營造業之致肺癌工作環境與從業人員之防護認知之研究

Abstract

國外職業性癌症研究發現，營造業為職業性癌症數最多的產業。由衛福部統計資料，癌症死亡為勞工首要死因。歷年常見之主要勞工癌症死因為肝癌、肺癌及口腔癌，皆是營造業從業人員居高。 故本研究旨在探討營造業作業環境不良致病因子；並了解營造人員作業狀況暴露風險及健康認知；且調查營造業作業環境與肺疾之狀況，及研擬改善建議。研究方法先採用文獻探討作業環境危害因子，而後對營造產業相關之資深管理人員進行訪談，探討工地與作業情形。由兩者結果設計調查內容進行問卷調查，了解營造人員作業狀況，與個人健康認知。 由文獻探討常見營造業作業環境不良致肺病因子有：石綿、二氧化矽、多環芳香烴(包含柴油廢氣、焦油瀝青等)、二手菸等。除石綿產品受政府控制，暴露機會漸減外，其餘四項仍存在並持續暴露於作業環境中。根據問卷調查，營造人員作業時，暴露最頻繁之物質為二手菸，其次為材料粉塵，更次之為柴油引擎廢氣，而以煤焦油與瀝青為最少。健康認知方面，由計量迴歸結果，當運動頻率增加自身健康狀況認知會較佳；相對的，工作作業暴露、飲酒頻率或工作壓力反應增加時，自身健康狀況認知會較差。有關營造業作業環境與肺疾之狀況，受訪營造工地人員只有8.5%表示曾有同工作夥伴罹患肺疾，與33.3%受訪專家認為營建人員罹患肺疾的狀況較嚴重。雖無法完全歸因於工作環境導致，但也難以直接排除此可能性。而且多重有害因子之暴露會有加成或相乘作用。 受調查之從業人員普遍有戴口罩防護的認知，且過半數認為工作環境會導致肺疾。然而勞工呼吸性防護使用率不高，仍有改善空間。故對於實務，建議多實施個人防護具之教育訓練，使勞工了解工作環境肺癌致癌因子與其工作中暴露風險，並注意自身健康與安全，以增加使用意願及防護認知，而落實個人防護具之使用。此外，研究從業人員戴口罩時造成之不方便因素，並設法改善(如選擇更舒適之口罩款式)，或是使之培養使用習慣，以避免個人意願因素而減少或放棄工作防護行為。而對於戴口罩之規定與要求，公司可能需搭配足夠之防護意義使員工了解，否則無法明顯增加防護行為。除此之外，雖然工地會設立吸菸區，然而二手菸暴露仍高，尚有必要檢討如何減少工作職場之菸害暴露情形。

Foreign researches on occupational cancer found that construction industry led to the most cases of occupational cancer. According to statistics from Ministry of Health and Welfare, cancer is the leading cause of death for Taiwanese labors. And the majority are because of liver cancer, lung cancer and oral cancer, which are all high-ranking cancer deaths in the construction industry. Therefore, this study aimed to investigate the carcinogens within construction sites. Next, learn the risks of working exposure of labors and their health awareness. Then, investigate the status of operating environment and lung diseases in construction industry, and provide suggestions for improvement. Literature research method is used to investigate the hazard factors within working environment, and interview with senior management personnel is used to discuss the working situations in construction sites. Both results give some advice about designing the questionnaire in order to understand labors’ working situations and personal health awareness. From the literature review, major substances that cause lung diseases in construction industry are: asbestos, silica, polycyclic aromatic hydrocarbons (including diesel engine exhaust, coal tar and pitches etc.), and secondhand smoke. These things are still present in the working environment except asbestos products which are strictly con-trolled by the government, so exposure opportunities would decrease. According to questionnaire, the carcinogen that labors are exposed to most frequently is secondhand smoke, followed by material dust and diesel engine exhaust, and they are exposed to coal tar and pitches the least frequently. Based on the regression results, as their exercise frequency increases, their valuing the state of health would also increases. On the other hand, as their working environment exposure, drinking frequency, or work pres-sure reaction increases, their valuing of the state of health would decreases. When it comes to operating environment and lung disease in construction industry. Only 8.5% of interviewees say that at least one of their (previous) partners suffered from lung disease, and 2 out of 6 experts believe that construction workers suffered from lung disease severer than other people. Although those lung diseases could not completely be attributed to occupational causes, it is hard to rule out this possibility directly. And exposure to multiple hazardous substances would have an additive or synergistic effect. Those construction labors be interviewed showed common cognition of protection during work, and more than half of them believe that their working environment could lead to lung disease. However, there is still room for improving masks usage. For practical recommendation, more occupational training of personal protective equipment is needed in order to make the labors better understand lung cancer carcinogens in their working environment and risks of exposure to those materials. In that way they would enhance their health and safety awareness of themselves. Then, increase protection awareness and willingness. Eventually, usage of personal protective equipment would be increased. Furthermore, study on the inconvenient factors when labors wear masks at work, then try to reduce them (like choose a more comfortable mask),or make the labors get used to wear masks in order to avoid personal willingness that makes labors reduce or give up protecting themselves. Also, the company should have their employees understand the meaning behind the regulation of wearing masks, otherwise protection behaviors would not significantly increased. In addition, in spite of smoking area located at construction sites, secondhand smoke exposure is high though. It’s necessary to go over on how to reduce secondhand smoke exposure within working sites.