Table of Contents
Current Asthma By Industry and Occupation
Introduction
New Hampshire is among the states with the highest adult current asthma rate. In 2023, the estimated prevalence was 11.8% (CDC, 2026). Between 2013 and 2024, estimates fluctuated from 9.1% (lower 95% confidence in 2015) to 14.6% (upper 95% confidence in 2022), with a consistently higher-than-national-average 8.7% in 2024.
Asthma is a common chronic respiratory illness characterized by airway inflammation, airflow limitation, and recurring symptoms such as wheezing, shortness of breath, chest tightness, and coughing. Asthma can substantially affect quality of life by limiting daily activities, reducing work productivity, and increasing the need for medical care. Asthma is strongly influenced by genetic and environmental factors (e.g., air pollution, tobacco smoke, etc.), as well as occupational risk factors (Toskala, 2015). McHugh et al. (2010) found clear differences in asthma rates by occupation in the U.S. working age population, highlighting that certain occupations, including miners, healthcare workers, and teachers, had disproportionately high prevalence of asthma.
This present report estimates the prevalence of asthma among workers in New Hampshire using the Behavioral Risk Factor Surveillance System (BRFSS) 2013-2024 data, and further investigates the differences in asthma burden across industry and occupation. The report provides evidence to prioritize prevention strategies across industries and occupations in New Hampshire.
Methods
BRFSS is a nationally representative health surveillance survey conducted collaboratively by the Centers for Disease Control and Prevention (CDC) and state health departments. The survey collects information on health behavior, health outcome, select disease/condition status, and healthcare utilization, through landline and cellphone interviews (Behavioral Risk Factor Surveillance System).
The New Hampshire Occupational Health Surveillance Program funds the state supplemental data collection module for industry and occupation.
The BRFSS survey defines a worker to be a person who was (at the time the survey was administered) “[e]mployed for wages”, “[s]elf-employed”, or “[o]ut of work for less than 1 year”. These respondents were then asked:
- Industry: “What kind of business or industry do you work in, for example, a hospital, elementary school, clothing manufacturing, or restaurant?”
- Occupation: “What kind of work do you do, for example, registered nurse, janitor, cashier, auto mechanic?”
The industry and occupation information were coded by the New Hampshire Department of Health and Human Services (New Hampshire Department of Health and Human Services). The industry and occupation codes were cross-walked to NAICS 2022 and SOC 2018, the most recent versions of the standardized industry and occupation classifications, for consistency and comparison across years.
Comparison of the number and percentages of workers aged 16 and over in industry and occupation between New Hampshire and the U.S. was sourced from the American Community Survey (5-year, 2020-2024) (S2403: Industry by Sex for the - Census Bureau Table).
Comparatively, the American Community Survey, the data source for Tables 1 and 2 in the present report, defines a worker to be a person who in the last week “work[ed] for pay at a job (or business)”, and industry and occupation as:
- Industry: “What kind of business or industry was this?” - referring to the respondents “business, agency, or branch of the Armed Forces.”
- Occupation: “What was this person’s main occupation?”
This present report used BRFSS data collected from 2013 to 2024. Data years have been pooled as 3-year blocks to reduce measurement uncertainty.
The BRFSS defines current asthma status as a person who “ha[s] been told they currently have asthma”.
Additionally, the Asthma Call-Back Survey (ACBS 2022 to 2024) data is incorporated into this analysis to inspect work-related asthma demographic differences. Within ACBS, current asthma status was defined by BRFSS as the respondent responding “Yes” to the question “having been told by a healthcare professional that they currently have asthma.” The three years of ACBS analyzed in this report have been pooled.
Analysis for this report was conducted using R version 4.5.1. Standard analysis methods were used to account for the stratified, nested, and weighted complex sample design of the BRFSS.
Results
Demographics
Analysis was first performed to outline the distributions of workers in industry and occupation at the national and New Hampshire geographic levels.
In New Hampshire between 2020 and 2024, there were approximately 750,000 workers aged 16 years and older. The top industries in New Hampshire were (highest number of workers) educational services, and healthcare and social assistance (24.5%), professional, scientific, and management, manufacturing (12.7%), and administrative and waste management services (12.4%), and retail trade (11.8%). This aligns with the worker distributions reported by Armenti (2020) for New Hampshire workers from 2013 to 2017.
The top occupations in New Hampshire between 2020 and 2024 were (highest number of workers) management occupations (12.8%), office and administrative support occupations (10.0%), and sales and related occupations (9.8%).
Table 1: Number of workers age 16 or older by industry in the U.S. and N.H. 2020-2024
| Industry (NAICS 2022) | U.S. Population (SE) | U.S. Percentage (SE) | N.H. Population (SE) | N.H. Percentage (SE) |
|---|---|---|---|---|
| Civilian employed population 16 years and over | 161,297,000 (101,000) | 100.0 (0.2) | 750,000 (2,000) | 100.0 (0.7) |
| Agriculture, forestry, fishing and hunting, and mining: | 2,511,000 (10,000) | 1.6 (0.1) | 5,000 (400) | 0.7 (0.1) |
| Agriculture, forestry, fishing and hunting | 1,890,000 (9,000) | 1.2 (0.1) | 5,000 (400) | 0.7 (0.1) |
| Mining, quarrying, and oil and gas extraction | 621,000 (4,000) | 0.4 (0.1) | 400 (80) | 0.1 (0.1) |
| Construction | 11,167,000 (35,000) | 6.9 (0.1) | 54,000 (1,000) | 7.2 (0.2) |
| Manufacturing | 15,940,000 (24,000) | 9.9 (0.1) | 95,000 (2,000) | 12.7 (0.3) |
| Wholesale trade | 3,508,000 (10,000) | 2.2 (0.1) | 16,000 (700) | 2.2 (0.1) |
| Retail trade | 17,457,000 (25,000) | 10.8 (0.1) | 89,000 (1,000) | 11.8 (0.3) |
| Transportation and warehousing, and utilities: | 9,569,000 (18,000) | 5.9 (0.1) | 30,000 (900) | 4.0 (0.2) |
| Transportation and warehousing | 8,165,000 (19,000) | 5.1 (0.1) | 24,000 (800) | 3.1 (0.2) |
| Utilities | 1,404,000 (8,000) | 0.9 (0.1) | 6,000 (400) | 0.8 (0.1) |
| Information | 3,001,000 (12,000) | 1.9 (0.1) | 14,000 (700) | 1.9 (0.1) |
| Finance and insurance, and real estate and rental and leasing: | 10,783,000 (25,000) | 6.7 (0.1) | 49,000 (1,000) | 6.5 (0.2) |
| Finance and insurance | 7,813,000 (23,000) | 4.8 (0.1) | 38,000 (900) | 5.0 (0.2) |
| Real estate, rental, and leasing | 2,970,000 (10,000) | 1.8 (0.1) | 11,000 (500) | 1.4 (0.1) |
| Professional, scientific, and management, and administrative and waste management services: | 20,282,000 (36,000) | 12.6 (0.1) | 93,000 (2,000) | 12.4 (0.3) |
| Professional, scientific, and technical services | 13,369,000 (44,000) | 8.3 (0.1) | 65,000 (1,000) | 8.6 (0.2) |
| Management of companies and enterprises | 189,000 (3,000) | 0.1 (0.1) | 700 (100) | 0.1 (0.1) |
| Administrative and support and waste management services | 6,725,000 (18,000) | 4.2 (0.1) | 28,000 (800) | 3.7 (0.2) |
| Educational services, and health care and social assistance: | 37,914,000 (81,000) | 23.5 (0.1) | 184,000 (2,000) | 24.5 (0.4) |
| Educational services | 15,198,000 (64,000) | 9.4 (0.1) | 74,000 (1,000) | 9.9 (0.2) |
| Health care and social assistance | 22,715,000 (28,000) | 14.1 (0.1) | 109,000 (2,000) | 14.6 (0.3) |
| Arts, entertainment, and recreation, and accommodation and food services: | 13,952,000 (32,000) | 8.7 (0.1) | 58,000 (2,000) | 7.7 (0.3) |
| Arts, entertainment, and recreation | 3,344,000 (11,000) | 2.1 (0.1) | 13,000 (600) | 1.8 (0.1) |
| Accommodation and food services | 10,609,000 (32,000) | 6.6 (0.1) | 45,000 (1,000) | 6.0 (0.2) |
| Other services, except public administration | 7,588,000 (15,000) | 4.7 (0.1) | 32,000 (900) | 4.3 (0.2) |
| Public administration | 7,624,000 (27,000) | 4.7 (0.1) | 31,000 (900) | 4.1 (0.2) |
Data Source: 2020-2024 American Community Survey (ACS) 5-Year Estimate United States Census Bureau Summary File S2403.
Table 2: Number of workers age 16 or older by occupation in the U.S. and N.H. 2020-2024
| Occupation (SOC, 2018) | U.S. Population (SE) | U.S. Percentage (SE) | N.H. Population (SE) | N.H. Percentage (SE) |
|---|---|---|---|---|
| Civilian employed population 16 years and over | 161,297,000 (101,000) | 100.0 (0.2) | 750,000 (2,000) | 100.0 (0.7) |
| Management, business, science, and arts occupations: | 68,789,000 (196,000) | 42.6 (0.2) | 342,000 (3,000) | 45.6 (0.5) |
| Management, business, and financial occupations: | 28,380,000 (62,000) | 17.6 (0.1) | 141,000 (2,000) | 18.9 (0.3) |
| Management occupations | 18,585,000 (36,000) | 11.5 (0.1) | 96,000 (1,000) | 12.8 (0.3) |
| Business and financial operations occupations | 9,795,000 (32,000) | 6.1 (0.1) | 45,000 (1,000) | 6.0 (0.2) |
| Computer, engineering, and science occupations: | 11,706,000 (54,000) | 7.3 (0.1) | 65,000 (1,000) | 8.7 (0.2) |
| Computer and mathematical occupations | 6,114,000 (30,000) | 3.8 (0.1) | 32,000 (900) | 4.3 (0.2) |
| Architecture and engineering occupations | 3,688,000 (19,000) | 2.3 (0.1) | 24,000 (800) | 3.2 (0.2) |
| Life, physical, and social science occupations | 1,903,000 (11,000) | 1.2 (0.1) | 9,000 (500) | 1.2 (0.1) |
| Education, legal, community service, arts, and media occupations: | 18,373,000 (69,000) | 11.4 (0.1) | 84,000 (1,000) | 11.2 (0.2) |
| Community and social service occupations | 2,925,000 (12,000) | 1.8 (0.1) | 14,000 (600) | 1.8 (0.1) |
| Legal occupations | 1,944,000 (9,000) | 1.2 (0.1) | 7,000 (400) | 0.9 (0.1) |
| Educational instruction, and library occupations | 10,099,000 (46,000) | 6.3 (0.1) | 49,000 (900) | 6.6 (0.2) |
| Arts, design, entertainment, sports, and media occupations | 3,407,000 (13,000) | 2.1 (0.1) | 14,000 (600) | 1.9 (0.1) |
| Healthcare practitioners and technical occupations: | 10,330,000 (25,000) | 6.4 (0.1) | 51,000 (1,000) | 6.8 (0.2) |
| Health diagnosing and treating practitioners and other technical occupations | 7,186,000 (22,000) | 4.5 (0.1) | 38,000 (1,000) | 5.0 (0.2) |
| Health technologists and technicians | 3,143,000 (8,000) | 1.9 (0.1) | 14,000 (600) | 1.8 (0.1) |
| Service occupations: | 26,342,000 (53,000) | 16.3 (0.1) | 109,000 (2,000) | 14.5 (0.3) |
| Healthcare support occupations | 5,330,000 (17,000) | 3.3 (0.1) | 21,000 (700) | 2.8 (0.1) |
| Protective service occupations: | 3,412,000 (10,000) | 2.1 (0.1) | 12,000 (600) | 1.6 (0.1) |
| Firefighting and prevention, and other protective service workers including supervisors | 1,911,000 (8,000) | 1.2 (0.1) | 7,000 (400) | 0.9 (0.1) |
| Law enforcement workers including supervisors | 1,501,000 (7,000) | 0.9 (0.1) | 5,000 (400) | 0.7 (0.1) |
| Food preparation and serving related occupations | 8,257,000 (24,000) | 5.1 (0.1) | 37,000 (1,000) | 4.9 (0.2) |
| Building and grounds cleaning and maintenance occupations | 5,387,000 (23,000) | 3.3 (0.1) | 22,000 (800) | 2.9 (0.2) |
| Personal care and service occupations | 3,956,000 (11,000) | 2.5 (0.1) | 17,000 (600) | 2.3 (0.1) |
| Sales and office occupations: | 31,710,000 (30,000) | 19.7 (0.1) | 149,000 (2,000) | 19.9 (0.3) |
| Sales and related occupations | 14,707,000 (22,000) | 9.1 (0.1) | 74,000 (1,000) | 9.8 (0.2) |
| Office and administrative support occupations | 17,003,000 (26,000) | 10.5 (0.1) | 75,000 (1,000) | 10.0 (0.2) |
| Natural resources, construction, and maintenance occupations: | 13,666,000 (38,000) | 8.5 (0.1) | 64,000 (1,000) | 8.6 (0.2) |
| Farming, fishing, and forestry occupations | 921,000 (7,000) | 0.6 (0.1) | 2,000 (200) | 0.3 (0.1) |
| Construction and extraction occupations | 7,844,000 (32,000) | 4.9 (0.1) | 38,000 (1,000) | 5.1 (0.2) |
| Installation, maintenance, and repair occupations | 4,901,000 (10,000) | 3.0 (0.1) | 24,000 (700) | 3.2 (0.1) |
| Production, transportation, and material moving occupations: | 20,791,000 (37,000) | 12.9 (0.1) | 86,000 (1,000) | 11.5 (0.2) |
| Production occupations | 8,530,000 (17,000) | 5.3 (0.1) | 44,000 (1,000) | 5.9 (0.2) |
| Transportation occupations | 6,035,000 (17,000) | 3.7 (0.1) | 21,000 (700) | 2.8 (0.1) |
| Material moving occupations | 6,225,000 (17,000) | 3.9 (0.1) | 21,000 (800) | 2.8 (0.2) |
Data Source: 2020-2024 American Community Survey (ACS) 5-Year Estimate United States Census Bureau Summary File S2401.
Current asthma prevalence by industry and occupation
Within healthcare and social assistance, current asthma prevalence has increased over the analysis time frame to 16.9%. Workers in the information industry experienced an increased current asthma prevalence to 18.1%. Professional, scientific, and technical services and other services workers saw increases to 13.2% and 14.0%, respectively.
For workers working in community and social service occupations, the current asthma prevalence has increased to 14.3%. Education, instruction, and library occupations increased to 16.4%. Healthcare support occupations increased to 23.5%.
Chart 1: Current asthma prevalence by industry
Current Asthma Prevalence by Industry. This information is found in Table 3.
Chart 1-continued: Current asthma prevalence by industry
Current Asthma By Industry. This information is found in Table 3.
Table 3: Current asthma prevalence by industry and 3-year periods
| Industry | 2013 to 2015 % (SE) | 2016 to 2018 % (SE) | 2019 to 2021 % (SE) | 2022 to 2024 % (SE) |
|---|---|---|---|---|
| Total Workers | 8.7 ( 0.4) | 11.1 ( 0.5) | 10.0 (0.4) | 11.7 ( 0.5) |
| Accommodation and Food Services | 10.5 ( 2.1) | 15.3 ( 3.0) | 14.3 (2.2) | 9.4 ( 2.3) |
| Administrative and Support and Waste Management and Remediation Services | 6.0 ( 2.2) | 6.5 ( 1.9) | 8.0 (2.8) | 9.3 ( 3.1) |
| Agriculture, Forestry, Fishing and Hunting | 1.4 ( 1.0) | 4.1 ( 1.9) | 6.2 (2.6) | 4.8 ( 2.7) |
| Arts, Entertainment, and Recreation | 11.9 ( 3.8) | 16.8 ( 5.7) | 9.0 (3.4) | 14.7 ( 5.3) |
| Construction | 3.9 ( 0.8) | 8.0 ( 1.7) | 8.3 (1.4) | 8.6 ( 1.4) |
| Educational Services | 12.0 ( 1.4) | 10.5 ( 1.3) | 12.1 (1.3) | 14.2 ( 1.5) |
| Finance and Insurance | 9.3 ( 1.7) | 8.2 ( 1.8) | 7.8 (1.6) | 11.0 ( 1.9) |
| Health Care and Social Assistance | 10.0 ( 0.9) | 13.6 ( 1.4) | 13.0 (1.1) | 16.9 ( 1.5) |
| Information | 5.4 ( 1.7) | 14.8 ( 4.5) | 6.5 (2.5) | 18.1 ( 3.8) |
| Management of Companies and Enterprises | 25.1 (20.5) | 28.0 (21.1) | 2.2 (2.5) | 0.0 ( 0.0) |
| Manufacturing | 7.9 ( 1.0) | 9.9 ( 1.4) | 8.0 (1.2) | 9.2 ( 1.3) |
| Mining, Quarrying, and Oil and Gas Extraction | 12.4 ( 9.2) | 0.0 ( 0.0) | 0.0 (0.0) | 15.8 (14.3) |
| Other Services (except Public Administration) | 7.8 ( 1.6) | 11.1 ( 2.3) | 10.3 (1.8) | 14.0 ( 2.4) |
| Professional, Scientific, and Technical Services | 7.0 ( 1.2) | 10.2 ( 1.7) | 10.4 (1.5) | 13.2 ( 1.9) |
| Public Administration | 8.7 ( 1.5) | 9.2 ( 1.7) | 9.0 (1.4) | 8.8 ( 1.5) |
| Real Estate and Rental and Leasing | 7.6 ( 2.5) | 9.0 ( 3.1) | 9.6 (2.8) | 10.7 ( 2.7) |
| Retail Trade | 7.0 ( 1.0) | 13.8 ( 1.9) | 10.3 (1.5) | 11.7 ( 1.8) |
| Transportation and Warehousing | 9.0 ( 2.3) | 9.5 ( 2.4) | 14.0 (3.0) | 9.6 ( 2.6) |
| Utilities | 13.1 ( 4.8) | 2.1 ( 1.7) | 2.7 (1.3) | 6.7 ( 3.3) |
| Wholesale Trade | 6.5 ( 2.3) | 15.9 ( 5.4) | 6.7 (2.3) | 6.9 ( 3.3) |
Data Source: 2013-2024 Behavioral Risk Factors Surveillance System (BRFSS).
Chart 2: Current asthma prevalence by occupation
Current Asthma By Occupation. This information can be found in Table 4.
Chart 2-continued: Current asthma prevalence by occupation
Current Asthma By Occupation. This information can be found in Table 4.
Table 4: Current Asthma Prevalence By Industry and 3-year periods
| Industry | 2013 to 2015 % (SE) | 2016 to 2018 % (SE) | 2019 to 2021 % (SE) | 2022 to 2024 % (SE) |
|---|---|---|---|---|
| Total Workers | 8.7 (0.4) | 11.1 (0.5) | 10.0 (0.4) | 11.7 (0.5) |
| Architecture and Engineering Occupations | 8.5 (1.7) | 8.8 (1.9) | 7.8 (1.7) | 7.1 (1.9) |
| Arts, Design, Entertainment, Sports, and Media Occupations | 6.8 (1.9) | 15.9 (4.8) | 5.4 (2.1) | 13.6 (4.3) |
| Building and Grounds Cleaning and Maintenance Occupations | 1.6 (0.6) | 10.6 (2.9) | 7.2 (1.8) | 10.1 (3.0) |
| Business and Financial Operations Occupations | 7.6 (1.7) | 8.2 (1.8) | 11.2 (1.8) | 10.3 (1.6) |
| Community and Social Service Occupations | 10.2 (2.2) | 11.2 (2.7) | 13.8 (3.1) | 14.3 (3.3) |
| Computer and Mathematical Occupations | 8.9 (2.0) | 7.0 (1.8) | 9.5 (1.8) | 9.5 (1.7) |
| Construction and Extraction Occupations | 3.9 (1.0) | 8.1 (1.9) | 8.4 (1.6) | 9.6 (1.8) |
| Educational Instruction and Library Occupations | 10.1 (1.4) | 12.6 (1.7) | 13.0 (1.7) | 16.4 (2.2) |
| Farming, Fishing, and Forestry Occupations | 0.0 (0.0) | 11.5 (7.1) | 3.0 (3.0) | 2.6 (2.7) |
| Food Preparation and Serving Related Occupations | 11.0 (2.5) | 11.6 (2.9) | 10.4 (2.3) | 9.8 (2.7) |
| Healthcare Practitioners and Technical Occupations | 10.0 (1.3) | 13.0 (1.6) | 15.3 (1.8) | 14.2 (1.8) |
| Healthcare Support Occupations | 10.4 (2.5) | 14.6 (4.1) | 12.5 (3.0) | 23.5 (4.5) |
| Installation, Maintenance, and Repair Occupations | 5.5 (1.6) | 7.3 (2.2) | 5.1 (1.8) | 9.3 (2.3) |
| Legal Occupations | 6.3 (2.3) | 7.4 (2.9) | 6.8 (2.3) | 11.4 (3.7) |
| Life, Physical, and Social Science Occupations | 4.5 (1.8) | 4.5 (2.0) | 10.0 (4.0) | 9.2 (3.0) |
| Management Occupations | 7.9 (1.2) | 7.3 (1.2) | 8.1 (1.1) | 11.7 (1.4) |
| Office and Administrative Support Occupations | 10.4 (1.3) | 14.1 (1.8) | 8.9 (1.2) | 14.9 (1.9) |
| Personal Care and Service Occupations | 9.9 (2.2) | 17.0 (4.2) | 14.4 (2.8) | 18.4 (4.6) |
| Production Occupations | 7.3 (1.6) | 10.5 (2.3) | 9.1 (1.9) | 6.9 (2.0) |
| Protective Service Occupations | 7.0 (2.8) | 7.7 (3.9) | 6.5 (1.8) | 5.1 (2.3) |
| Sales and Related Occupations | 9.3 (1.2) | 14.9 (2.1) | 10.5 (1.4) | 13.4 (2.0) |
| Transportation and Material Moving Occupations | 8.0 (1.7) | 8.9 (2.2) | 14.9 (2.9) | 9.2 (2.3) |
Data Source: 2013-2024 Behavioral Risk Factors Surveillance System (BRFSS).
Work-related Asthma
In the time frame 2022 to 2024, 13.6 % of ever-employed New Hampshire workers with current asthma have discussed their asthma with a doctor (Table 5). This is down from 21.8% in 2014 to 2016 (Armenti, 2020). In the same period, 10.1% of ever-employed New Hampshire workers had ever been told by a health professional that their asthma was work-related; again, down from 14.8% in 2014 to 2016 (Armenti, 2020).
Our analysis showed that the percentage of being diagnosed as work-related asthma in New Hampshire was nearly the same as the national level (10.1 vs. 10.6 nationally)
A significantly higher percentage of patients believed that their asthma was caused or made worse by their current job (19.9% in New Hampshire and 28.3% nationally, Table 6). However, our analysis found that New Hampshire workers were less likely to believe that their asthma is associated with their current job, as compared with the overall U.S. population. This pattern is consistent in most demographic groups by gender, age, education, and income. The two groups with an average closer to the national level are “high school or less” and "income less than $35,000”.
Table 5 Work-Related Asthma Among New Hampshire Adults with Current Asthma, Ever Employed Outside Home, 2022-2024
| Measure | U.S. Percentage (SE) | N.H. Percentage (SE) |
|---|---|---|
| Ever discussed work and asthma with doctor | 14.5 (0.4) | 13.6 (1.2) |
| Have ever been told by a doctor or other health professional that their asthma was work-related (diagnosed with work-related asthma) | 10.6 (0.3) | 10.1 (1.1) |
Data Source: 2022-2024 Behavioral Risk Factors Surveillance System (BRFSS).
Table 6 New Hampshire Adults with Current Asthma, Who Were Currently Employed And Who Reported They Believe Their Asthma Is Caused Or Made Worse By Their Current Job 2022-2024
| Characteristic | U.S. Percentage (SE) | N.H. Percentage (SE) |
|---|---|---|
| Total | 28.3 (0.8) | 19.9 (2.4) |
| Female | 28.1 (1.0) | 19.5 (3.0) |
| Male | 28.8 (1.4) | 20.5 (4.0) |
| 18 to 44 | 28.8 (1.1) | 20.4 (3.9) |
| 45 to 64 | 28.6 (1.4) | 20.4 (3.0) |
| 65+ | 24.0 (2.5) | 15.0 (4.2) |
| College graduate or more | 22.6 (1.2) | 12.3 (2.2) |
| High School or less | 35.3 (1.8) | 31.0 (6.2) |
| Technical school or some college | 30.2 (1.4) | 23.5 (5.3) |
| $100,000 or more | 21.3 (1.4) | 12.7 (3.0) |
| $35,0000 to less than $100,000 | 30.1 (1.2) | 22.1 (4.3) |
| Less than $35,000 | 38.8 (2.4) | 35.0 (8.3) |
Data Source: 2022-2024 Behavioral Risk Factors Surveillance System (BRFSS).
Limitations
All data is based on self-reported survey responses, including asthma condition status (not health record documentation). While much work has been undertaken to ensure industry and occupation are collected and evaluated as factors impacting worker health, standard coding is difficult, given the great variability in workplace and work-type, which brings a degree of uncertainty in the internal validity of industry and occupation reported within the surveys. This isn’t to say that it’s not valuable to measure, but the specifics of work task and exposure are often lost when being summarized within the context of survey collection (even before analysis). This, along with sampling difficulties related to low prevalence conditions, make measuring and evaluating WRA inherently uncertain. Furthermore, by aggregating these categories during analysis we may be both oversimplifying the groups and obscuring specific pockets of increased asthma prevalence. This work acknowledges that both the factors impacting asthma prevalence and asthma condition status itself may be impacted by underreporting and recall bias.
Discussion
This analysis shows that recent asthma prevalence for workers in New Hampshire is estimated to be around 11.7% in 2022-2024, and of that 19.9% was reported to believe their asthma was work related. Putting together, it reveals an approximate 3% of the working population believed that their asthma is a result of, or has been made worse by their current job. The study also provides data on asthma prevalence by industry and occupation, highlighting potential high-risk industry and occupational sectors, such as healthcare and social assistance, information industry, professional, scientific, and technical services and other services workers, workers working in community and social service occupations, education instruction and library occupations, etc.
Industry and occupation are important to worker health surveillance because they allow for identifying where work increases hazard exposure, thereby increasing potential for disease, which ultimately provides a spotlight for discovering and remediating health disparities. Consistent with existing literature, the report highlights first that work (where it happens and what is being done by the worker) matters, evidencing that asthma is not independent of work. Further, our findings confirmed the association between asthma and the nature of work, including industry and occupation, although making a causal link requires further investigation.
This report investigated the prevalence rate of asthma among workers in New Hampshire despite the fact that in 2024, New Hampshire air quality was fourth best in the United States (Air Quality, 2026) and smoking rates were middling at 15.7% (19th lowest) (Smoking Rates, 2026). This, therefore, leaves occupational exposures as one of the major explanatory contributions to the increased adult asthma prevalence.
Workplace Exposures
Industry and occupation may create different exposure profiles influencing asthma onset, including varied workplace environments and workloads. Job tasks may involve exposure to fumes, vapors, smoke, disinfectants, sensitizers, or irritants that can affect the airways over time. Workers in certain industries or occupations may spend time in buildings with poor ventilation, dampness, mold, dust, pests, cleaning chemicals, renovation materials, or other indoor air contaminants.
Working in older buildings is a contributing factor to asthma particular to New Hampshire workers and residents. New Hampshire’s buildings are: (a) located in cold climate (Yu, 2011); (b) may be prone to higher endotoxin concentrations and mold/mildew exposure rates from older buildings (Yu, 2011; Gasana, 2021); (c) may have higher humidity and poor ventilation (common to older buildings) allowing for dust mite propagation (Yu, 2011); and may utilize less combustion-efficient heating systems like wood stoves and oil heat, which can contribute to poor air-quality (Barrett, 2017).
Below, we describe factors that exist in several potential high-risk industries and occupational sectors that could be contributing to elevated asthma rates.
Healthcare and Social Assistance Sector: Workers providing healthcare and healthcare support personnel are exposed to disinfectants, sterilizing agents, latex, cleaning chemicals, and other irritants. Common asthma irritants in healthcare settings include glutaraldehyde, formaldehyde, acrylates in adhesives, and biological enzymes (New Jersey DHEOHSP, 2006; Dumas et al., 2017).
Educational Services: Teachers, school support staff, and childcare workers are exposed to classroom dust, mold from aging school buildings (particularly relevant given New Hampshire’s older building stock), chalk/dry erase markers, cleaning products, and poor ventilation systems. New Hampshire’s average commercial building age of 61 years in 2023 compounds these risks through accumulated moisture, mold, and dust mite proliferation in school infrastructure (Demand Side, 2024).
Accommodation and Food Services: Restaurant and hotel workers can be exposed to respiratory irritants like common food-related dust, like flour and cereal dust, cleaning chemicals, which can then be made worse by inadequate ventilation in kitchens. These workers may also experience exposure to smoke and combustion byproducts (Juntarawijit, 2017; Lin, 2021; Viegas, 2020).
Manufacturing Sector: Specific manufacturing subsectors may expose workers to metal dust, chemical vapors, cutting oils, welding fumes, and cleaning agents. (Jajosky, 1999).
General Environmental Factors in New Hampshire: Beyond occupation and industry-specific exposures, New Hampshire workers face particular environmental risk factors. The state’s cold climate and older building stock create conditions favorable for mold and mildew growth, particularly when buildings lack adequate ventilation or have unresolved moisture problems.
Prevention
Prevention of work-related asthma starts with first eliminating exposure to aerosolized and volatile irritants in the workplace. If the source irritant cannot be eliminated (due to it’s necessity in producing the good or service), substitution of this irritant with less harmful alternatives should be evaluated for use. With the elimination and substitution of source irritants, engineering controls also need to be put into place. Engineering controls include ensuring air turnover rates are adequate to purpose in the workspaces provided with HVAC and local exhaust ventilation (LEV) systems, as needed; tasks involving irritants are enclosed; wet methods are employed for non-hydrophobic powders; and automation is leveraged to physically isolate the irritant from workers. Adequate administrative controls also need to be in place, including establishing and communicating workplace policies that support worker safety; ensuring that worker schedules are designed to minimize exposure; and training is well communicated to ensure workers are not just aware of the risks but that prevention of certain exposures is possible. Finally, as the last line of defense, PPE must not be just available, not just used, but used correctly and consistently. Breathing protection like NIOSH-approved N95 industrial respirators (colloquially face masks) must not just be available when needed, but utilized and utilized correctly.
OSHA released several Standards regulating hazardous airborne chemicals and respiratory protection, including the Hazard Communication Standard, the Respiratory Protection Standard (29 CR 1910.134). Employers should refer to OSHA guides to identify, monitor, and control workplace respiratory hazards.
Failing prevention, the incidence of WRA must be documented with a healthcare professional.
Recommendations
The National Institute for Occupational Safety and Health (NIOSH) provides guides for preventing work-related asthma for both employers and employees (NIOSH, 2024). Employees should pay attention to their work environment, identify and avoid exposures to asthma triggers. On the other hand, employers have obligations to inform employees if they work with harmful chemicals and to provide adequate safety training.
Employees need to report immediately if PPE or engineering controls malfunction to the supervisor or designated person. When not feeling well, report to a doctor and the designated person at the workplace. If the employee has asthma, take medications as prescribed and regularly see the doctor/occupational physician. Employers should implement medical evaluation to identify general medical conditions that place employees at risk of serious medical consequences. Employers are also obligated to provide reasonable accommodations, such as job restructuring and reassignment, to eliminate exposures for workers susceptible to asthma triggers.
The NIOSH also recommends that employees participate in a medical surveillance plan when their employers provide it. Medical surveillance plans can help identify workers with asthma at earlier stages of disease. This can eliminate workers from exposure and prevent disease progression. Surveillance can be as simple as periodically completing a questionnaire. Plans also include periodic screening of workers for symptoms of asthma and medical follow-ups.
References
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