title: Prevention of traumatic nail gun injuries in apprentice carpenters: use of population-based measures to monitor intervention effectiveness.
abstract: BACKGROUND
  Nail guns are responsible for a significant injury burden in residential construction. Risk, based on hours of work, is particularly high among apprentice carpenters due in part to more frequent exposure to tool use.
  
  
  METHODS
  Nail gun injuries were evaluated over 3 years among carpenters enrolled in two apprenticeship programs in the Midwest (2.3 million residential work hours observed) following initiation of training and a voluntary ANSI standard change calling for safer sequential triggers on framing nailers. Injury rates, based on hours of tool use, were calculated yearly. Rates and adjusted rate ratios were calculated with Poisson regression. Attributable risk percent (AR%) and population attributable risk (PAR%) were calculated yearly for modifiable independent risk factors for injury including lack of training in tool use and type of trigger mechanism on tools being used.
  
  
  RESULTS
  As apprentices received training and safer trigger mechanisms became more widespread, injury rates decreased significantly (31%). While school training and hands-on mentoring were both important, injury rates were lowest among apprentices who received both. Although injury rates changed over the observation period, the relative risk comparing trigger mechanisms did not; contact trip triggers consistently carried a twofold risk.
  
  
  CONCLUSIONS
  Although training and safer trigger use both increased, because of the relative prevalence of training and trigger exposures in this population, the engineering solution consistently had the potential to make more difference in population risk. Our findings demonstrate the utility of observational methods including measures of population-based risk in monitoring intervention effectiveness and making recommendations that lead to injury reduction.
authors.affiliation: Division of Occupational and Environmental Medicine, Duke University Medical Center, Durham, NC 27710, USA. hester.lipscomb@duke.edu
authors.forename: Hester J
authors.initials: HJ
authors.lastname: Lipscomb
authors.forename: James
authors.initials: J
authors.lastname: Nolan
authors.forename: Dennis
authors.initials: D
authors.lastname: Patterson
authors.forename: John M
authors.initials: JM
authors.lastname: Dement
mesh_terms: D000062:Accidents, Occupational / Q000517:prevention & control* / Q000706:statistics & numerical data; D003252:Construction Materials; D004864:Equipment and Supplies / Q000592:standards; D006230:Hand Injuries / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D007318:Inservice Training; D016012:Poisson Distribution; D015995:Prevalence; D017751:Safety Management / Q000379:methods*; D014950:Wounds, Penetrating / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*