Data from the National Traumatic Occupational Fatalities surveillance system were used to analyze occupational injury deaths of civilian 16- and 17-year-olds during 1980 through 1989. There were 670 deaths; the rate was 5.11 per 100,000 full-time equivalent workers. The leading causes of death were incidents involving motor vehicles and machines, electrocution, and homicide. Workers 16 and 17 years old appear to be at greater risk than adults for occupational death by electrocution, suffocation, drowning, poisoning, and natural and environmental factors. Improved enforcement of and compliance with federal child labor laws, evaluation of the appropriateness of currently permitted activities, and education are encouraged.

There was an increased risk of mortality from IHD associated with cumulative exposure to coal dust, and with coal rank. The effect of coal rank may be due differences in the composition of coal mine dust particulate. The association of risk of IHD mortality with cumulative particulate exposure is consistent with air pollution studies.

INTRODUCTIONDuring the past half century, traumatic injuries have emerged as a pre-em inent public health challenge. Injury is the leading cause of hospitalization and death in persons younger than 45 years of age; results in more years of potential life lost than cancer or heart disease; and is second only to respiratory conditions as a reason for contact with physicians (3). One third of all nonfatal injuries and one sixth of all injury fatalities among adults aged 20 to 64 occur on the job (3).The public health response to a broad spectrum of occupational health and safety problems has embraced three traditional applications of epide miology: surveillance; etiologic research (i.e. studies to identify risk factors); and evaluation of the effect of interventions. With the increased recognition of injury as a serious public health problem, it is logical that efforts to prevent and control occupational injury should rely on the same epidemio logical approach used to attack other public health problems (9, 13).In industry and government, the role of surveillance in identifying the most important occupational injury problems, targeting high-risk popUlations, and monitoring trends has been recognized for a long time (16, 26, 28,48). The application of epidemiological methods to the study of the etiology of occupational injury is far less common.This review is intended to summarize etiologic studies of occupational injuries, identify their methodological strengths and limitations, point out needs for methodological improvement in such studies, and suggest a research agenda. In order to limit the scope of this broad topic, studies focusing exclusively on musculoskeletal injuries and intentional injuries have been excluded from this review. The epidemiological research literature on back injuries has been reviewed elsewhere (l6a, 18a, 37). Intentional injuries have only been recognized as a serious public health problem (outside and within the workplace) within the past decade (2a, 34, 52a, 58) and the preponderance of causality studies to date have appeared in criminology and sociology literature, rather than in the public health literature. BACKGROUND

An estimated 136,985 nonfatal, work-related injuries to workers 55 years of age and older were presented for treatment in hospital emergency departments across the United States during 1993. Men accounted for 63.7% of the injuries and had an injury rate of 1.06 per 100 workers, compared with a rate of 0.76 among women. Among the oldest workers (65+ years), injuries were more likely to be fractures or dislocations, to result from falls on the same level, or to involve hospitalization. The services industry had the largest number of injuries (31.9%), whereas the highest injury rate occurred in the agriculture/forestry/fishing industry (1.50 per 100 workers). The types of injuries most frequently requiring hospitalization were fractures or dislocations that resulted from a fall. Because older workers' employment demographics and injury patterns differ from the remainder of the labor force, interventions need to be developed which are specific to the workplace for this older working population.

The objectives of this study were to describe workplace noise exposures, risk factors for hearing loss, and hearing levels among sand and gravel miners, and to determine whether full shift noise exposures resulted in changes in hearing thresholds from baseline values. Sand and gravel miners (n = 317) were interviewed regarding medical history, leisure-time and occupational noise exposure, other occupational exposures, and use of hearing protection. Audiometric tests were performed both before the work shift (following a 12-hour noise-free interval) and immediately following the work shift. Full shift noise dosimetry was conducted. Miners' noise exposures exceeded the Recommended Exposure Limit (REL) of the National Institute for Occupational Safety and Health (NIOSH) for 69% of workers, and exceeded the Mine Safety and Health Administration's action level for enrollment in a hearing conservation program for 41% of workers. Significantly higher noise exposures occurred among employees of small companies, among workers with a job classification of truck driver, among males, and among black workers. Hearing protection usage was low, with 48% of subjects reporting that they never used hearing protection. Hearing impairment, as defined by NIOSH, was present among 37% of 275 subjects with valid audiograms. Black male workers and white male workers had higher hearing thresholds than males from a comparison North Carolina population unexposed to industrial noise. Small but statistically significant changes in hearing thresholds occurred following full shift noise exposure among subjects who had good hearing sensitivity at baseline. In a logistic regression model, age and history of a past noisy job were significant predictors of hearing impairment. Overall, sand and gravel workers have excessive noise exposures and significant hearing loss, and demonstrate inadequate use of hearing protection. Well-designed hearing conservation programs, with reduction of noise exposure, are clearly needed.