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Innovative Approaches to Worker Health Protection in
Vietnamese Shrimp Fishermen of the Gulf Coast
IFISH 5, St. John‘s/Labrador
Session 5A
Obstacles to Performing OSH Research in Commercial Fishing
Jeffrey Levin, Ann Carruth, Thu Bui, Robert Perkins
Tuesday, June 12, 2018
9:00 – 10:30 a.m.
With support from: CDC/NIOSH,
Cooperative Agreement U54 OH07541
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Collaborations and Acknowledgements
• Karen Gilmore, MPH*
• Amanda Wickman, BS, MBA*
• Sara Shepherd, MAMS*
• Eva Shipp, PhD – Texas A&M University
• Matthew Nonnenmann, PhD, CIH*
• Ann Carruth, DNS, RN – Southeastern Louisiana University *University of Texas Health Science Center at Tyler
• Other Partners:
–U.S. Coast Guard Marine Safety Unit, 8th District
–Area Health Education Centers
–Cooperative Extension Service
–Sea Grant
–SW Ag Center External Advisory Committee
–Other stakeholders/volunteers
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Permissions
Portions of this presentation, including figures and tables, were reused
with permission for on-line publication from articles as noted below:
** Levin JL, Gilmore K, Shepherd S, Wickman A, Carruth A, Nalbone JT, Gallardo G,
Nonnenmann MW. Factors influencing safety among a group of commercial fishermen
along the Texas Gulf Coast. J Agromedicine. 2010;15(4):363-374. [PubMed: 20954032]
Available online at: http://www.tandfonline.com/doi/full/10.1080/1059924X.2010.509701
§ Levin JL, Gilmore K, Wickman A, Shepherd S, Shipp E, Nonnenmann M, Carruth A.
Workplace safety interventions for commercial fishermen of the Gulf. J Agromedicine.
2016;21(2):178-189. [PubMed: 26788841] Available online at:
http://www.tandfonline.com/doi/full/10.1080/1059924X.2016.1143430
§§ Levin JL, Gilmore K, Carruth A, Wickman A, Shepherd S, Gallardo G, Nonnenmann
M. Helping Gulf shrimpers adopt safety measures: importance of partnerships and
research to practice. J Agromedicine. 2012;17:15-21. [PubMed: 22191499]
Available online at:
http://www.tandfonline.com/doi/full/10.1080/1059924X.2012.627312
Source: https://www.bls.gov/iif/oshwc/cfoi/cfch0014.pdf
Source: https://www.cdc.gov/niosh/docs/2017-174/pdf/2017-174.pdf
Number and trend of unintentional fatal falls overboard (N = 204, 27% of
all work-related deaths in the commercial fishing industry) by year
— United States, 2000–2016
Source: Case SL, Lincoln JM, Lucas DL. Fatal Falls Overboard in
Commercial Fishing — United States, 2000–2016. MMWR Morb Mortal Wkly
Rep 2018;67:465–469. DOI: http://dx.doi.org/10.15585/mmwr.mm6716a2 .
Fatal Falls Overboard
• Most frequent on East Coast (62; 30.4%)
• Followed by Gulf of Mexico (60; 29.4%)
• Gulf of Mexico shrimp fishery had highest
number (34, 16.7%)
Source: Case SL, Lincoln JM, Lucas DL. Fatal Falls Overboard in
Commercial Fishing — United States, 2000–2016. MMWR Morb Mortal Wkly
Rep 2018;67:465–469. DOI: http://dx.doi.org/10.15585/mmwr.mm6716a2 .
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Background
• Systematic review, Pubmed, 1996-2015,
―commercial fishing occupational injury United
States‖
• Less is known about non-fatal injuries and
illnesses
• Behavioral factors and attitudes may contribute
to fatal and non-fatal outcomes
** Figure reused
with permission.
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Long-term Objectives
for 5 year study
• to characterize selective workplace factors and
attitudes/behaviors which may contribute to
morbidity and mortality among Gulf Coast
shrimp fishermen (shrimpers) and
• to utilize a community-based approach to
planning, implementing, and evaluating
prevention and education measures directed at
priority workplace factors and behaviors as
identified by stakeholders.
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• Survey of work and related behavioral factors
• Noise level monitoring and audiometry
• Focus groups to prioritize and select intervention strategies
• Follow-up survey emphasizing selected interventions and measuring intent
Mixed Methods
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Methodology
Quasi-experimental
community trial with
focus group selected
areas for intervention
development and
deployment
§ Figure reused with permission.
§ Figure reused with permission.
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Theory of Planned Behavior
• Despite limitations, the theory of planned
behavior served as the theoretical framework for
development of the survey in this study.
• The theory considers attitudes toward a
behavior, subjective norms, and perceived
behavioral control as they influence intention
and the ultimate behavior itself.
Source: Ajzen, I. (1991). The theory of planned behavior.
Organizational Behavior and Human Decision Processes,
50:179-211.
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Quantitative Analysis
• Comparison of group question means for
each question between first and follow-up
surveys (t-test)
• Proportion of each community group with
strong ―intent to action‖ responses
compared with location of intervention
• Minimum sample size calculations (n=65
for each group)
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Focus Group Selected Intervention Areas
• Houston/Palacios – noise/hearing
• Belle Chase – winch safety awareness
• Abbeville – fatigue
** Figure reused
with permission.
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Community Training Meetings
as Recruitment and Dissemination Forums
• Focus on group specific intervention
• Ship-to-ship communication/MayDay simulation
• Damage control, abandon ship, fire suppression
• Blood pressure information
• First aid – choking, CPR, bleeding, fractures,
etc.
§§ Figure reused with permission.
§§ Figure reused with permission.
Hearing/Noise
§ Figure reused with permission.
§ Figure reused with permission.
Winch Safety
Awareness
§ Figure reused with permission.
Fatigue
§ Figure reused with permission.
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Follow-up Survey
• Repeat survey of 3 convenience samples
• Shortened survey with repeat questions related to each of the 3 selected intervention areas
• Add questions regarding intention to adopt intervention: – E.g., This safety information about noise helped me. I
will wear ear protection while working aboard vessel.
Results
Demographic and work-practice findings from the initial and follow-up
surveys conducted in 2008 and 2012 respectively.
§ Table reused
with permission.
Findings from ‗intent to action‘ questions from follow-up survey (post-
only evaluation; *indicates location where intervention occurred).
§ Table reused with permission.
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Sound Levels and Hearing Loss
on Commercial Fishing Vessels
• Hazardous noise levels were measured in
the engine rooms of 4 commercial fishing
vessels in the Gulf of Mexico, ranging from
94.8 to 105.0 dBA.
• Patterns consistent with noise-induced
hearing loss NIHL appeared to be
significantly associated with years spent
fishing, but not with age.
Source: Levin JL, Curry WF, 3rd, Shepherd S, Nalbone JT, Nonnenmann MW. Hearing
loss and noise exposure among commercial fishermen in the Gulf Coast. J Occup
Environ Med. 2016;58(3):306-313. [PubMed: 26949882]
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Conclusions - 1
• Culture plays a significant role in
attitudes/beliefs among Vietnamese
shrimp fishermen of the Gulf, and may
influence behaviors that are risk factors for
fatal and non-fatal injuries. In particular,
commercial fishing industry leaders are
able to influence behaviors and practices
among fishermen.
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Conclusions - 2
• Culturally appropriate training and awareness
measures combined with recognizing normative
influences can favorably alter attitudes, beliefs,
and behavioral intent related to workplace safety
in this population of Vietnamese shrimp
fishermen along the Gulf Coast. This includes
not only opinion leaders among commercial
fishermen, but also authority figures such as the
USCG.
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Conclusions - 3
• Community participatory methods such as
selection of priorities for workplace intervention
can be an effective strategy for translating
research findings into practice.
• Occupational noise-induced hearing loss serves
as a good example. Implementation of hearing
conservation measures including use of PPE
may lead not only to sensory preservation, but
may also reduce risk for associated injuries and
fatalities.
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Limitations
• Inability to randomize community participants to
study conditions
• Different participants between first and follow-up
surveys
• Cross-contamination of groups due to migration
between landing sites
• Impact of increased general safety awareness
across groups
• Self-selection and sustainability of intervention
effect (generalizability of results?)
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Dr. Carruth‘s Work
• Identify:
– barriers to use of lifesaving PFDs (e.g.,
comfort, heat)
– preferences of commercial fishermen for
various PFD designs, and
– development of a social media campaign to
promote use on deck.
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Obstacles and Barriers to: -occupational safety and health research
-adoption/acquisition of safety messages/skills
• Internal
– Culture/language
– Fatalism
– Trust versus respect for authority and opinion leaders
– Pride/embarrassment pre-empting English communication
• External
– Peaks/troughs of work versus boredom
– Economic – equipment, fuel
– Regulatory – fishing season, U.S. Coast Guard, vessel
operations, inspection and training requirements
– Timing logistics/availability
– Weather events and disasters
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Benefits of
Strategic Partnerships
• Knowledge/skills
• Resources
• Different perspectives
• Personal relationships
• Enhanced engagement
• Range of experience
• Overcoming
barriers/obstacles ** Figure reused
with permission.
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Panel
• Ann Carruth – cultural factors and their
implication for research
• Thu Bui – collaborating with researchers
as a community liaison
• Robert Perkins – insights from the
perspective of the USCG as a
―regulator/enforcer‖ versus a civilian
marine safety manager/trainer
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Panel Questions
• What do you feel has been a key barrier to
the adoption of safety practices among
commercial fishermen in the Gulf of
Mexico?
• Can you recall a personal experience or
anecdote related to barriers to safe
behavior adoption in this population?
• How has this research project(s) helped to
overcome to those barriers?
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Some Stories/Illustrations
• Lack of navigation knowledge and skills related
to sound signaling, creating hazardous
situations – despite fishing for 20 years, “I never
knew what the horn blasts meant.”
• Language gap and reluctance to communicate
by radio – winch entanglement episode in which
hesitation to make a MayDay call in English (and
efforts to contact fellow Vietnamese fishermen
by cell phone) resulted in emergency response
delays that likely contributed to a fatality.
Questions and Discussion
§§ Figure reused with permission.
