of injured teens reported having safety training. No significant association between injuries and age of working youth in North Carolina as well as South Carolina.

Descriptive Statistics of Use of Protective Equipment Among Injured Youth in North Carolina None of the five youth who reported burn injuries in fast food restaurants used cooking mitts. Of the three youth who worked on a construction site and reported multiple injuries none used a hard hat or helmet, only one reported using steel toed boots, only one reported using glasses, goggles, or some type of eye protection and only one reported using a safety harness or vest. Descriptive statistics and cross tabulations were used to describe injuries and their relationships with safety training, protective equipment, clothing, and issuance of work permits. Protective equipment were specific to the type of job and place of employment. No significant association between injuries and age of working youth in North Carolina as well as South Carolina.

Discussion Most common injuries appear to be in food service industry, construction sites, and recreational facilities. Findings suggest that safety training may not be adequate or relevant to the specific tasks that youth perform on the job. Safety interventions may need to address gaps in training, supervision and factors that influence the willingness of youth to use personal protective equipment on the job. Other than training and supervision parents need to be engaged with their teens about workplace safety and with employers about compliance with safety regulations and safety procedures. Employer issuance of work permits was not associated with reported injuries. Chi- square statistic was used for test of association between permit issuance and reported injuries.

Limitations Surveys did not employ state-wide random sampling procedures; results may not be generalizeable. Small number of reported injuries limited the analytical statistical techniques that were applied. Self report by working teens. Recall bias. Teens who worked in domestic employment or in agriculture were excluded from the study. School-based survey so school drop-outs not represented .

Conclusions Findings have implications for targeting injury prevention interventions at the industries where injuries were most frequently reported: fast food restaurants, construction sites, and recreational facilities. Safety interventions should address gaps in training, supervision and the use of personal protective devices since the majority of injured youth reported having safety training. The findings that about half of the injured teens had work permits in North Carolina calls into question employer compliance with safety regulations and the efficacy of the work permits in protecting young workers from injuries.