Ethnic discrimination, asking for fair treatment, and poor self-rated health: a gender stratified analysis of 13,443 Korean Chinese waged workers in South Korea.

BACKGROUND: In South Korea, Korean Chinese workers experience ethnic discrimination although they share physical similarities and ethnic heritage with native-born Koreans. This study aimed to examine whether perceived ethnic discrimination is associated with poor self-rated health and whether the association differs by gender among Korean Chinese waged workers in South Korea. METHODS: We conducted a pooled cross-sectional analysis using data of 13,443 Korean Chinese waged workers from the Survey on Immigrants' Living Conditions and Labor Force conducted in 2018, 2020, and 2022. Based on perceived ethnic discrimination, asking for fair treatment, and subsequent situational improvement, respondents were classified into the following four groups: "Not experienced," "Experienced, not asked for fair treatment," "Experienced, asked for fair treatment, not improved," and "Experienced, asked for fair treatment, improved." Poor self-rated health was assessed using a single question "How is your current overall health?" We applied logistic regression to examine the association between perceived ethnic discrimination and poor self-rated health, with gender-stratified analyses. RESULTS: We found an association between ethnic discrimination and poor self-rated health among Korean Chinese waged workers. In the gender-stratified analysis, the "Experienced, not asked for fair treatment" group was more likely to report poor self-rated health compared to the "Not experienced" group, regardless of gender. However, gender differences were observed in the group stratified by situational improvements. For male workers, no statistically significant association was found in the "Experienced, asked for fair treatment, improved" group with poor self-rated health (odd ratios: 0.87, 95% confidence intervals: 0.30-2.53). Conversely, among female workers, a statistically significant association was observed (odd ratios: 2.63, 95% confidence intervals: 1.29-5.38). CONCLUSIONS: This study is the first to find an association between perceived ethnic discrimination and poor self-rated health, along with gender differences in the association between situational improvements after asking for fair treatment and poor self-rated health among Korean Chinese waged workers in South Korea.

Female workers with long working hours are more likely to have depressive symptoms when having family-to-work conflict.

PURPOSE: Workers' health can be influenced by risk factors from their family environments as well as their work environments. This paper sought to examine how the association between long working hours and depressive symptoms differs based on the level of FWC after being stratified by worker's gender. METHODS: We used the dataset of 20,384 full-time wage workers from the sixth Korean Working Conditions Survey (2020). Long working hours were defined as working 52 h or more per week. FWC was measured using a 2-item questionnaire, and depressive symptoms were measured using the WHO-5 well-being index. Applying modified Poisson regression, we evaluated how the association between long working hours and depressive symptoms differs by the level of FWC male and female workers separately. RESULTS: In the analysis of the female workers, long working hours were associated with depressive symptoms in the high FWC group (PR 1.35, 95% CI 1.17, 1.55) after adjusting for potential confounders whereas no association was observed in the low FWC group. Among the male workers, a statistically significant association was observed in both high FWC (PR 1.22, 95% CI 1.07, 1.38) and low FWC (PR 1.28, 95% CI 1.12, 1.47) groups. CONCLUSION: FWC may act as a workplace stressor that potentially amplifies the health impact of long working hours among female workers.

Racism, xenophobia, discrimination, and the determination of health.

This Series shows how racism, xenophobia, discrimination, and the structures that support them are detrimental to health. In this first Series paper, we describe the conceptual model used throughout the Series and the underlying principles and definitions. We explore concepts of epistemic injustice, biological experimentation, and misconceptions about race using a historical lens. We focus on the core structural factors of separation and hierarchical power that permeate society and result in the negative health consequences we see. We are at a crucial moment in history, as populist leaders pushing the politics of hate have become more powerful in several countries. These leaders exploit racism, xenophobia, and other forms of discrimination to divide and control populations, with immediate and long-term consequences for both individual and population health. The COVID-19 pandemic and transnational racial justice movements have brought renewed attention to persisting structural racial injustice.

Racism, xenophobia, and discrimination: mapping pathways to health outcomes.

Despite being globally pervasive, racism, xenophobia, and discrimination are not universally recognised determinants of health. We challenge widespread beliefs related to the inevitability of increased mortality and morbidity associated with particular ethnicities and minoritised groups. In refuting that racial categories have a genetic basis and acknowledging that socioeconomic factors offer incomplete explanations in understanding these health disparities, we examine the pathways by which discrimination based on caste, ethnicity, Indigeneity, migratory status, race, religion, and skin colour affect health. Discrimination based on these categories, although having many unique historical and cultural contexts, operates in the same way, with overlapping pathways and health effects. We synthesise how such discrimination affects health systems, spatial determination, and communities, and how these processes manifest at the individual level, across the life course, and intergenerationally. We explore how individuals respond to and internalise these complex mechanisms psychologically, behaviourally, and physiologically. The evidence shows that racism, xenophobia, and discrimination affect a range of health outcomes across all ages around the world, and remain embedded within the universal challenges we face, from COVID-19 to the climate emergency.

Internalized homophobia and HIV testing among Korean gay and bisexual men: a study in a high-income country with pervasive HIV/AIDS stigma.

Limited research has been conducted on factors contributing to HIV testing among sexual minority populations in South Korea (hereafter, Korea), where stigma against homosexuality and HIV/AIDS is pervasive. We used a nationwide cross-sectional survey of 907 Korean cisgender gay and bisexual (GB) men who were HIV-negative or HIV-unknown in 2016. Regarding internalized homophobia (IHP), participants were categorized into tertiles (low, moderate, and high). Past 12-month HIV testing was assessed via a single yes/no question. Using a modified Poisson regression model, we examined the association between IHP and HIV testing among cisgender GB men in Korea. The overall prevalence of obtaining an HIV test was 41.8% among Korean cisgender GB men. We also found a statistically significant association between IHP and past 12-month HIV testing in this population. Specifically, participants with low IHP had a higher prevalence of HIV testing (adjusted PR = 1.37, 95% CI = 1.14-1.65) compared to those with high IHP. Given these findings, more efforts are needed in Korea to enhance GB men's access to HIV testing, such as improving social circumstances to lower IHP of GB men and creating an environment that enables and facilitates GB men to receive HIV testing without stigma against their sexual identity.

Associations between discrimination experiences and symptoms of depression and anxiety among transgender adults: a nationwide cohort study of 269 transgender adults in South Korea.

PURPOSE: Recently, there has been an increase in awareness of social stigma and mental health issues experienced by transgender individuals in South Korea. To provide quantitative evidence, we conducted a nationwide cohort study of transgender adults, first of its kind in Asia. The aim of the study is to assess the prevalence of depressive and anxiety symptoms and examine their associations with discrimination experiences among transgender adults. METHODS: We conducted a two-wave longitudinal survey of 269 Korean transgender adults, where the baseline was collected in October 2020 and the follow-up in October 2021. Experiences of discrimination in the past 12 months at follow-up were categorized accordingly: those who experienced (1) none, (2) only anti-transgender discrimination, (3) only other types of discrimination, and (4) both anti-transgender and other types of discrimination. Depressive symptoms were measured using the Center for Epidemiologic Studies Depression scale at both waves and anxiety symptoms were measured using the Generalized Anxiety Disorder 7 only at follow-up. We used modified Poisson regression to examine the association between experiences of discrimination and mental health outcomes at follow-up and adjusted for sociodemographic characteristics and baseline depressive symptoms. RESULTS: A total of 63.9% had depressive symptoms and 47.2% had anxiety symptoms. Participants who experienced both anti-transgender and other types of discrimination had 1.38-times (95% CI 1.06-1.81) and 1.77-times (95% CI 1.16-2.70) higher prevalence of depressive and anxiety symptoms, respectively, compared to those without any experiences of discrimination. CONCLUSIONS: Interventions to lessen discrimination towards transgender individuals are needed for the promotion of mental health among transgender individuals.

Validity evaluation of indirect adjustment method for multiple unmeasured confounders: A simulation and empirical study.

BACKGROUND: An indirect adjustment method was developed to control for unmeasured confounders in a large administrative cohort study. A previous study that proposed the indirect adjustment method assessed the validity of the method by simulations but did not consider the direction of bias and scenarios with multiple missing confounders. In this study, we evaluated the direction and the magnitude of bias of the indirect adjustment method with multiple correlated unmeasured confounders using simulation and empirical datasets. METHODS: A simulation study was conducted to compare the bias of the indirect adjustment by varying the number of confounders, magnitude of correlation between confounders, and the number of adjustment variables. An empirical study was conducted by applying the indirect adjustment method to the association between PM10 and mortality using the Korea National Health and Nutrition Examination Survey linked Cause of Death data for 2007-2016. RESULTS: The simulations of the present study demonstrated that 1) when a confounder is positively associated with both exposure and outcome, indirect adjustment might bias the effect size downward; 2) the magnitude of bias might depend on the correlation between unmeasured confounders; and 3) indirect adjustment for multiple missing confounders at once could result in a higher bias than that for some of the missing confounders. Empirical analyses also showed consistent results, but the bias of indirectly adjusted effect estimates was sometimes larger than that of unadjusted effect estimates. CONCLUSIONS: The indirect adjustment method is a promising technique to reduce the bias from unmeasured confounding; however, it should be implemented carefully, particularly when there are multiple correlated unmeasured confounders of the same direction.

Role of SES on the association between childhood parental death and adulthood suicidal ideation: a mediation analysis using longitudinal dataset in South Korea.

BACKGROUND: We sought to examine the association between childhood experience of parental death (CEPD) and adulthood suicidal ideation, and the mediating role of adulthood SES in the association. METHODS: We analyzed a nationally representative dataset of 8609 adults from the Korea Welfare Panel Study, which is a longitudinal cohort dataset in South Korea. CEPD was measured using a question: "During your childhood (0-17 years old), have you experienced the death of parents?" We classified responses of CEPD during 2006-2011 into 'yes,' and the others into 'no.' Suicidal ideation over the past year was assessed annually during 2012-2019. As a potential mediator, adulthood educational attainment and household income in 2011 were included in the analysis. Logistic regression was applied to examine the association of CEPD with adulthood suicidal ideation across age groups (early adulthood, 19-39 years old; middle adulthood, 40-59 years old; late adulthood, ≥60 years old), after excluding people who reported lifetime suicidal ideation in 2011. Causal mediation analysis using a parametric regression model was applied to examine the mediating role of adulthood SES in the association between CEPD and adulthood suicidal ideation. RESULTS: After adjusting for potential confounders including childhood SES, CEPD was significantly associated with adulthood suicidal ideation among the late adulthood group (OR: 1.43; 95% CI: 1.13-1.81), while the association was not statistically significant among the early; and middle adulthood groups. In mediation analysis of adulthood household income, both indirect association (ORNIE: 1.05; 95% CI: 1.02-1.09) and direct association (ORNDE: 1.37; 95% CI: 1.09-1.73) were statistically significant among the late adulthood group. In the mediation analysis of adulthood education attainment among the late adulthood, only a direct association was statistically significant (ORNDE: 1.43; 95% CI: 1.14-1.80). CONCLUSIONS: These results suggest that CEPD could be a risk factor for adulthood suicidal ideation. Furthermore, the findings imply that income security policy might be necessary to reduce suicide among the late adulthood group.

Rejection of workers' compensation claims may increase depressive symptoms among firefighters with occupational injury: a nationwide study in South Korea.

OBJECTIVES: This study sought to examine whether the experience of occupational injuries was associated with depressive symptoms and whether the rejection of workers' compensation claims was associated with depressive symptoms among Korean firefighters. METHODS: We conducted a nationwide survey of 6793 Korean firefighters in 2015. Based on the experience of occupational injuries and workers' compensation claims over the past year, respondents were classified into four groups: "Not injured", "Injured, not applied", "Injured, applied, but rejected" and "Injured, applied, and accepted." Depressive symptoms over the preceding week were assessed using the 11-item version of the Centers for Epidemiologic Studies Depression Scale. RESULTS: Compared to firefighters who did not get injured, injured firefighters had a higher prevalence of depressive symptoms (PR 2.01, 95% CI 1.83, 2.22) after controlling for confounders including job assignment. Also, when we restricted the analysis to injured firefighters, a higher prevalence of depressive symptoms was observed among "Injured, applied, but rejected" (PR 1.70, 95% CI 1.11, 2.59) group, compared to "Injured, applied, and accepted" group. CONCLUSIONS: This finding suggests that rejection of workers' compensation claims, as well as the experience of occupational injuries, may increase the risk of depressive symptoms among Korean firefighters.

Association between labor union presence and return to work after occupational injury or illness: A nationally representative longitudinal study in South Korea.

BACKGROUND: This study sought to examine the association between labor union presence and return to work after occupational injury or illness (RTW) among workers in South Korea. METHODS: We analyzed the first (2018) and second (2019) wave data from the Panel Study of Workers' Compensation Insurance in South Korea. The cohort consisted of 3,294 workers who had suffered occupational injury or illness and completed their convalescence by 2017. We examined whether RTW was associated with the presence of labor unions in the workplace at the time of the occupational injury or illness occurred. RESULTS: Compared to workers without labor unions, those with labor unions were more likely to report RTW (prevalence ratio: 1.35, 95% confidence interval: 1.20-1.51) after adjusting for potential confounders, including employment status, duration of convalescence, and severity of injury or illness. CONCLUSION: This study found that labor union presence was associated with RTW among workers who suffered occupational injury or illness in South Korea.

Sexual harassment and its relationship with depressive symptoms: A nationwide study of Korean EMS providers.

BACKGROUND: Emergency medical service (EMS) providers may face sexual harassment (SH) from citizens. No studies have assessed SH prevalence and its association with depressive symptoms among EMS providers in South Korea. METHODS: We conducted a nationwide cross-sectional survey of 1346 EMS providers in South Korea. SH experience was assessed by asking, "During the past 12 months, have you ever experienced sexual harassment on duty by civil citizens?" Depressive symptoms during the preceding week were assessed using the Centers for Epidemiologic Studies Depression Scale. Modified Poisson regression was applied to examine association between SH and depressive symptoms. RESULTS: Among EMS providers, 28.1% of females and 5.6% of males reported sexual harassment. In the gender-stratified analysis, EMS providers those who experienced SH were more likely to have depressive symptoms among females (PR: 2.97, 95% CI: 1.99, 4.44) and males (PR: 2.01, 95% CI: 1.41, 2.86). CONCLUSIONS: Female EMS providers were about five times more likely to experience SH than males.

Job insecurity and depression among automobile sales workers: A longitudinal study in South Korea.

BACKGROUND: Job insecurity, the subjective perception of fear due to uncertainty about job continuity, could have long-term health effects. We aimed to examine the effect of job insecurity on depression among automobile sales workers in South Korea. METHODS: We analyzed data collected in 2007 and 2014 from a longitudinal cohort of 560 sales workers from an automobile company in South Korea. Change in job insecurity was classified into four groups: secure to secure; insecure to secure; secure to insecure; and insecure to insecure. RESULTS: After adjusting for potential confounders, workers in the insecure to insecure group had a significantly higher likelihood of depression in 2014 than workers in the secure to secure group (OR: 2.74; 95%CI: 1.41, 5.31). CONCLUSIONS: We found that chronic job insecurity may be a risk factor for developing depression among Korean automobile sales workers. This is the first longitudinal study examining the association between job insecurity and depression in South Korea.

Association between workplace discrimination and depressive symptoms among firefighters in South Korea.

BACKGROUND: Workplace discrimination is associated with poor mental health. However, there is a lack of studies examining the effects of discrimination on depressive symptoms among firefighters. METHODS: We analyzed a national cross-sectional survey of 6369 firefighters in South Korea. Workplace discrimination during the past year was measured and main reasons for the discriminatory experience (gender, birth region, age, education, field/office work, job division) were identified separately by gender and job division. Depressive symptoms during the previous week were measured by the CES-D11. RESULTS: Overall, 30.3% of firefighters experienced workplace discrimination and the main reasons for discrimination differed by gender and job division. Firefighters who experienced workplace discrimination had a higher likelihood of depressive symptoms than those who did not after adjusting for potential confounders (PR: 1.73; 95%CI: 1.55, 1.92). CONCLUSIONS: This finding suggests that experience of workplace discrimination could aggravate the mental health of firefighters who provide an important public service.

Association between interpersonal trust, reciprocity, and suicidal behaviors: A longitudinal cohort study in South Korea.

While a growing body of evidence suggest that social capital including interpersonal trust and reciprocity might be associated with mental health outcomes, few studies have explored the relationship with suicidal behaviors. This research examined the prospective association between interpersonal trust and reciprocity and suicidal behaviors using the Korea Welfare Panel Study, a nationally representative longitudinal cohort dataset in South Korea. Interpersonal trust and reciprocity were assessed at the 7th wave of the survey (2012), and each measure was classified into two categories (low vs. high). Experience of suicidal ideation, planning, and attempt was assessed between the 8th (2013) and 10th wave (2015) of the surveys. After adjusting for confounders including lifetime experience of suicidal behaviors at the 7th wave of the survey (2012) as well as socio-demographic information, the low interpersonal trust group was more likely to experience suicidal ideation (OR: 1.30, 95% CI: 1.11-1.53) compared to the high interpersonal trust group whereas no statistically significant association was observed in the reciprocity analysis.

Lookism hurts: appearance discrimination and self-rated health in South Korea.

BACKGROUND: Despite a growing body of evidence suggesting that discrimination harms health, the association between appearance discrimination and health has been understudied. Our study investigated the association between perceived appearance discrimination and self-rated health among emerging adults using a nationally representative cohort study in South Korea. METHODS: We analyzed the 2nd-10th (2005-2013) waves of cohort data from the Korean Education Employment Panel (KEEP). KEEP consists of two groups of individuals who were 15 (group I) and 18 (group II) years old at the 1st wave of the survey (2004) and were followed annually. Appearance discrimination was assessed at baseline (19 years old: 5th wave for group I, 2nd wave for group II) and at follow-up (24 years old: 10th wave for group I, 7th wave for group II). Responses of appearance discrimination at the two-time points were classified into four groups: 1) never (no discrimination at both baseline and follow-up); 2) repeated (discrimination at both baseline and follow-up); 3) incident (discrimination only at follow-up); and 4) in error (discrimination only at baseline). Multivariate logistic regression was applied to examine the association between reporting patterns of appearance discrimination and poor self-rated health, adjusting for potential confounders. RESULTS: Compared to those who did not experience appearance discrimination, 'repeated' (OR: 3.70; 95% CI: 2.19-6.27) and 'incident' (OR: 3.10; 95% CI: 1.99-4.83) groups had a higher odds ratio of poor self-rated health after adjusting for potential confounders including respondents' body mass index change and baseline self-rated health. However, no significant association was observed among those who reported appearance discrimination 'in error'. CONCLUSIONS: These results suggest that perceived appearance discrimination is associated with the health of Korean emerging adults considering participants' reporting patterns of appearance discrimination.

Nurses' but not supervisors' safety practices are linked with job satisfaction.

AIMS: To test the associations of safety practices as reported by nurses and their respective unit supervisors with job satisfaction. BACKGROUND: Psychosocial workplace factors are associated with job satisfaction; however, it is unknown whether nurses and supervisors accounts of safety practices are differentially linked to this outcome. METHODS: Cross-sectional study design including nurses (n = 1052) nested in 94 units in two hospitals in Boston (MA, USA). Safety practices refer to the identification and control of occupational hazards at the unit. Safety practices were measured aggregating nurses' responses per unit, and supervisory levels. Individual's job satisfaction for each nurse was the response variable. RESULTS: Supervisors assessed safety practices more favourably than their unit nursing staff. Adjusted random intercept logistic regressions showed that the odds of higher job satisfaction were higher for nurses at units with better safety practices (OR: 1.67, 95% CI: 1.04, 2.68) compared with nurses at units that averaged lower safety practices. Supervisors' reports of safety practices were not correlated with the job satisfaction of their staff. CONCLUSIONS: Adequate safety practices might be a relevant managerial role that enhances job satisfaction among nurses. IMPLICATIONS FOR NURSING MANAGEMENT: Nursing supervisors should calibrate their safety assessments with their nursing staff to improve nurses' job satisfaction.

Don't ask for fair treatment? A gender analysis of ethnic discrimination, response to discrimination, and self-rated health among marriage migrants in South Korea.

BACKGROUND: Ethnic discrimination is increasingly common nowadays in South Korea with the influx of migrants. Despite the growing body of evidences suggests that ethnic discrimination negatively impacts health, only few researches have been conducted on the association between ethnic discrimination and health outcomes among marriage migrants in Korea. This study sought to examine how ethnic discrimination and response to the discrimination are related to self-rated health and whether the association differs by victim's gender. METHODS: We conducted two-step analysis using cross-sectional dataset from the 'National Survey of Multicultural Families 2012'. First, we examined the association between perceived ethnic discrimination and self-rated health among 14,406 marriage migrants in Korea. Second, among the marriage migrants who experienced ethnic discrimination (n=5,880), we examined how response to discrimination (i.e., whether or not asking for fair treatment) is related to poor self-rated health. All analyses were conducted after being stratified by the migrant's gender. RESULTS: This research found the significant association between ethnic discrimination and poor self-rated health among female marriage migrants (OR: 1.53, 95 % CI: 1.32, 1.76), but not among male marriage migrants (OR: 1.16, 95 % CI: 0.81, 1.66). In the restricted analysis with marriage migrants who experienced ethnic discrimination, compared to the group who did not ask for fair treatment, female marriage migrants who asked for fair treatment were more likely to report poor self-rated health (OR: 1.21, 95 % CI: 0.98, 1.50); however, male marriage migrants who asked for fair treatment were less likely to report poor self-rated health (OR: 0.65, 95 % CI: 0.36, 1.04) although both were not statistically significant. CONCLUSIONS: This is the first study to investigate gender difference in the association between response to ethnic discrimination and self-rated health in South Korea. We discussed that gender may play an important role in the association between response to discrimination and self-rated health among marriage migrants in Korea. In order to prevent discrimination which could endanger the health of ethnic minorities including marriage migrants, relevant policies are needed.

Who is working while sick? Nonstandard employment and its association with absenteeism and presenteeism in South Korea.

OBJECTIVES: This study sought to examine whether nonstandard employment is associated with presenteeism as well as absenteeism among full-time employees in South Korea. METHODS: We analyzed a cross-sectional survey of 26,611 full-time employees from the third wave of the Korean Working Conditions Survey in 2011. Experience of absenteeism and presenteeism during the past 12 months was assessed through self-reports. Employment condition was classified into six categories based on two contract types (parent firm and subcontract) and three contract durations [permanent (≥1 year, no fixed term), long term (≥1 year, fixed term), and short term (<1 year, fixed term)]. RESULTS: We found opposite trends between the association of nonstandard employment with absenteeism and presenteeism after adjusting for covariates. Compared to parent firm-permanent employment, which has been often regarded as a standard employment, absenteeism was not associated or negatively associated with all nonstandard employment conditions except parent firm-long term employment (OR 1.88; 95 % CI 1.57, 2.26). However, presenteeism was positively associated with parent firm-long term (OR 1.64; 95 % CI 1.42, 1.91), subcontract-long term (OR 1.61; 95 % CI 1.12, 2.32), and subcontract-short term (OR 1.26; 95 % CI 1.02, 1.56) employment. CONCLUSIONS: Our results found that most nonstandard employment may increase risk of presenteeism, but not absenteeism. These results suggest that previous findings about the protective effects of nonstandard employment on absenteeism may be explained by nonstandard workers being forced to work when sick.

Contractor-, steward-, and coworker-safety practice: associations with musculoskeletal pain and injury-related absence among construction apprentices.

OBJECTIVES: This paper sought to assess organizational safety practices at three different levels of hierarchical workplace structure and to examine their association with injury outcomes among construction apprentices. METHODS: Using a cross-sectional sample of 1,775 construction apprentices, three measures of organizational safety practice were assessed: contractor-, steward-, and coworker-safety practice. Each safety practice measure was assessed using three similar questions (i.e., on-the-job safety commitment, following required or recommended safe work practices, and correcting unsafe work practices); the summed average of the responses ranged from 1 to 4, with a higher score indicating poorer safety practice. Outcome variables included the prevalence of four types of musculoskeletal pain (i.e., neck, shoulder, hand, and back pain) and injury-related absence. RESULTS: In adjusted analyses, contractor-safety practice was associated with both hand pain (OR: 1.27, 95 % CI: 1.04, 1.54) and back pain (OR: 1.40, 95 % CI: 1.17, 1.68); coworker-safety practice was related to back pain (OR: 1.42, 95 % CI: 1.18, 1.71) and injury-related absence (OR: 1.36, 95 % CI: 1.11, 1.67). In an analysis that included all three safety practice measures simultaneously, the association between coworker-safety practice and injury-related absence remained significant (OR: 1.68, 95 % CI: 1.20, 2.37), whereas all other associations became non-significant. CONCLUSIONS: This study suggests that organizational safety practice, particularly coworker-safety practice, is associated with injury outcomes among construction apprentices.

Association between perceived inadequate staffing and musculoskeletal pain among hospital patient care workers.

OBJECTIVE: To examine association between perceived inadequate staffing and musculoskeletal pain and to evaluate the role of work-related psychosocial and physical work factors in the association among hospital patient care workers. METHODS: A cross-sectional study was conducted among 1,572 patient care workers in two academic hospitals. Perceived inadequate staffing was measured using the "staffing adequacy subscale" of Nursing Work Index, which is a continuous scale that averages estimates of staffing adequacy by workers in the same units. Musculoskeletal pain (i.e., neck/shoulder, arm, low back, lower extremity, any musculoskeletal pain, and the number of area in pain) in the past 3 months was assessed using a self-reported Nordic questionnaire. Multilevel logistic regression was applied to examine associations between perceived inadequate staffing and musculoskeletal pain, considering clustering among the workers in the same units. RESULTS: We found significant associations of perceived inadequate staffing with back pain (OR 1.50, 95 % CI 1.06, 2.14) and the number of body area in pain (OR 1.42, 95 % CI 1.01, 2.00) after adjusting for confounders including work characteristics (job title, having a second job or not, day shift or not, and worked hours per week). When we additionally adjusted for physical work factors (i.e., use of a lifting device, and the amount of the time for each of five physical activities on the job), only the association between perceived inadequate staffing and back pain remained significant (OR 1.50, 95 % CI 1.03, 2.19), whereas none of the associations was significant for all of musculoskeletal pains including back pain (OR 0.96, 95 % CI 0.66, 1.41) when we additionally adjusted for work-related psychosocial factors (i.e., job demands, job control, supervisor support, and co-worker support) instead of physical work factors. CONCLUSIONS: Perceived inadequate staffing may be associated with higher prevalence of back pain, and work-related psychosocial factor may play an important role in the potential pathway linking staffing level to back pain among hospital workers.