Lenore S. Azaroff • Hoa Mai Nguyen • Tuan Do • Rebecca Gore • Marcy Goldstein-Gelb
L. S. Azaroff (&). T. Do. R. Gore
Work Environment Department, University of Massachusetts Lowell,
One University Avenue, Lowell, MA 01854, USA
H. M. Nguyen Vietnamese-American Initiative for Development, Dorchester, MA, USA
M. Goldstein-Gelb Massachusetts Coalition for Occupational Safety and Health, Dorchester, MA, USA
Springer Science+Business Media, LLC 2011
A community-university partnership used community-based participatory research (CBPR) to design, implement, and evaluate a multi-cultural public health campaign to eliminate ﬂammable products and reduce use of products high in volatile organic compounds (VOCs) in hardwood ﬂoor ﬁnishing in Massachusetts. Leading participants were Vietnamese-American organizations and businesses.
Following the public health campaign, a multilingual survey of self-reported experiences with ﬁres, product use, exposure to outreach activities, and changes made, was conducted with ﬂoor ﬁnishers. One hundred nine ﬂoor ﬁnishers responded. Over 40% reported ﬁres at their companies’ jobs, mostly caused by lacquer sealers. Over one third had heard radio or TV shows about health and safety in ﬂoor ﬁnishing, and over half reported making changes as a result of outreach. Exposure to various out¬reach activities was associated with reducing use of ﬂam-mable products, increasing use of low-VOC products, and greater knowledge about product ﬂammability. However, most respondents still reported using ﬂammable products. Outreach led by community partners reached large pro¬portions of ﬂoor ﬁnishers, was associated with use of safer products, and adds to recent work on CBPR with immigrant workers. Continued use of ﬂammable products supports the belief that an enforceable ban was ultimately necessary to eradicate them.
Community-based participatory research.
Toxics use reduction.
Protecting worker health and safety in small businesses has long been an important challenge  that has become more urgent with the growth in low-wage, contingent, and informal employment. Increasing numbers of immigrants, in particular, hold non-standard jobs in hazardous indus¬tries, where forces that promote safety, such as government enforcement, labor union representation, and industry standards, are rare [2–6].
One fruitful approach to improving such work environments is community-based participatory research (CBPR). CBPR involves community, labor, and academic partners in jointly deﬁning problems and solutions and assessing effectiveness . A series of CBPR projects has been funded by the National Institute for Occupational Safety and Health (NIOSH), the Environmental Protection Agency, and the National Institute for Environmental Health Sciences (NIEHS) through the Environmental Justice Partnerships for Communication  and Partnerships for Environmental Public Health (PEPH) programs .
Small ﬁrms often lack information about products, depend on suppliers for education, and choose controls based on custom [10, 11]. CBPR projects have sought to address these obstacles by reducing exposures to toxic substances in print shops , car repair , painting , and house cleaning . The Dorchester Occupational Health Initiative (DOHI), funded by NIEHS through the Partnerships for Communication and PEPH programs, addressed hazardous products in hardwood ﬂoor ﬁnishing.
DOHI focused on the Dorchester neighborhood of Boston, where most ﬂoor ﬁnishers are from Vietnam . Partners were the Vietnamese-American Initiative for Development (Viet-AID); Massachusetts Coalition for Occupational Safety and Health (MassCOSH); New Ecol¬ogy, Inc. (NEI); the University of Massachusetts Lowell (UML); and Dorchester House, Codman Square, and Bowdoin Street Health Centers.
Hazards of Floor Finishing
DOHI identiﬁed little information about ﬂoor ﬁnishing in the scientiﬁc literature and found that ﬂoor ﬁnishers were too busy and suspicious of competitors to share their knowledge in planned focus groups. Two Boston-area house ﬁres that killed three Vietnamese ﬂoor ﬁnishers and badly burned three others in 2004 and 2005 [17–19] then created a ‘‘teachable moment’’ that moved DOHI to convene experts from industry, labor, and environmental protection who explained the following:
• Vietnamese-American ﬁnishers often applied a ﬁrst coat of an inexpensive, quick-drying product called ‘‘lacquer sealer.’’
• Lacquer sealers are extremely ﬂammable, with ﬂash points as low as 9F and high volatility [20, 21].
• Lacquer sealers are not designed for ﬂoor ﬁnishing and result in a poor quality ﬁnish. However, they initially produce an attractive amber color, require little skill to apply, and disguise errors in sanding.
• Lacquers, as well as wood dust, rags wet with solvents, and a few other ﬂammable products frequently combust.
• A broad range of high quality, non-ﬂammable products, both solvent-borne (‘‘oil-based’’) and water-borne, are available.
• The sickening vapors from solvent-borne ﬂoor ﬁnishes can be avoided by using water-borne products and very-low-VOC solvent-borne products.
• Proper application of water-borne products can produce a superior ﬁnish.
The cause of ﬁres perceived to be most urgent and most feasibly eliminated was lacquer sealers, which had started the two fatal ﬁres . (Lacquers are deﬁned as ‘‘clear or pigmented wood ﬁnishes, including clear lacquer sanding sealers, formulated with nitrocellulose or synthetic resins to dry by evaporation without chemical reaction.’’ )
Many ﬂoor ﬁnishing products contain volatile organic compounds (VOCs). Breathing VOCs can cause acute (feeling dizzy or ‘‘drunk,’’ headache, respiratory irritation) and long-term (neurological impairment, liver and kidney damage) health effects . In addition, ﬂoor ﬁnishes are important sources of VOCs that contribute to ground level ozone [24–26]. Some ﬁnishes (including some low in VOCs ) also contain known carcinogens, asthmagens, or reproductive toxins, but several low-VOC products do not .
Respirable wood dust causes respiratory irritation, dermatitis, and cancer, and dusts from certain types of wood cause asthma . Sanding painted ﬂoors can expose workers to lead dust. Sanding some ﬂoor ﬁnishing products from the 1950s and 60s can cause signiﬁcant exposures to PCBs . Dustless sanding systems, which typically cost several thousand dollars, are designed to dramatically reduce dust.
Flammable or toxic dusts and vapors are particular risks for smokers, and about 30% of Vietnamese immigrants smoke. They are also three times more likely than other U.S. residents to not visit a doctor due to lack of money .
Public Health Campaign to Prevent Hazards in Wood Floor Finishing
DOHI learned that ﬂoor ﬁnishing products and practices were determined by a complex system (Figure 1). Partners launched a campaign targeting several levels.
Societal and Industry Levels
MassCOSH recruited several product distributors, ﬂoor ﬁnishers, environmental experts, labor representatives, and community leaders to form the Massachusetts Floor Finishing Safety Task Force. Members agreed on the need to eliminate lacquers to prevent ﬁres in ﬂoor ﬁnishing and explored a range of policy alternatives.
All ﬂoor product distributors in Massachusetts known to the Task Force voluntarily halted sales of lacquer sealers to ﬂoor ﬁnishers for several months. Floor ﬁnisher demands then led one to resume lacquer sales, forcing the others to follow. This demonstrated the need for enforceable rules.
The Task Force then moved to a legislative approach. One bill was ﬁled with the Massachusetts legislature to require certiﬁcation and safety training of ﬂoor ﬁnishers, and a second to prohibit the sale and use of ﬂammable products in commercial wood ﬂoor ﬁnishing [31–34].
The Task Force also proposed a regulation banning ﬂammable ﬂoor ﬁnishing products to the Massachusetts Board of Fire Prevention Regulations. Based on feedback from the Board, the Task Force submitted an alternative regulation to require safety measures and permits for jobs using ﬂammable products.
Task Force members testiﬁed before the legislature and the Fire Prevention Board and visited legislators several times . In June 2010, the Board passed the regulation requiring permitting and safety measures [36, 37]. In July, the legislature passed a bill banning the sale and use of lacquer sealers for wood ﬂoor ﬁnishing [38, 39].
DOHI disseminated information to consumers via fact sheets, media releases, and presentations to homebuyer classes. Viet-AID collaborated with the Massachusetts Department of Public Health (MDPH) in translating a Fatality Assessment and Control Evaluation (FACE) Alert describing the fatal ﬁres and safety recommendations, and translating and designing it to make it appealing to Vietnamese ﬂoor ﬁnishers [40, 41]. MDPH sent over 3,000 copies of the FACE Alert to audiences including insurance agencies, building inspectors, property managers, and landlord associations. The Massachusetts Department of Fire Services distributed copies to ﬁre chiefs and to institutions afﬁliated with the Massachusetts Burn Injury Reporting System.
The Task Force developed a Floor Finishing Safety Checklist that was distributed to ﬂoor ﬁnishing companies, product distributors, and product manufacturers .
NEI identiﬁed quality as customers’ main concern . In response, MassCOSH and NEI encouraged several agencies and organizations involved in building and maintenance to use non-ﬂammable, low-VOC products to obtain high quality ﬁnished ﬂoors.
Company and Individual Levels
Viet-AID staff promoting free ﬂoor ﬁnishing health and safety trainings in Vietnamese discovered low awareness of the fatal ﬁres and little perceived need for safety education. Almost no one attended DOHI’s ﬁrst advertised trainings, which were canceled. Viet-AID staff then conducted an informal assessment of contractors’ interests and learned that they most needed more business. Viet-AID placed advertisements and columns in three major Vietnamese-language newspapers, six announcements on popular Vietnamese-language radio stations, and three discussions on the local Vietnamese public affairs television program with information about health and safety and advertising trainings on ‘‘Making Your Floor Finishing Business More Proﬁtable.’’
Industry experts in the Task Force designed training materials and curricula. Viet-AID identiﬁed one of just three certiﬁed master ﬂoor ﬁnishers in Massachusetts, a bilingual Vietnamese immigrant and talented instructor who volunteered as a trainer.
Several aspects of the training were designed to overcome barriers raised by ﬂoor ﬁnishers. When participants argued that water-borne products were too expensive, instructors guided them through analyses of time and labor costs of jobs using faster-drying water-borne products versus solvent-borne products. They explored the ‘‘high road’’ to competition, providing superior products and services that can enable contractors to charge more while building a good reputation and loyal customer base. In response to concerns that adopting unfamiliar products might harm quality and customer satisfaction, the sessions included hands-on practice in use of water-borne products, expert instructors, and trainers’ offers to travel to job sites with free technical assistance. Workers desiring additional practice attended advanced sessions at a corporate facility. Trainings helped dispel common beliefs, based on older formulations of water-borne products and incorrect application of current ones, that they produce an inferior ﬁnish.
Training participants viewed causes of ﬂoor ﬁnishing ﬁres, discussed ﬂash points, reviewed material safety data sheets (MSDSs), and received the FACE Alert.
By 2010, 146 ﬂoor ﬁnishers had completed 5 h of training in use of environmentally preferable products.
Viet-AID recruited participants to a planned Safer Floor Finishers Network. Network members must commit to give up lacquers and offer water-borne products as an option. The Massachusetts Toxics Use Reduction Institute (TURI) and Viet-AID designed websites marketing Network members.
Assessment of Results
The main goal of the public health campaign was to reduce ﬁres caused by lacquer sealers. Secondary goals included reducing health risks by promoting water-borne products. With no known data source on ﬁres or product use, we relied on a survey of experiences with ﬁres, products, exposure to outreach activities, changes made, and associations between changes and exposure to these activities . This was conducted prior to the banning of lacquers.
The interviewer administered questionnaire included items about characteristics of workers surveyed and their businesses and types and frequencies of products used. Open-ended questions asked for reasons that respondents did or did not use certain products.
Questions asked about exposure to outreach activities and other inﬂuences and whether the respondent had made changes as a result. Descriptions of such changes were requested.
Additional questions asked about knowing of ﬁres that had happened on other companies’ jobs or at jobs done by one’s own company; knowing others who feel dizzy or drunk when using ﬂoor ﬁnishing products or feeling such sensations oneself; having heard of the recent fatal ﬁres; and familiarity with ﬂash points.
The questionnaire was translated into Vietnamese and Spanish and back-translated. It was ﬁeld tested with four Vietnamese ﬂoor ﬁnishers and wording improved.
Viet-AID staff identiﬁed 418 businesses performing hardwood ﬂoor ﬁnishing listed in telephone and business directories in mainland central and eastern Massachusetts. Researchers attempted to call or visit each fourth business listed alphabetically. Most were no longer in operation, not present at listed addresses, or non-responsive. Researchers were able to interview only three people this way.
Interviewers then set up survey stations at three ﬂoor supply stores, visited coffee shops where ﬂoor ﬁnishers gathered, and identiﬁed ﬁnishers through friends and family. In one city, an interviewer failed to contact all 10 ﬂoor ﬁnishing contractors listed in directories, but recruited 10 different respondents through personal connections. In addition, 16 respondents were recruited because they had participated in a Viet-AID training. Interviews were con¬ducted between June 2009 and March 2010.
A gift card was offered for participation. Each potential respondent was read an informed consent form in his or her preferred language. No personal identifying information was collected. All procedures were approved by the Institutional Review Board for the Protection of Human Subjects at UML
Data were entered into a database in Microsoft Access. Open-ended responses were categorized by inspection. Associations between predictors and outcomes were expressed as prevalence ratios calculated by log-binomial models  using proc genmod in SAS version 9.2 (SAS Institute, Inc., Cary, North Carolina).
Respondents (Table 1)
One hundred nine ﬁnishers participated. About three quarters spoke Vietnamese. The great majority (83%) worked for small companies, with a maximum of ﬁve employees when busiest.
Knowledge and Experiences (Table 1)
Of 98 respondents, 64 said they knew others who had had ﬁres on the job. Of 91 who answered questions about ﬁres at their own companies’ jobs, 39 (43%) said that they knew of such ﬁres. With the option of reporting multiple causes, 33 reported lacquers as causes of ﬁres, 16 named wood dust, and 10 named used rags.
Two thirds of respondents said that they were aware of the recent fatal ﬁres
Fifty-two of 104 respondents said they would be able to ﬁnd a product’s ﬂash point. Forty named correct locations for locating a ﬂash point, such as the material safety data sheet (MSDS) or product label.
Twenty-four of 103 respondents reported that they sometimes felt dizzy or drunk when using ﬂoor ﬁnishing products, and 16 said they knew others who feel this.
Products (Table 2)
Two thirds of respondents reported using lacquer sealers for at least some jobs, though nearly half said they used them for ‘‘just a few’’ jobs. The most common reason given for using lacquers was that they look nice (37% of 89); the most common reason given for limiting their use was the risk of ﬁre or explosion (30%).
Most (85%) reported using water-based products for at least some jobs, though two thirds said they used them for ‘‘just a few’’ jobs. The greatest number (23% of 90) cited customer requests as a reason for using them, while 10% cited customer requests as a reason for not using them. Seventeen percent said they used water-based products because they are safer or non-ﬂammable and 13% because they are easy or quick to use, while nine percent reported avoiding them because they are difﬁcult or slow to use. Ten percent gave quality or durability as reasons for using them, while 13% gave poor quality or appearance as a reason for not using them.
One third of respondents reported using dustless systems for at least some jobs. Of the others, most said that these systems are too large or expensive or their current practices controlled dust adequately.
Exposure to Outreach Activities (Table 3)
Main outreach activities targeting ﬂoor ﬁnishers were radio programs, TV programs, and newspaper articles. For each of these, 41–46% of 79 Vietnamese-speaking respondents reported having seen or heard this outreach.
Twenty-two Vietnamese-speaking respondents had participated in a Viet-AID training. Thirty respondents had seen the FACE Alert. Of these, 15 had not attended Viet-AID trainings. Twenty-one reported seeing English news¬paper articles with ﬂoor ﬁnishing safety information.
Sixty-three percent of Vietnamese speakers and 26% of non-Vietnamese speakers reported hearing information from
Table 3 Floor Finishers’ Exposure to Outreach Activities or Input, n = 106 other ﬂoor ﬁnishers about health and safety. Twenty-three percent of Vietnamese speakers and 48% of non-Vietnamese-speakers reported that customers had asked them to use or to avoid products because of health or safety.
Fifty-ﬁve of 95 respondents reported that they had made a change as a result of outreach activities or other input. Fifteen said that they had reduced use of lacquers, and 14 that they had stopped using lacquers. Fourteen reported increasing use of water-based products. Seven said they stopped smoking near the job site, and two that they avoided turning light switches on and off when applying ﬂammable products. Fifteen reported changes that had not been promoted in the outreach activities: opening windows, using personal protective equipment, or just ‘‘being careful.’’
Factors Associated with Products and Practices (Table 4)
Knowing of a ﬁre at a job done by one’s own company and speaking Vietnamese were independently associated with several outcomes and predictors. Unless otherwise noted, models were adjusted for these factors. To identify predictors of changes among people who knew of ﬁres at their companies’ jobs, as well as those who did not, results were stratiﬁed by this factor. Associations reported below were statistically signiﬁcant at P\0.10.
Factors Associated with Products
Vietnamese speakers were more than three times as likely as others to report using lacquers for at least some jobs (unadjusted PR 3.2, 95% CI 1.6, 6.4). To investigate fac¬tors associated with limiting lacquer use, the responses ‘‘don’t use’’ and use ‘‘for just a few jobs’’ were combined. Vietnamese speakers were less likely to use lacquers for no or just a few jobs (PR 0.80, 95% CI 0.64, 0.99). Two factors were associated with limited lacquer use for all respondents: attending a Viet-AID training (PR 1.5, 95% CI 1.0, 2.3) and citing durability or quality as a reason for using water-based products (PR 1.4, 95% CI 0.94, 2.0). A factor associated with reduced prevalence of limited lacquer use was saying that a reason for using lacquers is that they look nice (PR 0.48, 95% CI 0.31, 0.77). Among respondents who knew of ﬁres at their companies’ jobs, seeing the FACE Alert was associated with this outcome (PR 1.6, 95% CI 0.99, 2.7).
Factors associated with using water-based products for all or most jobs were citing speed or ease of use as a reason for using water-based products (PR 4.2, 95% CI 1.4, 13) and citing customer requests as a reason for using lacquer sealers (PR 3.8, 95% CI 1.1, 13). Hearing customer requests regarding products was associated with a reduced prevalence of using water-based products for all or most jobs (PR 0.30, 95% CI 0.093, 0.95). Among respondents who knew of ﬁres at their companies’ jobs, citing durability and quality as a reason for using water-based products was the only factor associated with using them for all or most jobs (PR 3.8, 95% CI 1.0, 14). For others, both hearing from customers about products (PR 0.20, 95% CI 0.050, 0.83) and hearing from other ﬁnishers about health and safety (PR 0.23, 95% CI 0.050, 1.1) were associated with reduced prevalences of using water-based products for all or most jobs.
Factors Associated with Reported Changes
Respondents whose companies had had a ﬁre (unadjusted PR 1.8, 95% CI 1.2, 2.6) and Vietnamese speakers (unadjusted PR 2.3, 95% CI 1.2, 4.6) were more likely than others to report making a change.
For all respondents, factors associated with making any change were hearing radio programs (PR 1.8, 95% CI 1.1, 2.7), hearing from other ﬁnishers (PR 1.8, 95% CI 1.0, 3.3), and seeing any articles (PR 1.5, 95% CI 0.93, 2.5).
Among those whose companies had had a ﬁre, no predictors were associated with making a change. Among others, predictors associated with making changes were hearing from other ﬁnishers (PR 5.2, 95% CI 1.2, 20), correctly identifying locations of ﬂash points (PR 3.4, 95% CI 1.2, 10), hearing from customers (PR 3.2, 95% CI 1.1, 9.3), seeing the FACE Alert (PR 2.3, 95% CI 1.2, 4.2), hearing radio programs (PR 1.9, 95% CI 1.1, 3.3), and seeing any articles (PR 1.7, 95% 0.96, 3.2).
Respondents whose companies had had a ﬁre were more likely to report either reducing or stopping use of lacquers (unadjusted PR 2.9, 95% CI 1.2, 6.7). For all respondents, a factor associated with reducing or stopping use of lacquer sealers was seeing Vietnamese articles (PR 2.5, 95% CI 1.1, 5.7). Among those whose companies had had a ﬁre, factors associated with reducing or stopping lacquer use were attending a Viet-AID training (PR 1.9, 95% CI 0.93, 3.9) and seeing Vietnamese articles (PR 3.0, 95% CI 1.0, 8.5). For others, no factors were signiﬁcantly associated with reducing or stopping lacquer use.
Factors associated with adding water-based products were seeing the FACE Alert (PR 6.2, 95% CI 1.9, 20), citing avoidance of ﬁres as a reason for using water-based products (PR 11, 95% CI 1.5, 80), and attending a Viet-AID training (PR 3.8, 95% CI 1.3, 11). A factor associated with reduced prevalence of adding water-based products was the belief that lacquers look nice as a reason for using them (PR 0.26, 95% CI 0.062, 1.1).
Among respondents who knew of ﬁres at their companies’ jobs, no factor was associated with increasing use of water-based products. Among others, predictors of adding water-based products were citing avoidance of ﬁres as a reason for using water-based products (PR 7.6, 95% CI 1.1, 53), seeing the FACE Alert (PR 7.0, 95% CI 1.7, 28), and citing customers’ requests as a reason to use water-based products (PR 2.6, 95% CI 0.89, 7.3).
Predictors that co varied were included in models together. When adjusted for knowing of a ﬁre at a job done by one’s company, the best model for adding water-based products included both attending a Viet-AID training (PR 3.1, 95% CI 1.2, 8.2) and citing safety as a reason for using water-based products (PR 8.5, 95% CI 1.1, 63).
Factors Associated with Knowledge and Attitudes
Factors associated with respondents saying that they could locate product ﬂash points were hearing from other ﬁn¬ishers (PR 2.5, 95% CI 1.3, 5.2), attending a Viet-AID training (PR 2.2, 95% CI 1.1, 4.3), seeing the FACE Alert (PR 1.9, 95% CI 1.2, 2.9), sometimes feeling drunk or dizzy when using ﬂoor ﬁnishing products (PR 1.7, 95% CI 1.2, 2.6), and hearing customers request products (PR 1.5, 95% CI 0.96, 2.4). For those whose companies had had a ﬁre, these were seeing any articles (PR 3.8, 95% CI 1.3, 11), seeing the FACE Alert (PR 3.4, 95% CI 1.4, 8.2), hearing from other ﬁnishers (PR 2.5, 95% PI 0.87, 7.0), citing avoidance of ﬁres as a reason for using water-based products (PR 2.4, 95% CI 1.0, 5.9), feeling drunk or dizzy (PR 2.2, 95% CI 1.1, 4.3), and seeing Vietnamese articles (PR 2.1, 95% CI 0.97, 4.7). For others, they were hearing from other ﬁnishers (PR 2.5, 95% CI 0.97, 6.5), and hearing from customers (PR 2.4, 95% CI 1.1, 5.3).
Exposures to certain outreach activities were associated with avoiding lacquers because they cause ﬁres or explosions. Among Vietnamese speakers, this was attending a Viet-AID training (PR 4.1, 95% CI 2.1, 7.9). Among all respondents, the PR for this belief was 2.6 for those who had seen the FACE Alert (95% CI 1.4, 4.7). Attending the Viet-AID training was associated with a reduced prevalence of stating that they used lacquer because it looks nice (PR 0.094, 95% CI 0.014, 0.64).
Exposures to certain outreach activities were associated with respondents reporting that they used water-based products because they are safer. These were attending a Viet-AID training (PR 2.3, 95% CI 1.5, 3.6), and seeing the FACE Alert (PR 2.2, 95% CI 1.2, 3.5).
Some experiences were associated with reporting that they used water-based products because they are durable or good quality. Among Vietnamese speakers, the PR for stating this belief was 5.0 for those who had seen Vietnamese articles (95% CI 1.1, 22). Among all respondents, the PR was 10 for those who had seen any articles (95% CI 1.3, 80), 8.6 for those who had seen TV programs (95% CI 1.9, 39), 7.5 for those who had seen the FACE Alert (95% CI 1.7, 34), and 3.3 for those who had attended a Viet-AID training (95% CI 0.99, 11).
Community, labor, government, and industry partners deﬁned the source of a deadly problem, developed feasible solutions, identiﬁed inﬂuences on product choices, and designed corresponding outreach and policy initiatives. This ﬁt the classic deﬁnition of a public health communication campaign: ‘‘… an integrated series of communication activities, using multiple operations and channels, aimed at populations or large target audiences usually of long duration purpose.’’  We do not propose that information alone motivated or enabled ﬂoor ﬁnishers to change products. Thus, associations between exposure to outreach and changes do not imply simple causation, but help describe the process of change.
Limitations of the Study
Without other data sources, this research relied on a survey, which suffers from reliance on self-reports with no vali¬dation. Researchers attempted and failed to execute a survey sampling procedure. Instead, interviewers found ﬂoor ﬁnishers where they gathered and used personal networks. This is consistent with other community-based projects, in which, for example, indigenous community educators surveyed farm workers at homes, labor camps, and community centers , or Vietnamese-American residents interviewed members of personal networks about their occupational health .
The lack of an accurate list of businesses precluded the enumeration of eligible respondents. We estimate the number of ﬂoor ﬁnishers in the target area at 500–1,500, meaning we sampled between 22% and 7%. There is no apparent reason to believe that respondents differed systematically from non-respondents. Therefore, we believe that the survey is meaningfully representative of hardwood ﬂoor ﬁnishers in eastern and central Massachusetts. The exception was the 16 respondents who were included because they had participated in Viet-AID trainings, so might differ in some ways from the underlying population and were more likely to have seen FACE Alerts, which were distributed at the trainings.
Uncovering Elusive Data
Strikingly, 43% of respondents admitted knowledge of ﬁres at jobs performed by their companies, mostly caused by lacquers. This ﬁnding supported anecdotal information from Task Force members about ﬁres as a serious and frequent problem in the industry. Researchers were not able to locate documentation of such ﬁres in other data sources, and news media typically cover only the few tragic events involving loss of life or massive property damage.
The association between speaking Vietnamese and using lacquer sealers was also consistent with statements by Task Force members that these were especially marketed to Vietnamese immigrants. Results indicating that many people chose to use lacquers because they look nice also matched anecdotal information from the Task Force.
Effects of the Public Health Campaign
Outreach activities reached large proportions of the target population, with about one third of respondents reporting exposure to the FACE Alert or TV shows, radio, or articles with information on health and safety. More than half reported making changes as a result of such input, and more than a quarter reported reducing or stopping use of lacquers. Several associations between changes and
outreach suggest causality. For example, both seeing the FACE Alert and attending Viet-AID trainings were strongly associated with adding water-based products. (The FACE Alert did not promote the use of water-based products, only non-ﬂammable products generally, but some respondents reported using water-based products because they are not ﬂammable.)
Based on the model of ﬁres creating a ‘‘teachable moment’’ in which ﬂoor ﬁnishers might be open to alternatives, we examined knowing of a ﬁre at a job done by one’s company as an effect modiﬁer of associations between exposure to outreach activities and changes. Associations between seeing the FACE Alert and using lacquer for all or just a few jobs, and between attending Viet-AID trainings and stopping or reducing lacquer use, were in fact larger for those who knew of ﬁres at their companies’ jobs. Some other associations were much larger between exposure to certain inputs and making changes for those who did not know of such ﬁres, an interesting result inconsistent with our model.
Results reinforced suggestions by customers and ﬂoor ﬁnishers that messages about products should be framed in terms of quality and business advantages, a concept seen in other projects . The perception that water-based products are quick and easy to use, or durable and good quality, were strongly associated with using water-based products for all or most jobs. However, the perception that water-based products are safer or non-ﬂammable was also strongly predictive of increasing their use.
Outreach activities may have been especially effective at fostering the perception that water-based products produce a good quality ﬁnish, with people who reported exposure to any one of several outreach activities several times more likely than others to state this as a reason for using them.
Respondents reporting exposure to any of several outreach activities were also much more likely to express key concepts such as risk of ﬁre and explosions as a reason for avoiding lacquers and correct locations of product ﬂash points.
Perhaps most importantly, results demonstrate that voluntary measures such as product withdrawal by some vendors or educational initiatives were insufﬁcient to halt the use of a hazardous and unnecessary product. Two thirds of respondents to the survey, administered before the legislative ban, reported using lacquer sealers for at least some jobs. This reﬂects the consensus among Task Force members that legislation was needed to enable businesses to refuse to sell or use a product that is temptingly cheap and convenient.
This project adds to the growing body of literature highlighting the potential of synthesizing the expertise of community, labor, industry, and researchers to prevent hazards affecting vulnerable workers in small businesses.
The authors would like to thank Lap Le, Van Lan Truong, Marcela Villarroel, and Nisha Narvekar, who persisted in conducting the survey in challenging environments. We are grateful to Ed Connelly and Rachel Nania of New Ecology, Inc. for their expert communications with consumers and developers. Lee Weber kindly opened her businesses to ﬁeld researchers. Cora Roelofs and David Kriebel provided invaluable input into study design and presentation of results. This work would not have been possible without the determination and time provided by Karen van Unen, Stephen M. Tringale, and the Dorchester House Multi-Service Center and Codman Square Health Center in obtaining support and overcoming countless administrative obstacles. This research was funded by the National Institute for Environmental Health Sciences grants 3R25ES012585 and 3R25ES012585-04S1.
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