Graduation Year


Document Type




Degree Granting Department


Major Professor

Candace Burns


comprehension, material safety data, occupational health, occupational health nursing, readability, worker safety


More than 100 million American workers, 7 million workplaces, and 945,000 hazardous chemical products are covered under the Hazard Communication Standard (HCS), regulated by the Occupational Safety and Health Administration. There were a total of 1,183,500 recordable non-fatal illnesses and injuries in private industry workplaces in 2006 resulting in days away from work. Of these, 19,480 were due to chemicals and chemical products. In addition, there were a total of 5,703 work-related fatalities in 2006. In 191 of these, chemicals and chemical products were listed as the primary source of injury and as the secondary source of injury in 104 cases. The economic impact of both fatal and non-fatal occupational injuries amounted to $164.7 billion in 2006.

OSHA established the HCS in order to ensure that workers are informed of the hazardous chemicals with which they work, yet OSHA admits that many adults may have difficulty reading material that communicates hazards. Violations of OSHA's HCS were the third most cited violation in 2007. Since only 12 percent of the adults surveyed in the United States demonstrated Proficient health literacy, the state of affairs poses a serious problem for hazard communication, which nurses and nurse practitioners are often responsible for conveying. Health tasks that require Proficient health literacy include "drawing abstract inferences, comparing or contrasting multiple pieces of information within complex texts or documents, or applying abstract or complicated information from texts or documents".

Donabedian's Structure-Process-Outcome framework served as the conceptual basis for this study. Twelve research studies (nine journal articles and three doctoral dissertations) published between 1993 and 2003 were reviewed. None of these studies measured the participants' literacy level. The purpose of this single administration, cross-sectional study was to examine literacy levels as a hypothesized predictor of test scores of employees presenting to the Lakeside Occupational Medical Center, Downtown Clinic, for a physical examination, immunization, drug screening, or follow-up appointment. MSDS test scores served as the dependent variable and were measured by an investigator-made test consisting of seven passages, taken from seven separate MSDSs for sodium hypochlorite, each from a different manufacturer. Sodium hypochlorite is commonly utilized in numerous industries including the janitorial, pulp, paper, textile, dairy, and water-cooling industries and is known to cause work-related health effects such as asthma and irritation of the eyes and throat.

Each passage was followed by five multiple choice questions. Literacy levels were measured utilizing the Short Test of Functional Health Literacy in Adults (STOFHLA). The readability level of the written material was measured utilizing the Simplified Measure of Gobbledygook (SMOG) and the Flesch-Kincaid Grade Level (FKGL). The characteristics of age, highest grade level completed, native language, and job category were measured by a demographic sheet.

The results indicate that there was a significant positive correlation between the total STOFHLA scores and the total scores on the MSDS test. Therefore, hypothesis number 1 was supported. Findings on the readability level of the examples of the MSDSs to the participant's overall MSDS score were inconclusive. However, the format of the MSDS, specifically the number of lines/sentence and the number of words that are 3 syllables or more, may influence comprehension. Therefore, written hazard communication material should be written in short sentences and use words less than 3 syllables. This way the likelihood of the material being understood by the worker will be increased. Further research aimed at understanding exactly how reading grade level and sentence structure impacts comprehension of hazardous materials information is needed.