1. Hi Ho, Hi Ho -- Its off to work we go: injury and violence implications of teenage employment in the US Carol W. Runyan, MPH, PhD Director, UNC Injury Prevention Research Center Professor, Health Behavior & Health Education Professor, Pediatrics UNC-CH October 2009 U. Of MI

2. TRUE OR FALSE? 1) MI employer may not employ a teen (<18) without supervision, handling cash after 8 PM 2) A teen under age 16 in MI can work 25 hrs/week during the school year 3) A teen under age 18 can work 10 hours/day 4) Teens under age 18 must obtain a work permit from the employer 5) It is legal for a 17 year old to operate a meat slicer QUIZ on MI CHILD LABOR LAW

3. Objectives To describe public health issue of youth employment To review selected findings from a line of research on youth employment To consider research & intervention directions

4. Short video…

5. Child labor – early 1900’s in the US

6. Child labor – internationally today  ~ 250 million working children worldwide (age 5- 14)  www.ilo.org for more information www.ilo.org

7. Background re: teen labor, U.S.  About 75-80% of teens work before HS graduation  Largest proportion work in service & retail establishments (i.e., restaurants, shops).  Work involvement (% working & number of hours worked) increases by age) Percent working by grade level, US (Source: NIOSH) %

8. Potential benefits of youth labor Help teens with developmental tasks  self-esteem enhancement  autonomy from parents  learn responsibility  skill development Assist with future employment Develop strong work ethic Money for needs (e.g. college) Reduced delinquency & violence?

9. Potential risks of youth labor Foster poor work habits & attitudes Exposure to undesirable role models Money & how it’s used School performance declines with # hrs. Diminished relationships with family Fatigue & stress Exposure to hazards Injury Increased delinquency & violence?

10. Fatal occupational injuries among youth <18, by industry, U.S., 1992-2002, n=678 Types of events:  Transportation 45%  Contact w/ objects or equipment 19%  Assault 18%  Falls 7%  All other 12% Male: 89% White: 74% Age: 60% are age 16-17 40% < age 16 16% 11% 19% Source: NIOSH, 2004 43%

11. Causes of deaths & ED visits, age 14-17, US Cause Death (2006) ED visits (2007) MVC2,385 208,172 Homicide1060 190,927 Suicide837 50,752 Work-related38 ~52,600 (age 15-17 only, 2006)

12. Fatality Rates/100,000 Fulltime Equivalents (FTE) by Age Group, United States, 1994-2003

13. LEGAL CONTEXT

14. Work permits required (age 11-18), issued at schools - Maximum penalty: $500 Allowable Hours: Age <16: 40/week (school not in session); 18/week (school year); 10 hrs/day Age 16-17: 48/week (school & work combined); 10 hrs/day Michigan child labor law

15. Illegal to employ an unsupervised person <18 years of age to work alone after sunset or 8 PM doing cash handling Penalty: $2,000 Michigan child labor law (continued)

16. Child Labor Policy– basic elements Federal laws  U.S. Fair Labor Standards Act (1938)  Hazardous orders prohibit specific work (agricultural and non-agricultural)  Age restrictions on hours of work  State laws (NC)  Detrimental occupations  Additional hour restrictions  Work permits required

17. Hazardous orders -- prohibited tasks for workers age <18 (US) 1. Manufacturing or storing explosives 2. Driving a motor vehicle or work as an outside helper on motor vehicles 3. Coal mining 4. Logging and sawmilling 5. Power-driven woodworking machines 6. Exposure to radioactive substances & ionizing radiation

18. Hazardous orders -- prohibited tasks for workers age <18 (US) 7. Power-driven hoisting apparatus 8. Power-driven metal-forming, punching & shearing machines 9. Mining, other than coal 10. Power-driven meat-processing machines, slaughtering & meat packing plants 11. Power-driven bakery machines 12. Power-driven paper-products machines

19. Hazardous orders -- prohibited tasks for workers age <18 (US) 13.Manufacturing of brick, tile and related products 14. Power-driven circular saws, band saws & guillotine shears 15. Wrecking, demolition, & ship-breaking operations 16. Roofing operations 17. Trenching and excavation operations

20. Agricultural employment of youth -- US NO restrictions working on parents’ farm Prohibited for youth age <16 not on parent farm: Operating tractors >20 horsepower Operating corn pickers, cotton pickers, combines, etc. Handling breeding animals (e.g. sows with suckling pigs) Felling, loading, unloading timber >6 inch diameter Using ladders/scaffolds >20 feet Transporting passengers in/on vehicles; being passenger or outside helper on tractor or other moving apparatus Working inside grain storage silos, manure pits Explosives Specific types of agricultural chemicals

21. Line of research Fatality study, NC Statewide exposure studies NC US, teens & parents Ontario, teens & parents Jobs & violence prevention Symposium (synthesis & agenda setting)

22. NC Teen Construction Workers (Runyan CW, et al., Archives of Pediatric & Adolescent Med., 2007) Study population, n=187  100% male  85% white  Ages 10% age <16 54% age 16 36% age 17

23. NORTH CAROLINA DEPARTMENT OF LABOR YOUTH EMPLOYMENT CERTIFICATE Please Type or Print Clearly Name of Youth: Date of Birth: (mo/da/yr)Age:Sex:Area Code Phone ( ) Complete Mailing Address: CityStateZip Code Job Description: (Please be as complete as possible) Company Name:Type of Business:*ABC ON-PREMISES PERMIT? Yes NO Complete Mailing Address: City:State:Zip CodeArea Code Phone ( )

24. Teen construction workers’ supervision, NC, 2001, n=187

25. Percentage of 16-17 year old teen construction workers reporting PROHIBITED tasks, NC, 2001, n-168 (Runyan CW, et al., Archives of Pediatric & Adolescent Med., 2007) 36%Used hand held circular saw 36%Used any other reciprocating saw (besides power table saw or handheld circular saw) 25%Worked as electrician/electrician/s helper 23%Worked in trenches, holes, foundations > 4’ deep 20%Used power nail guns or staple guns 14%Operated forklift 12%Used power table saw 12%Put on shingles or other roofing materials

26. Number of prohibited tasks reported by 16-17 year old construction workers, NC, 2001 (n=168) (Runyan CW, et al., Archives of Pediatric & Adolescent Med., 2007)

27. Percentage of 16-17 year old teen construction workers reporting POSSIBLY ILLEGAL TASKS, NC, 2001, n-168 (Runyan CW, et al., Archives of Pediatric & Adolescent Med., 2007) 37%Drove motor vehicle 27%Worked on ladder, scaffold or other structure higher than 6 feet 20%Worked as outside helper on motor vehicle 20%Worked on open floor joists 17%Worked on roofs doing other things (i.e. besides shingles/roofing materials) 14%Operated tractor or other heavy equipment

28. Conclusions Teens in this industry are exposed to numerous hazards & risks Teen labor restrictions are not well enforced in construction industry in NC Efforts to understand & modify business practices are critical  Training of supervisors may be target for change

29. National (U.S.) Study of Teen Retail & Service Workers & Their Parents Supported by a grant from the National Institute of Occupational Safety and Health (NIOSH) to the UNC IPRC

30. Eligibility criteria  Teen age 14-18  Worked during prior 12 months for at > 2 months  Worked while age <18 years  English-speaking  Continental U.S. (excludes Alaska & Hawaii)  Parental consent  Teen assent

31. Teen & parent perceptions of hazards: “Do you consider any of your (your child’s) job tasks hazardous?” (Runyan, et al., J. of Adolescent Health, 2009) 14% YES 17% YES TEENSPARENTS 86% NO 83% NO

32. What parents of teens working in retail/service report they are somewhat or very concerned about re: teen work, U.S., 2003, n-860 (Runyan, et al., J. of Adolescent Health, 2009) Issues% Being there during a robbery48% Not having safety training39% Working alone37% Working too late at night37% Not getting enough sleep35% Getting physically or sexually assaulted33% Being rushed on the job29% Handling hazardous equipment, chemicals or toxic substances 22%

33. Parents’ and teens’ knowledge (% correct answers) of selected laws, US, 2003 (Rauscher, et al, under review)

34. Percent of U.S. teens in retail & service industry by work hours on school nights, 2003, n=866 (Runyan, et al., 2007, Pediatrics)

35. Percent of US teens working in retail/service reporting training & supervision experiences, 2003, n-866 Percent of US teens working in retail/service reporting training & supervision experiences, 2003, n-866 (Runyan, et al., 2007, Pediatrics)

36. Percent 16-17 year old retail/service workers reporting exposure to specific hazards, U.S., 2003 (Runyan, et al, Am. J or Industrial Medicine, 2008)

37. Use of personal protective equipment (PPE) by teen workers, U.S., 2003 (based on presence of hazard) ( Runyan, et al, Am. J or Industrial Medicine, 2008 )

38. Exposure to specific types of equipment, by sex, U.S. teens in groceries & restaurants, 2003, n=395 (Runyan, et al., 2007, Pediatrics)

39. Percent of US teens in groceries & restaurants reporting ILLEGAL exposure to equipment, by sex, 2003, n=395 (Runyan, et al., 2007, Pediatrics)

40. Workplace violations reported by U.S. working adolescents, age 14-17, 2003 (Rauscher, et al., Am. J. of Public Health 2008) %

41. Child labor violations by age group and type, US, 2003 (Rauscher, et al., Am. J. of Public Health 2008)

42. Child Labor Violations, by sex, US, 2003, (Rauscher, et al., Am. J. of Public Health 2008)

43. Numbers of violations, US workers, age 14-17, 2003 (Rauscher, et al., Am. J. of Public Health 2008)

44. Work Permit Status & HO Violations, US workers, 14-17, 2003 (Rauscher, et al., Am. J. of Public Health 2008) Work Permit Compliance? YES (62%)NO (38%) Any Hour Violation39%45% Night work violation13%22% Worked off the clock13%14% Weekly hour violation2%3% Any HO Violation33%

45. In summary… Teens perform many different:  dangerous tasks  prohibited tasks Males & older teens perform more risky & illegal tasks than females or younger teens Laws are not well enforced Supervision is varied Training is limited Teens & parents not very concerned about work safety Parental involvement is moderate, though safety is less of a focus than other topics Parent & teen knowledge very limited

46. What do we know about interventions to reduce injury in young workers?

47. Almost nothing….

48. Methodological issues in studying teen work

49. Definitional issues What is a job? What is a teen worker? What is a hazard? What is an injury?

50. Other surveillance & measurement issues Surveys vs. other methods  Sampling strategies  Quality of self-report  Human subjects issues  Contacting employers Surveillance & routine reporting Denominator issues

51. How do primary care clinicians interface with this issue?

52. Very little…

53. Employment represents a gap in adolescent medicine practice guidelines (Runyan, J. of Adolescent Health, 2007) INCLUDED:  Obesity & eating disorders  Sex & contraception  Use of tobacco, alcohol, other substances  Abuse  Driving behaviors  Sports exposures  Weapons exposure NOT INCLUDED  Work experience

54. Implications for adolescent medicine practice Advocate with: government, employers, parents, professionals for safer work for teens, enforcement of existing regulations Educate teens & parents re: child labor laws & risks Incorporate work history into care of adolescent patients  W ork hours (total & school nights)  O rganization type  R isks (hazards, equipment, assault)  K inds of training  S upervision by whom & how

55. Unanswered questions re: etiology & prevention– where do we go from here?

56. Teen worker Socio-cultural environment Social-Ecological Model Institutional & organizational environment Interpersonal environment (e.g. supervisor, parents, peers)

57. Socio-cultural level  Laws/policies about: Work permits Enforcement of labor laws  Norms and values about: Teen work Acceptability of risk Willingness to intervene through policy

58.  Vocational education / apprenticeships  Safety design of workplace  Safety monitoring at workplace  Safety training  Supervision practices  Training of business leaders  Culture of safety at workplace Institutional & organizational level (e.g. businesses):

59.  Peer influences on worker safety  Supervisor practices  Parental involvement in job selection, guidance re: safety Interpersonal level

60. Individual level Training working teens in:  safety practices  labor laws  exercising their rights as workers

61. Questions to pursue… How safe is work in different settings? How can we make work safer? What interventions are worthy of dissemination and how do we best disseminate?

62. Helpful websites for more information: Federal resources: http://www.dol.gov/dol/topic/youthl abor/ParentsofYoung.htm http://www.dol.gov/dol/topic/youthl abor/ParentsofYoung.htm http://www.youthrules.dol.gov/ www.stopchildlabor.org

63. Discussion?