DISSERTATION OCCUPATIONAL INJURIES AMONG CRAFT BREWERY WORKERS IN COLORADO Submitted by Colleen Brents Department of Environmental and Radiological Health Sciences In partial fulfillment of the requirements For the Degree of Doctor of Philosophy Colorado State University Fort Collins, Colorado Spring 2021 Doctoral Committee: Advisor: John Rosecrance William Brazile Brooke Anderson Alyssa Gibbons Jeff Biegert Copywrite by Colleen Brents 2021 All Rights Reserved ABSTRACT OCCUPATIONAL INJURIES AMONG CRAFT BREWERY WORKERS IN COLORADO Workers at craft breweries in the U.S. are an understudied occupational cohort in a rapidly growing industry. Between 2015 and 2019, the number of craft breweries in Colorado grew 120% (Brewers Association, 2020). At the start of 2020, Colorado had more than 420 craft breweries with more than 9,100 workers. California is the only state with more craft breweries than Colorado. In the U.S., 8,000 craft breweries employed 161,000 workers (Brewers Association, 2020). As craft brewery workers produce beer through manufacturing processes, they are exposed to numerous occupational hazards that have been associated with injuries. These hazards include awkward body postures, lifting/carrying heavy loads, highly repetitive activities, sharp edges on materials and equipment, hot surfaces, and high levels of noise. According to national injury surveillance data, occupational injury rates are higher among brewery workers compared to all industries including private, state, and local government. Unfortunately, the national injury surveillance data do not differentiate between large and craft breweries. Craft breweries are substantially smaller than large industrialized breweries. An analysis of national injury data that includes all sizes of breweries may lead to erroneous perceptions of injuries affecting craft brewery workers. To date, no published studies have specifically outlined occupational hazards and injuries associated with craft brewing tasks. To effectively improve safety among craft brewery workers, it is critical that researchers and industry stakeholders have a better understanding of the occupational exposures related to injuries specific to craft brewery workers. The purpose of the present study was to characterize injuries specific to craft brewery workers and to identify their contributing factors in order to inform practitioners tasked with directing intervention resources. Researchers used data from workers’ compensation to analyze injuries among Colorado craft brewery workers from 2013 to 2018. Researchers then analyzed accident narratives using the revised agent-host- environment epidemiologic model to better understand the relationship between the reported injury claim ii and the contributing factors to the agent, host, environment, and vehicle. Informal interviews with subject matter experts supplemented the workers’ compensation analysis. Due to restrictions caused by the COVID-19 Pandemic, qualitative data were collected through virtual informal interviews with subject matter experts. Researchers developed a series of injury process models to highlight the relationship between injury characteristics and contributing factors that resulted in an injury nature. These models included information on how an injury nature was the result of an injury event when energy was transferred from the environment or vehicle to the injured workers’ anatomical region. Researchers analyzed 570 claims. Results of the present study indicated that new workers experience occupational injuries, as more than 60% of claimants had less than two years of tenure at the time of injury. Among claims that incurred costs, the median total claim cost was $680 and the mean total claim cost was $2,100. Claims associated with sprains/strains incurred the highest costs per claim and the highest cumulative cost. Sprains/strains and contusions were the most frequent injury natures. The low back, hands, and fingers were the most frequently injured body parts. By analyzing accident narratives, researchers determined that injuries in craft breweries were typically associated with claimants either carrying items or performing cleaning tasks. The majority of injuries occurred in the packaging hall area of the craft brewery. Subject matter experts described how the packaging hall typically had the highest number of workers and the greatest proportion of new workers compared to other regions of the craft brewery. Contusions, lacerations, and burns affected the hands/fingers whereas sprains/strains predominately affected the low back. Sprains/strains and contusions both typically occurred in the packaging area of the craft brewery while the claimant carried an item. Lacerations typically occurred in the packaging area or kitchen. Burns typically occurred in the brewery or kitchen. Both burns and lacerations occurred while the worker performed maintenance work, cleaning activities, or food preparation tasks. Findings from this study (including the injury process models) can help guide practitioners tasked with developing interventions to reduce injuries and improve the quality of work life among craft brewery workers. iii ACKNOWLEDGMENTS I would like to thank Dr. John Rosecrance, my advisor of five years, for his guidance, expertise, and support. I am grateful for the numerous opportunities he has given me to take my education beyond the classroom and around the world. I am grateful for the financial and scholarly support from the National Institute for Occupational Safety and Health’s Mountain and Plaines Education Research Center. I would also like to thank Dr. Kristina Quynn, Dr. William Brazile, Dr. Josh Keller, Jeff Biegert, Dr. Alyssa Gibbons, Dr. Brooke Anderson, and Dr. David Gilkey for their advice and insight. I would especially like to thank Dr. Josh Keller and Dr. Zach Weller for their data analyses support. This dissertation would not have been possible without the cooperation of Pinnacol Assurance, the Brewers Association, the Colorado State University Fermentation Science and Technology Program, and the Colorado brewing community. I would like to especially thank Jim McMillen, Paul Washburn, and Oguz Akkas for their assistance with everything related to workers’ compensation. I would like to thank Chuck Skypeck, Matt Stinchfield, Elizabeth Embry, Kaylyn Kirkpatrick, Jim Stricker, Travis Rupp, Jeff Callaway, and Reva Golden for their help with everything related to the craft brewing industry. I would also like to thank Odell Brewing Company, New Belgium Brewing Company, and Horse and Dragon Brewing Company. I am grateful to many resources at Colorado State University: Franklin A. Graybill Statistical Laboratory, CSU Writes, and the CSU Writing Center. I would like to extend a special thank you to the following: Molly Hischke, JoiLynn Drescher, Amanda Craig, Yanhong (Shirley) Liu, Whitney Pennington, Kathy Peterson, Kelsey Townsend, Erin Reichert, and the staff at OSHA consultation. I would also like to thank Jared Brewer, Bryn Ronalds, Ed Charlesworth, Kyle Chudler, and Alex Naegele for their encouragement throughout this process. Finally, I would like to express my gratitude to my family and quarantine-pets. I am thankful to my parents for their patience and unwavering support and encouragement. iv TABLE OF CONTENTS ABSTRACT .................................................................................................................................................. ii ACKNOWLEDGMENTS ........................................................................................................................... iv LIST OF TABLES ..................................................................................................................................... viii LIST OF FIGURES ...................................................................................................................................... x Chapter 1: Introduction ................................................................................................................................. 1 Chapter 2: Literature review ......................................................................................................................... 5 2.1. Scope of literature review ...................................................................................................................... 5 2.2. Craft brewing industry ........................................................................................................................... 5 2.2.1. Definition of a craft brewery ......................................................................................................... 5 2.2.2. Craft brewery growth ..................................................................................................................... 6 2.2.3. Craft brewery size .......................................................................................................................... 7 2.3. Occupational health and safety in breweries .......................................................................................... 8 2.3.1. Occupational hazards in craft breweries ........................................................................................ 8 2.3.2. Occupational safety and health in breweries overview ................................................................ 10 2.3.3. National injury surveillance ......................................................................................................... 11 2.3.4. Professional