For more than two decades, shrimp fishing has been one of the most dangerous and deadliest occupations in the US.¹¹ It has an occupational fatality rate nearly 40x the national average, and employs many im/migrant, aging, and low-income workers.¹² To address their risk of occupational injury, our team conducted community-based participatory research (CBPR) with Gulf Coast fishermen, which is a relational model that values participants as equal partners in planning, disseminating, and implementing research. Consistent with CBPR, community members who are part of the commercial fishing industry assisted our team in developing research questions, our team brought initial results and analysis back to the community to correct misinterpretations, and then an intervention was developed based on the needs identified by the fishermen. Of interest were the ways that participants understood their injuries, the risks they faced on-the-job, and their ideas for improving their health. Workers were engaged throughout data collection and analysis, and they played a significant role moving the findings into actionable change.

Based on our findings, we developed, maintained, implemented, and tested the feasibility and effectiveness of the Docside Clinic: Connecting Docs to the Docks to address commercial fishermen’s access to healthcare, food, and immigration needs, which impacts their work and home life.¹³ The program was initially implemented at one location in July 2021 and has now expanded to two locations. We have had over 1000 patient encounters and provided access to medical and social services that commercial fishermen requested, such as diabetes and blood pressure screenings, antibiotics, flu kits, dental exams, and COVID, flu, and tetanus vaccines, as well as food, clothing, opioid antagonists, and immigration services. Applying CBPR methods to a high-risk occupational setting allowed us to examine the bidirectional relationship between work-related injuries (e.g., sleep deprivation) and non-work determinants of health (e.g., immigration status), particularly for a population that faces dangerous working conditions, has limited sick leave benefits, and lacks preventive healthcare access.

Badin, North Carolina is a company town, meaning that the employer owned and established housing and public resources. Established in 1916, Badin was home to one of the nation’s first aluminum smelting facilities, which extract aluminum from refined alumina through an electrolytic melting process in 1,700 degree baths. The facility shut down in 2007, but the plant buildings and waste remain. Residences and jobs in Badin were racially segregated, and the smelter and its dumping sites are in West Badin, the Black side of town. Our team conducted collaborative research with the Concerned Citizens of West Badin Community (CCWBC) and the North Carolina Environmental Justice Network in Badin, North Carolina to document structural racism and how it was manifested in people’s health. The CCWBC is a community organization that was formed to advocate for community rights and industrial waste cleanup.¹⁴ The group has raised former workers’ reports and concerns that the worst jobs were assigned to Black workers and that many members of their community died early.¹⁵

Since 2016, our team has documented occupational segregation by examining disparities in job assignment and trajectory in four domains: 1) a prestige measure from the sociology literature, 2) wage, 3) particulate matter exposure based on a job-exposure matrix, and 4) a danger rank assigned by CCWBC members. Workers identified jobs in the potroom, a room that houses the baths where the melting takes place, as the most dangerous. In all domains, Black workers were most likely to be hired into undesirable jobs and stay in them throughout their tenure.¹⁶ Furthermore, inspired by concerns about mortality in the community, and using union records, our team found excess respiratory cancer mortality among plant workers compared to the general population. We also found that potroom workers had higher respiratory cancer mortality rates than other Badin workers.¹⁷ Taken together, our community-based work validated community concerns and lived experiences in an environment of company-influenced narratives and reductive scientific literature that largely overlooked the CCWBC’s voices.

In the 1980s, North Carolina was largely a rural state albeit one with large textile and furniture manufacturing industries. Work in North Carolina has dramatically changed since then. Today, North Carolina is the 9th most populous state in the country with an economy centered on financial services, technology, and biological sciences. However, the proportion of the state’s population employed in manufacturing remains among the nation’s largest, female and minority participation in the labor force is high, and organizational capacity of labor is very low. We have worked with the state’s medical examiners, and labor and social advocacy organizations, to investigate the circumstances of fatal occupational injuries in North Carolina for nearly two decades.¹⁸ Our approach allowed us to estimate racial/ethnic disparities attributable to workforce segregation, such that Black and Hispanic workers generally work in different industries and occupations than White workers, and that attributable to racial/ethnic differences in task assignments and hazards within industries and occupations. We found that if Hispanic workers experienced the workplace safety of their non-Hispanic counterparts, fatal injury rates would be substantially reduced.¹⁹ The research points to root causes, like segregation of the NC Hispanic workforce into the most dangerous industries, as important points for intervention to eliminate injury disparities.²⁰

Training future occupational injury prevention researchers to adopt culturally responsive, community-engaged research methods is essential for studying challenging topics, such as racism and stress in socially vulnerable and marginalized working populations. Building authentic relationships and trust to conduct complex occupational injury studies in under-reached communities takes time, effort, and resources. One trainee from the Midwest Center for Occupational Health and Safety at the University of Minnesota, has taken on these challenges through her study of discrimination and racism among front-of-the-house and back-of-the-house workers within the food service industry. Part of her training has involved the study of critical race theory and systems of oppression and disparities within the food industry to inform her research questions and methods. Her research examines work structure and its impacts on physical and psychological injury for food industry workers in the Minneapolis-St. Paul Metropolitan Area.

In collaboration with two community partners from a local health department and a non-profit worker advocacy organization, established a robust Community Advisory Board (CAB)—which consisted of members from the food service industry, advocacy organization, health department, and civil rights department—that informed the development of research questions, data collection methods, and instruments. Using a mixed method design, based on the principles of Creswell participatory-social justice exploratory design,^21–22 the study began with qualitative interviews of food industry workers recruited with the assistance of her community partners. Her analysis of interviews identified key themes that reflected lived experiences of racism and discrimination, often manifested by abrupt changes in work schedules, reduced work hours, and wage theft. The instability of work hours reportedly led to feelings of disempowerment, financial strain, disruption to family life, and stress. Her qualitative findings led to the co-development of a quantitative instrument and recruitment strategies with the CAB to measure the association between discrimination, occupational injury, and stress. Plans to use the study’s findings to inform policy changes and interventions for marginalized food industry workers in collaboration with her community partners.