Exposure of sheet-metal workers to asbestos during the construction and renovation of commercial buildings in New York City. A case study in social medicine

Our plain-English summary of Exposure of sheet-metal workers to asbestos during the construction and renovation of commercial buildings in New York City. A case study in social medicine, by E. Drucker, D. Nagin, D. Michaels, et al (Annals of the New York Academy of Sciences, 1987).

The study

• Authors: E. Drucker, D. Nagin, D. Michaels, M. Lacher, S. Zoloth
• Journal: Annals of the New York Academy of Sciences
• Published: 1987;502:230-44
• Cited by: 7 articles, as counted by NIH iCite
• Read it: PubMed · Publisher
• In J-M's library: Johns-Manville's company medical library held a copy (J-M no. 000960).

Abstract

New York City sheet-metal workers have a history of significant exposure to asbestos. Prior to 1972 when the use of sprayed asbestos insulation was banned in New York City, sheet-metal workers involved in building construction were exposed as they worked adjacent to spraying operations. Subsequent to that date, exposure continued as they renovated these same buildings. In 1982 the Occupational Health Program of Montefiore Medical Center and the Albert Einstein College of Medicine initiated a multidimensional asbestos evaluation and intervention program for the sheet-metal industry and union in New York. The long-term goal of the program was to eliminate asbestos exposure through the safe, systematic removal of asbestos in New York City buildings, most likely a legislated solution. In the short term, we attempted to assess and reduce asbestos exposure in the sheet-metal trade by a series of steps consisting of: mortality and morbidity studies; a medical audit of clinical screening services provided to sheet-metal workers; a comprehensive health education program; development of safe work practices; evaluation of personal protective equipment; and investigation into and support of legislative and regulatory solutions to the problem of asbestos contamination of commercial buildings. This intervention can be seen as a case study in the practice of social medicine.

In plain English

This article described a program, begun in 1982 by the Occupational Health Program at Montefiore Medical Center, to assess and reduce asbestos exposure among New York City sheet-metal workers of Local 28. These workers had worked near asbestos spraying before New York City's 1972 ban and later renovated the same buildings. Of 19 workers first examined, five (27 percent) had lung abnormalities. A proportional mortality analysis of 385 deaths reported to the union pension plan from 1976 to 1983 found increased rates of mesothelioma, lung cancer and digestive-tract cancer. In screening chest X-rays, asbestos-related abnormalities rose with years worked, from 2.7 percent at 0-9 years to 39.6 percent at 30 or more years. Overall, 10.4 percent showed some asbestosis and 8.6 percent pleural disease. The authors called this analysis preliminary. A survey of 100 apprentices found gaps in knowledge about protection. An audit of 833 screening records found low use and record-keeping problems. The authors concluded that asbestos exposure had already harmed these workers and anticipated more disease over the next 10-15 years.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Descriptive report of a multi-part occupational health program, described by the authors as a case study in social medicine. It included a proportional mortality analysis, a review of screening chest X-ray records, a knowledge survey, an evaluation of respirators, a respirator fit-testing pilot, and an audit of a medical screening program.
• Who was studied: Members of Local 28 of the Sheet Metal Workers Association in New York City, studied from 1982 onward. The program included: 19 workers whose employer had been cited by OSHA; 385 deaths reported to the union pension plan between 1976 and 1983; medical records of more than 800 workers in a free examination program, of whom 757 had chest X-rays read; 100 apprentices surveyed; 75 apprentice and journeyman workers in a fit-testing pilot; and 833 medical records audited.
• Exposure: Sprayed asbestos insulation on the structural steel of high-rise commercial buildings in New York City. Workers were exposed while installing ductwork next to spraying operations during construction before the 1972 ban, and afterward while renovating the same buildings. The article does not name a fiber type. Exposure was measured as years employed in the union.
• Main results:
  • Among the 19 sheet-metal workers first examined, lung abnormalities were found in five (27 percent), mostly in those with 25 or more years in the trade.
  • In the proportional mortality analysis of 385 deaths, compared with an age-, race- and sex-matched segment of the United States population, the authors reported an increased rate of mesothelioma and of cancer of the lung and of the digestive tract.
  • The authors judged that these increases were in all likelihood not due to smoking, because other diseases normally associated with smoking were not elevated.
  • Among screened workers, the prevalence of asbestos-associated lung abnormalities rose with years worked: 2.7 percent (5 with, 183 without) at 0-9 years, 9.5 percent at 10-19 years, 24.3 percent at 20-29 years, and 39.6 percent (40 with, 61 without) at 30 or more years. The total was 16.4 percent (116 with, 591 without).
  • 10.4 percent of the sheet-metal workers examined showed some degree of asbestosis, rising to almost 22 percent among those employed 30 years or more.
  • 8.6 percent of the whole group showed signs of pleural disease, rising to 26.7 percent among those employed 30 years or more.
  • In the survey of 100 apprentices, workers knew asbestos was a serious hazard. However, they lacked basic knowledge needed to judge whether they were adequately protected at the worksite.
  • In the audit of the screening program, only one-third of the Local 28 membership used the service in any one year.
  • The audit found a marked difference in how lung abnormalities were detected by the in-house radiologist compared with a specialist in occupational lung disease.
  • In the respirator evaluation, the authors judged the single-use disposable paper mask to be inadequate.
• The authors' conclusion: The authors concluded that asbestos exposure had already taken its toll on the health of the workers they studied. Given the latency of asbestos disease, they anticipated a mounting toll over the next 10-15 years.
• Limitations the authors state:
  • The authors described the X-ray findings by years worked as a preliminary data analysis.
  • The authors called the initial group of 19 workers a small sample.
  • The authors assumed, rather than showed, that the 100 surveyed apprentices were representative of the Local 28 membership.
  • The recommended safe work practices had not yet been tested in sheet-metal renovation work. The authors noted little experience with these methods in general building renovation.

Topics

Medical terms in this study, explained in our Lexicon: Asbestos Exposure.

Related studies

• Asbestos-containing materials in New York City buildings — P. Lundy, M. Barer (1992)
• Asbestos disease in sheet metal workers: II. Radiologic signs of asbestosis among active workers — D. Michaels, S. Zoloth, et al. (1987)
• Occupational dermatoses and allergy to metals in Polish construction workers manufacturing prefabricated building units — M. Kieć-Swierczyńska (1990)
• Asbestos disease in sheet metal workers: proportional mortality update — D. Michaels, S. Zoloth (1988)
• Worker exposure to asbestos during removal of sprayed material and renovation activity in buildings containing sprayed material — N.W. Paik, R.J. Walcott, et al. (1983)
• Asbestos in New York City public school buildings--public policy: is there a scientific basis? — R. Wilson, A.M. Langer, et al. (1994)

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