Identifying occupational health inequities in the absence of suitable data: are there inequities in access to adequate bathrooms in US workplaces?

OBJECTIVES: Our research questions are often chosen based on the existence of suitable data for analysis or prior research in the area. For new interdisciplinary research areas, such as occupational health equity, suitable data might not yet exist. In this manuscript, we describe how we approached a research question in the absence of suitable data using the example of identifying inequities in adequate bathrooms in US workplaces. METHODS: We created a conceptual model that hypothesises causal mechanisms for occupational health inequities, and from this model we identified a series of questions that could be answered using separate data sets to better understand inequities in adequate workplace bathrooms. Breaking up the analysis into multiple steps allowed us to use multiple data sources and analysis methods, which helped compensate for limitations in each data set. RESULTS: Using the conceptual model as a guide, we were able to identify some jobs that likely have inadequate bathrooms as well as subpopulations potentially at higher risk for inadequate bathrooms. We also identified specific data gaps by reflecting on the challenges we faced in our multistep analysis. These gaps, which indicated future data collection needs, included difficulty finding data sources for some predictors of inadequate bathrooms that prevented us from fully investigating potential inequities. CONCLUSIONS: We share our conceptual model and our example analysis to motivate researchers to avoid letting availability of data limit the research questions they pursue.

Work as an Inclusive Part of Population Health Inequities Research and Prevention.

Despite its inclusion in models of social and ecological determinants of health, work has not been explored in most health inequity research in the United States. Leaving work out of public health inequities research creates a blind spot in our understanding of how inequities are created and impedes our progress toward health equity. We first describe why work is vital to our understanding of observed societal-level health inequities. Next, we outline challenges to incorporating work in the study of health inequities, including (1) the complexity of work as a concept; (2) work's overlap with socioeconomic position, race, ethnicity, and gender; (3) the development of a parallel line of inquiry into occupational health inequities; and (4) the dearth of precise data with which to explore the relationships between work and health status. Finally, we summarize opportunities for advancing health equity and monitoring progress that could be achieved if researchers and practitioners more robustly include work in their efforts to understand and address health inequities.

Shift work, job strain and changes in the body mass index among women: a prospective study.

OBJECTIVES: The effects of job strain and shift work on weight gain have not been studied jointly. Cross-sectional and longitudinal studies on shift work and weight gain have reported different results. This study examines potential effect modification by job strain on the link between shift work and weight gain, and concurrent and delayed effects of shift work on weight gain. METHODS: Data came from 52 622 women who participated in the Nurses' Health Study II, a prospective cohort study. Using linear regression, we modelled change in body mass index (BMI) over 4 years as a function of change in job strain, cumulative exposure to rotating night shift previously and during the 4 years (ie, previous and concurrent exposures) and the interaction between job strain and concurrent shift work exposure. Age, race/ethnicity, pregnancy history, baseline BMI, job types and health behaviours at baseline were controlled for. RESULTS: Job strain and rotating shift work, concurrent and previous, all had independent associations with BMI change during the 4-year period. There was no evidence for effect modification by job strain. Concurrent and previous exposures to rotating night shift had different associations with BMI change: an inverted U-shape for concurrent exposure (ranging from 0.01 to 0.14 kg/m2 increase), a dose-response for previous exposure (-0.02 to 0.09 kg/m2). CONCLUSIONS: Job strain and rotating night shift work have independent contributions to weight gain. Reducing job strain and supporting night shift workers are both important intervention goals.

Effects of Workplace Generalized and Sexual Harassment on Abusive Drinking Among First Year Male and Female College Students: Does Prior Drinking Experience Matter?

BACKGROUND: Workplace harassment, a known risk factor for adult drinking, is understudied in college samples, but may help explain observed gender differences in drinking patterns. OBJECTIVE: We examine effects of sexual and generalized workplace harassment on changes in drinking behavior over the first semesters of college, and the extent to which these effects differ based on prematriculation drinking for men and women students. METHOD: Data derive from two waves of a longitudinal study of eight Midwestern colleges and universities. Data were collected from 2080 employed students via a Web-based survey assessing sexual and generalized workplace harassment, stressful life events, drinking to intoxication, and binge drinking prior to freshman year (fall 2011) and approximately one year later (summer to fall 2012). At baseline, lifetime drinking status, frequency of alcohol consumption, and demographics were also assessed. RESULTS: Linear-mixed modeling indicated that employed women students who were frequent drinkers prematriculation were at risk for high levels of drinking associated with workplace harassment, while men who were nondrinkers were most at risk of increasing problem drinking over time when exposed to workplace harassment. CONCLUSIONS: Alcohol use prevention efforts directed towards employed students are needed both prior to and during college, to instruct students how to identify workplace harassment and cope in healthier ways with stressful workplace experiences. These efforts might be particularly useful in stemming problematic drinking among women who drink frequently prior to college, and preventing men who are nondrinkers upon college entry from initiating problematic drinking during subsequent enrollment years.

The effect of perceived overqualification on job satisfaction and career satisfaction among immigrants: Does host national identity matter?

Overqualification is a form of person-job misfit that is common among those who reside in a foreign country. It is associated with poor work-related well-being and can inhibit full adjustment to the host society. The goal of our study is to examine the impact of perceived overqualification on job satisfaction and career satisfaction among immigrants. Furthermore, we investigated immigrants' host national identity as a moderator of the impact of perceived overqualification on job satisfaction and career satisfaction. We analysed longitudinal online survey data from 124 Italian and Spanish immigrants who migrated to Germany between 2000 and 2014. Regression analyses show that perceived overqualification is negatively associated with job satisfaction six months later. Furthermore, host national identity moderates the association between perceived overqualification and job satisfaction: low overqualification is beneficial for job satisfaction whereas high overqualification is a threat for job satisfaction, especially for immigrants who identify strongly with the host society. We do not find corresponding direct and moderating effects on career satisfaction. We conclude that indicators of acculturation, such as host national identity, are worth considering in order to understand the impact of person-job misfit on work-related well-being among immigrants.

Job Strain and the Cortisol Diurnal Cycle in MESA: Accounting for Between- and Within-Day Variability.

Evidence of the link between job strain and cortisol levels has been inconsistent. This could be due to failure to account for cortisol variability leading to underestimated standard errors. Our objective was to model the relationship between job strain and the whole cortisol curve, accounting for sources of cortisol variability. Our functional mixed-model approach incorporated all available data-18 samples over 3 days-and uncertainty in estimated relationships. We used employed participants from the Multi-Ethnic Study of Atherosclerosis Stress I Study and data collected between 2002 and 2006. We used propensity score matching on an extensive set of variables to control for sources of confounding. We found that job strain was associated with lower salivary cortisol levels and lower total area under the curve. We found no relationship between job strain and the cortisol awakening response. Our findings differed from those of several previous studies. It is plausible that our results were unique to middle- to older-aged racially, ethnically, and occupationally diverse adults and were therefore not inconsistent with previous research among younger, mostly white samples. However, it is also plausible that previous findings were influenced by residual confounding and failure to propagate uncertainty (i.e., account for the multiple sources of variability) in estimating cortisol features.

Occupational characteristics and the progression of carotid artery intima-media thickness and plaque over 9†years: the Multi-Ethnic Study of Atherosclerosis (MESA).

OBJECTIVES: The role of occupation in the development of cardiovascular disease (CVD) remains a topic of research because few studies have examined longitudinal associations, and because occupation can be an indicator of socioeconomic position (SEP) and a proxy for hazard exposure. This study examines associations of occupational category as an SEP marker and selected occupational exposures with progression of the subclinical carotid artery disease. METHODS: A community-based, multiethnic sample (n=3109, mean age=60.2) provided subclinical CVD measures at least twice at three data collection points (mean follow-up=9.4 years). After accounting for demographic characteristics, SEP, and traditional CVD risk factors, we modelled common carotid intima-media thickness, carotid plaque scores, and carotid plaque shadowing as a function of occupational category, physical hazard exposure, physical activity on the job, interpersonal stress, job control and job demands. These job characteristics were derived from the Occupational Resource Network (O*NET). Random coefficient models were used to account for repeated measures and time-varying covariates. RESULTS: There were a few statistically significant associations at baseline. After all covariates were included in the model, men in management, office/sales, service and blue-collar jobs had 28-44% higher plaque scores than professionals at baseline (p=0.001). Physically hazardous jobs were positively associated with plaque scores among women (p=0.014). However, there were no significant longitudinal associations between any of the occupational characteristics and any of the subclinical CVD measures. CONCLUSIONS: There was little evidence that the occupational characteristics examined in this study accelerated the progression of subclinical CVD.

Psychosocial work characteristics of personal care and service occupations: a process for developing meaningful measures for a multiethnic workforce.

BACKGROUND AND OBJECTIVES: Despite their rapid increase in number, workers in personal care and service occupations are underrepresented in research on psychosocial work characteristics and occupational health. Some of the research challenges stem from the high proportion of immigrants in these occupations. Language barriers, low literacy, and cultural differences as well as their nontraditional work setting (i.e., providing service for one person in his/her home) make generic questionnaire measures inadequate for capturing salient aspects of personal care and service work. This study presents strategies for (1) identifying psychosocial work characteristics of home care workers that may affect their occupational safety and health and (2) creating survey measures that overcome barriers posed by language, low literacy, and cultural differences. DESIGN AND RESULTS: We pursued these aims in four phases: (Phase 1) Six focus groups to identify the psychosocial work characteristics affecting the home care workers' occupational safety and health; (Phase 2) Selection of questionnaire items (i.e., questions or statements to assess the target construct) and first round of cognitive interviews (n = 30) to refine the items in an iterative process; (Phase 3) Item revision and second round of cognitive interviews (n = 11); (Phase 4) Quantitative pilot test to ensure the scales' reliability and validity across three language groups (English, Spanish, and Chinese; total n = 404). Analysis of the data from each phase informed the nature of subsequent phases. This iterative process ensured that survey measures not only met the reliability and validity criteria across groups, but were also meaningful to home care workers. CONCLUSION: This complex process is necessary when conducting research with nontraditional and multilingual worker populations.

Perspectives on Communication and Participation in Research Notification Focus Groups.

Researchers are slowly acknowledging an ethical obligation to inform research participants about study findings. Research notification may help participants become aware of and manage potential health risks. Scholars and practitioners have acknowledged the need for better understanding of this process. This study investigates transcripts of focus groups conducted to gauge audience reactions to notification materials that communicate scientific research findings about occupational exposures. Focus groups are a useful way to tailor notification materials to audiences, but we caution that transmission models of communication used in risk research may obscure the full value of focus groups. The emphasis on translating scientific communication into "lay" language may overlook how scientists and lay audiences can work together to bridge differences in language, experiences, goals, and orientations toward health. This study demonstrates limitations in scientific risk communication that minimize participation in communicating science. The conclusion provides instructive insights for strengthening the process of communicating science.

Anticipated Job Benefits, Career Aspiration, and Generalized Self-efficacy as Predictors for Migration Decision-Making.

This study aims to identify person-level factors, rather than economic situations, that influence migration decision-making and actual migration. Building on the theory of planned behavior, this study investigated potential migrants' expectations and attitudes toward migration and career (i.e., anticipated job benefits of migration, career aspiration) as well as beliefs (i.e., generalized self-efficacy) as predictors of migration decision-making conceptualized in three phases: the pre-decisional, pre-actional, and actional phases. This was examined with cross-sectional pre-migration questionnaire data from 1163 potential migrants from Spain to Germany. We also examined whether the migration decision-making phases predicted actual migration with a subsample (n=249) which provided follow-up data within twelve months. For the cross-sectional sample, multinomial logistic regressions revealed that anticipated job benefits and career aspiration are predictive for all migration phases. Self-efficacy predicts the preactional (e.g., gathering information) and actional phases (e.g., making practical arrangements). Finally, for those with low self-efficacy, anticipated job benefits play a stronger role for taking action. For the longitudinal subsample, a logistic regression revealed that being in the preactional and actional phases at baseline is predictive of actual migration within twelve months. This study expands previous research on migration intentions and behaviors by focusing on expectations, values, and beliefs as person-level predictors for migration decision-making. With a longitudinal sample, it shows that international migration is a process that involves multiple phases.

Occupational risk factors for COPD phenotypes in the Multi-Ethnic Study of Atherosclerosis (MESA) Lung Study.

INTRODUCTION: The contribution of occupational exposure to the risk of chronic obstructive pulmonary disease COPD in population-based studies is of interest. We compared the performance of self-reported exposure to a newly developed JEM in exposure-response evaluation. METHODS: We used cross-sectional data from Multi-Ethnic Study of Atherosclerosis (MESA), a population-based sample of 45-84 year olds free of clinical cardiovascular disease at baseline. MESA ascertained the most recent job and employment, and the MESA Lung Study measured spirometry, and occupational exposures for 3686 participants. Associations between health outcomes (spirometry defined airflow limitation and Medical Research Council-defined chronic bronchitis) and occupational exposure [self-reported occupational exposure to vapor-gas, dust, or fumes (VGDF), severity of exposure, and a job-exposure matrix (JEM)-derived score] were evaluated using logistic regression models adjusted for non-occupational risk factors. RESULTS: The prevalence of airflow limitation was associated with self-reported exposure to vapor-gas (OR 2.6, 95%CI 1.1-2.3), severity of VGDF exposure (P-trend < 0.01), and JEM dust exposure (OR 2.4, 95%CI 1.1-5.0), and with organic dust exposure in females; these associations were generally of greater magnitude among never smokers. The prevalence of chronic bronchitis and wheeze was associated with exposure to VGDF. The association between airflow limitation and the combined effect of smoking and VGDF exposure showed an increasing trend. Self-reported vapor-gas, dust, fumes, years and severity of exposure were associated with increased prevalence of chronic bronchitis and wheeze (P < 0.001). CONCLUSIONS: Airflow limitation was associated with self-reported VGDF exposure, its severity, and JEM-ascertained dust exposure in smokers and never-smokers in this multiethnic study.

Multiple Job Holding, Job Changes, and Associations with Gestational Diabetes and Pregnancy-Related Hypertension in the National Birth Defects Prevention Study.

We used National Birth Defects Prevention Study data to investigate associations between working patterns shortly before and during pregnancy and gestational diabetes and pregnancy-related hypertension. We analyzed working patterns (multiple-job holders, job changers, single-job holders) during the three months before and during pregnancy for 8140 participants who delivered a live-born child without a birth defect. "Multiple-job holders" worked more than one job simultaneously, "job changers" worked more than one job with no overlap, and "single-job holders" (referent) worked one job. We used multivariable logistic regression to estimate associations between working pattern and each outcome, adjusting for maternal age and educational attainment at delivery. We explored effect measure modification by household income, peak weekly working hours, and maternal race/ethnicity. Multiple-job holders had higher odds of gestational diabetes (adjusted odds ratio [aOR]: 1.5; 95% confidence interval [CI]: 1.1-2.1) and pregnancy-related hypertension (aOR: 1.5; 95% CI: 1.0-2.2) compared with single-job holders. Multiple-job holders with a household income of more than 30,000 USD per year, 32-44 peak weekly working hours, and from racial/ethnic minority groups had higher odds of gestational diabetes compared with single-job holders in respective categories. Detailed occupational information is important for studies of occupation and maternal health.

Current employment status, occupational category, occupational hazard exposure and job stress in relation to telomere length: the Multiethnic Study of Atherosclerosis (MESA).

OBJECTIVE: Telomere length has been proposed as a biomarker of cell senescence, which is associated with a wide array of adverse health outcomes. While work is a major determinant of health, few studies have investigated the association of telomere length with various dimensions of occupation. Accelerated cellular aging could be a common pathway linking occupational exposure to several health outcomes. METHODS: Leukocyte telomere length was assessed using quantitative PCR in a community-based sample of 981 individuals (age: 45-84 years). Questionnaires were used to collect information on current employment status, current or main occupation before retirement and job strain. The Occupational Resource Network (O*NET) database was linked to the questionnaire data to create five exposure measures: physical activity on the job, physical hazard exposure, interpersonal stressors, job control and job demands. Linear regression was used to estimate associations of occupational characteristics with telomere lengths after adjustment for age, sex, race, socioeconomic position and several behavioural risk factors. RESULTS: There were no mean differences in telomere lengths across current employment status, occupational category, job strain categories or levels of most O*NET exposure measures. There was also no evidence that being in lower status occupational categories or being exposed to higher levels of adverse physical or psychosocial exposures accelerated the association between age and telomere shortening. CONCLUSIONS: Cellular aging as reflected by shorter telomeres does not appear to be an important pathway linking occupation to various health outcomes.

Associations of work hours with carotid intima-media thickness and ankle-brachial index: the Multi-Ethnic Study of Atherosclerosis (MESA).

OBJECTIVES: Long working hours may be associated with cardiovascular disease (CVD). The objective was to investigate cross-sectional associations of work hours with carotid intima-media thickness (CIMT) and ankle-brachial index (ABI). METHODS: Participants were 1694 women and 1868 men from the Multi-Ethnic Study of Atherosclerosis. CIMT and ABI were measured using standard protocols. Information on work hours was obtained from questionnaires. Mean values of CIMT and ABI were examined across five categories of hours worked per week (≤20, 21-39, 40, 41-50 and >50) using analysis of variance/analysis of covariance. p Values for trend were obtained from linear regression models. RESULTS: Mean age of participants was 56.9±8.4 years; 52.4% were men. Distinct patterns of association between work hours and the subclinical CVD biomarkers were found for women and men, although this heterogeneity by gender was not statistically significant. Among women only, work hours were positively associated with common (but not internal) CIMT (p=0.073) after full risk factor adjustment. Compared with women working 40 h, those working >50 h were more likely to have an ABI <1 (vs 1-1.4) (OR=1.85, 95% CI 1.01 to 3.38). In men, work hours and ABI were inversely associated (p=0.046). There was some evidence that the association between work hours and ABI was modified by occupational category (interaction p=0.061). Among persons classified as management/professionals, longer work hours was associated with lower ABI (p=0.015). No significant associations were observed among other occupational groups. CONCLUSIONS: Working longer hours may be associated with subclinical CVD. These associations should be investigated using longitudinal studies.

Investigating Employment Quality for Population Health and Health Equity: A Perspective of Power.

Employment quality (EQ) has gained increasing attention as a determinant of health, but the debate among occupational health researchers over the measurement of EQ poses a challenge to advancing the literature. This is especially problematic when the concept is used across social, cultural, and national borders, as EQ is shaped by power dynamics within sociopolitical and economic contexts that are specific to each society. Investigating EQ in context could help develop a clearer understanding as to why EQ is configured in certain ways, how best EQ could be measured, how EQ impacts health, and ultimately how EQ could be improved. In this paper, we propose that attention to social context-and in particular power-may help advance the research on EQ and health. We present an allegory, or a visual description, that articulates the power balance in the employer-worker relation as well as in the sociopolitical context in which the employer-worker relation takes place. We end by proposing specific approaches for occupational health researchers to incorporate a perspective of power in EQ research that may clarify the concept and measurement of EQ. A clearer recognition of EQ as a product of power in social context aligns with the research approach of addressing work as a social structural determinant of health.

What does non-standard employment look like in the United States? An empirical typology of employment quality.

Despite significant interest in the changing nature of employment as a critical social and economic challenge facing society-especially the decline in the so-called Standard Employment Relationship (SER) and rise in more insecure, precarious forms of employment-scholars have struggled to operationalize the multifaceted and heterogeneous nature of contemporary worker-employer relationships within empirical analyses. Here we investigate the character and distribution of employment relationships in the U.S., drawing on a representative sample of wage-earners and self-employed from the General Social Survey (2002 - 2018). We use the multidimensional construct of employment quality (EQ), which includes both contractual (e.g., wages, contract type) and relational (e.g., employee representation and participation) aspects of employment. We further employ a typological measurement approach, using latent class analysis, to explicitly examine how the multiple aspects of employment cluster together in modern labor markets. We present eight distinct employment types in the U.S., including one resembling the historical conception of the SER model (24% of the total workforce), and others representing various constellations of favorable and adverse employment features. These employment types are unevenly distributed across society, in terms of who works these jobs and where they are found in the labor market. Importantly, women, those with lower education, and younger workers are more likely to be in precarious forms of employment. More generally, our typology reveals limitations associated with binary conceptions of standard vs. non-standard employment, or insider-outsider dichotomies envisioned within dual labor market theories.

Associations of workplace aggression with work-related well-being among nurses in the Philippines.

OBJECTIVES: We examined whether workplace aggression was associated with self-rated health and work-related injury and illness among nurses in the Philippines. METHODS: Our data came from a cross-sectional survey of nurses (n = 687) in the Philippines. We assessed the associations of self-reported physical assault and verbal abuse with self-rated health, work-related injury and illness, and missed workdays with Poisson regression. Control variables included demographic and work characteristics (e.g., hours worked, work setting, shift). RESULTS: Verbal abuse was associated with poor general health (prevalence ratio [PR] = 1.94; 95% confidence interval [CI] = 1.09, 3.45). Both physical assault and verbal abuse were associated with work-related injury (PR = 1.48; 95% CI = 1.00, 2.20; PR = 1.72; 95% CI = 1.34, 2.23, respectively) and work-related illness (PR = 1.46; 95% CI = 0.99, 2.15; PR = 1.68; 95% CI = 1.32, 2.14, respectively) after demographic and work characteristics were accounted for in the model. In addition, physical assault was associated with missed workdays (PR = 1.56; 95% CI = 1.02, 2.33). CONCLUSIONS: Workplace aggression was associated with increased risks of poor general health and adverse work-related health outcomes among nurses in the Philippines.