Back to the future: Understanding past exposures to inform future practice

Background: Asbestos exposure is a well-recognized cause of malignant and non-malignant disease worldwide. Although production has declined significantly in the US, some occupational exposure continues in the US and worldwide. Policies to protect the current workforce have been informed by our understanding of past industrial exposures studied from an epidemiological perspective; however, we have used an ethnographic approach to identify the contextual factors that influence workplace exposures over time. Methods: We employed qualitative methodology to explore the experiences of workers working in the asbestos industry from the 1940s to present, and perspectives of family members who were often victims of secondary exposure. We examined the plant conditions at the Old Keasbey and Mattison asbestos manufacturing site located in Ambler, Pennsylvania. A comprehensive document analysis of 101 relevant documents and 6 semi-structured interviews were conducted. Data were entered into NVIVO 9.0 software and analyzed employing grounded theory. Results: Findings include: Evidence that asbestos exposures, sample testing and medical surveillance evolved over time, in part as a reaction to legislation, and the ways in which plant culture hindered adoption of safety and health interventions in the workplace and altered perceptions of risk. Conclusion: Examination of temporal patterns of asbestos exposure allow for deeper understanding of the historical context at this landmark industrial workplace. This information may inform new environmental and occupational health policy and provide a gateway into factors that influence exposures in the workplace. This approach serves as a template for ways that ethnographic approaches can inform occupational health and safety.