Introduction

The Boston Public Health Commission (BPHC) is charged with protecting, promoting, and preserving the health of the residents of Boston, particularly the most vulnerable. In carrying out this mission, BPHC is guided by the framework of the 10 essential public health services

Small automotive repair and body shops are a common sight in communities of all sizes across the United States. In Boston, old neighborhoods and mixed zoning have resulted in these businesses frequently being in close proximity to houses, schools, and other sensitive sites. The majority of Boston's more than 500 auto shops are predominantly located in the city's lower-income communities of color, making this situation not just an issue of public health and safety, but also an environmental justice concern. Table 1 summarizes some key statistics for these neighborhoods.

While providing a valuable source of skilled employment, auto shops can pose potential health risks to workers and nearby residents. Common hazards to workers and people living nearby include inhalation of solvents from parts cleaning and painting operations, airborne particulate matter from body work and brakes, dermal contact with solvents and corrosive materials, fire and explosion hazards from flammable materials, injury risks from stored automotive parts, heavy-metals exposure, and water and soil contamination from improper storage or disposal of hazardous wastes. Of particular concern to the project was reducing emissions and worker exposures to solvents and particulate matter from painting, parts cleaning, and brake jobs, as these exposures have been associated with serious health effects and can be easily addressed with product replacement, process changes, and personal protective equipment. According to a study conducted by the Toxics Use Reduction Institute at the University of Massachusetts Lowell, aerosol chlorinated solvents are frequently used in auto shops for brake cleaning, and other solvents, such as toluene, xylene, and acetone, are commonly used for cleaning of paint spray guns and for "off label" uses. These practices can result in high concentrations of these chemicals being volatilized into the air of the shop, where workers and the public can be exposed (Toxics Use Reduction Institute, 2006). Various studies have indicated a link between chronic overexposure to some common solvents and nervous system effects such as decreased learning and memory ability (Morrow, Steinhauer, Condray, & Hodgson, 1997), vision problems (Sharanjeet-Kaur, Mursyid, Kamaruddin, & Ariffin, 2004), peripheral neuropathy (Centers for Disease Control and Prevention [CDC], 2001), and hearing loss (El-Shazly, 2006).

Furthermore, exposure to such solvents and isocyanates from paint spraying has been linked to respiratory problems ranging from rhinitis to occupational asthma (Randolph, Lalloo, Gouws, & Colvin, 1997; Sari-Minodier, Charpin, Signouret, Poyen, & Vervloet, 1999). Exposure to isocyanates is widespread in the auto body industry because "the repair and refinishing of cars entails the sprayed on application of isocyanate-containing coatings on almost every vehicle" (Sparer et al., 2004, p. 570) and because exposure occurs through both skin contact and inhalation in those performing the painting work and those nearby in the shop (Pronk et al., 2006).

Sanding and body work also pose a health risk to workers and their families from exposure to solvents, lead, and other metals in the sanding dust, which can be inhaled or ingested by workers and may be taken home on work clothes to expose family members (Enander et al., 2002; Enander et al., 2004).

Small shops often fall through the cracks of federal, state, and local regulations or slip unnoticed into improper practices, and individuals often open such businesses without knowledge of what must be done to safely and legally run a shop. Problems commonly found in these shops are summarized in Table 2.

Several studies have highlighted the need for worker education and shop training in alternative practices (Enander, Gute, & Missaghian, 1998; Heitbrink, Wallace, Bryant, & Ruch, 1995). Historically, however, education and outreach efforts by health centers and community groups have had limited impact in changing shop behaviors because of a lack of authority to require change, while regulatory efforts by city enforcement agencies have also met with difficulties in delivering effective health education in the context of a stressful enforcement visit/inspection. The Safe Shops Project was formed to bring the stakeholders together. The project builds on the strengths of individual partners in an effort to reduce the occupational and environmental hazards posed by auto shops without resorting to closing down any but the most egregious polluters so that a valuable source of jobs and income for Boston residents can be preserved.

Methods

Monitor, Diagnose, and Investigate Health Hazards

Guided by the first two of the 10 essential public health services--to monitor health status and identify community health problems, and to diagnose and investigate these community health hazards--BPHC's Environmental Hazards Program (EHP) conducts inspections based on resident complaints. EHP also participates in the annual Health of Boston community meetings, at which BPHC shares city health statistics with the residents of each neighborhood and hears back from community members about issues that are of concern to them. Through these activities, it became evident that pollution and health hazards from small automotive shops were both a significant health hazard in the city and also a priority concern of the community.

Pulling together records from its own inspection files, inspection and permitting records from the Boston Inspectional Services Department (ISD), and Boston Fire Department records, EHP was able to compile a master list of almost 700 auto shops. The shop locations were then mapped with GIS software so that their distribution throughout the city could be viewed. Three neighborhoods were identified for intervention--Roxbury, Dorchester, and Mattapan (Table 1).

Building Community Partnerships

EHP next mobilized existing community partnerships and built new ones to address the issues. EHP met with ISD, the Bowdoin Street Health Center, and the Massachusetts Coalition for Occupational Safety and Health (MassCOSH) to form the nucleus of the partnership. In September 2004, BPHC received a three-year capacity-building grant from CDC funding the Safe Shops Project and allowing EHP to bring on staff resources and additional community partners. The current partnership comprises EHP, ISD, MassCOSH, Nuestra Comunidad Development Corporation, Doctor Richard Bird (an occupational health physician at Upham's Corner Community Health Center), the BPHC Public Health Van, the Mayor's Health Line, and several other supporting organizations.

Despite fluctuations over the course of the project, the components of the partnership have remained essentially the same. MassCOSH has been a dedicated community partner providing worker education and outreach from the beginning while staffing problems at other partners resulted in Safe Shops seeking new health resource partners--Dr. Bird and the Health Van. The project also brought in Nuestra Comunidad Development Corporation to provide financial and business development assistance to participating shops. Nuestra Comunidad had already had success in this kind of work with a local "auto-mall," which it set up to help a handful of struggling new auto shops comply with regulations and achieve business and financial stability. The contributions of the Safe Shops partners are summarized in Figure 1.

[FIGURE 1 OMITTED]

Safe Shops Activities

To assess the extent of hazards and needs in individual shops, inspectors with ISD conduct non-enforcement environmental-assessment visits at shops throughout the target neighborhoods using a standardized survey form as part of routine inspections. These visits collect general environmental information about each shop, such as status of compliance with permits, practices with respect to waste storage and handling, degree to which proper personal protective equipment is used, housekeeping practices, chemical storage, and record-keeping status. Shops from the master list that are found to have moved or no longer exist are removed, and the list is updated.

Using the list of shops visited by ISD, outreach workers from EHP and the community partners visit shops to encourage shop owners/managers to have their shop participate in the Safe Shops Project. At shops that agree to participate, the outreach workers collect survey data on worker knowledge and practices related to occupational hazards. The worker survey and environmental assessment data are used to coordinate delivery of educational information and resources appropriate to each shop.

The owner of each surveyed shop is offered the opportunity to schedule a Safe Shops Tailgate Training for the shop. This 60- to 90-minute training takes place within the shop and is scheduled around the shop's schedule. It includes viewing of the Auto-shop Pollution Prevention video created by EHP, trainer presentations on shop safety and best work practices, review of worker right-to-know information, and an extended question-and-answer session with the workers. Trainings may be for the workers of one shop or may draw an audience of workers from several shops in close proximity to one another. These trainings are highly interactive and rely heavily on trainers answering worker questions and concerns.

Linking People to Health Services and Innovative Solutions

At the conclusion of the training session, shops are offered a number of opportunities for additional follow-up. These include additional specialized training sessions, the opportunity for the shop owner to meet with project partners to plan shop improvements and work on the financial and bookkeeping aspects of making major changes to reduce pollution and come into compliance with regulations, and the chance to host the public health van at the shop for a Health Day at which workers and neighbors can receive free health screenings and health care referrals.

The Health Van visits (hosted once each month at a different shop) play a key role in linking individuals to needed personal health services and ensuring health care for the city's most at-risk individuals. The van provides free health screenings for common health problems (HIV/AIDS, high blood pressure, cholesterol, elevated blood glucose, etc.) to the shop workers, their families, and the neighbors/customers of the shops. Because most of the shop employees are young men of color without insurance, this is often their first contact with the health care system. For this reason, the van also assists clients in enrolling in various free or reduced-cost health insurance plans and makes referrals to health centers and other resources.

Nuestra Comunidad and MassCOSH provide valuable technical assistance to businesses wishing to make capital improvements to eliminate hazardous chemicals or work practices. MassCOSH assists them in making a plan for alternative products, practices, or equipment, while Nuestra Comunidad provides assistance with business management and financial issues critical to making the business credit worthy and seeking financial resources to implement the capital improvements.

Evaluating Effectiveness

The Safe Shops Project is constantly evaluating the impact of the trainings and interventions in order to deliver better services to the shops and neighborhoods. Participating shops always receive a follow-up visit from an outreach worker and an inspection visit by ISD. During the outreach worker visit, worker survey data is collected to assess changes in knowledge, attitudes, and practices resulting from training and other interventions. These visits are also used as an opportunity to answer additional worker questions and frequently become a "refresher course" for the employees. The follow-up visit by ISD inspectors uses the same environmental assessment tool to assess any changes that have occurred as a result of the project and to remind the owners of any outstanding items that they need to address in order to be in compliance with all pertinent regulations.

In both the pre- and post-intervention visits, data are collected by means of an electronic form on a Palm PDA to reduce data entry time, ensure consistency of data by standardizing answers, and reduce data entry errors. This system speeds the progression of a shop through the project because data can be put into the project database immediately after a shop visit through "hot-syncing" of the Palm and is instantly available for analysis or use by other project staff.

Performance measures include changes in the findings of environmental inspections of shops and in responses on worker surveys, as well as reduced numbers of complaint calls from neighbors. A final measure of program success is an increase in the number of shop workers accessing health care workers, as reported by our health center partners.

Informing and Empowering the Community and Building the Public Health Workforce

In tandem with this process, Safe Shops promotes community awareness though its community partners and outreach staff. The community partners have held several public forums on the issues of auto shops and pollution in the target neighborhoods, and they attend community events and health fairs to distribute information about the project and auto shop issues in general. The goal of these efforts is to make residents aware of the health issues associated with auto shops and the resources available to them should they have concerns or complaints about shops in their area. Safe Shops also conducts mass mailings to auto shops in the city to advertise the availability of the project and raise awareness of the issues it addresses. This activity has resulted in several shops contacting project staff asking to participate--a significant accomplishment since the project is working with a population that has been very resistant to working with city agencies in the past.

Finally, Safe Shops incorporates an important element of public health workforce development and capacity building by holding frequent trainings for project staff and partners. The partners hold monthly meetings to share field observations and discuss concerns with one another. These meetings also incorporate trainings to teach outreach workers how to conduct the Tailgate Training sessions as well as overviews of specific topics and issues in shop practices, pollution prevention, occupational health, and the work of similar efforts around the country

Results

After 18 months of operation, the project has conducted 124 initial and 100 follow-up shop inspections. These numbers represent approximately 20 percent of the known auto shops in Boston because project work has cleaned outdated data from the master list of shops to reduce the number of known shops to just over 500. Of these, 119 shops have been visited by outreach workers to collect 217 initial and 53 follow-up worker surveys. The in-shop trainings have been attended by over 250 individuals from 61 shops. The project has also organized 13 monthly health days at shops, with the public health van screening over 142 people for issues ranging from blood pressure to HIV status. Of these, 31 people received referral to the Mayor's Health Line to be connected with health care resources. These activities have resulted in a marked improvement in shop conditions, worker knowledge, and practices in the shops at follow-up, as indicated in Table 3, Table 4, and the sidebar above. Pre-training, 24.2 percent of worker survey respondents stated that they knew what an MSDS was, and post-training, 75 percent stated that they knew. Pre-training, 48 percent of workers indicated that they used safety goggles in their work; post-training, 70 percent indicated proper use of safety goggles.

Since participating in Safe Shops trainings, three shops have switched from perchloroethylene (PCE)-containing brake cleaners to aqueous brake cleaners, and one has switched to aqueous parts cleaner. At one shop, the average ambient total VOC level in the garage fell from a range of 8-12 ppm (compared with an outside background level of 63 ppb) to a range of 280-310 ppb (compared with an outside background level of 86 ppb) after switching to an aqueous brake cleaner. The use of an aqueous brake cleaner has the added benefit of being a "wet cleaning method," which is preferred by the Occupational Safety and Health Administration (OSHA) for infrequent brake work. This method keeps dust down and reduces worker exposure to fine particulates and asbestos, which is sometimes still found in brake and clutch linings and presents a substantial source of potential asbestos exposure and risk of mesothelioma, lung cancer, and asbestosis (OSHA, 2006). Infrequent brake work is categorized as no more than five brake jobs per week, which is characteristic for the size of shop with which the Safe Shops Project works.

In addition, auto body shops are implementing the use of nitrile gloves, vacuum sanders, and supplied-air respirators, and are purchasing new high-volume-low-pressure (HVLP) spray guns to reduce pollution, paint and sand waste, and worker exposure to hazards. These changes made by Safe Shops participants not only reduce pollution, but also may protect workers from occupational hazards that cause asthma or respiratory sensitivity.

Discussion and Conclusion

The Safe Shops Project built capacity by developing sustainable partnerships between local government, health care centers, and nonprofit organizations to deliver environmental health services to a hard-to-reach population. The 10 essential public health services have been a critical guiding framework of the partners, and Table 5 summarizes how the project's activities and indicators of success link to each of these services.

Through consistent trainings and outreach, Safe Shops has developed trusting relationships within the auto shop community. These relationships have resulted in real changes in purchasing policies, implementation of pollution prevention strategies, and increases in regulatory compliance. The relationships are further strengthened by provision of additional public health resources such as free Health Van screening events and health care and insurance referrals. The inclusion of a financial partner to assist small businesses with economic issues provides the final piece of the puzzle in promotion of change in shops.

The preliminary results showing substantial changes in a historically difficult-to-reach population demonstrate that Safe Shops is an effective model and an efficient use of limited public health resources. The nature of the changes being made in the shops and the health outcomes being addressed are such that a long-term health benefit cannot be measured at this time, but those benefits are ensured by the fact that hazardous substances are being replaced in the workplace and that, where replacement is impossible, engineering controls (supplied air respirators for painting, vacuum capture sanders, etc.) and best work practices (proper use of personal protective equipment, etc.) are being institutionalized. This change is happening not only at individual shops, but throughout the community as a whole as word of the project spreads and shops request trainings, and as employees move from one shop to another and take what they have learned with them. The ability of the shops to network and share information is a strong contributor to the success of Safe Shops.

The development of a successful partnership with community organizations and the expansion of the public health infrastructure have been as important as the improvement in shops. Grant funding allowed for initial project development, hiring of staff, and solicitation of community partners. Now that Safe Shops has been established and proven effective, it is receiving support through the commitment of some city resources and additional grant funding. In addition, it has allowed our community partners to expand their resources and knowledge base. Although the project continues to work to reach the entire auto repair industry in Boston, plans are also being made to expand Safe Shops to address other businesses that involve similar environmental hazards, such as nail salons, floor finishing, and dry cleaning.

This approach can be replicated in other municipalities that have similar health hazards and resources. To encourage replication, the Safe Shops team is currently engaged in providing an unwritten 11th essential public health service--"share successful models with others"--by publishing these findings and compiling a tool kit of all the project materials and process notes that may help others replicate what Boston has done.

Acknowledgements: The authors would like to acknowledge the Centers for Disease Control and Prevention, which provided the initial three-year capacity-building grant that allowed the Safe Shops Project to form. Thanks also go to the Massachusetts Department of Industrial Accidents, the Toxics Use Reduction Institute at University of Massachusetts Lowell, and the U.S. Environmental Protection Agency for providing continued funding for the Safe Shops Project. We would also like to recognize our community partners in this effort: the Massachusetts Coalition for Occupational Safety and Health, Nuestra Comunidad Development Corporation, Bowdoin Street Health Center, Upham's Corner Community Health Center and Dr. Richard Bird, Joseph Smith Community Health Center, the Allston-Brighton Health Boston Coalition, and the owners and employees of the auto repair and body shops that have participated in the project.

Disclaimer: This article was supported by grant U50/CCU124328-03 from the Centers for Disease Control and Prevention. Its content is solely the responsibility of the authors and does not necessarily represent the official view of the Centers for Disease Control and Prevention.

Corresponding Author: Tiffany Skogstrom, Safe Shops Project Coordinator, Environmental Hazards Program, Boston Public Health Commission, 1010 Massachusetts Avenue, 2nd Floor, Boston, MA 02118. E-mail: tskogstrom@bphc.org.

REFERENCES

Centers for Disease Control and Prevention. (2001). N-Hexane-related peripheral neuropathy among automotive technicians--California 1999-2000. Morbidity and Mortality Weekly Report, 50(45), 1011-1013.

El-Shazly, A. (2006). Toxic solvents in car paints increase the risk of hearing loss associated with occupational exposure to moderate noise intensity. B-ENT, 2(1), 1-5.

Enander, R.T., Cohen, H.J., Gute, D.M., Brown, L.C., Desmaris, A.M., & Missaghian, R. (2004). Lead and methylene chloride exposure among automotive repair technicians. Journal of Occupational and Environmental Hygiene, 1(2), 119-125.

Enander, R.T., Gute, D.M., Cohen, H.J., Brown, L.C., Desmaris, A.M., & Missaghian, R. (2002). Chemical characterization of sanding dust and methylene chlorine usage in automotive refinishing: Implications for occupational and environmental health. AIHA Journal, 63(6), 741-749.

Enander, R.T., Gute, D.M., & Missaghian, R. (1998). Survey of risk reduction and pollution prevention practices in the Rhode Island automotive refinishing industry. American Industrial Hygiene Association Journal, 59(7), 478-489.

Heitbrink, W.A., Wallace, M.E., Bryant, C.J., & Ruch, WE. (1995). Control of paint overspray in autobody repair shops. American Industrial Hygiene Association Journal, 56(10), 1023-1032.

Morrow, L.A., Steinhauer, S.R., Condray, R., & Hodgson, M. (1997). Neuropsychological performance of journeymen painters under acute solvent exposure and exposure-free conditions. Journal of the International Neuropsychological Society, 3(3), 269-275.

Occupational Health and Safety Administration, U.S. Department of Labor. (2006). Asbestos-automotive brake and clutch repair work: Safety and health information bulletin. Washington, DC: Author. Retrieved November 13, 2006, from http://www.osha.gov/dts/shib/shib072606.html#1.

Pronk, A., Tielemans, E., Skarping, G., Bobeidijk, I., Van Hemmen, J., Heederik, D., & Preller, L. (2006). Inhalation exposure to isocyanates of car body repair shop workers and industrial spray painters. Annals of Occupational Hygiene, 50(1), 1-14.

Randolph, B.W., Lalloo, U.G., Gouws, E., & Colvin, M.S. (1997). An evaluation of the respiratory health status of automotive spray-painters exposed to paints containing hexamethylene di-isocyanates in the greater Durban area. South African Medical Journal, 87(3), 318-323.

Sari-Minodier, I., Charpin, D., Signouret, M., Poyen, D., & Vervloet, D. (1999). Prevalence of self-reported respiratory symptoms in workers exposed to isocyanates. Journal of Occupational Environmental Medicine, 41(7), 582-588.

Sharanjeet-Kaur, Mursyid, A., Kamaruddin, A., & Ariffin, A. (2004). Effect of petroleum derivatives and solvents on colour perception. Clinical and Experimental Optometry, 87(4-5), 339-343.

Sparer, J., Stowe, M.H., Bello, D., Liu, Y., Gore, R.J., Youngs, F., Cullen, M.R., Redlich, C.A., & Woskie, S.R. (2004). Isocyanate exposures in autobody shop workers: The SPRAY Study. Journal of Occupational and Environmental Hygiene, 1(9), 570-581.

Toxics Use Reduction Institute at the University of Massachusetts Lowell. (2006). Five chemicals study. Lowell, MA: Author. Retrieved November 1, 2006, from http://www.turi.org/library/turi_publications/five_chemicals_study.

Woskie, S.R., Sparer, J., Gore, R.J., Stowe, M., Bello, D., Liu, Y., Youngs, F., Redlich, C., Eisen, E., & Cullen, M. (2004). Determinants of isocyanate exposures in auto body repair and refinishing shops. Annals of Occupational Hygiene, 48(5), 393-403.

Paul A. Shoemaker, M.P.H.

Tiffany Skogstrom

Shea, John, M.S.

Leon Bethune, M.P.H.

RELATED ARTICLE: Noted Post-training Changes in Shop Work Practices

* Three shops replaced perchloroethylene-containing brake cleaners with a water-based system.

* One shop replaced a solvent-based parts washer with a water-based cleaner.

* One shop went from use of a paper dust mask to use of a supplied-air respirator while painting cars.

* One shop replaced old spray guns with new high-volume-low-pressure (HVLP) spray guns with removable cups to reduce overspray and eliminate paint waste.

TABLE 1 Demographics and Shop Distribution in Target Neighborhoods
(Bolded) and Selected Other Neighborhoods

                                           Asthma Hospitalizations per
                  Pop.      Pop. Below     1,000 Children Under 5
Neighborhood      Nonwhite  Poverty Level  (1999-2003)

Roxbury           85%#      29.2%#         14.8#
Dorchester
  North           82%#      22.9%#         13.7#
  South           67%#      17.6%#         11.4#
Mattapan          97%#      17.5%#          9.9#
Allston/Brighton  31%       23%             3.4
Charlestown       11%       17.5%           4.5
West Roxbury      17%        6.8%           3.4
Roslindale        40%       11.2%           7.5
Jamaica Plain     49%       17.3%           9.7
East Boston       50%       19.5%           4.3

                  Elevated Blood Lead Levels   Number of
Neighborhood      (10 [micro]g/dL or greater)  Auto Shops

Roxbury           2.2%#                         36#
Dorchester
  North           4.4%#                        163#
  South           3.8%#
Mattapan          2.8%#                         45#
Allston/Brighton  2.5%                          91
Charlestown       2.1%                           2
West Roxbury      1.0%                          14
Roslindale        2.1%                          32
Jamaica Plain     2.5%                          28
East Boston       2.6%                          27

Note: Demographics and Shop Distribution in Target Neighborhoods
are indicated with #.

TABLE 2 Problems Commonly Found in Automotive Repair and Body Shops

Mechanical Repair Shop Hazards       Body and Paint Shop Hazards

Required permits not present         Required permits not present
Record keeping (MSDSs, waste         Record keeping (MSDS, waste
  manifests, etc.) not sufficient    manifests, etc.) not sufficient
Work done without use of proper      Work done without use of proper
  personal protective equipment      personal protective equipment
  (dust masks for working with       (dust masks for working with
  solvents/paint, etc.)              solvents/paint, etc.)
Improper storage of flammable        Improper storage of flammable
  materials                          materials
Workers not adequately trained/      Workers not adequately trained/
  informed--no knowledge of MSDS,    informed--no knowledge of MSDSs,
  safety plan, etc.                  safety plan, etc.
Parts cleaned in uncovered solvent   Cleaning of paint guns releasing
  systems                            large amounts of solvent into the
                                     air
Improper and off-label use of spray  Spray painting outside of an
  organic solvents                   enclosed spray booth
Improper storage of auto batteries,  Heavy-metals and vapors exposures
  scrap metal, and spare parts       from body work and cutting/welding
Improper labeling, storage, and      Sanding and body work being done
  disposal of hazardous wastes       without dust capture devices or
                                     respiratory protection

TABLE 3 Preliminary Results of Safe Shops Trainings--Changes in Shop
Conditions

                                 Pre-training  Post-training  Percentage
Compliance Issue                 (N = 100)     (N = 100)      Change

Occupancy permit present         66            89              34.85%
Business certificate present     36            83             130.56%
If shop has a dumpster, ISD      56            83              48.21%
  site cleanliness permit
  present
If shop does welding, cutting,   69            88              27.54%
  or other body work, BFD
  torch permit present
Flammable liquids stored in      45            72              60.00%
  DOT- or UL-approved
  containers or cabinets
Flammable liquids containers or  39            71              82.05%
  cabinets properly labeled
Hazardous waste storage area     41            74              80.49%
  labeled and limits marked
Access to waste storage area     69            83              20.29%
  clear and free of debris
Containers in waste area         50            81              62.00%
  properly labeled
Drained waste oil, antifreeze,   59            87              47.46%
  paints, and solvents stored
  in properly labeled
  containers
Solvents and parts cleaner       47            88              87.23%
  containers labeled and closed
Used oil filters punctured,      59            74              25.42%
  drained overnight, disposed
  of properly
Batteries stored on pallets or   40            89             122.50%
  shelving and disposed of
  properly
Scrap tires stored outdoors      59            85              44.07%
  covered and disposed of
  properly
Shop and lot in clean and        78            94              20.51%
  sanitary condition
Exit signs posted over doors     65            86              32.31%

TABLE 4 Preliminary Results of Safe Shops Trainings--Changes in Worker
Knowledge

                                            Pre-training  Post-training
Survey Question                             Percentage    Percentage

Trained in regulations / best practices in  10%           70%
  2005-2006
Have and use ear plugs                      18%           43%
Have and use safety goggles                 48%           70%
Have and use dust mask                      39%           64%
Have and use respirator with particle       24%           36%
  filter
Have and use respirator with VOC cartridge  20%           34%
Have and use rubber gloves                  47%           72%
Answered yes to have been exposed to a      35%           40%
  health hazard
Identified self as having been exposed to   19%           28%
  solvents
Identified self as having been exposed to   16%           21%
  paint fumes

TABLE 5 Linking Activities of the Safe Shops Project to the 10 Essential
Public Health Services

Essential Environmental Health
Service                                Project Activities

 1. Monitor health status to identify  Development of an auto shop map
    EH problems                        Track complaints of auto shops
                                       and maintain records of
                                       inspections
                                       Solicit feedback from project
                                       partners on areas in need of
                                       attention
 2. Diagnose and investigate EH        Conduct environmental assessments
    problems and hazards in the        of shops for hazards
    community                          Send outreach workers to auto
                                       shops on a weekly basis
 3. Inform, educate, and empower       Outreach workers provide on-site
    people about EH                    trainings for auto shop workers
                                       and owners on right to know and
                                       best methods and resources for
                                       protecting themselves from
                                       occupational hazards
                                       Community outreach events,
                                       participation at health fairs,
                                       and flyers advertising health van
                                       visits
 4. Mobilize community partnerships    Three health centers, one
    to identify and solve EH problems  workers' rights organization, two
                                       economic development partners are
                                       actively involved in Safe Shops
                                       Attend health fairs, make
                                       presentations to community groups
 5. Develop policies and plans that    Support development of a
    support EH efforts                 "licensure" ordinance
                                       Assist shops in implementing less
                                       toxic chemicals or preferable
                                       work practices to reduce
                                       pollution
 6. Enforce laws and regulations that  Increase compliance with permit
    protect EH                         regulations and local, state, and
                                       federal environmental regulations
                                       through education and inspection
                                       Partnerships with Inspectional
                                       Services
 7. Link people to needed EH services  New partnership with occupational
                                       health doctor
                                       Worker education on resources for
                                       occupational health
                                       Health Van partnership to provide
                                       free health screenings and health
                                       care/insurance referral
                                       assistance
 8. Assure a competent EH workforce    Monthly partnership meetings to
                                       discuss progress
                                       In-service trainings for staff
                                       and partners
 9. Evaluate the effectiveness,        Pre- and post-intervention
    accessibility and quality of EH    evaluation of worker knowledge
    services                           and practices
                                       Pre- and post-intervention
                                       evaluation of shop environmental
                                       conditions
                                       Records of complaints to city
                                       agencies by neighbors
                                       Report-back from health center
                                       partners and Health Van/Mayor's
                                       Health Line
10. Research for new insights and      Track change in materials/
    innovative solutions to EH         chemicals/equipment purchased
    problems                           Communicate and use tools created
                                       by other municipalities or
                                       programs