International Journal of Occupational and Environmental

Health

ISSN: 1077-3525 (Print) 2049-3967 (Online) Journal homepage: http://www.tandfonline.com/loi/yjoh20

A Program for the Reduction of Occupational

Injuries and Changes in Safety Culture among
Stevedores at Port of Havana, Cuba

Caristina Robaina, Timo J. Partanen & Ibis Ávila

To cite this article: Caristina Robaina, Timo J. Partanen & Ibis Ávila (2010) A Program for the
Reduction of Occupational Injuries and Changes in Safety Culture among Stevedores at Port of
Havana, Cuba, International Journal of Occupational and Environmental Health, 16:3, 312-319

To link to this article: http://dx.doi.org/10.1179/107735210799160156

Published online: 19 Jul 2013.

Submit your article to this journal

Article views: 6

View related articles

Full Terms & Conditions of access and use can be found at

http://www.tandfonline.com/action/journalInformation?journalCode=yjoh20

Download by: [University Library Utrecht] Date: 16 March 2016, At: 13:15
 A Program for the Reduction of Occupational
Injuries and Changes in Safety Culture among
Stevedores at Port of Havana, Cuba
CARISTINA ROBAINA, TIMO J. PARTANEN, IBIS ÁVILA
This study describes the structure, process, and impact
of a comprehensive sixteen-month safety enhancement
program among stevedores at the Port of Havana,
Cuba. Our objective was to reduce occupational injury
risk and improve safety conditions by enhancing
hazard knowledge and identification as well as improv-
ing safety behavior. The target group for the training
program consisted of 185 male stevedores in one port
terminal. A comparison group of 105 male stevedores
Downloaded by [University Library Utrecht] at 13:15 16 March 2016
was included from another terminal where the pro-
gram was not implemented. Other personnel were
included in the program. The training covered a
number of safety procedures and used various training
methods. As contrasted with the comparison group,
injury incidence decreased in the intervention group,
accompanied by significant improvements in safety
knowledge and behavior and injury hazard identifica-
tion. The practices of the program led to safety
enhancements in the port and are being considered
for adoption in other ports in Cuba. Key words: occupa-
tional health; intervention study; participatory train-
ing; safety; port workers; stevedores; Havana, Cuba.
I N T J O C C U P E N V I R O N H E A LT H 2 0 1 0 ; 1 6 : 3 1 2 – 3 1 9
INTRODUCTION
Determinants of occupational injuries include job tasks
and characteristics; safety management; work systems
design including engineering controls and other “struc-
tural” modifications; policies and organizational climate;
safety culture in a broad sense (perception, cognition,
motivation, and attitudes throughout the organization);
and operator characteristics.1–11 Some studies have
shown a link between safety culture and/or safety cli-
mate and injury incidence,5,7,9,11 while other studies have
Received from: National Institute of Workers’ Health, World
Health Organization (WHO) Collaborating Center for Occupational
Health, Havana, Cuba (CR, IA); Central American Institute for Stud-
ies on Toxic Substances (IRET), WHO Collaborating Center for
Occupational and Environmental Epidemiology and Toxicology,
National University, Heredia, Costa Rica (TJP). Send correspon-
dence to: Dr. Caristina Robaina, Oeste número 9108 entre J y K,
Miraflores Viejo, Habana, Cuba, CP 11800; email: <caristina.
robaina@infomed.sld.cu>.
Disclosures: Drs. Robaina and Ávila are members of the Scientific
Council of the National Institute of Workers’ Health, Cuba. Dr. Par-
tanen declares no conflicts of interest.
312
been less conclusive.6 Part of the uncertainty may be due
to the fact that various studies have differing concepts of
safety culture and safety climate, and that studies were
conducted in varying contexts.12–17
In Cuba, a decline has been registered in the inci-
dence of work injuries since 1987, probably due to the
adoption of preventitive measures. A decrease in
injuries has especially been seen in the industries with
highest injury risk: construction, manufacturing, agri-
culture, and transport.18–21 However, injury incidence
continued to be relatively high in these industries, and
fatalities did not decline.18–21 This latter finding may be
due to a variety of unknown circumstances, including a
possible tendency over time toward lower reporting
rates of nonfatal injuries.21
Injury incidence and fatalities among port workers
in Cuba are monitored and enumerated by the Cuban
Port Authorities. The major causes of injuries in
manual (non-container) operations (such as loading
and unloading) carried out by stevedores working in
ports include unsafe work systems design; inadequate
safety management; operational disturbances; deficient
warning systems; worker overestimation of his or her
physical capacity; underestimation of weights of loads;
lack, inadequacy, and incorrect use of manual or
mechanical accessories; inadequate surfaces; continu-
ous contact of workers with loads; irregular forms of
loads such as boxes, crates, sacks and bundles; poor
packaging at the point of origin; failure to provide or
use personal protection; improvised unsafe acts; incor-
rect lifting; handling of materials under suspended
loads; and use of damaged receptor containers.22–24
Common injuries in manual handling of loads include
cut wounds, lumbago caused by overstraining, disloca-
tions, sprains, contusions, lacerations, inflammation,
fractures, and lumbalgias.23–25
In addition to and in conjunction with technology
and general work systems design, training programs are
an important component in safety management in ports
as elsewhere. Such programs have occasionally been for-
mally shown to improve safety climate and injury rates in
industries involving manual operations.2 In particular, a
cross-sectional study in Taiwan7 showed that, among
operators at a container terminal, those who had under-
gone safety training had the best safety performance.
This study included the design, testing, and evalua-
tion of a program to evaluate and modify operant
 behaviors and build knowledge and capacity of the port
personnel, with the ultimate goal of reducing injury
incidence and severity among stevedores at the Port of
Havana, Cuba. The port is not heavily containerized,
elevating injury risk for stevedores. While the study
reported here included the managers, administrators,
supervisors, and occupational health and safety per-
sonnel as well as stevedores, we collected data only
from the stevedores themselves. We reported impacts
of this program on injury incidence among the steve-
dores and on their safety knowledge,26 safety behav-
ior,27 and injury hazard identification. An earlier arti-
cle28 described the results of the observational
component of this study. The results were thought to
be useful in future attempts at injury prevention in
other ports in Cuba and elsewhere where there are
non-containerized operations.
METHODS
Downloaded by [University Library Utrecht] at 13:15 16 March 2016
We used a controlled intervention study design with a
comparison group that was not offered the intervention.
The incidence and causes of injuries from January
1998 through December 2002 were initially assessed for
all Port of Havana stevedores, using data from the
injury surveillance system of the Port Authority.
Based on these data, researchers held discussions
with managers, administrators, occupational health
service personnel, brigade chiefs, supervisors, and
stevedores about the feasibility and establishment of a
safety training intervention in the harbor.
A facilitator group was formed, consisting of two
investigators, three union representatives, seven occu-
pational health service personnel, 12 brigade chiefs,
and three supervisors. The group prepared an inter-
vention protocol.
Two terminals at the Port of Havana were selected as
study sites based on the fact that they had the highest
injury rates at the port during 1999–2003. The termi-
nal operated by Haiphong, with 185 stevedores, was
chosen for the design and implementation of the inter-
vention program. A comparison group of 105 steve-
dores at the Juan Manuel terminal was not offered the
intervention. All stevedores were men.
The intervention began in January 2004 and lasted
16 months. There were two major target groups for the
intervention: the stevedores; and the manager/admin-
istrators and occupational safety and health personnel.
TABLE 1 Occupational Injury Trends 1998–2002, Port Authority of Havana, Total Workforce
Number of accidents
Mean annual workforce
Annual incidence rate/100 person-years
Note: An injury at work in Cuba is defined as a diagnosed and external, sudden, unexpected, unintended, and violent event
during the execution of work or arising out of it which causes damage to the health of, or loss of the life of the employee.
VOL 16/NO 3, JUL/SEP 2010 • www.ijoeh.com Occupational Injuries, Safety Culture among Stevedores in Cuba • 313
For the stevedores, the intervention components were
a training program and safety card. The training pro-
gram integrated three components:
1. A Colombian system known as “Momento Sincero”
(A Sincere Moment),29 which uses group discussions
to increase knowledge of the safety procedures that
the worker needs to know, take into account, ana-
lyze, and apply at work. Group discussion sessions
took place between workers in 12 work brigades of
20 stevedores each on the average, without an exter-
nal facilitator but with one stevedore leader. The ses-
sions lasted 10 minutes each. Each session dealt with
one of the following safety problems: identification
of health hazards in work environment; basic aspects
of injury prevention; safety behavior before, during,
and at end of work shift; prohibited activities; and
previous fatal injuries at the terminal. Each worker
attended 36 separate sessions, with a total of 84 ses-
sions held from May to July 2004, October to Decem-
ber 2004, and in February 2005.
2. Training sessions with a facilitator, based on a train-
ing manual specifically prepared for this interven-
tion,25 covered safety enhancement strategies;
manual handling of loads; injury statistics in Cuba;
technical, organizational, and human causes of
occupational injuries; basic concepts of injuries;
importance of notification and investigation; eco-
nomic losses due to injuries; common injuries asso-
ciated with manual and mechanical handling of
loads; work surfaces; and unsafe conditions and
actions. A total of 120 stevedores participated, each
attending three of 18 half-hour group sessions.
3. Videotraining sessions with discussions showed haz-
ardous situations and unsafe manual tasks, followed
by discussion about the problems shown and their
solutions. Three such sessions, each with a different
video, were conducted in August 2004, January
2005, and March 2005; each was attended by about
40 stevedores, as well and investigators and other
facilitators.
In addition to the training program, a special safety
card was prepared, printed and distributed to the steve-
dores in the intervention group. The card provided
guidelines for injury prevention in terms of work
organization, hazardous operations, equipment, and
handling. The card was explained to each stevedore in
1998 1999 2000 2001 2002 Total
71 50 35 44 39 239
2814 3018 2945 3192 3241 3042
2.5 1.7 1.2 1.4 1.2 1.6
 TABLE 2 Baseline Profile of Intervention and Comparison Groups
Intervention Comparison
(Haiphong) (Juan Manuel Díaz)
(N=185)
____________________ (N=105)
____________________
N % N %
Age, years (2004)
15–25 30 16.2 18 17.1
26–35 68 36.8 41 39.0
36–45 45 24.3 27 25.7
46–55 20 10.8 12 11.4
≥56 22 11.9 7 6.7
Education (2004)
Primary 9 4.9 6 5.7
Secondary 112 60.5 61 58.1
High school 62 33.5 37 35.2
University 2 1.1 1 1.0
Years as stevedore at Port of Havana (as of 2004)
0–5 75 40.5 41 39.0
6–10 49 26.5 29 27.6
11–25 35 18.9 21 20.0
Downloaded by [University Library Utrecht] at 13:15 16 March 2016

≥26 26 14.1 14 13.3

Injury rate/100 person-years (2000–2003) 4.8 8.6
High knowledge score (subjects with data for both 2004 and
2005 only) 45/122 36.7 20/80 25.0
High safe behavior score (subjects with data for both 2004 and
2005 only) 95/122 77.9 42/80 52.5
High hazard identification score (subjects with data for both 2004
and 2005 only) 85/122 69.7 20/80 25.0

a group meeting. Stevedores were instructed to always
keep the card with them during work hours.
Four capacity-building courses were conducted with
manager/administrators and occupational safety and
health personnel. Conducted in January, February,
March, and April 2004, these courses were 40 hours
each, and focused on on (1) prevention and control of
occupational injuries; (2) epidemiological surveillance
of data collection of injuries; (3) educational tech-
niques in injury prevention; and (4) strategies for
injury prevention.
Impact Assessment
Pre- and post-intervention injury rates were obtained
from the companies operating the terminals, and a ques-
tionnaire administered on injury hazard perception.
Longitudinal observations on safety behavior were also

TABLE 3 Injury Rates among Intervention and Comparison Groups

Group
__________________________________________
Intervention Comparison
Before intervention (2000–2003)
Injuries 44 60
Person-years (PY) 912 696
Rate/100 PY 4.8 8.6
During and after intervention (2004–2006)
Injuries 11 40
Person-years (PY) 555 306
Rate/100 PY 2.0 13.1
Pre-post comparisons
Pre-post rate difference: RD/100 PY (95%CI) –2.8([–3.1]–[–2.6]) 4.5 (4.0–4.9)
Impact indicator
RD = (RD1–RD0)/100 PY –7.3
95% CI –8.8–(–5.8)
Prevented fraction, percentage 58.8

314 • Robaina et al. www.ijoeh.com • INT J OCCUP ENVIRON HEALTH

 TABLE 4 Safety Knowledge Scale Score Distribution, behavior pre- and post-intervention. The questionnaire
Pre- and Post-Intervention was a modification of a structured Cuban questionnaire
with predetermined response choices, previously used
INTERVENTION GROUP
for construction workers.31 Three scales were con-
2005 structed for impact assessment.
Low Medium High All A safety knowledge scale was constructed from the
High — — 45 45 questionnaire responses to twelve multiple choice
Medium — 3 36 39 (binary to one-of-seven-choice) questions pertaining to
2004
Low — 15 23 38 injuries: nature, preventability, frequency, causes, pre-
All — 18 104 122
vention methods, knowledge, responsibility for preven-
tion, need for training for prevention, effectiveness of
COMPARISON GROUP protection equipment, and role of alcohol intake. Each
2005 response was coded as correct/incorrect. The number
Low Medium High All of correct answers was the scale value that was used in
High — 2 18 20 the statistical analyses both as such and categorized
Medium — 18 1 19 into high (>7), medium (5 to 7) and low (<5).
2004
Low 29 10 2 41 A safe behavior scale was constructed from the
All 29 30 21 80 responses to each of the two questions in the question-
naire pertaining to safe behavior. Each was coded as
Downloaded by [University Library Utrecht] at 13:15 16 March 2016

Note: Low: < 7 identifications; Medium: 7–10; High: > 10

conducted for stevedores in the intervention terminal
only; those results have been published elsewhere.30
Injury rates per 100 person-years (PY) were calcu-
lated for the pre-intervention period (2001 to 2003)
and intervention+post-intervention period (2004 to
2006) for both the intervention and comparison
groups. Rate differences (RD/100PY) between these
and 95% confidence interval (95%CI) over time were
calculated for the intervention and the comparison
groups. We also calculated an impact indicator, defined
as the difference between the mean change in each
group. A prevented fraction (observed/expected num-
bers of injuries) was calculated for the entire period
during and after intervention (2004 to 2006), with the
expected number being the product of the cumulative
annual incidence rate of injuries in the comparison
group and the number of PY in the intervention group.
The questionnaire on occupational injury hazard
perception was offered to all stevedores present and
available on the days of administration of the question-
naire in both the intervention and the comparison ter-
minals before intervention (January 2004). We did not
collect data on manager/administrator or occupa-
tional safety and health personnel’s knowledge and
correct/incorrect, and the number of correct answers
was calculated as the scale value that was used in the sta-
tistical analyses both as such and categorized into high
(2) and low (0 or 1).
A hazard identification scale was constructed from the
responses to each of the fourteen drawings in the ques-
tionnaire, which depicted a hazardous situation. The
number of correct identifications (possible range 0 to
14) was used in the statistical analyses both as such and
categorized into high (>10), medium (7 to 10), and low
(<7).
The original, non-categorized safety knowledge, safe
behavior, and hazard identification scores were used
also as such for calculation of mean changes in the
scale values from 2004 to 2006, and for linear regres-
sion analyses linking these changes with intervention,
work experience (years as stevedore at Port of Havana,
divided into categories of 0 to 5, 6 to 10, 11 to 25, and
>26 years) and education (primary, secondary, high
school, university). Age and work experience corre-
lated with r = 0.79; age was dropped from the regres-
sion analyses because of this collinearity while work
experience was kept as it was considered more relevant
than age for impact.
The statistical analyses were done using two versions
of the SPSS statistical software.

TABLE 5 Safety Knowledge Scale Results, Invervention vs. Comparison Group

Impact Statistics
__________________________________________________________
Intervention
_________________________ Comparison
_________________________
N % N % RD(95%CI)
Improved 74 60.7 13 16.3 41 (29.6–53.2)a
No change 48 39.3 65 81.3
Worsened — — 2 2.5
All 122 100.0 80 100.0
a
Rate difference for improved score among subjects with a low score in 2004 was 74.4 (95%CI, 63.0–85.8).

VOL 16/NO 3, JUL/SEP 2010 • www.ijoeh.com Occupational Injuries, Safety Culture among Stevedores in Cuba • 315
 TABLE 6 Safe Behavior Scale Score Distribution, The questionnaire was self-administered before the
Pre- and Post-Intervention morning shift and took approximately an hour to com-
plete, with availability rates of 89.8% in the interven-
INTERVENTION GROUP
tion group and 61.0% in the comparison group. Avail-
2005 ability was restricted by various job constraints or
Low High All absence due to illness at the time of data collection.
High 1 94 95 The respondents and nonrespondents were similar to
2004 Low 1 26 27 each other in age and work experience. Response rate
All 2 120 122 was 100% among the available stevedores at both ter-
minals. A repetition of the same questionnaire was
COMPARISON GROUP offered after the intervention (July 2005) to the steve-
2005 dores who responded the first time. At the intervention
Low High All terminal 122 (65.9%) were available and provided a
satisfactory quality of response. At the comparison ter-
High 2 40 42
2004 Low 31 7 38 minal 80 (76.2%) were available and provided a
All 33 47 80 response.
Table 2 shows the pre-intervention baseline profiles
of the intervention and comparison groups. The
groups were very similar in age, education, and years of
Downloaded by [University Library Utrecht] at 13:15 16 March 2016

The study protocol was assessed and approved by the

Scientific Committee of the Institute of Workers’ Health employment as stevedores at Port of Havana. The inter-
in Cuba as well as by the Director General and the Exec- vention group had a lower injury rate and scored
utive Council of the Port Authority of Havana. All sub- higher in the safety knowledge, safe behavio,r and
jects provided oral consent to participate in the study. hazard identification scales at baseline.

RESULTS Impact Assessment

Pre-intervention Background Data
The injury rate among the entire workforce of Port of
Havana was 2.5/100 PY in the year 1998 and decreased
during the subsequent years from 1999 to 2002 to a
level that vacillated annually between 1.2 and
1.7/100PY (Table 1). The most common activities
related to the injuries from 1998 to 2002 were various
direct operations with loads (in 57.8% of injuries) and
operating or working near equipment and working sur-
faces (in 16.2%). The most common factors associated
with injuries were work environment (inside ships,
open air, height [8.7%]), unsafe access (5.8%), cli-
matic conditions (3.5%), and mobile machinery
(2.9%). The most common types of injuries were colli-
sions (40.3%), falls (28.9%), and being caught in or
between mechanical and other objects (17.9%). Unsafe
positions (17.2%) and ways of loading, unloading, and
depositing (8.7%) were the most common worker
actions associated with the injuries.
Injury rate decreased in the intervention group from
4.8 per 100PY during pre-intervention (2000 to 2003)
to 2.0 from 2004 to 2006 (Table 3). The mean change
of –2.8 (95%CI [–3.1]–[–2.6]) was statistically signifi-
cant. The rate increased in the comparison stevedores
from 8.6 to 13.1. The mean change in the comparison
group was thus 4.5 (95%CI, 4.0–4.9).
The impact indicator, taken as the difference
between the mean changes between the groups, was
–7.3/100PY (95% CI –8.8 to –5.8). Prevented fraction
in the intervention group was calculated at 59%.
All three questionnaire scales showed clear signifi-
cant improvement in the intervention group, as con-
trasted with the comparison group, with all but one
comparison.
In the analysis with a dichotomized score, safety
knowledge improved in 60.7% of the subjects in the
intervention group and 16.3% in the comparison
group, with a rate difference of 41.4% (95%CI,
29.6–53.2%) (Table 4 and 5). For subjects with possi-

TABLE 7 Safe Behavior Scale Results, Invention vs. Comparison Group

Intervention
_________________________ Comparison
_________________________
N % N % RD(95%CI)
Improved 26 21.3 7 8.8 12.5% (3.0 – 22.0%)a
No change 95 77.9 71 88.8
Worsened 1 0.8 2 2.5
All 122 100.0 80 100.0
Note: Low: no or one correct identification; High: 2 correct identifications
a
Rate difference for improved score among subjects with a low score in 2004 was 77.9% (95% CI 58.7–92.1 %).

316 • Robaina et al. www.ijoeh.com • INT J OCCUP ENVIRON HEALTH

 TABLE 8 Hazard Identification Scale Score Distribution, intervention group and 8.8% in the comparison group,
Pre- and Post-Intervention with a rate difference of 12.5% (95%CI, 3.0–22.0%)
(Tables 6 and 7). For subjects with the possibility for
INTERVENTION GROUP
improvement (medium or low score at baseline), the
2005 rate difference was 77.9% (95%CI, 58.7–92.1%).
Low Medium High All Using the original numerical variable of safe behavior
High — — 85 85 (range 0 to 2), a significant (p = 0.003) between-group
2004 Medium — 2 24 26 difference was observed in mean change (mean change
Low — 2 9 11 0.28 in the intervention group and 0.03 in the compari-
All — 4 118 122 son group). The regression analysis of score change on
intervention, work experience, and education showed
COMPARISON GROUP again a clear effect of intervention (p = 0.004), but nei-
2005 ther work experience nor education had an effect.
Low Medium High All In the analysis with dichotomized score, hazard iden-
tification improved in 28.7% of the subjects in the inter-
High — 5 31 36
2004 Medium 2 17 5 24 vention group and 18.8% in the comparison group,
Low 10 10 — 20 with a rate difference of 9.9%, but not significantly so
All 12 32 36 80 (95%CI, –1.8–21.6%) (Tables 8 and 9). For subjects
with the possibility for improvement (medium or low
Downloaded by [University Library Utrecht] at 13:15 16 March 2016

Note: Low: < 7 identifications; Medium: 7–10; High: >10

bilities for improvement (medium or low score at base-
line), rate difference was 74.4% (95%CI, 63.0–85.8%).
Using the original numerical variable of safety knowl-
edge (range 0 to 12), a significant (p < 0.001) between-
group difference was observed in mean change (mean
change 2.3 in the intervention group and 0.16 in the
comparison group). The regression analysis of score
change on intervention, work experience and educa-
tion showed again a significant (p < 0.001) effect of
intervention, but years of work experience also had an
effect (p = 0.027). We therefore examined interaction
effects between intervention and work experience,
using intervention and the product ([intervention]

[work experience]) as independent variables. The
coefficients demonstrated such an interaction effect
(0.16; p = 0.025) in addition to the clear intervention
effect (1.93; p < 0.001). This means that the interven-
tion effect, taken as the regression-smoothed differ-
ence in mean change between intervention and com-
parison groups, was close to +2 units at experience less
than 5 years, but +2.5 units at experience over 25 years.
In the analysis with dichotomized score, the safe
behavior score improved in 21.3% of the subjects in the
score at baseline) however, the rate difference was
60.5%, and the impact was significant (95%CI,
44.8–76.2%). Using the original numerical variable of
hazard identification (range 0 to 14), a significant (p <
0.001) between-group difference was observed in mean
change (mean change 2.18 in the intervention group
and –0.13 in the comparison group). The regression
analysis of score change on intervention, work experi-
ence, and education showed again a clear effect of
intervention (p < 0.001), but neither work experience
nor education had a significant effect.
DISCUSSION
An effective occupational injury prevention framework
should include a contextually optimal mixture of job
task modification, safety management, work system
design, engineering controls, organizational and safety
climate, and operator characteristics. The key concepts
of our intervention program were safety knowledge,
safety behavior, injury hazard identification, and the
injury rate itself. We found a 59% prevented fraction in
injury incidence among stevedores in Port of Havana
during and after a 16-month training program offered
to stevedores, manager/administrators, and occupa-
tional safety and health personnel. The reduction was

TABLE 9 Hazard Identification Scale Results, Intervention vs. Comparison Group

Intervention
_________________________ Comparison
_________________________
N % N % Rate Difference (95%CI)
Improved 35 28.7 15 18.8 9.9 (–1.8–2.16)a
95% CI –1.8 … 21.6)
No change 87 71.3 58 72.5
Worsened — — 7 8.8
All 122 100.0 80 100.0
a
Rate difference for improved score among subjects with low or medium score in 2004 was 60.5 (95%CI, 44.8–76.2).

VOL 16/NO 3, JUL/SEP 2010 • www.ijoeh.com Occupational Injuries, Safety Culture among Stevedores in Cuba • 317
 accompanied by improved safety knowledge, safety
behavior, and injury hazard identification among steve-
dores, as assessed by a questionnaire in an intervention-
comparison group design. This is in line with the
results of Lu and Shang7 on container terminal opera-
tors and Nielsen et al.2 on wind turbine manufacturing
operators. The findings reported here also agree with
the observed safety behavior in our intervention group:
16 out of 18 safety behavior indicators that were
observed improved during and after the intervention.28
In contrast with the findings of Gyekye and Salminen9
in Ghana, educational level did not affect the interven-
tion effect on the questionnaire scales in our study, but
we found that long work experience enhanced the
effect on safety knowledge.
The role of management is important in injury
reduction.32 Managers and supervisors were included
in our program, but their contribution to the impact
was not formally assessed. We believe that our results
Downloaded by [University Library Utrecht] at 13:15 16 March 2016
add to much desired documentation17 of the predictive
value of safety climate on safety-related outcomes, in
this case particularly on injury risk.
As for the validity of the study, the use of the com-
parison group of stevedores of another port terminal
removed a number of doubts about the confounding
effects of diagnostic and reporting practices of injuries,
technology change, seasonality, and questionnaire rep-
etition. This included a possible general tendency in
Cuba for lower reporting of nonfatal injuries. Catego-
rization of the questionnaire scales introduced some
inaccuracy for the corresponding change variable due
to intra-category information loss. This loss was coun-
teracted by parallel calculations on the original, uncat-
egorized variables that confirmed the results. The ini-
tial baseline differences in injury incidence and
behavior/knowledge characteristics between the inter-
vention and comparison groups was unavoidable and,
given the directions of the changes in the two groups,
might have caused a slight negative bias in the results
through a regression toward the mean. The reason for
the increase of risk in the comparison group remained
without explanation, as this was not expressly studied.
The rates were provided by the Port Authority, not
assessed in the study itself.
We believe that the results of this study show real
improvement in injury rate reduction, safety knowl-
edge, safe behavior, and hazard identification. The
training program was comprehensive in terms of the
number of components included. The experiences of
the program have led to further safety enhancements
in the entire Port of Havana and are being evaluated
for adoption in other major ports in Cuba.
References
1. Lund J, Aaro LE. Accident prevention. Presentation of a model
placing emphasis on human, structural and cultural factors.
Safet Sci. 2004 Apr;42(4):271-324.
318 • Robaina et al.
2. Nielsen KJ, Rasmussen K, Glasscock D, Spangenberg S. Changes
in safety climate and accidents at two identical manufacturing
plants. Safet Sci. 2008 Mar;46(3):440-449.
3. Zohar D. Safety climate in industrial organizations: Theoretical
and applied implications. J Appl Psychol. 1980 Feb;65(1):96-
102.
4. Griffin M, Neal A. Perceptions of safety at work: A framework
for linking safety climate to safety performance, knowledge and
motivation. J Occup Health Psychol. 2000 Jul;5(3):347-358.
5. Cooper MD, Phillips RA. Exploratory analysis of the safety cli-
mate and safety behavior relationship. J Safet Res.
2004;35(5):497-512.
6. DeJoy DM, Schaffer BS, Wilson MG, Vandenberg RJ, Butts MM.
Creating safer workplaces: Assessing determinants and role of
safety climate. J Safet Res. 2004;35(1):81-90.
7. Lu CS, Shang KC. An empirical investigation of safety climate in
container terminal operators. J Safet Res. 2005;36(3):297-308.
8. Pousette A, Larsson S, Törner M. Safety climate cross-validation,
strength and prediction of safety behavior. Safet Sci. 2008
Mar;46(3):398-404.
9. Gyekye SA, Salminen S. Educational status and organizational
safety climate: Does educational attainment influence workers’
perceptions of workplace safety? Safet Sci. 2009 Jan;47(1):
20-28.
10. Choudhry RM, Fang D. Why operatives engage in unsafe work
behavior: Investigating factors on construction sites. Safet Sci.
2008 Apr;46(4):566-584.
11. Tharaldsen JE, Olsen E, Rundmo T. A longitudinal study of
safety climate on the Norwegian continental shelf. Safet Sci.
2008 Mar;46(3):427-439.
12. Williamson AM, Feyer AM, Cairns D, Biancotti D. The develop-
ment of a measure of safety climate: The role of safety percep-
tions and attitudes. Safet Sci. 1997 Feb-Apr;25(1-3):15-27.
13. Hale AR. Culture’s confusions. Safet Sci. 2000;34:1-14.
14. Gadd S, Collins AM. Safety culture: A review of literature.
Report No. HSL/2002/25. Sheffield, England: Health and
Safety Laboratory; 2002.
15. Choudhry RM, Fang D, Mohamed S. The nature of safety cul-
ture: A survey of the state-of-the-art. Safet Sci. 2007 Dec;
45(10):993-1012.
16. Guldenmund FE. The use of questionnaires in safety culture
research—an evaluation. Safet Sci. 2007 Jul;45(6):723-743.
17. Johnson SE. The predictive validity of safety climate. J Safet Res.
2007;38(5):511-521.
18. Robaina Aguirre C, Almiral P, Pérez R. Formación de recursos:
accidentes en trabajo: una visión epidemiológica. [Accidents at
work: An epidemiological view.] Havana, Cuba: Ciencias Médi-
cas. 1997:9-11.
19. Principales indicadores de protección, Cuba 1997-1998 [Princi-
pal indicators of protection, Cuba 1997–1998]. Havana, Cuba:
Oficina Nacional de Estadísticas [National Office of Statistics];
2000.
20. Principales indicadores de protección e higiene del trabajo, año
2005.[Principal indicators of protection and occupational
hygiene, year 2005]. Havana, Cuba: Oficina Nacional de Estadís-
ticas [National Office of Statistics]; 2006.
21. Robaina Aguirre C, Avila RI, Sevilla MD. Una reflexión acerca
de la notificación de los accidentes da trabajo en Cuba. [Reflec-
tion on the notification of work accidents in Cuba] [Internet].
Rev Cubana Gen Med Integr. 2008 Enero–Mar;24(1). Available
from: http://bvs.sld.cu/revistas/mgi/vol24_1_08/mgi06108.
htm.
22. Accidents and safety management. Encyclopaedia of Occupa-
tional Safety and Health. Geneva: International Labour Office.
1998:56.2-60.28.
23. Nag PK, Hsiang S. Ergonomics in manual materials handling
tasks. [Internet]. ICMR Bull. 2000 Aug;30(8):1-9. Available
from: http://icmr.nic.in/buaug00.pdf.
24. Chinchón Romo P. Riesgos típicos en la faenas portuarias [Typ-
ical harbor workshift risks]. Chile: Instituto de Salud y Trabajo.
[Zonal Viña del Mar]; 2003. Available from: http://www.tinet.
org/~amelero/textos/portuar.htm.
25. Ávila I, Robaina AC. Aproximación a los riesgos del trabajo y sus
consecuencias en la actividad marítimo portuaria. [Approach to
the occupational risks and their consequences in the marine
port activity]. Rev Cub Salud Trab. 2007;8:28-36.
www.ijoeh.com • INT J OCCUP ENVIRON HEALTH
 26. Chatigny C, Montreuil S. Apprenticeship in a work setting: The
contribution and limits of operational resources constructed by
workers. Safet Sci. 2003 Jun;41(4):377-391.
27. Williams JH, Geller ES. Behavior-based intervention for occu-
pational safety: Critical impact of social comparison feedback. J
Safety Res. 2000;31(3):135-142.
28. Robaina AC, Doos M, Avila I. Trabajo de intervención para la
prevención de accidentes del trabajo [Intervention study for
the prevention of occupational accidents]. Rev Cub Med Gen
Integr. 2001;17:592-605.
29. Modelo zero accidentes en Suratep [Accident model zero in
Suratep]. Medellin, Colombia: Administradora de Riesgos Pro-
fesionales (Occupational Risk Administration); 1997.
Downloaded by [University Library Utrecht] at 13:15 16 March 2016
VOL 16/NO 3, JUL/SEP 2010 • www.ijoeh.com Occupational Injuries, Safety Culture among Stevedores in Cuba • 319
30. Momento sincero de Suratep [Sincere moment of Suratep].
Medellín, Colombia: Administradora de Riesgos Profesionales
[Occupational Risk Administration]; 1997.
31. Robaina C, Ávila I. Las observaciones de seguridad. Su impor-
tancia en la identificación y evaluación de las conductas seguras
en la actividad marítima portuaria. [Safety observations. Their
importance in the identification and evaluation of secure behav-
iors in the marine port activity]. Rev Cub Salud Trab. 2008;9:19-
25.
32. Fernández-Muñiz B, Montes-Peón JM, Vázquez-Ordás CJ. Safety
culture: Analysis of the causal relationships between its key
dimensions. J Safet Res. 2007;38(6):627-641.