Jane L. Uva, MD, MPH

Disclosures

April 01, 2011

In This Article

Unintentional Work-Related Injury

Unintentional injuries are the leading cause of death for children and adolescents aged 10-19 years in the United States.[1] Unintentional injuries occur in the home, during recreation, at school, while participating in sports, and in work settings. Whereas youth injury prevention is often directed toward the home, recreation, and school environments, the work environment is also an important area for injury prevention efforts. This article will briefly review statistics on unintentional work-related injuries, illnesses, and deaths in young workers; the Healthy People objectives; ways in which adolescent workers differ from adult workers; and clinical guidance for healthcare providers. In addition, this article will review legal regulations that protect working minors and provide recommendations and resources for clinicians for reducing and preventing work-related injuries and deaths among working youth.

Scope of Youth Injuries

According to the National Institute for Occupational Safety and Health (NIOSH), approximately 1.9 million adolescents aged 15 to 17 years worked in the United States in 2009.[2] However, official employment statistics are not available for younger adolescents who are also known to work, especially in agricultural positions. In 2007, more than 48,000 injuries and illnesses in youths 15 to 17 years old were treated in hospital emergency departments (EDs). According to NIOSH, an estimated one third of adolescents with work-related injuries are seen in EDs; therefore, approximately 146,000 youths in the United States each year are injured or become ill on the job.[2] During 2008, as many as 34 people under 18 years of age died from work-related injuries.[3] Young workers who are low income, who are immigrants, who live in an urban environment, or who have developmental and learning disabilities may experience workplace injury and death at higher rates.

Healthy People 2010 and 2020 provide science-based, 10-year national objectives for promoting health and preventing disease from the US Department of Health and Human Services. Healthy People 2010 set a goal to decrease the rate of ED treatment of work-related injuries in 15- to 17-year-olds by 30% to a rate of 3.6 per 100 full-time equivalents (FTE).[4] In 2007, the most recent year of analysis, the rate fell just short of the goal to 4.2 per 100 FTE. Healthy People 2020 expands the 2010 objective to include 18- to 19-year-olds because they have the highest injury rate among young workers.[5] The occupational safety and health objective of Healthy People 2020 is to reduce nonfatal work-related injuries among adolescent workers 15-19 years of age.[5]

Differences Between Youth and Adult Workers

Biologic, social, and economic characteristics make young workers susceptible to unique and considerable risks for work-related injuries and illnesses. Although youth are still maturing physically, they can sometimes look like adults. As a result, minors are often given tasks to perform that are inappropriate for their bodies, such as heavy lifting, operating machinery, driving motor vehicles, and working long hours. These unsuitable activities place them at risk for injuries. Imbalance between equipment and physique can lead to equipment-related injuries, and working long hours causes fatigue and musculoskeletal overuse syndromes.

Youth who start working early in their lives while they are still developing may be more vulnerable to exposure to certain chemicals, noise, and extreme temperatures that could cause amplified or lasting damage. Young workers may be exposed to suspected asthma-causing agents and substances that disrupt the function or maturation of the endocrine and central nervous systems or that may cause an early loss of hearing.

Many adolescents lack job knowledge, experience, skills, and the ability to identify equipment and workplace hazards.[6] When youth workers are injured, they will often not report or seek care for their injuries. Seldom aware of their rights as workers, minors are less likely to speak up to address inappropriate work assignments, overtime hours, or unsafe equipment. Furthermore, the employer may not listen to the opinions of young employees.

Youth are known for risk-taking behavior. They have a sense of invulnerability and may not comply with employer policy and safe work practices, such as using personal protective equipment. Adolescents who work and use tobacco, alcohol, or drugs are at significant risk for injury, illness, and death. Minors commonly do not receive adequate supervision while they are working. They may be easily distracted and thus may get injured if they are not paying attention to their surroundings. Young workers may not be able to multitask as well as older workers. Talking on cell phones and texting places youth at increased risk for injury while working. Workplace violence and bullying cause anxiety and stress and may go unrecognized. All of these place adolescents in danger while working.

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