The Effectiveness of Interventions for Preventing Injuries in the Construction Industry

A Systematic Review


      Occupational injury rates among construction workers are the highest among the major industries. A number of injury-prevention interventions have been proposed, yet the effectiveness of these is uncertain. Thus a systematic review evaluating the effectiveness of interventions for preventing occupational injuries among construction workers was conducted.


      Seven databases were searched, from the earliest available dates through June 2006, for published findings of injury prevention in construction studies. Acceptable study designs included RCTs; controlled before–after studies; and interrupted time series (ITS). Effect sizes of similar interventions were pooled into a meta-analysis in January 2007.


      Of 7522 titles found, four ITS studies and one controlled ITS study met the inclusion criteria. The overall methodologic quality was low. No indications of publication bias were found. Findings from a safety-campaign study and a drug-free-workplace study indicated that both interventions significantly reduced the level and the trend of injuries. Three studies that evaluated legislation did not decrease the level (ES 0.69; 95% CI=−1.70, 3.09) and made the downward trend (ES 0.28; 95% CI=0.05, 0.51) of injuries less favorable.


      Limited evidence was found for the effectiveness of a multifaceted safety campaign and a multifaceted drug program, but no evidence was found that legislation is effective to prevent nonfatal or fatal injuries in the construction industry.
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        • Bondy J.
        • Lipscomb H.
        • Guarini K.
        • Glazner J.E.
        Methods for using narrative text from injury reports to identify factors contributing to construction injury.
        Am J Ind Med. 2005; 48: 373-380
        • Hoonakker P.
        • Loushine T.
        • Carayon P.
        • Kallman J.
        • Kapp A.
        • Smith M.J.
        The effect of safety initiatives on safety performance: a longitudinal study.
        Appl Ergon. 2005; 36: 461-469
        • Haslam R.A.
        • Hide S.A.
        • Gibb A.G.F.
        • et al.
        Contributing factors in construction accidents.
        Appl Ergon. 2005; 36: 401-415
        • Chi C.F.
        • Chang T.C.
        • Ting H.I.
        Accident patterns and prevention measures for fatal occupational falls in the construction industry.
        Appl Ergon. 2005; 36: 391-400
        • Arndt V.
        • Rothenbacher D.
        • Daniel U.
        • Zschenderlein B.
        • Schuberth S.
        • Brenner H.
        All-cause and cause specific mortality in a cohort of 20 000 construction workers; results from a 10 year follow up.
        Occup Environ Med. 2004; 61 (Erratum in: Occup Environ Med. 2004;61:721): 419-425
        • Loushine T.W.
        • Hoonakker P.L.T.
        • Carayon P.
        • Smith M.J.
        Quality and safety management in construction industry.
        Total Quality Management. 2006; 17: 1-42
        • Dong X.
        • Men Y.
        • Haile E.
        Work-related fatal and nonfatal injuries among U.S. construction workers, 1992–2003.
        The Center to Protect Workers' Rights, Silver Springs MD2005
        • Bentley T.A.
        • Hide S.
        • Tappin D.
        • et al.
        Investigating risk factors for slips, trips and falls in New Zealand residential construction using incident-centred and incident-independent methods.
        Ergonomics. 2006; 49: 62-77
        • Lipscomb H.J.
        • Glazner J.E.
        • Bondy J.
        • Guarini K.
        • Lezotte D.
        Injuries from slips and trips in construction.
        Appl Ergon. 2006; 37: 267-274
        • Leamon T.B.
        • Murphy P.L.
        Occupational slips and falls: more than a trivial problem.
        Ergonomics. 1995; 38: 487-498
        • Becker P.
        • Fullen M.
        • Akladios M.
        • Hobbs G.
        Prevention of construction falls by organizational intervention.
        Inj Prev. 2001; 7: i64-i67
        • Darragh A.R.
        • Stallones L.
        • Bigelow P.L.
        • Keefe T.J.
        Effectiveness of the HomeSafe pilot program in reducing injury rates among residential construction workers, 1994–1998.
        Am J Ind Med. 2004; 45: 210-217
        • Suruda A.
        • Whitaker B.
        • Bloswick D.
        • Philips P.
        • Sesek R.
        Impact of the OSHA trench and excavation standard on fatal injury in the construction industry.
        J Occup Environ Med. 2002; 44: 902-905
        • Winn G.L.
        • Seaman B.
        • Baldwin J.C.
        Fall protection incentives in the construction industry: literature review and field study.
        Int J Occup Saf Ergon. 2004; 10: 5-11
        • Lipscomb H.J.
        • Li L.
        • Dement J.
        Work-related falls among union carpenters in Washington State before and after the Vertical Fall Arrest Standard.
        Am J Ind Med. 2003; 44: 157-165
        • Rivara F.P.
        • Thompson D.C.
        Prevention of falls in the construction industry: evidence for program effectiveness.
        Am J Prev Med. 2000; 18: 23-26
        • Hsiao H.
        • Simeonov P.
        Preventing falls from roofs: a critical review.
        Ergonomics. 2001; 44: 537-561
        • Lipscomb H.J.
        Effectiveness of interventions to prevent work-related eye injuries.
        Am J Prev Med. 2000; 18: 27-32
        • Higgins J.P.T.
        • Green S.
        Cochrane handbook of systematic reviews of interventions 4.2.5 (updated May 2005).
        • Koningsveld E.A.
        • van der Molen H.F.
        History and future of ergonomics in building and construction.
        Ergonomics. 1997; 40: 1025-1034
        • Robinson K.A.
        • Dickersin K.
        Development of a highly sensitive search strategy for the retrieval of reports of controlled trials using PubMed.
        Int J Epidemiol. 2002; 31: 150-153
        • Verbeek J.
        • Salmi J.
        • Pasternack I.
        • et al.
        A search strategy for occupational health intervention studies.
        Occup Environ Med. 2005; 62: 682-687
        • The Cochrane Effective Practice and Organisation of Care Group (EPOC)
        Including interrupted time series (ITS) designs in a EPOC Review.
        EPOC, Ottawa ON, Canada2006
        • Downs S.H.
        • Black N.
        The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions.
        J Epidemiol Community Health. 1998; 52: 377-384
        • Ramsay C.R.
        • Matowe L.
        • Grilli R.
        • Grimshaw J.M.
        • Thomas R.E.
        Interrupted time series designs in health technology assessment: lessons from two systematic reviews of behavior change strategies.
        Int J Technol Assess Health Care. 2003; 19: 613-623
        • Yassin A.S.
        • Martonik J.F.
        The effectiveness of the revised scaffold safety standard in the construction industry.
        Saf Sci. 2004; 42: 921-931
        • Derr J.
        • Forst L.
        • Chen H.Y.
        • Conroy L.
        Fatal falls in the U.S. construction industry, 1990 to 1999.
        J Occup Environ Med. 2001; 43: 853-860
        • Spangenberg S.
        • Mikkelsen K.L.
        • Kines P.
        • Dyreborg J.
        • Baarts C.
        The construction of the Oresund link between Denmark and Sweden: the effect of a multifaceted safety campaign.
        Saf Sci. 2002; 40: 457-465
        • Wickizer T.M.
        • Kopjar B.
        • Franklin G.
        • Joesch J.
        Do drug-free workplace programs prevent occupational injuries?.
        Health Serv Res. 2004; 39: 91-110
        • Ilmarinen J.
        The ageing workforce—challenges for occupational health.
        Occup Med (Lond). 2006; 56: 362-364
        • Shadish W.R.
        • Campbell D.T.
        • Cook T.D.
        Experimental and quasi-experimental designs for generalized causal inference.
        Houghton Mifflin Company, Boston MA2002
        • Neal A.
        • Griffin M.A.
        • Hart P.M.
        The impact of organizational climate on safety climate and individual behavior.
        Saf Sci. 2000; 34: 99-109
        • Altayeb S.
        Efficacy of drug testing programs implemented by contractors.
        Journal of Construction Engineering and Management. 1992; 118: 780-790
        • Nelson N.A.
        • Kaufman J.
        • Kalat J.
        • Silverstein B.
        Falls in construction: injury rates for OSHA-inspected employers before and after citation for violating the Washington State fall protection standard.
        Am J Ind Med. 1997; 31: 296-302
        • Gerber J.K.
        • Yacoubian Jr, G.S.
        An assessment of drug testing within the construction industry.
        J Drug Educ. 2002; 32: 53-68
        • Johnson K.A.
        • Ruppe J.
        A job safety program for construction workers designed to reduce the potential for occupational injury using tool box training sessions and computer-assisted biofeedback stress management techniques.
        Int J Occup Saf Ergon. 2002; 8: 321-329
        • Halperin K.
        • McDougall V.
        • Waddoups C.J.
        • Bodah M.M.
        • Roelofs C.
        • Vogel M.
        New England project final report.
        CDC NIOSH, Cincinnati OH2001
        • van der Molen H.F.
        • Sluiter J.K.
        • Hulshof C.T.
        • Vink P.
        • van Duivenbooden C.
        • Frings-Dresen M.H.
        Conceptual framework for the implementation of interventions in the construction industry.
        Scand J Work Environ Health. 2005; 31: 96-103
        • Robson L.S.
        • Shannon H.S.
        • Goldenhar L.M.
        • Hale A.R.
        Guide to evaluating the effectiveness of strategies for preventing work injuries: how to show whether a safety intervention really works. DHHS (NIOSH) Publication No. 2001–119.
        CDC DHHS, National Institute for Occupational Safety and Health, Cincinnati OH2001