Occupational inequalities in mortality from cardiovascular disease, 2020-2021.

BACKGROUND: In recent years previous declines in cardiovascular disease (CVD) have stalled. There are occupational risk factors for CVD mortality. This study seeks to examine inequalities in CVD mortality for working-age adults in the United States by occupation. METHODS: Death certificate data for CVD deaths were obtained from the National Center for Health Statistics. Occupation data from these death certificates were coded to major occupation groups. Using information about the number of workers employed in these occupations obtained from the American Community Survey, we calculated mortality rates and rate ratios (RRs), adjusted for covariates associated with CVD mortality. RESULTS: After adjusting for age, sex, race/ethnicity, and educational attainment, workers in 11 occupations had significantly elevated RRs: food preparation and serving; construction and extraction; arts, design, entertainment, sports, and media; life, physical, and social science; farming, fishing, and forestry; legal; protective services; building and grounds cleaning and maintenance; healthcare practitioners and technical; personal care and service; and community and social services. CONCLUSIONS: Occupation appears to be a significant predictor of CVD mortality. Further research is needed to assess how occupational risk factors contribute to changing trends for CVD mortality. Interventions are needed to address workplace risk factors for CVD.

The Healthy Work Survey: A Standardized Questionnaire for the Assessment of Workplace Psychosocial Hazards and Work Organization in the United States.

OBJECTIVES: Work-related psychosocial stressors have been recognized as occupational hazards and assessed in workplaces in many countries for decades. Identifying tools to measure work-related psychosocial hazards to increase awareness in the United States about the impact on employees' health and safety is critical ( J Occup Environ Med. 2021;63:e245-e249). METHODS: We describe the development and psychometric validation of an online tool, the Healthy Work Survey, utilizing items from the National Institute for Occupational Safety and Health Quality of Work Life questionnaire. RESULTS: There are 55 items in the final core work section of the HWS. Factor analyses confirmed nine factors, and the subsequent multi-item scales had acceptable internal consistency. A user-friendly, online system and automated report compares individual's and organization's scores to distributions from a representative US working population (General Social Survey Quality of Work Life). DISCUSSION: The HWS is a reliable, valid tool for organizations and individuals to assess psychosocial work hazards.

Evaluation of workplace opioid prevention and response training for union and employer instructors and leadership.

OBJECTIVE: Opioids and the Workplace Prevention and Response (OWPR) Train-the-Trainer (TTT) and Leadership programs were piloted to improve trainees' abilities to conduct opioid awareness training and to introduce policies and programs in their workplaces. METHODS: The TTT (N = 54) and Leadership (N = 19) pilot trainees were administered voluntary pre- and post-training surveys and observed for discussion on knowledge and confidence regarding teaching and on workplace policies and workplace injury prevention related to opioids. RESULTS: Percentage agreement with correct responses for all TTT and 10 out of 14 (71.4 percent) Leadership knowledge and confidence questions increased significantly from pre- to post-test. CONCLUSION: We found some evidence that the OWPR TTT and Leadership training programs and materials were effective in improving trainee's abilities to conduct opioid awareness training and to introduce policies and programs to address opioids and the workplace.

Improving Awareness of Workplace Opioid Use and Addiction Prevention: A Train-the-Trainer Approach.

BACKGROUND: The National Institute of Environmental Health Sciences Worker Training Program developed instructor curriculum, a training tool, and materials to prepare trainees to conduct opioids workplace awareness training. Opioids and the Workplace Prevention and Response (OWPR) Train-the-Trainer (TTT) courses were held during three instructor-led online programs. METHODS: The OWPR TTT was evaluated using an online pre- and posttest among registered participants, and an assessment of discussion among trainees during the training program. RESULTS: A total of 31 pretests and 24 posttests were completed for the three TTT courses conducted. Quantitative and qualitative data complemented each other in supporting the conclusion that the training achieved intended objectives. CONCLUSION/APPLICATIONS TO PRACTICE: The evaluation illustrated that the training was effective in increasing knowledge and confidence in conducting awareness training on opioid use and addiction prevention.

Recognizing careworkers' contributions to improving the social determinants of health: A call for supporting healthy carework.

Workers engaged in reproductive labor-the caring work that maintains society and supports its growth-contribute to societal health while also enduring the harms of precarious labor and substantial work stress. How can we conceptualize the effects of reproductive labor on workers and society simultaneously? In this commentary, we analyze four types of more relational and less relational careworkers-homeless shelter workers, school food workers, home care aides, and household cleaners-during the COVID-19 pandemic. We then make a case for a new model of societal health that recognizes the contributions of careworkers and healthy carework. Our model includes multi-sectoral social policies supporting both worker health and societal health and acknowledges several dimensions of work stress for careworkers that have received insufficient attention. Ultimately, we argue that the effects of reproductive labor on workers and society must be considered jointly, a recognition that offers an urgent vision for repairing and advancing societal health.

Opioids and the Workplace Prevention and Response Train-the-Trainer and Leadership Training Mixed Methods Follow-up Evaluation.

OBJECTIVES: This study was designed to evaluate the outcomes of a national summer 2020 'Opioids and the Workplace' Prevention and Response (OWPR) Train-the-Trainer (TTT) and Leadership training tool and program at 6-month follow-up. The TTT program goal is to help instructors plan and conduct education and training on opioids and the workplace awareness. The Leadership program goal is to help trainees, who are in a position to take organizational level actions, implement policies, and programs related to opioid and substance use and injury prevention. METHODS: Trainees were from various backgrounds, such as labor unions, academic consortiums, health and safety professionals, government, and community organizations. About 6 months following each individual course date a follow-up survey was sent to each available participants' e-mail (n = 53 TTT, n = 28 Leadership) with a response rate of 47.2% for the TTT (n = 25) and 63.2% for Leadership (n = 12). Trainees were asked about individual or workplace level actions taken; any obstacles that prevented them or their coworkers from being involved in or conducting activities; if the OWPR training tool was used in their workplace for a training program; and whether the pandemic impacted their ability to address opioids in the workplace. RESULTS: Among TTT trainees, about half of follow-up survey respondents from the 2020 training reported planning and conducting training and education, reaching out to coworkers to see how they are doing, sharing factsheets and information from the opioid training with coworkers, and re-focusing on self-care. Among Leadership trainees, about two-fifths of follow-up survey respondents from the 2020 training reported sharing factsheets and information from the opioid training. Some trainees described the COVID-19 pandemic as limiting their ability to take actions in addressing opioids and the workplace. CONCLUSIONS: Evidence supports that the 'Opioids and the Workplace' Train-the-Trainer program and materials have contributed to helping trainees plan and conduct opioids awareness training at their organizations. Evidence supports that the Opioids in the Workplace Leadership program helped contribute to trainees taking workplace level actions to implement policies and programs.

Introduction to the Special Issue: Opioids and the Workplace - Risk Factors and Solutions.

The workplace has been a neglected element in the national response to the opioid crisis. This ignores that workplace safety and health and drug policies have become important factors in opioid use disorder among workers. This results from physical or emotional pain related to workplace injuries, illnesses, and stress, and through punitive workplace drug policies, failure to address stigma, and inadequate access to treatment and recovery resources. This comprehensive New Solutions special issue encompasses timely cutting-edge research, commentaries, activism, and calls for action on primary prevention in the workplace and intervention research. It also addresses the convergence of the COVID-19 and the opioid crises, high-risk occupations and industries, health inequalities, employer and union programs, peer advocacy and member assistance programs, worker training, health parity for addiction treatment and recovery services, protection of first responders and site clean-up workers, working conditions of substance use treatment workers, and calls for necessary funding.

Predicting new major depression symptoms from long working hours, psychosocial safety climate and work engagement: a population-based cohort study.

OBJECTIVES: This study sought to assess the association between long working hours, psychosocial safety climate (PSC), work engagement (WE) and new major depression symptoms emerging over the next 12 months. PSC is the work climate supporting workplace psychological health. SETTING: Australian prospective cohort population data from the states of New South Wales, Western Australia and South Australia. PARTICIPANTS: At Time 1, there were 3921 respondents in the sample. Self-employed, casual temporary, unclassified, those with working hours <35 (37% of 2850) and participants with major depression symptoms at Time 1 (6.7% of 1782) were removed. The final sample was a population-based cohort of 1084 full-time Australian employees. PRIMARY AND SECONDARY OUTCOME MEASURES: The planned and measured outcomes were new cases of major depression symptoms. RESULTS: Long working hours were not significantly related to new cases of major depression symptoms; however, when mild cases were removed, the 41-48 and ≥55 long working hour categories were positively related to major depression symptoms. Low PSC was associated with a threefold increase in risk for new major depression symptoms. PSC was not related to long working hours, and long working hours did not mediate the relationship between PSC and new cases of major depression symptoms. The inverse relationship between PSC and major depression symptoms was stronger for males than females. Additional analyses identified that WE was positively related to long working hours. Long working hours (41-48 and ≥55 hours) mediated a positive relationship between WE and major depression symptoms when mild cases of major depression were removed. CONCLUSION: The results suggest that low workplace PSC and potentially long working hours (41-48; ≥55 hours/week) increase the risk of new major depression symptoms. Furthermore, high WE may increase long working hours and subsequent major depression symptoms.

Upper extremity musculoskeletal disorders and work exposures among railroad maintenance-of-way workers.

BACKGROUND: Our objective was to examine occupational risk factors for musculoskeletal disorders of the shoulders, elbows, wrists, and hands among railroad maintenance-of-way (MOW) workers. Little systematic research on musculoskeletal disorders has been conducted in this occupational group. METHODS: In total, 3995 active members of the Brotherhood of Maintenance of Way Employes Division (BMWED) completed a standardized survey focusing on disorders caused by hand-transmitted vibration. We computed adjusted prevalence ratios (aPRs) using Poisson regression for shoulder, elbow, carpal tunnel syndrome, and vibration white finger musculoskeletal symptoms by work exposures, adjusted for age, region, race/ethnicity, smoking, potential second job, and spare time vehicle vibration exposure, and other work exposures. RESULTS: Among active male BMWED members, we found associations between >5.2 years (vs. 0.0-0.7 years) duration of full-time equivalent power tool use and shoulder pain (aPR = 2.01; 95% confidence interval [CI], 1.43-2.85), elbow pain (aPR = 2.88; 95% CI, 1.86-4.46), vibration white finger symptoms (aPR = 2.49; 95% CI, 1.06-5.85), hand/wrist pain (aPR = 2.40; 95% CI, 1.74-3.32), finger numbness or tingling (aPR = 1.86; 95% CI, 1.38-2.50) and self-reported carpal tunnel syndrome diagnosis (aPR = 2.16; 95% CI, 1.24-3.77). Associations were not consistent across outcomes for the duration of non-powered hand tool use and "repeated lifting, pushing, pulling, or bending." Positive gradients were observed for most outcomes. CONCLUSIONS: Hand-arm vibration and some other biomechanical exposures were associated with shoulder, elbow, wrist, hand, and finger symptoms. Prevention programs should address occupational risk factors for upper extremity musculoskeletal disorders among MOW workers.

Opioids and the Workplace Prevention and Response Awareness Training: Mixed Methods Follow-Up Evaluation.

The National Institute of Environmental Health Sciences Worker Training Program piloted an Opioids and the Workplace: Prevention and Response training tool and program in 2019. The pilot trainees (N = 97) were surveyed (n = 27) and interviewed (n = 6) six months posttraining, and those who downloaded the training tool from the Worker Training Program website (n = 87) were surveyed (n = 19) and interviewed (n = 1) two to six months postdownload, to evaluate the impact of the training program. Workplace policy and program-level actions were reported less frequently than individual-level actions by trainees, except for planning and conducting training and education. Barriers to taking actions included not being able to make changes on their own without supervisor support and lack of upper management support and approval. We found some evidence that the Opioids in the Workplace training program and materials contributed to helping workers introduce policies and programs related to opioids within their workplace or union.

Work Characteristics, Body Mass Index, and Risk of Obesity: The National Quality of Work Life Survey.

OBJECTIVES: To examine work characteristics in relation to body mass index (BMI) and risk of obesity. METHODS: We analyzed data from 1150 participants working 20+ h week-1 from the 2014 National NIOSH Quality of Work Life Survey, based on a representative sample of US workers. We used multiple linear regression for BMI and multiple logistic regression for obesity to estimate associations with 19 different work characteristics plus one set of occupational categories controlling for age, gender, race/ethnicity, education, marital status, job physical exertion, and television watching. RESULTS: We found significant positive linear associations between BMI and night shift (versus day shift) schedule (B = 2.28, P = 0.008) and blue-collar (versus management/professional) work (B = 1.75, P = 0.008). Night shift schedule [odds ratio (OR) = 2.19, P = 0.029], sales/office work (OR = 1.55, P = 0.040), and blue-collar work (OR = 2.63, P = 0.006) were associated with increased risk of obesity versus 'healthy weight'. No other statistically significant associations between work characteristics and BMI or obesity were observed. CONCLUSIONS: Night shift schedule and blue-collar work were related to increased BMI and obesity risk in US workers in 2014. Identifying risk factors in blue-collar work and redesigning jobs to reduce those risk factors, and reducing night shift work, could play a role in reducing the prevalence of obesity in the USA.

Expanding the Conceptualization of Support in Low-Wage Carework: The Case of Home Care Aides and Client Death.

Home care aides are a rapidly growing, non-standard workforce who face numerous health risks and stressors on the job. While research shows that aides receive limited support from their agency employers, few studies have explored the wider range of support that aides use when navigating work stress and considered the implications of these arrangements. To investigate this question, we conducted 47 in-depth interviews with 29 home care aides in New York City, focused specifically on aides' use of support after client death. Theories of work stress, the social ecological framework, and feminist theories of care informed our research. Our analysis demonstrates aides' extensive reliance on personal sources of support and explores the challenges this can create in their lives and work, and, potentially, for their communities. We also document aides' efforts to cultivate support stemming from their home-based work environments. Home care aides' work stress thus emerges as both an occupational health and a community health issue. While employers should carry responsibility for preventing and mitigating work stress, moving toward health equity for marginalized careworkers requires investing in policy-level and community-level supports to bolster employer efforts, particularly as the home care industry becomes increasingly fragmented and non-standard.