vocational schools), and government agencies. Several of the presenters at the 2017 USE conference are making great advances in this line of research, both as investigators studying ways to improve OSH among small businesses and as intermediaries sharing their stories of success with helping small employers and their workforces. USE is the premiere small business occupational safety and health conference and provides a forum where researchers and other national and world leaders in the study of worker health convene to discuss ways to prevent workplace illnesses and injuries among small business employees. It provides a forum for critical reviews, discussions, collaborations, and education on issues of occupational exposures and their human health effects. The 2017 program was a stimulating mixture of talks, discussion sessions, posters, and mini-symposia with contributors from all over the world, with a forward-looking emphasis on addressing challenges for occupational epidemiology in the 21st century. Holding this world-renowned conference in the United States (for the first time) provided an excellent opportunity for U.S. researchers and small business stakeholders to participate with and engage in significant ways with their global peers. USE Conference History The different foci of the three previous Understanding Small Enterprises (USE) conferences reflect a progression in the study of managing safety in small and medium-sized enterprises (SMEs). The first Understanding Small Enterprises Conference (USE 2009) took place in October 2009 in Elsinore (Helsingør), Denmark. This initial conference focused on "understanding the issues (for practice)." The second conference (USE 2013