Publications by authors named "Sonia El-Zaemey"

27 Publications

  • Page 1 of 1

Are There Ethnic Disparities in Exposure to Workplace Hazards Among New Zealand Migrants to Australia?

Asia Pac J Public Health 2021 Apr 13:10105395211007648. Epub 2021 Apr 13.

Curtin University, Bentley, Western Australia, Australia.

Disparities in exposure to workplace hazards exist between Māori and non-Māori workers in New Zealand, with Māori workers generally incurring poorer conditions. This study aimed to determine if these ethnic disparities are similar after migration to Australia. A national cross-sectional telephone survey asked participants what tasks they undertook in their job to assess exposure to carcinogens as well as whether they experienced ethnic discrimination, bullying, job precariousness, or job strain. A total of 389 New Zealand Caucasians and 152 Māori/Pasifika workers were recruited. After adjustment, 79% of Māori/Pasifika compared with 67% of New Zealand Caucasian workers were assessed as being exposed to at least one carcinogen at work (adjusted prevalence ratio [aPR] = 1.2, 95% confidence interval [CI] = 1.1-1.4). Māori/Pasifika workers were also more likely to report ethnic discrimination (aPR = 6.9, 95% CI = 2.6-18.3) and fair or poor current health (aPR = 1.9, 95% CI = 1.1-3.2) than New Zealand Caucasians. Some ethnic disparities in exposure to workplace hazards in New Zealand are apparent after migration to Australia.
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http://dx.doi.org/10.1177/10105395211007648DOI Listing
April 2021

Exposure to Occupational Hazards among Health Care Workers in Low- and Middle-Income Countries: A Scoping Review.

Int J Environ Res Public Health 2021 Mar 5;18(5). Epub 2021 Mar 5.

School of Public Health, Curtin University, Bentley, WA 6102, Australia.

Health care workers are exposed to numerous workplace hazards. The implementation of safety measures in high-income countries has largely mitigated these risks. However, in many low- and middle- income countries (LMICs), resources to institute safety measures are lacking, increasing the risk of occupational exposures to these hazards. The aim of this scoping review is to map and synthesize the available research on occupational hazards among health care workers in LMICs, identify research gaps and inform policy. Searches for relevant articles were conducted in five electronic databases using a broad range of search terms. The inclusion criteria were: quantitative observational or experimental studies which examined exposure to one or more occupational hazards among health care workers in a LMCI; and the article was published in English in a peer-reviewed journal. A total of 99 studies met the inclusion criteria, and data were extracted from these studies. Large proportions of health care workers in LMICs were exposed to biological hazards (bloodborne pathogens, tuberculosis), psychosocial hazards (workplace violence, burnout, job dissatisfaction), ergonomic hazards (musculoskeletal complaints), and chemical hazards (exposure to latex and antineoplastic drugs). The implementation of risk reduction strategies was suboptimal. The majority of the literature was on biological hazards (48%), and research on other hazards was limited in comparison. Occupational safety needs to become a priority public health issue to protect health care workers in LMICs. More research is needed to understand the magnitude of the problem in these countries.
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http://dx.doi.org/10.3390/ijerph18052603DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7967386PMC
March 2021

Impact of the age expansion of breast screening on screening uptake and screening outcomes among older women in BreastScreen western.

Breast 2021 Apr 11;56:96-102. Epub 2021 Feb 11.

Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.

Objectives: To assess the impact of age expansion of screening (EOS) of the target age group from 50 to 69 to 50-74 in Australia, which began mid-2013, by examining screening uptake and outcomes of older women, and by identifying factors associated with continuing screening after reaching the age of 75 years.

Methods: Retrospective study using data from women aged 65+ who attended BreastScreen Western Australia between 2010 and 2017 for free mammograms. Screening uptake and screening outcomes were calculated for the periods before (2010-2012) and after (2015-2017) the age EOS to women aged 70-74. Logistic regression was used to identify variables associated with continuing screening after reaching age 75 years, while controlling for possible confounding variables.

Results: Age EOS increased screening uptake amongst women aged 70-74 b y 36% and amongst women ≥75 years by 3% while screening uptake in women aged 65-69 decreased by 3%. Rate of invasive screened-detected cancers significantly decreased among women aged 70-74 from 11.4/1000 screens before to 8.1/1000 screens after age EOS. Likelihood of continuing screening into age ≥75 years was higher in women who had a personal history or a family history of breast cancer, or used hormone replacement therapy within six months of screening. Women who were born outside Australia were less likely to continue screening after reaching age 75 years.

Conclusions: Our study found that age EOS to women aged 70-74 was effective in increasing screening uptake in this age-group but was accompanied by a moderate increase in screening uptake amongst women ≥75 years via self-referral for whom potential benefit of screening may be limited.
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http://dx.doi.org/10.1016/j.breast.2021.02.006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7933533PMC
April 2021

Authors' Reply.

Int J Occup Environ Med 2020 10;11(4):216-217

School of Public Health, Curtin University, Bentley, Australia.

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http://dx.doi.org/10.34172/ijoem.2020.2196DOI Listing
October 2020

Occupational exposures to hazardous chemicals and agents among healthcare workers in Bhutan.

Am J Ind Med 2020 12 12;63(12):1109-1115. Epub 2020 Oct 12.

School of Public Health, Curtin University, Bentley, Western Australia, Australia.

Background: Occupational exposures to hazardous chemicals among healthcare workers can result in long-term adverse health outcomes. Research on such exposures from low- and middle-income countries is limited. The aim of this study was to estimate the prevalence of exposures to a range of chemicals used in healthcare settings among Bhutanese healthcare workers.

Methods: A cross-sectional study was conducted among healthcare workers (n = 370) working in three hospitals in the western region of Bhutan. Demographic and occupational information was collected, and exposures to asthmagens, carcinogens, ototoxic and other agents were assessed using a web-based tool. The prevalence of exposure to these chemicals was calculated and the circumstances resulting in such exposures were examined.

Results: The prevalence of exposure to one or more asthmagen, carcinogen, and ototoxic agent was 98.7%, 28.1%, and 7.6%, respectively; and was 6.2% for anesthetic gases and 2.2% for antineoplastic drugs. The most common exposures were to latex, and cleaning and disinfecting agents in the asthmagens group; formaldehyde in the carcinogens group; and p-xylene among ototoxic agents. The circumstances resulting in exposures were using latex gloves, using bleach and chlorhexidine for cleaning, using formaldehyde as a disinfectant and in the laboratory, and using p-xylene in the laboratory.

Conclusions: The results indicate that a large proportion of Bhutanese healthcare workers are occupationally exposed to chemicals linked to chronic diseases, with exposure prevalence higher than in high-income countries. The study provides information that can be used to formulate policies and to implement control measures to protect healthcare workers.
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http://dx.doi.org/10.1002/ajim.23192DOI Listing
December 2020

Prevalence of exposure to multiple occupational carcinogens among exposed workers in Australia.

Occup Environ Med 2020 Sep 18. Epub 2020 Sep 18.

School of Public Health, Curtin University, Bentley, Western Australia, Australia

Objectives: Workers can be exposed to a range of different carcinogenic agents in the workplace. However, previous studies have often focused on prevalence of exposure to a single carcinogen, resulting in substantial knowledge gaps regarding the extent of multiple exposures in the workplace. This study aims to investigate the current prevalence of occupational exposure to multiple carcinogens among exposed workers in Australia.

Methods: The data for this study come from the Australian Work Exposures Study, a nationwide cross-sectional telephone survey of Australian workers aged between 18 and 65. Information was collected about the respondents' current employment and numerous demographic factors using a web-based application (Occupational Integrated Database Exposure Assessment System) to conduct the interview, with predefined algorithms used to automatically assign exposures to carcinogens based on the respondents' job tasks.

Results: The majority (81%) of exposed respondents were assessed as being probably exposed to more than one carcinogen, and 26% reported exposure to five or more carcinogens. We found that after adjusting for occupation, exposure to multiple carcinogens was more likely among male respondents, while older workers (aged between 55 and 65) were less likely to be exposed to multiple carcinogens.

Conclusions: This study provides information on the prevalence of exposure to multiple carcinogens in the general population that has not previously been reported. This information could be useful for the intervention and control of occupational exposures to the prioritised carcinogens identified in this study.
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http://dx.doi.org/10.1136/oemed-2020-106629DOI Listing
September 2020

Reliability and Validity of an Adapted Questionnaire Assessing Occupational Exposures to Hazardous Chemicals among Health Care Workers in Bhutan.

Int J Occup Environ Med 2020 07;11(3):128-139

School of Public Health, Curtin University, Bentley, Australia.

Background: Collection of reliable and valid occupational history data is of utmost importance to assess work-related exposures and their health effects. Few standardized questionnaires are available for the collection of occupational history data in low-and-middle income countries.

Objective: To adapt and test a validated questionnaire developed in the United States by the National Institute of Safety and Health, in order to assess occupational chemical exposures among health care workers in Bhutan.

Methods: The questionnaire was first adapted to suit the Bhutanese context with the advice of an expert review committee. 30 health care workers then completed the questionnaire at baseline and 10-14 days later. Test-retest reliability was assessed by calculating Cohen's κ and percentage agreement.

Results: The questionnaire had high test-retest reliability. Cohen's κ ranged from 0.61 to 1.00, and percentage agreement ranged from 86.7% to 100%. Further adaptations included omitting questions on chemicals not available in Bhutan.

Conclusion: The adapted questionnaire is appropriate for assessing occupational chemical exposures among health care workers in Bhutan.
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http://dx.doi.org/10.34172/ijoem.2020.1878DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7426735PMC
July 2020

Does exposure to workplace hazards cluster by occupational or sociodemographic characteristics? An analysis of foreign-born workers in Australia.

Am J Ind Med 2020 09 23;63(9):803-816. Epub 2020 Jun 23.

School of Public Health, Curtin University, Perth, Western Australia, Australia.

Background: Disparities in exposure to occupational hazards may be linked to social position as well as the type of job a person holds. This study aimed to describe the prevalence of exposure to workplace hazards among three migrant worker groups and to assess whether social disparities in exposure for these groups remain after adjusting for occupational characteristics.

Methods: Data were collected in 2017/2018 from 1630 Australian workers born in New Zealand, India, and the Philippines. Weighted estimated prevalence of exposure to 10 carcinogens and four psychosocial hazards (discrimination, job strain, vulnerability, and insecurity) was calculated for sociodemographics and occupation. Regression estimated the likelihood of exposure by sociodemographics after adjustment for occupational characteristics.

Results: Exposure to workplace hazards ranged from 11.7% (discrimination) to 61.2% (exposed to at least one carcinogen). Compared with workers born in India, New Zealand born workers were over twice as likely to be exposed to diesel engine exhaust (adjusted odds ratio [aOR] = 2.60) and 60% more likely to be exposed to at least one carcinogen (aOR = 1.60) but less likely to be exposed to any psychosocial hazard. Social disparities by country of birth, sex, age, education, and number of years in Australia, as well as company size, employment type, and hours, worked remained associated with greater likelihood of reporting one or more workplace hazards after adjusting for occupational characteristics.

Conclusion: Examining sociodemographic as well as occupational characteristics helps to clarify groups most likely to be exposed to workplace hazards who can be hidden when examining occupational characteristics alone.
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http://dx.doi.org/10.1002/ajim.23146DOI Listing
September 2020

No association between night shiftwork and mammographic density.

Occup Environ Med 2020 08 28;77(8):564-567. Epub 2020 May 28.

Centre for Genetic Origins of Health and Disease, University of Western Australia, Perth, Western Australia, Australia

Background: Increased mammographic density is one of the strongest risk factors for breast cancer. Night shiftwork and its related factors, which include light at night, phase shift and sleep disruption, are believed to increase breast cancer risk however, their effects on mammographic density have barely been studied.

Methods: This study included 1821 women enrolled in the Breast Cancer Environment and Employment Study between 2009 and 2011. Mammographic density was measured using the Cumulus software program. The association of night shiftwork factors with square root transformed absolute dense area (DA) and percentage dense area (PDA) were modelled using linear regression adjusted for confounders.

Results: Ever doing graveyard shiftwork (between 24:00 and 05:00 hours) was not associated with PDA (β=-0.10; 95% CI -0.27 to 0.08)) and DA (β=-0.12; 95% CI -0.33 to 0.09)). No association was found between night shiftwork related factors (light at night, phase shift and sleep disturbance) with PDA or DA.

Conclusions: Shiftwork and its related factors are not associated with mammographic density. Using high-quality, comprehensive shiftwork data from a large population-based breast cancer case-control study, this study suggests that mammographic density does not play a role in the relationship between shiftwork and breast cancer risk.
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http://dx.doi.org/10.1136/oemed-2019-106315DOI Listing
August 2020

The estimated prevalence of exposure to carcinogens, asthmagens, and ototoxic agents among healthcare workers in Australia.

Am J Ind Med 2020 07 31;63(7):624-633. Epub 2020 Mar 31.

School of Public Health, Curtin University, Bentley, Western Australia, Australia.

Background: Healthcare workers are occupationally exposed to various hazardous chemicals and agents that can potentially result in long-term adverse health effects. These exposures have not been comprehensively examined at a population level. The aim of this study was to examine occupational exposures to a wide range of asthmagens, carcinogens, and ototoxic agents among healthcare workers in Australia.

Methods: Data were collected as part of the Australian Work Exposures Studies, which were computer-assisted telephone surveys conducted in 2011, 2014, and 2016 to assess the prevalence of occupational exposures to carcinogens, asthmagens, and ototoxic agents, respectively, among Australian workers. Using data on healthcare workers, the prevalence of exposures to these agents was calculated and associations of demographic variables and occupation groups with exposure status were examined.

Results: The prevalence of exposure to at least one asthmagen, carcinogen, and ototoxic agent was 92.3%, 50.7%, and 44.6%, respectively. The most common exposures were to (a) cleaning and sterilizing agents in the asthmagen group; (b) shift work in the carcinogen group; and (c) toluene and p-xylene among ototoxic agents. Exposure varied by occupation, with exposure to carcinogens and ototoxic agents highest among personal carers and exposure to carcinogens most likely among nursing professionals and health and welfare support workers.

Conclusion: The results demonstrate that a substantial proportion of Australian healthcare workers are occupationally exposed to asthmagens, carcinogens, and ototoxic agents. These exposures are more common among certain occupational groups. The information provided by this study will be useful in prioritizing and implementing control strategies.
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http://dx.doi.org/10.1002/ajim.23108DOI Listing
July 2020

Occupational Health and Safety in the Palm Oil Industry: A Systematic Review.

Int J Occup Environ Med 2019 10;10(4):159-173

School of Public Health, Curtin University, Perth, Australia.

Background: The palm oil industry is the largest contributor to global production of oils and fats. Indonesia and Malaysia are the largest producers of palm oil. More than a million workers are employed in this industry, yet there is a lack of information on their occupational health and safety.

Objective: To identify and summarize occupational hazards among oil palm plantation workers.

Methods: A search was carried out in June 2018 in PubMed, Web of Science, Scopus, and Ovid. Relevant publications were identified by a systematic search of four databases and relevant journals. Publications were included if they examined occupational hazards in oil palm plantation workers.

Results: 941 publications were identified; of these, 25 studies were found eligible to be included in the final review. Of the 25 studies examined, 19 were conducted in Malaysia, 2 in Costa Rica, and one each in Ghana, Indonesia, Myanmar, Papua New Guinea, and Cameroon. Oil palm plantation workers were found to be at risk of musculoskeletal conditions, injuries, psychosocial disorders, and infectious diseases such as malaria and leptospirosis. In addition, they have potential exposure to paraquat and other pesticides.

Conclusion: In light of the potential of palm oil for use as a biofuel, this is an industry with strong growth potential. The workers are exposed to various occupational hazards. Further research and interventions are necessary to improve the working conditions of this already vast and growing workforce.
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http://dx.doi.org/10.15171/ijoem.2019.1576DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6820316PMC
October 2019

Lifestyle and occupational factors associated with participation in breast mammography screening among Western Australian women.

J Med Screen 2020 06 3;27(2):77-84. Epub 2019 Oct 3.

School of Public Health, Curtin University, Bentley, Australia.

Objectives: Various lifestyle and occupational factors have been associated with an increased risk of breast cancer, but there is limited research investigating the relationship between these factors and participation in breast cancer screening. This study explores the associations between lifestyle and occupational factors and participation in breast mammography screening among women living in Western Australia.

Methods: This study involved 1705 women aged 40 and older who participated as controls in the Breast Cancer Environment and Employment Study conducted in Western Australia. Self-reported questionnaire data were collected on participation in mammography screening, demographic factors, and lifestyle and occupational variables (smoking, physical activity, alcohol consumption, body mass index, use of contraceptive pill and hormone replacement therapy, breastfeeding, occupation, and participation in shift work). Multivariate modified Poisson regression was used to identify variables associated with ever participation in breast mammography screening.

Results: Just over 88% of women reported having ever had a mammogram. Likelihood of having ever had a mammogram was higher among women who had ever used hormone replacement therapy (adjusted prevalence ratio (aPR) = 1.05, 95% CI 1.02-1.07). Women who worked in clerical occupations (aPR = 1.06, 95% CI 1.01-1.11) or home duties (aPR = 1.05, 95% CI 1.00-1.11) were also more likely to report having ever had a mammogram compared with those in professional or technical occupations.

Conclusions: Participation in mammography screening was found to differ by lifestyle and occupational factors. These results have important implications for public health strategies on improving screening participation.
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http://dx.doi.org/10.1177/0969141319878747DOI Listing
June 2020

Lifestyle and occupational factors associated with participation in colorectal cancer screening among men and women in Australia.

Prev Med 2019 09 15;126:105777. Epub 2019 Jul 15.

School of Public Health, Curtin University, Kent Street, Bentley, Western Australia 6102, Australia.

This study explores the associations between lifestyle and occupational factors and participation in colorectal cancer (CRC) screening among men and women aged 50 and over and living in Australia. We used weighted data from the Australian National Health Survey 2014-15 to produce population estimates. Lifestyle variables investigated were smoking, physical activity, alcohol consumption, fruit and vegetable consumption, and body mass index, while the occupational variables were labour force status, occupation, and participation in shift work. Using weighted data, 1,990,287 men (55%) and 1,898,232 women (49%) reported ever-screening for CRC. Female current smokers were less likely to report ever-screening for CRC (adjusted RR = 0.78, 95% CI 0.64-0.96), as were men who were less physically active (aRR = 0.87, 95% CI 0.78-0.97), reported no alcohol consumption (aRR = 0.73, 95% CI 0.59-0.91), and reported eating more vegetables (aRR = 0.84, 95% CI 0.72-0.99). When lifestyle behaviours were combined into a healthy lifestyle index score, a significant trend was observed for both men and women, whereby those who reported engaging in more healthy behaviours were more likely to have ever-screened for CRC (p = .027 men; p < .001 women). No associations were observed between CRC screening and occupational variables. This is the first comprehensive assessment of the lifestyle and occupational factors associated with participation in CRC screening among men and women in Australia. Participation in CRC screening was greater among those engaging in more healthy behaviours, suggesting that an individual's pattern of lifestyle behaviours may be important in determining screening participation. These results have important implications for public health strategies on improving CRC screening participation.
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http://dx.doi.org/10.1016/j.ypmed.2019.105777DOI Listing
September 2019

Animal farming and the risk of lymphohaematopoietic cancers: a meta-analysis of three cohort studies within the AGRICOH consortium.

Occup Environ Med 2019 11 13;76(11):827-837. Epub 2019 Jul 13.

Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute (NCI), Bethesda, Maryland, USA.

Objective: Animal farming entails a variety of potential exposures, including infectious agents, endotoxins and pesticides, which may play a role in the aetiology of lymphohaematopoietic cancers (LHCs). The aim of this study was to assess whether farming specific animal species is associated with the risk of overall LHC or its subtypes.

Methods: Data from three prospective cohort studies in the USA, France and Norway which are part of the Agricultural Cohort consortium and which collected information about animal farming and cancer were used. Analyses included 316 270 farmers and farm workers. Adjusted Cox models were used to investigate the associations of 13 histological subtypes of LHC (n=3282) with self-reported livestock (cattle, pigs and sheep/goats) and poultry (ever/never and numbers raised) farming. Cohort-specific HRs were combined using random-effects meta-analysis.

Results: Ever animal farming in general or farming specific animal species was not meta-associated with overall LHC. The risk of myeloid malignancies decreased with increasing number of livestock (p trend=0.01). Increased risk of myeloproliferative neoplasms was seen with increasing number of sheep/goats (p trend <0.01), while a decreased risk was seen with increasing number of livestock (p trend=0.02). Between cohorts, we observed heterogeneity in the association of type of animal farmed and various LHC subtypes.

Conclusions: This large-scale study of three prospective agricultural cohorts showed no association between animal farming and LHC risk, but few associations between specific animal species and LHC subtypes were observed. The observed differences in associations by countries warrant further investigations.
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http://dx.doi.org/10.1136/oemed-2018-105655DOI Listing
November 2019

Variations in exposure to carcinogens among shift workers and non-shift workers.

Am J Ind Med 2019 04 24;62(4):352-356. Epub 2019 Jan 24.

School of Public Health, Curtin University, Bentley, Western Australia, Australia.

Background: There is limited information on whether the prevalence of exposure to workplace carcinogens varies among shift workers and non-shift workers.

Methods: This analysis used data from the Australian Work Exposures Study-Cancer, a telephone survey which examined exposure to carcinogens in the workplace. Workers were classified as shift workers if they indicated that their usual roster ever included work between the hours of midnight and 5 am. Modified Poisson regression was used to estimate the adjusted prevalence ratios (aPRs) and 95% confidence internals (CIs).

Results: Among the 5425 workers, 6.88% reported being exposed to shift work. Overall, shift workers were more likely to be exposed to any carcinogen (aPR = 1.16; 95% 1.06-1.26) and to specific carcinogens such as asbestos (aPR = 1.93; 95% 1.33-2.83) than non-shift workers.

Conclusions: Our study shows that there are differences in exposure to carcinogenic agents among shift and non-shift workers, and so there is a need for prevention programs in order to reduce these discrepancies.
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http://dx.doi.org/10.1002/ajim.22950DOI Listing
April 2019

DDT exposure in early childhood and female breast cancer: Evidence from an ecological study in Taiwan.

Environ Int 2018 12 28;121(Pt 2):1106-1112. Epub 2018 Oct 28.

Department of Economics, National Chung Cheng University, Chiayi County, Taiwan.

Researchers still lack consensus on the association between exposure to DDT and the risk of breast cancer. One reason could be that the measurements of DDT obtained during or near the time of diagnosis may not reflect exposure during the etiologically relevant time period in a woman's life. This study undertook an ecological analysis to investigate whether exposure to DDT among cohort born between 1951 and 1959 (i.e. age 0-5 years) and who reached the age 50-54 years during 2001-2013 had an increased risk of breast cancer in adulthood. To do this, we used the number of DDT sprays in each township during the anti-malaria campaign in Taiwan in the 1950s as a proxy for direct DDT exposure. The DDT sprays were then linked to the township female breast cancer incidence rate in the 2000s when the birth cohorts had reached age 50-54 years. Insurance claims data were used to identify breast cancer cases during 1996-2013. Zero-Inflated Poisson regression was performed to estimate the effect of DDT sprays on the breast cancer incidence rate. The analysis was based on a total of 9 birth cohorts (1951-1959) in 349 townships who had lived at least up to age 50. On average, one DDT spray experienced during age 0-5 years was associated with an increase of 8 more female breast cancer cases per 100,000 during age 50-54. The effect appears to increase with the number of sprays. Our finding suggests that DDT exposure in early childhood could raise the risk of breast cancer in adulthood.
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http://dx.doi.org/10.1016/j.envint.2018.10.023DOI Listing
December 2018

The prevalence of exposure to high molecular weight asthmagens derived from plants among workers in Australia.

Am J Ind Med 2018 10 30;61(10):824-830. Epub 2018 Aug 30.

School of Public Health, Curtin University, Bentley, Western Australia, Australia.

Background: Limited information is available on exposure to high molecular weight (HMW) asthmagens derived from plants and on the main occupations and tasks that result in such exposure among workers.

Methods: Data were collected as part of the Australian Work Exposures Study-Asthma. We estimated adjusted prevalence ratios (aPR) using modified Poisson regression models to determine which factors were associated with exposure.

Results: A 12.8% of 4878 workers were exposed to HMW asthmagens derived from plants. The highest prevalence of exposure was found among farmers/animal workers, education workers, and food processing workers. The main circumstances of exposure were through handling flour, freesias, or through raising livestock. Exposure was more common among female workers (aPR = 1.26, 1.10-1.43) than males, while it was lower among workers born overseas (aPR = 0.70, 0.57-0.86) than those born in Australia.

Conclusion: Prevention of exposure to HMW asthmagens derived from plants requires a broad strategy targeting different tasks and occupations.
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http://dx.doi.org/10.1002/ajim.22903DOI Listing
October 2018

Does the Size of a Company Make a Difference in the Prevalence of Exposure to Asthmagens and in the Use of Respiratory Protective Equipment?

Ann Work Expo Health 2018 07;62(6):765-769

School of Public Health, Curtin University, Bentley, Western Australia, Australia.

Introduction: About half of all workers in high-income countries work in small companies. However, regulatory bodies and researchers predominantly work with large companies because they are more convenient to study and easier to reach. We aimed to estimate the prevalence of exposure to asthmagens and the use of respiratory protective equipment (RPE) by company size.

Methods: This analysis used data from the Australian Work Exposures Study-Asthma, a telephone survey which investigated exposure to 27 asthmagen groups.

Results: Among 4844 respondents, 18.8, 19.9, 31.9, and 29.4% of workers reported working in micro (<5 employees), small (5-19 employees), medium (20-200 employees), and large (>200 employees) companies, respectively. Compared to workers in large companies, workers in micro, small, or medium companies had higher prevalence of exposure to most asthmagens and lesser use of RPE.

Conclusion: Our results suggest that policy actions and regulatory measures should target micro/small companies in order to have the greatest effect.
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http://dx.doi.org/10.1093/annweh/wxy031DOI Listing
July 2018

Latex glove use among healthcare workers in Australia.

Am J Infect Control 2018 09 17;46(9):1014-1018. Epub 2018 Apr 17.

School of Public Health, Curtin University, Bentley, Western Australia, Australia.

Background: Exposure to natural rubber latex, primarily through the use of gloves, is a well-recognized cause of occupational asthma. We investigated latex glove use among Australian workers and estimated the resultant burden of occupational asthma among healthcare workers (HCWs).

Methods: Data were collected in 2014 as part of the Australian Work Exposures Study-Asthma, a telephone survey investigating the prevalence of current occupational exposure to asthmagens, including latex. We estimated adjusted prevalence ratios (aPRs) to determine variables associated with the use of latex gloves among HCWs and calculated the asthma-related disability-adjusted life years due to latex exposure among HCWs.

Results: Latex gloves were used by 22% of respondents. Almost two-thirds (63%) of HCWs reported wearing latex gloves, with 26% using powdered latex gloves. The use of latex gloves was more common among those employed in micro companies (less than 5 employees) than large companies (200+ employees) (aPR = 1.5, 95% confidence interval 1.1-2.0). Latex exposure in HCWs was estimated to contribute 3% of the total asthma-related burden.

Discussion: Latex gloves are widely used by Australian workers and by HCWs in particular.

Conclusions: This is the first estimate of the burden of asthma attributable to occupational exposure to latex among HCWs. These results can be used to guide decisions regarding the control of occupational exposure to latex.
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http://dx.doi.org/10.1016/j.ajic.2018.03.011DOI Listing
September 2018

Isocyanates in Australia: Current exposure to an old hazard.

J Occup Environ Hyg 2018 07;15(7):527-530

a School of Public Health , Curtin University , Western Australia , Australia.

Exposure to isocyanates has consistently been reported as the most common cause of occupational asthma. The objectives of this study were to assess how many Australian workers are currently exposed to isocyanates, identify the occupations with highest proportion of exposed workers and identify the main circumstances of exposures. Data comes from the Australian Workplace Exposure Study-Asthma, a national telephone survey which explored the prevalence of current occupational exposure to 227 asthmagens, grouped into 27 groups, among current Australian workers aged 18-65 years. A web-based tool, OccIDEAS, was used to collect job task information and to assign exposure to asthmagens, including isocyanates. Of the 4,878 eligible participants, 2.5% of them were deemed to be probably exposed to isocyanates at work in their current job (extrapolated to 3.0% of the Australian working population). The majority of those exposed were males (90.8%). The most common tasks undertaken that led to these exposures were using expanding foam fillers/sprays and isocyanate and/or polyurethane paints. Exposure occurred mainly among construction workers, wood workers, and painters or printers. This study investigating occupational exposure to isocyanates in a national working population provides information that can be used to inform the direction of occupational interventions and policies to decrease occupational asthma.
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http://dx.doi.org/10.1080/15459624.2018.1461221DOI Listing
July 2018

Case-control study to assess the association between colorectal cancer and selected occupational agents using INTEROCC job exposure matrix.

Occup Environ Med 2018 04 8;75(4):290-295. Epub 2017 Dec 8.

School of Public Health, Curtin University, Perth, Western Australia, Australia.

Background: Colorectal cancer is the third most prevalent cancer in the world and is twice as common in developed countries when compared with low-income and middle-income countries. Few occupational risk factors for colorectal cancer have been identified. This case-control study aimed to assess the association between colorectal cancer and occupational exposure to selected solvents, combustion products, metals, dusts and other agents.

Methods: Cases (n=918) were enrolled from the Western Australian Cancer Registry from June 2005 to August 2007. Controls (n=1021) were randomly selected from the Western Australian electoral roll. We collected lifetime occupational history from cases and controls, in addition to their demographic and lifestyle characteristics. We applied the INTEROCC job exposure matrix to convert the occupational history to occupational exposure for 18 selected agents. Three exposure indices were developed: (1) exposed versus non-exposed; (2) lifetime cumulative exposure; and (3) total duration of exposure. The associations between colorectal cancer and the selected agents were estimated using logistic regression models adjusting for sex and age.

Results: None of the 18 selected agents showed an association with colorectal cancer. No dose-response relationships with lifetime cumulative exposure or duration of exposure were observed.

Conclusion: There was no evidence to suggest that occupational exposure to 18 selected agents increased the risk of colorectal cancer.
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http://dx.doi.org/10.1136/oemed-2017-104795DOI Listing
April 2018

Prevalence of occupational exposure to asthmagens derived from animals, fish and/or shellfish among Australian workers.

Occup Environ Med 2018 04 24;75(4):310-316. Epub 2017 Nov 24.

School of Public Health, Curtin University, Perth, Western Australia, Australia.

Objective: Several animal, fish and/or shellfish derived substances encountered in the workplace can initiate or exacerbate asthma. The aims of this study were: to produce a population-based estimate of the current prevalence of occupational exposure to animal, fish and/or shellfish derived asthmagens, to identify the main circumstances of exposures and to identify occupations with the highest proportions of exposed respondents.

Methods: We used data from the Australian Work Exposure Study-Asthma, a national telephone survey that investigated the current prevalence of occupational exposure to asthmagens among Australian workers. A web-based tool was used to collect job task information and assign exposure to asthmagens, including animal, fish and/or shellfish derived asthmagens. Prevalence ratios to determine risk factors for exposure were estimated using modified Poisson regression.

Results: Of the 4878 respondents, 12.4% were exposed to asthmagens derived from animals, fish and/or shellfish. Exposure to these asthmagens was significantly higher in workers residing in regional and remote areas, compared with major cities. The main circumstance of exposure to animal derived asthmagens was through cleaning up rat/mice infestations, while the main circumstance of exposure to fish and/or shellfish derived asthmagens was through preparing and cooking salmon. Occupational groups with the highest proportion of exposure to animal or fish and/or shellfish derived asthmagens were farmers/animal workers and food workers, respectively.

Conclusions: This is the first study investigating occupational exposure to animal, fish and/or shellfish derived asthmagens in a nationwide working population. The results of this study can be used to inform the direction of occupational interventions and policies to reduce work-related asthma.
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http://dx.doi.org/10.1136/oemed-2017-104459DOI Listing
April 2018

Australian work exposures studies: occupational exposure to pesticides.

Occup Environ Med 2017 01 8;74(1):46-51. Epub 2016 Sep 8.

School of Public Health, Curtin University, Perth, Western Australia, Australia.

Background: Pesticides are widely used in some occupational settings. Some pesticides have been classified as carcinogens; however, data on the number of workers exposed to pesticides are not available in Australia. The main aim of this study was to estimate the current prevalence of pesticide exposure in Australian workplaces.

Methods: The analysis used data from the Australian Work Exposures Study, a series of nationwide telephone surveys which investigated work-related prevalence and exposure to carcinogens and asthmagens, including pesticides, among current Australian workers. Information about the respondents' current job and various demographic factors was collected in a telephone interview using the web-based tool OccIDEAS. Workers were considered exposed to pesticides if they reported applying or mixing pesticides in their current job.

Results: Of the 10 371 respondents, 410 (4%) respondents were assessed as being exposed to pesticides in the workplace, with exposure being more likely among males, individuals born in Australia, individuals with lower education level and those residing in regional or remote areas. Glyphosate was the most common active ingredient used by workers.

Conclusions: This is the first study to describe the prevalence of occupational pesticide exposure in Australia and one of the few recent studies internationally.
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http://dx.doi.org/10.1136/oemed-2016-103723DOI Listing
January 2017

Noticing pesticide spray drift from agricultural pesticide application areas and breast cancer: a case-control study.

Aust N Z J Public Health 2013 Dec;37(6):547-55

Objectives: To examine the relationship between self-reported noticing of pesticide spray drift from agricultural areas and breast cancer.

Methods: A case-control study of breast cancer was conducted in Western Australia from 2009 to 2011. Awareness of pesticide spray drift from agricultural areas was assessed by a self-report of whether the participant had noticed spray drift. To evaluate recall bias, we stratified the analysis by participants' belief about whether pesticides increase the risk of breast cancer. Unconditional logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs). This analysis included 1,743 controls and 1,169 cases. Sensitivity analysis for potential selection and misclassification bias was also conducted.

Results: Among women who reported 'ever noticed' pesticide spray drift from agricultural areas, an increased risk of breast cancer was also observed (OR=1.43; 95% CI 1.15, 1.78). A dose response relationship between lifetime exposure to noticing pesticide spray drift and risk of breast cancer was observed (p<0.001). An increased risk of breast cancer was observed among women who noticed pesticide spray drift: initially at the age of 20 or younger (OR=1.61; 95% CI 1.19, 2.16); at least 20 years before diagnosis (OR=1.51; 95% CI 1.19, 1.92); and for 10 years or more (OR=1.51; 95% CI 1.18, 1.94).

Conclusion: These findings support the hypothesis that women who ever noticed spray drift or who first noticed spray drift at a younger age had increased risk of breast cancer.
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http://dx.doi.org/10.1111/1753-6405.12111DOI Listing
December 2013

Household and occupational exposure to pesticides and risk of breast cancer.

Int J Environ Health Res 2014 Apr 14;24(2):91-102. Epub 2013 Jun 14.

a School of Population Health , The University of Western , 35 Stirling Highway, Crawley , 6009 , Australia .

The association between breast cancer in women and the use of household or occupational pesticides was examined in a population-based case-control study. This study was conducted in Western Australia in 2009-2011 and included 1,789 controls and 1,205 cases. Information on household pesticide exposure was collected from questionnaires. For occupational pesticide exposure, job-specific modules (JSMs) were used. To evaluate potential recall bias, we stratified the analysis by belief about whether pesticides contribute to breast cancer. Unconditional logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs). Women's exposures to pesticides in households and workplaces were not related to increased risk of breast cancer (OR = 1.10; CI: 0.86-1.37) and (OR = 0.77; CI: 0.45-1.32), respectively. The prevalence of occupational exposure to pesticides among women in our study was low. In the stratified analyses, the odd ratios associated with household pesticide use were similar among participants who believed pesticides increased breast cancer risk and those who did not. The results of our study did not show associations between breast cancer and household or occupational exposure to pesticides.
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http://dx.doi.org/10.1080/09603123.2013.800958DOI Listing
April 2014

Occupational pesticide exposure among Yemeni women.

Environ Res 2013 Apr 16;122:45-51. Epub 2013 Jan 16.

School of Population Health, Faculty of Medicine, Dentistry and Health Sciences, The University of Western Australia (M431), 35 Stirling Highway, Crawley, WA 6009, Australia.

Objectives: Limited research on the nature and extent of pesticide exposure among women in developing countries is available. The aim of this study was to describe potential pesticide exposure among women living in Yemen that occurs through agricultural work.

Methods: In this cross-sectional study, 410 women who had a daughter enrolled in high school during 2011-2012 were surveyed regarding pesticide exposure.

Results: Of the 410 women who responded to the survey, 171 women reported working on farms during their lifetime. Of these 171 women, 147 reported working on a farm prior to marriage and 108 reported working on a farm after marriage. Among the women who reported working on a farm before marriage, 47% had worked on farms where pesticides were used. Among those women who reported working on farms after marriage, 69% of women worked on farms where pesticides were used. Among women who reported working on a farm before marriage where pesticides were used, 45% reported not using any protective equipment. This proportion was 33% among women who worked on a farm after marriage. Among the 28 commercial pesticides that were listed within the questionnaire, the banned compound dimethoate was the most commonly reported pesticide to be used on farms.

Conclusions: The findings suggest that improving safe pesticide management practices among farmers and enforcing effective banning of the most toxic pesticides is needed to reduce pesticide exposure among Yemeni women.
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http://dx.doi.org/10.1016/j.envres.2012.12.002DOI Listing
April 2013

Including questionnaires with the invitation package appeared to increase the response fraction among women.

J Clin Epidemiol 2012 Jun 15;65(6):696-9. Epub 2012 Mar 15.

Western Australian Institute for Medical Research, The University of Western Australia, B Block, Hospital Avenue, Nedlands, WA 6009, Australia.

Objective: The Breast Cancer Environment and Employment Study (BCEES) is a case--control study that began in 2009. The study experienced a lower than expected response fraction, a trend that appears to be occurring internationally. A 32-page questionnaire was included in the initial invitation to participate, and previous research suggests that long questionnaires decrease response fractions. The aim of this study was to test whether removal of the questionnaire from the invitation package increased participation.

Study Design And Setting: A randomized controlled trial was undertaken among the BCEES controls from June to August 2010. One group of 250 received the questionnaire in the initial invitation package, and the other group of 250 received only the invitation package and was sent the questionnaire after their consent was received. The proportion of responses for the two groups was compared using contingency tables and chi-square statistics.

Results: Those who received the questionnaire with the invitation package were more likely to consent to participate than those who did not (40.8% and 33.2%, respectively). However, this difference was not statistically significant (P=0.078).

Conclusion: To improve response fractions and reduce time in following up nonresponses, questionnaires should be included in the invitation package.
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http://dx.doi.org/10.1016/j.jclinepi.2011.11.007DOI Listing
June 2012