Solvent neurotoxicity in vehicle collision repair workers : a thesis by publications presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Public Health, Massey University, Wellington, New Zealand
Previous studies have shown that vehicle collision repair workers may be at risk of solvent-induced symptoms of neurotoxicity. Changes in industry practices have likely resulted in reduced exposure, but little research has been conducted to assess whether this has reduced the risk of neurotoxicity. This thesis describes a series of studies, which aimed to assess: i) contemporary airborne solvent exposures in collision repair workers; ii) the determinants of airborne solvent exposures; iii) the prevalence of self-reported symptoms of neurotoxicity and objectively measured neuropsychological performance, compared to an unexposed reference group; iv) dose-response associations; and v) the effect of personal protective equipment (PPE) and good workplace hygiene on symptom prevalence.
In total, 370 vehicle collision repair and 211 construction workers (reference group) were recruited. Personal airborne solvent exposure was assessed in 85 collision repair workers, and information on demographics, work practices and symptoms was collected by questionnaire. A sub-group of 47 collision repair and 51 reference workers also completed a battery of neuropsychological tests.
Full-shift, airborne exposures were well below New Zealand and international occupational exposure limits (range, 0.04 – 16.5 ppm). Job title was the strongest predictor of exposure, and non-spraying tasks (e.g. mixing paint and cleaning equipment) were associated with higher exposures than spray painting itself.
Collision repair workers reported significantly more symptoms of neurotoxicity than the reference group, with odds ratios (ORs) of 2.0, 95% CI 1.3-3.3; 2.4, 1.2-4.8; and 6.4, 1.8-23.0, for reporting ≥5, ≥10 and ≥15 symptoms, respectively. They also performed more poorly on neuropsychological tests, particularly those that measure attention/concentration and motor speed/dexterity (e.g. reference vs. collision repair group score on the RBANS total attention scale, -9.5, 95% CI, -15.9, -2.8).
Consistent use of PPE (particularly gloves) and good workplace hygiene practices were strongly protective against symptoms, with reductions in risk of up to 90% for those who most consistently wore PPE.
In conclusion, despite relatively low airborne exposure levels, collision repair workers continue to be at risk of solvent-induced neurotoxicity. These findings provide a strong evidence-base for the development and implementation of intervention programmes to reduce solvent exposures and associated morbidity in this population.
Chapter 3 was published as Keer, S., Taptiklis, P., Glass, B., McLean, D., McGlothlin, J.D., & Douwes, J. (2018). Determinants of airborne solvent exposure in the collision repair industry. Annals of Work Exposures and Health, 62(7), 871–883.
Chapter 4 was published as Keer, S., Glass, B., Prezant, B., McLean, D., Pearce, N., Harding, E., Echeverria, D., McGlothlin, J., Babbage, D.R., & Douwes, J. (2016). Solvent neurotoxicity in vehicle collision repair workers in New Zealand. NeuroToxicology, 57, 223-229. https://doi.org/10.1016/j.neuro.2016.10.005
Chapter 5 was published as Keer, S., Glass, B., McLean, D., Harding, E., Babbage, D., Leathem, J., Brinkmann, Y., Prezant, B., Pearce, N., & Douwes, J. (2017). Neuropsychological performance in solvent-exposed vehicle collision repair workers in New Zealand. PLoSONE 12(12), e0189108. https://doi.org/10.1371/journal.pone.0189108
Chapter 6 was published as Keer, S., McLean, D., Glass, B., & Douwes, J. (2018). Effects of personal protective equipment use and good workplace hygiene on symptoms of neurotoxicity in solvent-exposed vehicle spray painters. Annals of Work Exposures and Health, 62(3), 307–32.