Psychosocial Factors in IAQ Crises
Factory workers often don't complain until airborne chemical exposures are relatively high. The same exposure in an office setting would be intolerable.
HOW often do we as health and safety professionals ask ourselves, "I wonder if there is a psychosocial component to these indoor air quality complaints?" In fact, environmental health & safety professionals are not qualified to make judgment calls regarding the psychological basis of reported or displayed symptoms among employees. It is also not appropriate to demean a person by assuming his symptoms have no physical or organic basis. We are just not qualified to do that, nor would it be good bedside manner--or, in our case, "workplace manner," if I may coin a phrase.
A health and safety professional must treat employees with respect and professionalism, while letting them know exactly what we are evaluating in the workplace. Being dismissive or evasive will destroy the employees' confidence in us. We as EHS professionals must remain focused on the following:
- Anticipate workplace antagonistic factors,
- Recognize which environmental factors may be at work,
- Evaluate potential problems, and
- Recommend corrections or control measures.
Industrial hygienists are trained to recognize dose/response relationships. We know the TLV is not a line that poses no risk until crossed. There is a spectrum of responses associated with a spectrum of exposures. Further, we understand that a population's response to a given challenge results in a bell curve, with the sensitive members of the population residing in the tail at the low-dose end. One thing we must realize is that often, the simple act of an industrial hygienist's showing up to address the potential complaint serves to allay the employees' fears. They usually feel they have been heard and their complaint has been taken seriously.
Let me be clear, I am not a supporter or a detractor of the concept of environmental illness or chemical sensitivity. As an IH, I am not qualified to be either. What I do is anticipate, recognize, evaluate, and control. Among the important groups of standards I rely on heavily in this regard are the ASHRAE standards. They are developed by engineers who define how buildings should be designed, operated, and maintained.
The IAQ literature describes how perceived environmental illnesses become localized epidemics within a defined group. Reports also describe chemical sensitivity and multiple chemical sensitivity and are full of strong opinions from both proponents and antagonists. Finally, there is much written on the concept of sick building syndrome and what this term really means. The vast majority of articles and books on the subject are written by medical doctors, psychologists, or sociologists. The authors tend to write from the point of view of their professional model. M.D.s talk about defining disease; sociologists try to classify people; journalists go for hooks (can this happen to me?).
Very little is written on the subject by health and safety professionals; perhaps we have excluded ourselves because we don't feel qualified, but the fact is, whenever you deal with people, you are dealing with psychosocial issues. And the basis of our profession is people.
Post-Anthrax Skin Rashes
Consider a specific example of a recent indoor environmental crisis at schools across the nation. The skin rash episodes coincided with the anthrax attacks.The New America Institute is a non-profit, non-political think tank for writers on American culture. Margaret Talbot of the New America Institute wrote in The New York Times Magazine about an epidemic of skin rashes among elementary and middle and high school children that started in an Indiana school on Oct. 4, 2001, the same day the first anthrax outbreak was reported in Florida. Skin rash outbreaks occurred in 27 states and affected 110 schools. Talbot described a severe outbreak in Medford, Ore. Generally, the rashes spread quickly by line of sight. Chaos ensued as children were sent home on repeated days. Teachers were scratching themselves while instructing children not to scratch. Finally, the school was closed for an entire week.
Robert E. Bartholomew, a sociologist and anthropologist who has written extensively on the subject of mass psychogenic illness, reports more than 80 different terms in the literature used to describe mass psychogenic reactions. He defines two types of psychosocial situations: mass epidemic hysteria, which may have cultural or community influences, and a type of epidemic illness associated with workplaces (or schools) that he calls mass anxiety hysteria. The latter affects people in segregated groups (a school or workplace) having:
- low status,
- a low level of control,
- low pay (or few other rewards),
- repetitive, mundane jobs, and
- poor relations with managers (or teachers).
Batholomew claims this is not a diagnosis of exclusion, that "even before environmental tests (air, water, food) come back, one can diagnose anxiety hysteria." Of course, that is heresy, to industrial hygienists. Many a professional has gotten into trouble by trying to guess at a diagnosis before all of the data are in.
The Talbot school skin rashes might be an example of anxiety hysteria. Sigmund Freud defined "conversion hysteria" as converting psychological conflict into involuntary physical symptoms without corresponding organic basis. Bartholomew states epidemic hysteria is the rapid spread of conversion hysteria within a cluster of people. He believes symptoms enable victims unconsciously to avoid undesirable activities and receive support. They are not malingering, but are seeking relief from conditions they deem intolerable or frightening. In schools, for example, students and parents often are not convinced even if tests show that no environmental threat exists.
I must repeat here that it is not for the industrial hygienist to determine whether symptoms are real. We are only meant to ferret out the real environmental threats from the non-real and effectively communicate our findings to all parties.
Bartholomew's corrective actions, which are based on his perspective as a sociologist, include:
- Resolve supervisor conflict.
- Provide stimulating positions.
- Offer appropriate pay or other appropriate reward.
- Offer future security.
- Offer career development (in the case of employees).
- Foster a climate of respect.
From an industrial hygienist's perspective, there are additional measures that help ensure a healthy, efficicient workplace or place of learning. These include adequate lighting, adequate ventilation, adequate building maintenance, a clean environment, responding quickly and decisively to IAQ complaints, communicating findings to employees including any corrective actions that are anticipated, and carrying out corrective actions promptly.
A Case Study
A case study involving motor assembly workers demonstrates the importance of employees' perception of their environment on their physical well-being. Assembly workers in a small motor manufacturing plant were moved from an open, ground floor location with plenty of natural lighting and good ventilation to a cramped basement with no windows and poor ventilation. Management scoffed at employee complaints. The workplace had open containers of oils, caustic mists, and solvents. Odors were rampant, even though there were no excessive exposures to chemicals. One female employee lost consciousness. Upon seeing this, several others of both sexes passed out. Fear struck throughout the plant, and it was several weeks before operations returned to normal.
To resolve the problem, management improved conditions in the plant by getting rid of or enclosing odor-causing chemicals, improving ventilation, installing windows in walls above grade and improving lighting. They called in an industrial hygiene team to investigate any possibility of health hazards. The team continuously kept the workers apprised of what they were checking for and what the results were. Employee-management relations were improved. Slowly, the problem resolved.
Skin rash epidemic writer Margaret Talbot found that one school superintendent, Tony Pierantozzi, of South Dennis, Mass., used a technique that resolved the skin rash issue quickly and decisively in his school district:
- He set up a triage system whereby students were kept at school if they only had a small body part affected but sent them home if multiple body areas were affected.
- He segregated those affected from those unaffected (eliminating the line of sight, as well as discussion of the problem and comparison of rashes among the children).
- He treated the rashes with ice only, no calamine, which marked students as victims (or heroes).
His actions stopped the rashes very quickly.
The Signal Detection Theory
Dr. Alan Hedge, a psychologist and professor of Design and Environmental Analysis at Cornell University, reviewed 14 studies performed between 1987 and 1997 that compared environmental conditions found in indoor air quality complaint and non-complaint buildings. He found only sporadic correlations between complaints and actual environmental problems. In the correlations that he found, there were more complaints in buildings with air conditioning than those with natural ventilation, and he found a correlation between complaints and high airborne dust concentrations. He found that thorough office cleaning dramatically reduced symptoms. He also found that complaints correlate with non-environmental conditions more than with environmental conditions. The non-environmental conditions that he identified included gender, computer use, job stress, job satisfaction, atopy (allergy prevalence), migraine, eyewear (glasses or contacts), age (more complaints originate from those under 35 than over 35), and smoking.
To explain workers' response to environmental conditions, Hedge proposes the signal detection theory. Perception depends on intensity of stimulus (signal) relative to background nervous system activity or background competing stimuli (noise). What we can and cannot detect depends on the signal to noise ratio. The drive toward an odor-free building is doomed to failure, because as we remove odors (noise) we enhance sensitivity to the presence of smaller and smaller stimuli (signals). It's like having someone leave dirty socks in a locker room. If someone else brings in another pair of dirty socks, no one's going to notice. But bring only one pair into a pristine office setting, and you will get lots of complaints.
This is why on the factory floor, workers often don't complain until airborne chemical exposures are relatively high, whereas the same exposure in an office setting would be intolerable. Imagine a milligram per cubic meter of inert or nuisance dust in a factory--not really that uncommon, but this would not be acceptable to an office worker. There would be aggressive complaints about both airborne and settled dust at the workstation. Unfortunately, because of this, we are working with two sets of criteria defining acceptable air quality for two different employee groups. This is an ethical dilemma that will not be solved any time soon, one requiring some excellent communications skill to negotiate.
This article originally appeared in the October 2003 issue of Occupational Health & Safety.