The National Institute for Occupational Safety and Health (NIOSH), has had a longstanding interest in nonstandard work hours and associated health and safety effects. The last NIOSH meeting on this topic was held in 2004 and centered around long working hours and the impact on injuries, illnesses, and health behaviors. To build on this expertise, the NIOSH Working Hours, Sleep and Fatigue Forum: Meeting the needs of American Workers and Employers was recently hosted by the Healthy Work Design Program’s Working Hours, Sleep, and Fatigue Workgroup on September 13-14, 2019 in Coeur D’Alene. This forum followed the 24^th International Shift Work and Working Time Symposium. The purpose of this inaugural Forum was to take an industry-specific approach, with a special session on vulnerable workers, to identify the gaps and needs in this topic area, effective mitigation techniques, and future directions for research.

Over 90 attendees participated. Attendees included academics, scientists, officials from government agencies (e.g. Finnish National Institute for Occupational Health, Japanese NIOSH, DOT), industry members, occupational health and safety professionals and labor representatives.

Key messages from the extended abstracts presented during the breakout sessions are highlighted below.  We are now synthesizing the results of the Forum discussions and preparing scientific manuscripts to be published in a special themed issue of American Journal of Industrial Medicine.

Key Messages Presented during Breakout Sessions

Agriculture, Forestry and Fishing

Given the nature of work in the agriculture, forestry and fishing (AgFF) sector (in which extremely long hours often result from pressures to harvest and produce products during peak seasons), fatigue is a major factor that contributes to fatalities, injuries, and illness. However, there has been limited research addressing this critical safety and health issue in the AgFF sector. There are no regulations to limit work hours for almost all workers. In addition, there is evidence that older workers, new/young workers, immigrant or migrant workers, and workers in small operations are at higher risk for fatigue-related injury/illness. To develop and evaluate practical interventions that reduce fatigue-related risks, researchers and practitioners cannot focus solely on educational efforts, but must also address the structural issues that affect workplace organization, cultural acceptance of long work hours and fatigue, and psychosocial factors.

Mining

Fatigue in the mining industry is common due to a combination of shiftwork, long hours, repetitive tasks, physically and mentally demanding jobs, and poor lighting. Mineworkers may be particularly vulnerable to the negative effects of fatigue due to especially lengthy commute times and traditionally poor sleeping habits. Measuring and mitigating mineworker fatigue presents unique challenges compared to other industries. A multilevel systems approach based on research and implementation completed in other industries may help address mineworker fatigue. Implementing a lighting-based fatigue intervention for underground miners may be necessary as well, yet remains challenging due to a complex environment, utter darkness, and shiftwork schedules.

Health Care and Services

The Healthcare and Social Assistance (HCSA) Sector is one of the fastest growing industrial sectors in the United States, with over 20 million workers. About 80% of these workers are women, and African American and Asian workers account for a higher percentage of this sector in comparison with other sectors. To provide their critical services around the clock, workers in HCSA often have to work during the evening, at night, and sometimes irregular or long hours. Nearly 28% work evening shift, night shift, rotating shifts, or other non-day shift schedules. Almost 17% work 48 or more hours a week, and almost 6% work over 60 or more hours. Twelve-hour shifts are common, and some regularly work longer shifts. A portion of the sector, more than 100,000 resident physicians, work more than 60 hours per week.

Compared to other sectors, HCSA has a significantly higher prevalence of fatigue, job stress, depression/anxiety, burnout, substance abuse, and non-fatal injuries and illnesses. Sleep deficiency is common; 52% of healthcare workers on night shift report sleeping 6 hours or less per day. Sleeping less than 7 hours on a regular basis is associated with numerous adverse health and safety outcomes. The highest research priorities are developing better designs for the work schedules and improving the culture, which historically has not given attention to the impact of shift work, long work hours, and fatigue on workers’ safety and health. Additional research priorities are identified to improve work hours, sleep, and fatigue issues in the HCSA sector.

Oil and Gas Extraction

Workers in the U.S. Oil and Gas Extraction (OGE) industry work long hours and have an elevated fatality rate. While fatigue has been shown to be a significant health and safety risk in other industries, minimal research on worker fatigue has been conducted in this workforce. Regulations intended to manage fatigue among OGE workers are limited to hours-of-service regulations, which apply only to large truck drivers. However, international OGE operators and the U.S. petrochemical industry recognize the workplace health and safety risks posed by fatigue and have developed guidance documents to help employers manage those risks.

Research is needed to quantify the impacts of worker fatigue and to examine the interactions between on- and off-the-job risk factors for fatigue in the U.S. OGE industry. Technologies and other interventions that can identify and manage fatigue need to be evaluated in this workforce, particularly among small companies with the assistance of intermediaries. Further collaboration between researchers and oil and gas operators and contractors could lead to significant improvements in understanding the impact of fatigue and shiftwork on OGE workers and in implementing effective FRM for both large and small companies.

Public Safety

The public safety sector includes law enforcement, corrections, fire service, wildland firefighting, and emergency medical services (EMS). Public safety workers are exposed to a variety of workplace hazards that put them at increased risk for acute injuries, workplace violence, chronic disease such as cardiovascular disease and cancer, infectious diseases, and motor-vehicle crashes. Across public safety sector occupations, shiftwork and long work hours are a necessity for 24-hour response to protect and serve the public.

Work tasks, environments, and cultures differ markedly across public safety sector occupations. Increased risk for injury and chronic disease are common across public safety sector occupations. Fatigue can exacerbate these risks for public safety workers and can pose risk to the public by reducing capability for decision-making and performing work tasks.

The stressful nature of work tasks in the public safety sector intensifies the risk for illness and injury associated with work hours, sleep, and fatigue. There are research gaps on effective interventions to reduce risk associated with work hours, sleep, and fatigue in the public safety sector. The depth of existing research and readiness to develop interventions varies across public safety occupations.

Transportation

The Transportation, Warehousing and Utilities (TWU) industry includes establishments engaged in transportation of passengers and freight via air, ground, rail, and water; warehousing and storage of goods; and provision of utility services. There were approximately 8 million workers in the TWU sector in 2016.¹ Although TWU comprised 5% of the workforce, it experienced 17% of the fatalities among U.S. workers and 7% of the total occupational injuries and illnesses.¹ The TWU industry sector is uniquely characterized by continuous operations exemplified in almost every subsector.

Round the clock operations and heavy workloads can lead to decreased quality sleep opportunities resulting in disrupted circadian cycles, impaired cognitive performance, and increased reaction times, leading to increased risk for injury and illness. Extended and variable length work schedules are prevalent throughout this sector. Individual schedules may not be consistent across days or weeks. Time pressures may limit sleep times.

Fatigue may not be understood or recognized by workers. Education on the causes, recognition, and consequences of fatigue should be incorporated into an organization’s employee training and integrated into its safety culture. Fatigue may exacerbate physical and mental health disorders, which can adversely affect sleep and further increase fatigue.

Vulnerable Populations

Beyond differential hazard exposure, other factors can make some workers more vulnerable than others to workplace illness or injury, including demographic factors such as age; social dynamics such as race, class, and gender; economic trends such as the growth of the temporary workforce; and organizational factors such as business size. The term occupational health disparities refers to increased rates of work-related illness and injuries in particularly vulnerable populations [Centers for Disease Control and Prevention (CDC) 2011]. Vulnerable populations are often described using a single characteristic (age, race, income, employment, etc.) [Cutter et al. 2005]. There is broad evidence of occupational health disparities related to sleep duration among U.S. workers, as Whites have been reported to have a lower prevalence of short sleep duration than Blacks or persons of other races [Luckhaupt et al. 2010].

Working hours, sleep, and fatigue, are significant occupational safety and health issues for vulnerable working populations including young workers, immigrant workers, and small business employees. There is an increasing focus on non-traditional occupational safety and health issues among vulnerable worker populations, and this provides an opportunity for researchers to address work-related fatigue and working hours among workers in high-risk populations. Interventions to address work-related fatigue among specific vulnerable worker groups should also take into account the multiple other vulnerable groups that workers may belong to.

Comment on our Blog

How does fatigue affect your work or workplace? How do you manage it?

If you would like to participate in future forums please send your name and contact information to iwong@cdc.gov.  In the comment section below, let us know if there are specific topics that you would like to see covered (e.g. Fatigue Risk Management, identifying fatigue, discussions on best practices).

Imelda Wong, PhD, is a Senior Service Fellow in the NIOSH Division of Science Integration; is the Co-Lead of the NIOSH Working Hours and Fatigue Workgroup; and Director, Working Time Society of the International Commission on Occupational Health.  She was a co-organizer of the NIOSH Working Hours, Sleep and Fatigue Forum.

Naomi Swanson, PhD, is a Senior Science Advisor in the NIOSH Division of Science Integration, is the Co-Manager of the Healthy Work Design and Well-Being Cross Sector Program, and is the Chair of the NIOSH Working Hours and Fatigue Workgroup. She was a co-organizer of the NIOSH Working Hours, Sleep and Fatigue Forum.

The blog text was edited on 2/24/2022 as some materials are no longer available online.