Lung Cancer Risk in Construction Workers in Cincinnati, Ohio: A Public Health Perspective

Abstract

Lung cancer, characterized by abnormal cell growth in the lungs, is projected to affect an estimated 226,600 people in the United States in 2025.¹ In addition to smoking, occupational hazards contribute to rising incidence rates of lung cancer in younger populations. Construction workers are particularly at risk due to frequent contact with hazardous substances, including silica, asbestos, and lead. However, preventative treatment is largely absent and inaccessible due to high costs, lack of company coverage, and other factors. To address this issue, multiple social determinants were analyzed to design an effective intervention that promotes preventive care among construction workers. Thirty-one sources were used from PubMed, Google Scholar, and JSTOR. Articles were selected based on their relevance to occupational exposure, health disparities, and intervention strategies. Stakeholder perspectives were obtained through an interview. Findings were then synthesized into an intervention with an accompanying plan of action. The results demonstrate that uninsured laborers, racial minorities, and immigrant construction workers in Cincinnati, Ohio, are among the most at risk. Key social determinants include limited access to healthcare, poor workplace regulation, socioeconomic inequality, and misguided social norms. Existing interventions were found to have limited reach and cultural relevance. Thus, targeted, evidence-based strategies are crucial for reducing exposure and improving outcomes. This report outlines a scalable approach to community health interventions with the potential to have a long-term impact in Cincinnati and other cities.

Keywords: Lung cancer; construction workers; occupational hazards; social determinants of health; immigrant workers; screenings

Introduction

Defined as the uncontrolled growth of abnormal lung cells, lung cancer is often fatal when diagnosed in later stages. Lung cancer poses a severe threat to public health in the United States, particularly among high-risk occupational groups.¹ Construction workers represent a vulnerable yet frequently overlooked population due to routine exposure to occupational carcinogens, such as asbestos, silica, and diesel exhaust. Without intervention, these exposures can lead to poor survival outcomes, reduced quality of life, and substantial financial burdens. Furthermore, many workers lack health insurance, which delays care and exacerbates economic hardship. Socially vulnerable populations, including minorities and undocumented laborers, face additional barriers such as stigma and limited healthcare access.

This report examines lung cancer among construction workers nationwide and in Cincinnati, Ohio, a city with aging infrastructure and ongoing renovation projects. Key public health determinants, including workplace safety, healthcare access, and socioeconomic disparities, were analyzed to inform a targeted, evidence-based intervention. The research addresses four main objectives: (1) identifying the occupational and systemic factors that lead to lung cancer in construction workers, (2) comparing Cincinnati trends to national trends, (3) examining barriers that hinder early detection and treatment, and (4) exploring the role of technology and local partnerships to improve outcomes.

The Importance of a Public Health Lens 

Examining lung cancer among construction workers solely from a clinical perspective frequently overlooks social and environmental factors. A public health perspective is therefore essential to address risk factors, promote prevention, provide education, facilitate early detection, and advocate for policy reform. Achieving these goals requires collaboration between healthcare providers, occupational safety organizations, policymakers, and community leaders.

The socio-ecological model (a framework that examines an issue from the individual, interpersonal, institutional, community, and policy level to create effective, holistic solutions) was applied to address multiple factors affecting lung cancer risk in construction workers. At the individual level, a lack of access to healthcare and education disadvantages workers. On the interpersonal level, peer norms may discourage use of protective equipment or make workers hesitant to voice health concerns, particularly in environments that value toughness over self-advocacy. Organizational factors, such as poorly enforced safety measures and a lack of health benefits, leave workers unsupported. Community-level conditions, including aging infrastructure and limited access to healthcare facilities, make regular health maintenance challenging. Furthermore, current legislation fails to hold systems accountable at the policy level, despite well-documented risks. Taken together, the socio-ecological model suggests that lung cancer disparities among construction workers are rooted in structural patterns that intentional, layered, and equity-focused public health efforts can address.

Methods

A literature review was conducted to understand the determinants that increase the risk of lung cancer in construction workers at the local and national levels. Sources were gathered from PubMed, Google Scholar, and other academic databases. Specifically, articles that discussed the risk factors and more profound disparities in the treatment of lung cancer among construction workers were examined. Articles that investigated other cancers, focused on non-occupational risks, or were conducted outside the scope of the paper were excluded. In total, 31 articles were incorporated in this review.

Stakeholders, representing perspectives from grassroots organizations to policy-level agencies, were contacted to gain a deeper understanding of lung cancer. Of the 24 individuals contacted, one agreed to participate in an interview. Key questions surrounded company protocols and interorganizational collaborations. The interview was transcribed and synthesized into a cohesive document.

Insights from both the literature review and stakeholder interview informed the design of a plan of action to aid construction workers. Potential intervention strategies were brainstormed and consolidated into a structured one-year plan.

National Literature Review 

Although the national survival rate has increased from 26.4% to 28% in the past 5 years, lung cancer still affects an estimated 226,600 people and contributes to 124,730 deaths in 2025 alone.¹ Individuals of higher socioeconomic standing typically have a 5-year or longer survival rate.2 Among those at risk, African American populations have the highest mortality rate, with 50.² deaths per 100,000 men and 27.8 deaths per 100,000 women annually, while non-Hispanic White populations have a lower mortality rate of 35.1 deaths per 109,126.³ People aged 65 and older are at the highest risk for lung cancer; however, lung cancer incidence has risen notably among individuals over 40.¹

Several factors have contributed to the rise of lung cancer in the United States. Current United States Preventive Services Task Force guidelines recommend screening for patients aged 50-80 with a smoking history of 20 years or more⁴, which excludes other vulnerable populations, including younger individuals. Financial barriers further limit access to the best lung cancer services.⁵ Additionally, misinformation, language barriers, and rural geography impede appropriate screening for lung cancer among vulnerable populations.² Research also indicates that up to 15% of the approximately 150,000 annual lung cancer deaths in the United States are attributable to hazardous occupational exposures.⁶ Collectively, these social and structural determinants exacerbate disparities in lung cancer risk and treatment.

Justification for Target Population

Cincinnati has a high concentration of renovation and demolition construction projects, which exposes construction workers to hazardous materials such as asbestos and silica dust, increasing their risk for developing lung cancer. Data from the Health and Retirement Study indicate that construction workers are twice as likely to die from lung cancer compared to white-collar workers.⁷ Given Cincinnati’s aging infrastructure and the large workforce involved, the city represents a critical location for targeted intervention.

Lung cancer poses a significant public health concern in Cincinnati and throughout Hamilton County. The age-adjusted lung cancer incidence rate of 63.2 cases exceeds the national average of 53.3 cases.⁸ Neighborhoods, such as Lower Price Hill and Avondale, experience disproportionately high rates of lung cancer⁹, driven by limited health insurance coverage, aging infrastructure, and racial and educational disparities. Uninsured rates in some areas can reach 18%, and low screening rates make early detection less likely.¹⁰ 60% of Hamilton County homes were built before 1970, a period when asbestos use was widespread.¹¹ Black men experience higher lung cancer mortality due to later-stage diagnoses and restricted access to treatment¹². Hispanic and undocumented workers are also disproportionately affected, as they are more likely to work for smaller contracting companies that lack benefits. Additionally, individuals with lower educational attainment are more likely to be employed in jobs with airborne exposures.¹³ As a result, specific ZIP codes within Cincinnati bear a significantly higher burden of lung cancer.

Construction workers in Cincinnati face several individual barriers to lung cancer prevention. In addition to elevated smoking rates¹⁴, construction workers in Hamilton County often lack health benefits, face unaffordable insurance costs, and receive inadequate safety training.^{10, 15} Low wages and job insecurity further prevent workers from taking time off for medical appointments. Nationally, 88% of workers struggle to meet basic needs¹⁶, contributing to poor nutrition, limited exercise, and chronic stress. These intersecting personal and systemic challenges significantly hinder workers’ ability to maintain long-term health.

Interpersonal and cultural factors also shape lung cancer risk among construction workers. Dement et al. (2020) observed that workers with abnormal lung function frequently delayed care due to stigma, even when symptoms were concerning for lung disease or cancer.¹⁷ Family members may also be unaware of the occupational hazards associated with construction work and may not encourage routine medical screenings. Following a diagnosis, families often experience distress, caregiver burnout, and financial strain.¹⁸ Peer culture within construction trades further reinforces risk behaviors. Bricklayers and roofers, for instance, showed higher lung cancer rates compared to other construction workers. Worksite norms to “skip the mask, tough it out,” or avoid protective equipment contribute to prolonged exposure to carcinogens.¹⁹ Strengthening social support networks is essential for disrupting these cycles.

Organizational barriers within Cincinnati’s construction industry further exacerbate risk. Although the Occupational Safety and Health Administration’s (OSHA) 2016 silica rule limits breathable silica dust and emphasizes engineering controls, few construction sites measure silica dust, use HEPA vacuums, or conduct inspections routinely.²⁰ IARC’s 2001 pooled analysis also confirmed a clear dose-response relationship between silica exposure and lung cancer.²¹ Despite this evidence, many small construction firms in Ohio continue to bypass engineering controls and medical surveillance. For example, a 2014 OSHA citation in Piqua, Ohio, documented workers inhaling silica dust without adequate personal protective equipment (PPE).²² These findings highlight the need for stronger enforcement and organizational commitment.

At the community level, Cincinnati offers several resources to support individuals suffering from lung cancer. TriHealth offers a free 12-week Cancer Wellness Program designed to motivate patients to exercise.²³ Participation in structured exercise programs has been shown to enhance physical resilience and psychological well-being. Additionally, the Cancer Support Community (CSC) offers free, online services that extend beyond clinical treatment plans.²⁴ CSC’s flexible and accessible programming is particularly beneficial for construction workers, who may face barriers to care.

At the policy level, Ohio has enacted regulations to ensure proper compliance with procedures to prevent lung cancer. Part F of the Ohio Administrative Code, Rule 3701-4-01, mandates that companies monitor malignant diseases, conduct epidemiologic studies, and improve work conditions.²⁵ However, gaps remain. The Ohio Asbestos Bill (Senate Bill 63) shields companies from asbestos-related lawsuits by imposing strict documentation requirements on workers.²⁶ Claimants must provide detailed evidence (e.g., worksite histories, product names, dates, and witnesses) within 60 days of filing or risk case dismissal. Repealing or revising this legislation could improve access to justice for construction workers harmed by occupational exposures.