Promoting integrated approaches to reducing health inequities among low-income workers: applying a social ecological framework.

BACKGROUND: Nearly one of every three workers in the United States is low-income. Low-income populations have a lower life expectancy and greater rates of chronic diseases compared to those with higher incomes. Low- income workers face hazards in their workplaces as well as in their communities. Developing integrated public health programs that address these combined health hazards, especially the interaction of occupational and non-occupational risk factors, can promote greater health equity. METHODS: We apply a social-ecological perspective in considering ways to improve the health of the low-income working population through integrated health protection and health promotion programs initiated in four different settings: the worksite, state and local health departments, community health centers, and community-based organizations. RESULTS: Examples of successful approaches to developing integrated programs are presented in each of these settings. These examples illustrate several complementary venues for public health programs that consider the complex interplay between work-related and non work-related factors, that integrate health protection with health promotion and that are delivered at multiple levels to improve health for low-income workers. CONCLUSIONS: Whether at the workplace or in the community, employers, workers, labor and community advocates, in partnership with public health practitioners, can deliver comprehensive and integrated health protection and health promotion programs. Recommendations for improved research, training, and coordination among health departments, health practitioners, worksites and community organizations are proposed.

Complementary and alternative medical practice: self-care preferred vs. practitioner-based care among patients with asthma.

BACKGROUND: Interest in disease self-management has increased as the US population ages, as health care costs skyrocket, and as more evidence is gathered on the etiologic basis of most chronic diseases. This study uses National Health Interview Survey (NHIS) data to analyze the association between asthma episode during the past 12 months and patterns of complementary and alternative medicine (CAM) use within the same period among adults, controlling for comorbid conditions. METHODS: Using questions taken from the adult sample questionnaire and the Alternative Supplement of the 2002 NHIS, responses of those ever having asthma (N=3327) were analyzed in this cross-sectional, correlational study. The chi2 test of independence was used to examine the relationships between experiencing an asthma episode in the past year, coexisting comorbidity, and the use of self-care based CAM compared to practitioner-based CAM. RESULTS: Overall CAM use differed significantly by asthma status, with 49% of those with asthma episodes using CAM compared with 42% of those who did not have an episode in the past year. Self-care based therapies were more likely to be used than practitioner-based therapies by individuals with single comorbid condition compared to those with 2 or more comorbidities. CONCLUSION: Although this study supports previous work indicating that disease severity--in this instance, asthma within the past year--is significantly associated with CAM use, it did not support studies showing greater CAM use in the presence of a greater number of comorbidities, suggesting that disease burden is a limiting factor when it comes to self-care based CAM use.

Occupational injuries and illnesses in the solid waste industry: a call for action.

Work-related injuries and illnesses are multi-factorial and remain major problems of public health magnitude requiring the attention of all stakeholders in the solid waste industry. The objective of this article was to describe the patterns of occupational injury and illness (OII) reporting incidence among workers in a major private U. S. solid waste management company. A five-year (2003-2007) retrospective review of the corporate Occupational Safety and Health Administration (OSHA) logs 300/300A/301 was conducted and employee OII reports (n = 1895) were analyzed from 37 establishments across 11 different states. The OII reporting rates were compared to industry average.