NEHA January/February 2024 Journal of Environmental Health

sures reported by participants. A similar expo- sure pattern has been observed among EHPs in Australia (Dine et al., 2021, 2022). Global evi- dence on occupational sun exposure suggested a higher risk of keratinocyte cancers (the most common form of skin cancer) among outdoor workers (Loney et al., 2021). EH is a field-based occupation; therefore, it is not surprising that EHPs spend a significant part of their job out- doors on a weekly basis. In Australia, despite the known established risk of sun exposure as a carcinogen (Fransen et al., 2012), a sig- nificant number of workers are still exposed to solar radiation, and only 9% of workers are using adequate sun protection (Carey et al., 2014). Studies suggest that the perceived risk of occupational sun exposure is relatively low among outdoor workers (Grandahl et al., 2018; Rocholl et al., 2020; Rother et al., 2020), which might also be the belief shared by EHPs. Congruent with our survey, exposure to chemical substances and biological agents were common themes that came from the focus group discussion. When chemical exposure was discussed, one participant stated, “You just don’t know what you can walk into.” Biological exposure was strongly associated with the COVID-19 virus. Partici- pants expressed how they were concerned about working in a potentially high-risk COVID-19 environment while at the same time maintaining personal responsibilities for their families, colleagues, and themselves. Exposure to organic dust has been associ- ated with compromised pulmonary functions for decades (Rylander, 1985; Zuskin et al., 1993). Exposure has been described among workers in agriculture (Omland, 2002), veg- etable markets (Goel et al., 2018; Heibati et al., 2021), and bakeries (Viegas et al., 2020). EHPs conduct regular inspections in these types of premises as part of their regulatory functions. Accessing these premises can potentially put EHPs at risk of exposure to organic dust. Awareness of such risks and the provision of PPE is important for EHPs when entering these premises. In the U.S., approximately 20% of house- holds still depend on septic systems (Profes- sional Testing, Inc., 2020); septic systems make up a large fraction of workplace inspec- tion eorts for EHPs. Further, EHPs regularly access sites with onsite wastewater treat- ment systems for the purpose of compliance inspection and permit processing, and this

FIGURE 1

Reported Level of Work-Related Musculoskeletal Pain and Tiredness Experienced by Survey Respondents the Week Before Completing the Survey ( N = 158)

Sometimes

Rarely

Never

Often

All the time

Tiredness

Pain in Shoulders, Arms, Wrists, or Hands

Pain in Back or Neck

Pain in Hips, Legs, Knees, or Feet

( M = 1.52) and physical violence ( M = 1.18). Participants who self-identified as male were more likely to report incidents of both physical and verbal violence. The dierences, however, were not statistically significant: physical vio- lence ( U = 2,546.0, p =.960) and verbal violence ( U = 2,317.5, p =.328). No significant results were observed across other demographic vari- ables (e.g., age group, employer description, education level, position description). Overarching Themes From the Focus Group Discussion Table 2 presents the overarching themes from the focus group discussion and illustrative quotations from participants. Workplace vio- lence, high work demand, and exposure to chemicals and chemical substances were the common hazards expressed by participants. In response to the question, “How would you describe your current employer approach to occupational health and safety,” the general theme was that the OHS system was frag- mented and inconstant. Poor OHS culture was identified as the main barrier to the implementation of health and safety in the

EH workforce. The dierent circumstances brought about by the pandemic appear to be key mechanisms of some OHS issues raised by the participants (Table 2). Discussion Our study indicates that there are significant workplace hazards associated with the EH workforce in the U.S. Workplace violence and psychosocial and physical work demands were the most common hazards identified in our study. Biological and chemical expo- sures appear to be important hazards, but an in-depth study is required to determine the nature and mechanism of these hazards within the EH workforce. Furthermore, our study suggests that the unprecedented COVID-19 pandemic had a significant impact on the health and safety of EH professionals in terms of increased work demand, the stress of poten- tially contracting the virus, and the unforeseen hostility from some groups in the community. General Workplace Exposures Exposure to direct sunlight, chemicals, and biological agents were the most common expo-

January/February 2024 • Journal of Environmental Health