PPRT- Aurora Le

2021-2022 PPRT Project

Evaluating Occupational Biohazards, Stress, and Readiness for Uptake of Total Worker Health Interventions in U.S. Waste Workers: University of Michigan

Research Mentor: Richard Neitzel, PhD, MS, CIH, FAIHA, Associate Professor, Department of Environmental Health Sciences, School of Public Health, University of Michigan

Principal Investigator: Aurora Le, PhD, MPH, CSP, CPH, Assistant Professor, Department of Environmental Health Sciences, School of Public Health, University of Michigan


Aurora Le, PhD, Assistant Professor

Rick Neitzel, PhD, Associate Professor

Waste workers experience occupational hazards daily. Particularly, solid and medical waste workers are exposed to bioaerosols, bloodborne pathogens, and human and animal excrements in the process of collecting, sorting, and disposing waste. In tandem, the constant chronic biological occupational exposures can result in elevated stress. Occupational stress, in turn, can result in increased injury and illness rates among workers. Significant research, both in and outside of the United States, has been conducted on waste workers regarding their chemical and ergonomic occupational exposures. However, information about the biological exposures of U.S. waste workers and their associated workplace stress is limited despite comparable risks to biohazards as healthcare workers. Evidence suggests that Total Worker Health (TWH) approaches are efficacious in addressing both the physical and psychosocial stressors of the workplace, but to our knowledge, this has not been explored among U.S. waste workers. Consequently, the proposed pilot study aims to address the aforementioned research gaps. We propose a comprehensive assessment of a sample of U.S. solid and medical waste workers to determine occupational biohazard exposures and knowledge and training to mitigate these hazards. Additionally, perceived occupational stress and readiness for uptake of TWH interventions will be measured using existing validated assessment tools. Perceived self- reported stress will be compared to the worker’s physiological stress via collection of saliva samples to analyze cortisol levels. The proposed study will create the foundation for a long-term collaboration between the university researchers and national stakeholders in the waste industry. Furthermore, it will generate pilot data for use in future development of TWH interventions, as well as bolstered biohazard training and education to improve the health, safety, and wellbeing of this overlooked yet vulnerable population of workers in solid and medical waste.


1.      Le, A.B., Shkembi, A., Tadee, A., Sturgis, A.C., Gibbs, S.G., Neitzel, R.L. (2023). Characterization of perceived biohazard exposures, personal protective equipment, and training resources among a sample of formal US solid waste workers: A pilot study. Journal of Occupational and Environmental Hygiene. https://doi.org/10.1080/15459624.2023.2179060

2.      Shkembi, A., Le, A.B., Neitzel, R.L. (2023). Associations between poorer mental health with work-related effort, reward, and overcommitment among a sample of formal US solid waste workers during the COVID-19 pandemic. Safety and Health at Work, 14(1): 89-95. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9897872/

7.      Le, A.B. , Shkembi, A., Sturgis, A.C., Tadee, A., Gibbs, S.G., Neitzel, R.L. (2022). Effort-Reward-Imbalance among a sample of formal US solid waste workers. International Journal of Environmental Research and Public Health, 19(11): 6791. https://pubmed.ncbi.nlm.nih.gov/35682374/

2023 ERC Regional Symposium Poster Session

PPRT Director:

Adam M. Finkel, Sc. D., CIH
Clinical Professor of Environmental Health Sciences