Occupational Hearing Loss among Chinese Municipal Solid Waste Landfill Workers: A Cross-Sectional Study

Background

Occupational hearing loss is an increasingly prevalent occupational condition worldwide, and has been reported to occur in a wide range of workplaces; however, its prevalence among workers from municipal solid waste landfills (MSWLs) remains less clear. This study aimed to investigate the occupational hearing loss among Chinese MSWL workers.

Methods

A cross-sectional study of 247 workers from 4 Chinese MSWLs was conducted. Noise and total volatile organic compounds (TVOCs) levels at worksites were determined. We conducted hearing examinations to determine hearing thresholds. A worker was identified as having hearing loss if the mean threshold at 2000, 3000 and 4000 Hz in either ear was equal to or greater than 25 dB. Prevalence of occupational hearing loss was then evaluated. Using unconditional Logistic regression models, we estimated the odds ratios (ORs) of MSWL work associated with hearing loss.

Results

According to the job title for each worker, the study subjects were divided into 3 groups, including group 1 of 63 workers without MSWL occupational hazards exposure (control group), group 2 of 84 workers with a few or short-period MSWL occupational hazards exposure, and group 3 of 100 workers with continuous MSWL occupational hazards exposure. Both noise and TVOCs levels were significantly higher at worksites for group 3. Significantly poorer hearing thresholds at frequencies of 2000, 3000 and 4000 Hz were found in group 3, compared with that in group 1 and group 2. The overall prevalence rate of hearing loss was 23. 5%, with the highest in group 3 (36.0%). The OR of MSWL work associated with hearing loss was 3.39 (95% confidence interval [CI]: 1.28-8.96).

Conclusion

The results of this study suggest significantly higher prevalence of hearing loss among MSWL workers. Further studies are needed to explore possible exposure-response relationship between MSWL occupational hazards exposure and hearing loss.     

Exploratory Cumulative Risk Assessment (CRA) Approaches Using Secondary Data

Cumulative risk assessments (CRAs) include the examination of risks posed by multiple stressors and include population-specific vulnerabilities and susceptibilities. In this case study, we assess potential hearing impairment hazard due to joint exposure from noise and volatile organic compounds (VOCs) in order to examine the strengths and limitations of using secondary data on exposure and health effects for a CRA. Block group-level noise categories were estimated using modeled street-level data. A quantile regression model of sociodemographic and personal predictors from the 1999–2000 U.S. National Health and Nutrition Examination Survey VOC dataset was used along with block group-level sociodemographic and personal variables to estimate VOC exposures. Hazard indices (HIs) for potential hearing impairment due to joint noise and VOC exposures were calculated. County-averaged HIs for hearing impairment ranged from 0.8 (10th total VOCs percentile and 45–60 dB) to 1.7 (90th total VOCs percentile and 71–75 dB). Limitations of the exposure and health effects data included issues combining heterogeneous data and a lack of established threshold levels for combined low-level exposures; yet, this case study illustrates that screening-level CRAs, including non-chemical stressors, can be accomplished with publicly available data and existing methods.     

Noise-Induced Hearing Loss in Korean Workers: Co-Exposure to Organic Solvents and Heavy Metals in Nationwide Industries

Background

Noise exposure is a well-known contributor to work-related hearing loss. Recent biological evidence suggests that exposure to ototoxic chemicals such as organic solvents and heavy metals may be additional contributors to hearing loss. However, in industrial settings, it is difficult to determine the risks of hearing loss due to these chemicals in workplaces accompanied by excessive noise exposure. A few studies suggest that the effect of noise may be enhanced by ototoxic chemicals. Therefore, this study investigated whether co-exposure to organic solvents and/or heavy metals in the workplace modifies the risk of noise exposure on hearing loss in a background of excessive noise.

Methods

We examined 30,072 workers nationwide in a wide range of industries from the Korea National Occupational Health Surveillance 2009. Data on industry-based exposure (e.g., occupational noise, heavy metals, and organic solvents) and subject-specific health outcomes (e.g., audiometric examination) were collected. Noise was measured as the daily 8-h time-weighted average level. Air conduction hearing thresholds were measured from 0.5 to 6 kHz, and pure-tone averages (PTA) (i.e., means of 2, 3, and 4 kHz) were computed.

Results

In the multivariate linear model, PTA increment with occupational noise were 1.64-fold and 2.15-fold higher in individuals exposed to heavy metals and organic solvents than in unexposed individuals, respectively.

Conclusion

This study provides nationwide evidence that co-exposure to heavy metals and/or organic solvents may exacerbate the effect of noise exposure on hearing loss in workplaces. These findings suggest that workers in industries dealing with heavy metals or organic solvents are susceptible to such risks.     

Assessment of personal protective equipment use and occupational exposures in small industries in Jeddah: Health implications for workers

Small-scale industries account for a large proportion of jobs and play a vital role in most countries’ economic growth and prosperity. Due to the very low use of personal protective equipment (PPEs), employees are exposed to numerous physical, chemical, and accidental hazards in small-scale industries. PPEs are very effective in minimizing occupational injuries, accidents, and other hazards which otherwise result in substantial manpower and financial losses. The study objective was to assess the availability and use of PPEs as well as self-reported occupational exposures among workers in surveyed small industries in Jeddah. The study involved 102 workers from 28 small-scale industries (vehicle repair, welding, and paint). A survey was conducted to gather data of socio-demographic characteristics, self-reported occupational exposures, and frequency of PPEs used by workers. The occupational exposures (never exposed, sometimes exposed and always exposed) were reported in percentages including; noise exposure (19.6, 73.5 and 6.9%); dust/smoke exposure (9.8, 69.6 and 20.6%); vapors/fumes exposure (11.8, 60.8 and 27.5%); and direct sunlight (43.1, 56.9 and 0%), respectively. The reported use of different PPEs in descending order was; knee joints mats (50%), welding shields (50%), safety glasses (33.3%), gloves (27.5%), face masks (26.5%), safety shoes (10.8%) and earplugs/ muffs (8.8%). On the basis of this study findings, hand hygiene and general OSH awareness like interventions can be developed which will help in minimizing workplace exposures among small-scale industry workers.     

Measuring noise

High levels of noise encountered both in leisure activities and at workplaces can be somewhat annoying, but they can also cause hearing damage. In order to lessen these risks, some physical characteristics of the sound phenomenon need to be understood. The level of a sound is given in dB, a logarithmic unit in which simple addition is not available : 100 dB + 100 dB = 103 dB. The highest level of noise which can be tolerated by the human ear is considered to be 120 dB. Another component of sound characteristics is the frequency, which describes the height of a sound. The frequency is given in Hz, the human hearing field is comprised in the range of 20 to 20,000 Hz. Regarding the sensitivity of the ear, depending on the frequency, acusticians use a weighed dB, called dB(A), which takes into account a lower risk to hearing below 500 Hz and above 6 kHz. They also integrate the energy measured during a period of time to take the fluctuation of usual noise levels into account. So that currently, the levels of noise are often given in LAeq (equivalent to the level of continuous noise given in dBA). For moderate levels of noise, another weighted filter is used in sound level meters : the C curve, because low frequencies, although they are less dangerous for the ear, are more disturbing. In every day life, we sometimes have noise levels reaching 100 dB, and even 120 dB (fire alarms). Amplified music can reach 110 dBA, but a French regulation limits the output of PCPs (Walkmans) to 100 dB and the levels in concerts and discotheques to 105 dBA. At the workplace, the maximum level of noise allowed by French Law is 90 dBA for an 8 hour exposure, and 140 dB for peaks. In order to improve the protection of all workers in the EC, a recent European Directive will decrease the maximum level to 87 dBA before March 2006.     

Urban noise pollution

Noise is responsible for cochlear and general damages. Hearing loss and tinnitus greatly depend on sound intensity and duration. Short-duration sound of sufficient intensity (gunshot or explosion) will not be described because they are not currently encountered in our normal urban environment. Sound levels of less than 75 d (A) are unlikely to cause permanent hearing loss, while sound levels of about 85 d (A) with exposures of 8 h per day will produce permanent hearing loss after many years. Popular and largely amplified music is today one of the most dangerous causes of noise induced hearing loss. The intensity of noises (airport, highway) responsible for stress and general consequences (cardiovascular) is generally lower. Individual noise sensibility depends on several factors. Strategies to prevent damage from sound exposure should include the use of individual hearing protection devices, education programs beginning with school-age children, consumer guidance, increased product noise labelling, and hearing conservation programs for occupational settings.     

Amyotrophic lateral sclerosis and occupational exposure to electromagnetic fields

In an hypothesis-generating case-control study of amyotrophic lateral sclerosis, lifetime occupational histories were obtained. The patients (n = 28) were clinic based. The occupational exposure of interest in this report is electromagnetic fields (EMFs). This is the first and so far the only exposure analyzed in this study. Occupational exposure up to 2 years prior to estimated disease symptom onset was used for construction of exposure indices for cases. Controls (n = 32) were blood and nonblood relatives of cases. Occupational exposure for controls was through the same age as exposure for the corresponding cases. Twenty (71%) cases and 28 (88%) controls had at least 20 years of work experience covering the exposure period. The occupational history and task data were used to classify blindly each occupation for each subject as having high, medium/high, medium, medium/low, or low EMF exposure, based primarily on data from an earlier and unrelated study designed to obtain occupational EMF exposure information on workers in “electrical” and “nonelectrical” jobs. By using the length of time each subject spent in each occupation through the exposure period, two indices of exposure were constructed: total occupational exposure (E₁) and average occupational exposure (E₂). For cases and controls with at least 20 years of work experience, the odds ratio (OR) for exposure at the 75th percentile of the E₁ case exposure data relative to minimum exposure was 7.5 (P < 0.02; 95% Cl, 1.4–38.1) and the corresponding OR for E₂ was 5.5 (P < 0.02; 95% CI, 1.3–22.5). For all cases and controls, the ORs were 2.5 (P < 0.1; 95% CI, 0.9–8.1) for E₁ and 2.3 (P = 0.12; 95% CI, 0.8–6.6) for E₂. This study should be considered an hypothesis-generating study. Larger studies, using incident cases and improved exposure assessment, should be undertaken. Bioelectromagnetics 18:28–35, 1997. © 1997 Wiley-Liss, Inc.     

Biomarkers in styrene-exposed boatbuilders.

14 fiberglass-reinforced plastics (FRP) boatbuilders were compared with 9 unexposed controls with respect to several chemical specific and nonspecific biomarkers measured in peripheral blood. Biomarkers included styrene-hemoglobin adducts (styrene-Hb), sister-chromatid exchanges (SCEs), micronuclei (MN), single-strand breaks (SSBs) and N-acetoxy-2-acetylaminofluorene-induced DNA binding (NA-AAF binding) as a measure of susceptibility to DNA damage. Workers' exposures averaged 11 ppm (8-h TWA; geometric mean) and ranged from 0.6 to 44 p.p.m. Mandelic acid levels were measured in end-of-shift urine samples and reflected an average styrene exposure equivalent to 15 p.p.m. There was a large though not significant difference in levels of styrene-Hb adducts among exposed workers and controls, largely the consequence of a single heavily-exposed individual with an extremely high level of adducts. Significant differences between biomarker levels in exposed workers and controls were observed with MN, SSBs and NA-AAF binding. No significant differences were seen in mean levels of SCEs nor in the incidence of cells with a high frequency of SCEs. The data suggest that exposure to levels of styrene in occupational settings near or below the current OSHA standard (50 p.p.m.) can induce damage at the cellular/molecular level. Appropriately-selected panels of biomarkers can be useful in identifying potentially harmful exposures.     

Adenosine amine congener mitigates noise-induced cochlear injury

Hearing loss from noise exposure is a leading occupational disease, with up to 5% of the population at risk world-wide. Here, we present a novel purine-based pharmacological intervention that can ameliorate noise-induced cochlear injury. Wistar rats were exposed to narrow-band noise (8–12 kHz, 110 dB SPL, 2–24 h) to induce cochlear damage and permanent hearing loss. The selective adenosine A₁ receptor agonist, adenosine amine congener (ADAC), was administered intraperitoneally (100 μg/kg/day) at time intervals after noise exposure. Hearing thresholds were assessed using auditory brainstem responses and the hair cell loss was evaluated by quantitative histology. Free radical damage in the organ of Corti was assessed using nitrotyrosine immunohistochemistry. The treatment with ADAC after noise exposure led to a significantly greater recovery of hearing thresholds compared with controls. These results were upheld by increased survival of sensory hair cells and reduced nitrotyrosine immunoreactivity in ADAC-treated cochlea. We propose that ADAC could be a valuable treatment for noise-induced cochlear injury in instances of both acute and extended noise exposures.     

Noise-induced hearing loss: news in the regulation

Noise-induced hearing losses (NIHL) are among the most often encountered occupational diseases in many industrial countries. This is true in terms of the number of exposed workers and in the amount of health insurance or State health care compensations. These handicaps are not reversible. In order to understand why this is, we will explain how high levels of noise pressure can affect the ear, by describing the three parts of the ear, including some details about the inner ear and its sensitive cells. Several epidemiological surveys indicate that an average of 6.8 %, French employees are exposed to dangerous levels of noise with vast differences according to their sector of activity. The most exposed are found in the wood and paper industries (37.4 %), in large plants and amongst intermittent workers. Males are five times more exposed than females, but they are much more numerous in these industries. About 5 million French people suffer from hearing disorders; 2 million of them are under 55 years of age. The Labour Ministry controls the occupational medicine services where exposed workers are subjected to a special check-up, which includes an audiometric examination at least every two years. But for the others, it is useful to know the danger signs of hearing disorders, like hearing fatigue (TTS), tinnitus or difficulties in understanding with background noise. Aging also affects hearing capabilities: this is called presbyacusis, which can be a confusing factor in the assessment of NIHL in older workers. In order to improve the protection of all workers in the EC, a recent European Directive will decrease the maximum level of tolerated noise (from the current 90 dBA) to 87 dBA before March 2006. In addition, the level at which a preventive programme has to be developed (hearing conservation programme) will start at 80 dBA instead of the current 85. The French compensation system for workers suffering from NIHL has also recently been modified. Such a modification will increase the number of compensations (probably by 4 times). The annual cost of the aforementioned compensations was 100 million in 2003.     

Comparing Occupational and Environmental Risk Assessment Methodologies Using Pharmacokinetic Modeling

Human health risks from occupational exposures are managed by limiting exposures to acceptable levels established by the American Conference of Governmental Industrial Hygienists or another similar body. Acceptable environmental exposures are benchmarked by values such as U.S. Environmental Protection Agency's Reference Doses and Reference Concentrations. The approaches to establishing these values are different, as are the groups they are intended to protect, complicating direct comparisons. Occupational limits are based on a healthy workforce in a narrow age range and do not generally consider sensitive populations. Limits for environmental exposures consider sensitive populations. In this evaluation, physiologically based pharmacokinetic modeling was used to predict tissue doses from acceptable/safe exposures as established by different organizations and agencies. Internal doses calculated for an agency's acceptable/safe exposures via oral and inhalation routes may differ substantially, but are sometimes in excellent agreement. The finding that internal doses resulting from occupational exposures are almost uniformly greater than those from environmental exposures suggests different mindsets among these groups regarding how safe is “safe.”     

Frequency-specific association of antibodies against heat shock proteins 60 and 70 with noise-induced hearing loss in Chinese workers

Noise exposure may result in production of auto-antibodies against heat shock proteins (Hsps), which might be of significance in the pathogenesis or prognosis (or both) of auto-immune ear diseases. However, it is not known whether these antibodies are associated with noise-induced hearing loss (NIHL) in workers exposed to noise in occupational settings. Using immunoblotting with human recombinant Hsps, audiological assessment, and multivariate logistic regression models, we investigated the presence of antibodies against Hsp60 and Hsp70 and hearing levels, and analyzed their associations with NIHL in 399 workers exposed to noise between 75 and 115 dB. Our findings showed that the prevalence of positive anti-Hsp70 was significantly higher in the workers with slight and moderate high-frequency hearing loss than in normal workers (P < 0.05). Furthermore, the prevalence of positive anti-Hsp60 in workers with moderate low-frequency NIHL was significantly higher than in the normal (P < 0.01). The levels of anti-Hsp70 and anti-Hsp60 seemed correlated, and the level of anti-Hsp70 better predicted the level of anti-Hsp60. An elevated plasma level of anti-Hsp70 was associated with a nonsignificantly increased risk of high-frequency NIHL (adjusted OR = 1.45; 95% CI = 0.89-2.36) and an elevated plasma level of anti-Hsp60 was associated with a nonsignificantly increased risk of the low-frequency NIHL (adjusted OR = 2.25; 95% CI = 0.85-5.96). These results suggest that the production of anti-Hsp60 and anti-Hsp70 may play a role in the pathogenesis of NIHL, and that anti-Hsps may be a risk factor. The precise mechanisms for the elevation of antibodies against Hsps caused by noise exposure and their possible role in the development of NIHL warrant further investigations.     

Noise and the classical musician.

OBJECTIVES--To test the hypothesis that noise exposure may cause hearing loss in classical musicians. DESIGN--Comparison of hearing levels between two risk groups identified during the study by measuring sound levels. SETTING--Symphony orchestra and occupational health department in the west Midlands. MAIN OUTCOME MEASURES--Hearing level as measured by clinical pure tone audiometry. RESULTS--Trumpet and piccolo players received a noise dose of 160% and 124%, respectively, over mean levels during part of the study. Comparison of the hearing levels of 18 woodwind and brass musicians with 18 string musicians matched for age and sex did not show a significant difference in hearing, the mean difference in the hearing levels at the high (2, 4, and 8 KHz) audiometric frequencies being 1.02 dB (95% confidence interval -2.39 to 4.43). CONCLUSIONS--This study showed that there is a potential for occupational hearing loss in classical orchestral musicians.     

长江鲟幼鱼的听觉阈值研究

试验采用室内噪声控制的方式模拟野外自然噪声环境,以长江鲟(Acipenser dabryanus Dumeril)幼鱼为实验对象,使用TDT听觉测试系统,在100—500 Hz的刺激频率下,通过听性脑干反应(Auditory Evoked Potential, AEP法)测定其听力阈值。结果显示,长江鲟的最敏感频率为300 Hz,声压为(133±0.5) dB,听力曲线呈“V”型,听觉阈值随着频率的不同而发生变化。总体看,长江鲟听觉阈值较高,听力较弱,不能听到500 Hz以上的声音,其中,长江鲟的听觉阈值与湖鲟和匙吻鲟等鲟鱼类基本相似,但比长江中常见的淡水鱼类的听觉阈值高、听频范围窄。研究结果将为长江鲟的野外放归和种群重建提供重要基础资料,为评价涉渔工程建设运行对长江鱼类的影响提供基础数据支撑。     

Noise Exposure and Hearing Impairment among Chinese Restaurant Workers and Entertainment Employees in Hong Kong

Background

Noise-induced hearing loss (NIHL) is a major concern in the non-manufacturing industries. This study aimed to investigate the occupational noise exposure and the NIHL among Chinese restaurant workers and entertainment employees working in the service industry in Hong Kong.

Methods

This cross-sectional survey involved a total of 1,670 participants. Among them, 937 were randomly selected from the workers of Chinese restaurants and 733 were selected from workers in three entertainment sectors: radio and television stations; cultural performance halls or auditoria of the Leisure and Cultural Services Department (LCSD); and karaoke bars. Noise exposure levels were measured in the sampled restaurants and entertainment sectors. Each participant received an audiometric screening test. Those who were found to have abnormalities were required to take another diagnostic test in the health center. The “Klockhoff digit” method was used to classify NIHL in the present study.

Results

The main source of noise inside restaurants was the stoves. The mean hearing thresholds showed a typical dip at 3 to 6 KHz and a substantial proportion (23.7%) of the workers fulfilled the criteria for presumptive NIHL. For entertainment sectors, employees in radio and television stations generally had higher exposure levels than those in the halls or auditoria of the LCSD and karaoke bars. The mean hearing thresholds showed a typical dip at 6 KHz and a substantial proportion of the employees fulfilled the criteria for presumptive NIHL (38.6%, 95%CI: 35.1–42.1%). Being male, older, and having longer service and daily alcohol consumption were associated with noise-induced hearing impairment both in restaurant workers and entertainment employees.

Conclusion

Excessive noise exposure is common in the Chinese restaurant and entertainment industries and a substantial proportion of restaurant workers and entertainment employees suffer from NIHL. Comprehensive hearing conservation programs should be introduced to the service industry in Hong Kong.     

Does the Emperor Have Any Clothes: Using Mechanistic Information or Doing Houdini Risk Assessments?

Risk assessment research rarely quells controversy. Mega-mouse, and mega-rat, experiments contradicted a threshold for carcinogenesis, yet thresholds are still argued. High to low dose continuity of response from cigarette smoking to environmental tobacco smoke, and from occupational asbestos exposure to take-home asbestos, contradict thresholds in people. Nevertheless, mechanistic hypotheses allege “Houdini Risk Assessments”, which make risks disappear or allow industries to escape from protecting workers. Despite concerns for animal-to-human extrapolations, priority occupational exposures with sufficient or substantial evidence of carcinogenicity in people not addressed by new exposure limits include silica, sulfuric acid mist, chromates, diesel particulate matter, particulate matter generally, metalworking fluids, welding fume, and formaldehyde. “Houdini Risk Assessments” are exercises in “anti-hypothesis generation”: ignore selected tumor sites and types; ignore data from people (as with formaldehyde and diesel); choose the most resistant species in laboratory tests; select biochemical parameters in which the most resistant species resembles people; assume a mechanism that gives threshold or steep exposure response for carcinogenic effect; and reduce estimated people risk by the parameter ratio to the most resistant species. NORA research should focus on quantitative reconciliation of laboratory and epidemiology studies, and develop a counter “anti-hypothesis” generation research agenda for key exposure circumstances.     

Effects of noise on inner ear

The effects of noise on health depend both on individual factors and characteristics of sound exposure. In case of acoustic trauma, reversible or irreversible lesions of inner ear components are possible. Most often there is immediately an acute tinnitus and hearing loss. Audiometric tests demonstrate hearing loss on the high frequency, generally focused on 4 kHz. Immediate treatment is recommended even there is no currently indicator of the ability to restore hearing. New perspectives on treatment are directed to local treatment and/or using new procedure as antioxidative treatment. Occupational and leisure are the two conditions in which chronic exposure to noise is found. Detection and prevention of noise-induced hearing loss is easier in case of industrial workers than in case of noise exposition for musicians and other sounds and stage technicians or concert managers, and of course non-professional with exposure to amplified music.     

Molecular Biomarkers and Epidemiologic Risk Assessment

The use of molecular biomarkers in epidemiologic studies has been advancedas a way to improve risk assessments for occupational and environmental exposuresto toxic agents. We have used the detection of two cancer-related, molecular biomarkers of vinyl chloride exposure (mutant ras-p21 and mutant p53) to examine workers with equivalent cumulative exposures that would be above or below the current permissible workplace exposure limit for vinyl chloride for differences in the presence of these biomarkers. Workers with cumulative exposures above the current permissible exposure limit (equivalent of > 40 ppm-years) have a statistically significantly increased occurrence of both biomarkers in comparison to unexposed controls (p < 10^?3). Although workers with cumulative exposures of < 10 ppm-years, i.e., well below the current limit, do not have a statistically significantly increased occurrence of these biomarkers (p > 0.05), workers with cumulative exposures of 10 to 40 ppm-years, i.e., still below the current limit, are found to have a statistically significant increase (p < 0.05). This suggests that the current exposure limit may not be adequately protective and illustrates the potential utility of molecular biomarkers in the refinement of risk assessments for toxic exposures.     

Lifetime Risk of Fatal Occupational Injuries within Industries,by Occupation,Gender, and Race

Estimates of risk accumulated over a working lifetime are used to assess the significance of many workplace health hazards. Most studies which have estimated this risk have focused on a worker's lifetime risk of dying of a stated illness based on exposure to a hazard in a specific job. The concept, however, has not been widely applied to occupational injury deaths. This study examines the use of lifetime risk based on national fatal injury data from the Bureau of Labor Statistics (BLS) Census of Fatal Occupational Injuries (CFOI). Lifetime risks are defined by specific causal events for those groups identified as having the highest general lifetime risks. The lifetime risk model for injury used in this work can be compared with risk assessments for occupational illnesses. Fatal injury lifetime risk estimates will be useful in defining traumatic injury exposures that are appropriate for targeting research and prevention efforts needed to reduce the burden of work-related death within the United States. These estimates also provide a means of prioritizing traumatic injury research with fatal illness research, while providing the additional benefit of providing a means of informing workers of their fatal injury risks.     

Occupational exposures and reproductive health: 2003 Teratology Society Meeting Symposium summary

Assuring reproductive health in the workplace challenges researchers, occupational safety and health practitioners, and clinicians. Most chemicals in the workplace have not been evaluated for reproductive toxicity. Although occupational exposure limits are established to protect 'nearly all' workers, there is little research that characterizes reproductive hazards. For researchers, improvements in epidemiologic design and exposure assessment methods are needed to conduct adequate reproductive studies. Occupational safety and health programs' qualitative and quantitative evaluations of the workplace for reproductive hazards may differ from standardized approaches used for other occupational hazards in that estimates of exposure intensity must be considered in the context of the time-dependent windows of reproductive susceptibility. Clinicians and counselors should place the risk estimate into context by emphasizing the limitations of the available knowledge and the qualitative nature of the exposure estimates, as well as what is known about other non-occupational risk factors for adverse outcomes. This will allow informed decision-making about the need for added protections or alternative duty assignment when a hazard cannot be eliminated. These policies should preserve a worker's income, benefits, and seniority. Applying hazard control technologies and hazard communication training can minimize a worker's risk. Chemical reproductive hazard training is required for workers by the Occupational Safety and Health Administration's Hazard Communication Standard. The National Institute for Occupational Safety and Health (NIOSH) has formed a National Occupational Research Agenda Team to promote communication and partnering among reproductive toxicologists, clinicians and epidemiologists, to improve reproductive hazard exposure assessment and management, and to encourage needed research.