Disclosure, Privacy and Workplace Accommodation of Episodic Disabilities: Organizational Perspectives on Disability Communication-Support Processes to Sustain Employment.

Purpose Employers increasingly are asked to accommodate workers living with physical and mental health conditions that cause episodic disability, where periods of wellness are punctuated by intermittent and often unpredictable activity limitations (e.g., depression, anxiety, arthritis, colitis). Episodic disabilities may be challenging for workplaces which must comply with legislation protecting the privacy of health information while believing they would benefit from personal health details to meet a worker's accommodation needs. This research aimed to understand organizational perspectives on disability communication-support processes. Methods Twenty-seven participants from diverse employment sectors and who had responsibilities for supporting workers living with episodic disabilities (e.g., supervisors, disability managers, union representatives, occupational health representatives, labour lawyers) were interviewed. Five participants also had lived experience of a physical or mental health episodic disability. Participants were recruited through organizational associations, community networks and advertising. Semi-structured interviews and qualitative content analysis framed data collection and analyses, and mapped communication-support processes. Results Seven themes underpinned communication-support process: (1) similarities and differences among physical and mental health episodic disabilities; (2) cultures of workplace support, including contrasting medical and biopsychosocial perspectives; (3) misgivings about others and their role in communication-support processes; (4) that subjective perceptions matter; (5) the inherent complexity of the response process; (6) challenges arising when a worker denies a disability; and (7) casting disability as a performance problem. Conclusions This study identifies a conceptual framework and areas where workplace disability support processes could be enhanced to improve inclusion and the sustainability of employment among workers living with episodic disabilities.

Risk of work injury among adolescent students from single and partnered parent families.

BACKGROUND: Parental involvement in keeping their children safe at work has been examined in a handful of studies, with mixed results. Evidence has suggested that non-work injury risk is higher among children from single-parent families, but little is known about their risk for work-related injuries. METHODS: Five survey cycles of the Canadian Community Health Survey were pooled to create a nationally representative sample of employed 15-19-year old students (N = 16,620). Multivariable logistic regression estimated the association between family status and work injury. RESULTS: Risk of work-related repetitive strains (OR:1.24, 95%CI: 0.69-2.22) did not differ by family type. However, children of single parents were less likely to sustain a work injury receiving immediate medical care (OR:0.43, 95%CI: 0.19-0.96). CONCLUSION: Despite advantages and disadvantages related to family types, there is no evidence that work-related injury risk among adolescents from single parent families is greater than that of partnered-parent families. Am. J. Ind. Med. 60:285-294, 2017. © 2017 Wiley Periodicals, Inc.

Course of Depressive Symptoms Following a Workplace Injury: A 12-Month Follow-Up Update.

Introduction To estimate the prevalence, incidence and course of depressive symptoms, their relationship with return-to-work, and prevalence of depression diagnosis/treatment 12 months following a lost-time workplace musculoskeletal injury. Methods In a prospective cohort study, 332 workers' compensation claimants with a back or upper extremity musculoskeletal disorder completed interviews at 1, 6 and 12 months post-injury. Participants self-reported they had not received a depression diagnosis 1 year pre-injury. Cutoff of 16 on the CES-D defined a high level of depressive symptoms. Self-reported data on depression diagnosis and treatment and work status since injury were collected. Results Cumulative incidence of high depressive symptom levels over 12 months was 50.3 % (95 % CI 44.9-55.7 %). At 12 months, 24.7 % (95 % CI 20.1-29.3 %) of workers exhibited high levels. Over 12 months, 49.7 % (95 % CI 44.3-55.1 %) had low levels at all 3 interviews, 14.5 % (95 % CI 10.7-18.2 %) had persistently high levels, and 25.6 % (95 % CI 20.9-30.3 %) demonstrated improvements. Among workers with low baseline levels, incidence of high levels at 12 months was 6.0 % (95 % CI 2.7-9.3 %). For workers with high baseline levels, 36.1 % (95 % CI 27.9-44.3 %) exhibited persistent high symptoms at 6 and 12 months, while 38.4 % (95 % CI 30.1-46.6 %) experienced low levels at 6 and 12 months. Problematic RTW outcomes were common among workers with a poor depressive symptom course. Among workers with persistent high symptoms, 18.8 % (95 % CI 7.7-29.8 %) self-reported receiving a depression diagnosis by 12 months and 29.2 % (95 % CI 16.3-42.0 %) were receiving treatment at 12 months. Conclusions Depressive symptoms are common in the first year following a lost-time musculoskeletal injury and a poor depressive symptom course is associated with problematic RTW outcomes 12 months post-injury. While symptoms appear to improve over time, the first 6 months appear to be important in establishing future symptom levels and may represent a window of opportunity for early screening.

Examining job tenure and lost-time claim rates in Ontario, Canada, over a 10-year period, 1999-2008.

OBJECTIVE: We sought to examine the association between job tenure and lost-time claim rates over a 10-year period in Ontario, Canada. METHODS: Data were obtained from workers' compensation records and labour force survey data from 1999 to 2008. Claim rates were calculated for gender, age, industry, occupation, year and job tenure group. A multivariate analysis and examination of effect modification were performed. Differences in injury event and source of injury were also examined by job tenure. RESULTS: Lost-time claim rates were significantly higher for workers with shorter job tenure, regardless of other factors. Claim rates for new workers differed by gender, age and industry, but remained relatively constant at an elevated rate over the observed time period. CONCLUSIONS: This study is the first to examine lost-time claim rates by job tenure over a time period during which overall claim rates generally declined. Claim rates did not show a convergence by job tenure. Findings highlight that new workers are still at elevated risk, and suggest the need for improved training, reducing exposures among new workers, promoting permanent employment, and monitoring work injury trends and risk factors.

The demographic and contextual correlates of work-related repetitive strain injuries among Canadian men and women.

BACKGROUND: The study sought to identify gender differences in work-related repetitive strain injuries (RSI), as well as examine the degree to which non-work factors such as family roles interact with gender to modify RSI risk. Another aim is to examine whether there are potential provincial differences in work-related RSI risk. METHODS: The 2003/2005 Canadian Community Health Survey included over 89,000 respondents who reported working in the past 12 months. Separate multi-level models for men and women were used to identify the correlates of work-related RSIs. RESULTS: Women reported sustaining more work-related RSIs than men. Also, having one or more children in the household was associated with lower work-related RSI risk for females. Both men and women in British Columbia reported higher work-related RSI rates than in Ontario. CONCLUSIONS: Gender contributes to RSI risk in multiple and diverse ways based on labor market segregation, non-work exposures, and possibly biological vulnerability, which suggests more tailored interventions. Also, the provincial differences indicate that monitoring and surveillance of work injury across jurisdictions can assist in province-wide prevention and occupational health and safety evaluation.

Examining the decline in lost-time claim rates across age groups in Ontario between 1991 and 2007.

OBJECTIVES: Given the tendency for young people to show elevated work injury rates, this study sought to examine trends in young worker and adult compensation claim rates in a Canadian province. METHODS: Workers' compensation records and labour force survey data from 1991 to 2007 were used to compute claim rates by age group. To examine the contribution of work-related factors to claim rates by age group, multivariate analyses included industry and job tenure. RESULTS: Descriptive analysis showed that age groups had different rates of declines over the time period. Multivariate analyses showed that claim rate declines for older adults were greatest prior to 1999. Young workers showed the largest declines after 1999. There was no indication that changes in industry or job tenure accounted for the trends in claim rates among older or younger workers. CONCLUSIONS: This study is one of the first to show a convergence in youth and adult workers' compensation claims in a North American jurisdiction. Ruling out work-related factors increases the possibility that systemic interventions may have contributed to the convergence. This provides policy makers in occupational health and safety with empirical data to guide targeting of resources.

Assessing occupational health and safety of young workers who use youth employment centers.

BACKGROUND: Adolescents and young adults who are out of school are at elevated risk for a work injury. METHODS: To obtain more information on this "high risk" group of young workers, young people at youth employment centers across Ontario were asked through an online survey about training, unsafe work conditions, work injuries and safety knowledge. RESULTS: The 1,886 youth who completed the survey reported a medically attended work injury rate of 14.45 per 100 FTEs. Also, the most common unsafe work conditions were dust/particles, trip hazards and heavy lifting. In addition, many young workers reported using much of their income for living essentials (e.g., rent). CONCLUSIONS: Though not a representative sample, it appears that youth using employment centers experience many unsafe work conditions and work injuries. While many report safety training, the nature and effectiveness of this training remains to be determined. The large portion of young workers out of school and working for living essentials included in this sample suggest that youth employment centers should be considered in future prevention efforts targeting this vulnerable subgroup of workers.

Effectiveness of health and safety in small enterprises: a systematic review of quantitative evaluations of interventions.

INTRODUCTION: This systematic review was conducted to identify effective occupational health and safety interventions for small businesses. METHODS: The review focused on peer-reviewed intervention studies conducted in small businesses with 100 or fewer employees, that were published in English and several other languages, and that were not limited by publication date. Multidisciplinary members of the review team identified relevant articles and assessed their quality. Studies assessed as medium or high quality had data extracted, which was then synthesized. RESULTS: Five studies were deemed of medium or high quality, and proceeded to data extraction and evidence synthesis. The types of interventions identified: a combination of training and safety audits; and a combination of engineering, training, safety audits, and a motivational component, showed a limited amount of evidence in improving safety outcomes. Overall, this evidence synthesis found a moderate level of evidence for intervention effectiveness, and found no evidence that any intervention had adverse effects. CONCLUSIONS: Even though there were few studies that adequately evaluated small business intervention, several studies demonstrate that well-designed evaluations are possible with small businesses. While stronger levels of evidence are required to make recommendations, these interventions noted above were associated with positive changes in safety-related attitudes and beliefs and workplace parties should be aware of them.

Work injury risk among young people with learning disabilities and attention-deficit/hyperactivity disorder in Canada.

OBJECTIVES: We sought to gain a better understanding of the relationship between learning disabilities, attention-deficit/hyperactivity disorder (ADHD), and risk of occupational injury among young workers. METHODS: We assessed 15- to 24-year-old workers (n = 14 379) from cycle 2.1 of the Canadian Community Health Survey (CCHS). We gathered data on demographic characteristics, work-related factors, and presence of learning disabilities or ADHD. We conducted a multivariate logistic regression analysis to assess occurrences of medically attended work injuries. RESULTS: There was an 89% adjusted increase in work injury risk among workers with self-reported dyslexia (a type of learning disability) relative to workers reporting no learning disabilities, although this result did not meet traditional statistical significance criteria. Being out of school, either with or without a high school diploma, was associated with a significantly increased risk of work injury, even after control for a number of demographic and work-related variables. CONCLUSIONS: Our findings underscore the notion that individual differences salient in the education system (e.g., learning disabilities, school dropout) need to be integrated into conceptual models of injury risk among young workers.

Course, diagnosis, and treatment of depressive symptomatology in workers following a workplace injury: a prospective cohort study.

OBJECTIVES: To estimate prevalence, incidence, and course of depressive symptoms and prevalence of mental health treatment following a workplace injury, and to estimate the association between depressive symptoms and return-to-work (RTW) trajectories. METHOD: In a prospective cohort study, workers filing a lost-time compensation claim for a work-related musculoskeletal disorder of the back or upper extremity were interviewed 1 month (n = 599) and 6 months (n = 430) postinjury. A high level of depressive symptoms was defined as 16 or more on the self-reported Center for Epidemiologic Studies-Depression (CES-D) Scale. The following estimates are reported: prevalence of high depressive symptom levels at 1 and 6 months postinjury; incidence, resolution, and persistence of high depressive symptom levels between 1 and 6 months; and prevalence of self-reported mental health treatment and depression diagnosis at 6 months postinjury. RESULTS: Prevalence of high depressive symptom levels at 1 month and 6 months postinjury were 42.9% (95% CI 38.9% to 46.9%) and 26.5% (95% CI 22.3% to 30.7%), respectively. Among participants reporting high depressive symptom levels at 1 month postinjury, 47.2% (95% CI 39.9% to 54.5%) experienced a persistence of symptoms 6 months postinjury. By 6 months, 38.6% of workers who never returned to work or had work disability recurrences had high depressive symptom levels, compared with 17.7% of those with a sustained RTW trajectory. At 6-month follow-up, 12.9% (95% CI 5.8% to 20.1%) of participants with persistently high depressive symptom levels self-reported a depression diagnosis since injury and 23.8% (95% CI 14.7% to 32.9%) were receiving depression treatment. CONCLUSIONS: Depressive symptoms are pervasive in workers with musculoskeletal injuries, but transient for some, and seldom diagnosed as depression or treated.

The role of educational level and job characteristics on the health of young adults.

The mediating effect of job characteristics in the socioeconomic status (SES)-health relationship has not been well studied in the young adult population. The early health trajectory is important to study since the health trajectories of young people shape their health in later years. The purpose of this study was to determine whether the education defined SES-health relationship is mediated through job characteristics, controlling for healthy lifestyle factors in young adults. We hypothesize that accounting for differences in job quality would reduce the education-health gradient. Using a sample of 10,215 Canadian workers aged 20-29 years, we used multivariable logistic regressions to examine the associations of sociodemographic, work, and lifestyle factors with two health outcomes, self-perceived health and work-related injury. The key findings indicate that job characteristics partly explain the education gradient observed in work-related injuries, and to a lesser extent in self-perceived health for working young adults. Our results show that increased physical exertion and working in sales and service or manual occupations were job characteristics which were independently associated with work-related injuries, while low work-related social support and irregular shift work were associated with poor self-perceived health. Lifestyle factors have a greater association with the education-self-perceived health relationship. This pattern of findings suggests that work factors related to education have a more specific effect on occupational health early in the health trajectory. These findings have potential practical implications since policies to reduce poor health must be targeted at appropriate age groups, as workers need to be healthy in their younger years in order to stay in the workforce as they age.

The relationship between job tenure and work disability absence among adults: a prospective study.

Little population-based, prospective research has been conducted to examine the demographic and work-related determinants of occupational injury or illness. This study examined the relative contribution of sociodemographic characteristics and work factors to the likelihood of a work-related disability or illness. In a representative sample of adult Canadians 25-70 years old from a prospective survey, a hazard modelling approach of time to work disability absence from the start of a new job was estimated with the following predictors: age, gender, type of job (manual, non-manual, and mixed), hours worked, highest education achieved, multiple concurrent job, job tenure, school activity, union membership and living in a rural or urban area. Workers holding manual or mixed jobs and having a low education level were factors independently associated with the increased likelihood of a work disability absence. Gender was not independently associated with work disability absences. A strong job tenure gradient in the unadjusted work disability absence rates was virtually eliminated when controlling for demographic/individual and other work factors. In multivariate analyses, work-related factors remained predictors of work disability absence whereas individual characteristics such as gender did not. The exception was workers with less education who appeared to be particularly vulnerable, even after controlling of physical demands on the job. This may be due to inadequate job training or increased hazard exposure even in the same broad job category.

Educational status and work injury among young people: refining the targeting of prevention resources.

OBJECTIVES: To examine the risk of work injuries among young workers out of school compared to those working while still in school. METHODS: The 12,506 fifteen to twenty-four year old workers were part of a national survey that used a multi-staged, stratified sampling procedure. Respondents were divided into four groups based on current school activity (i.e., out of school vs. in school) and educational level (i.e., not having completed high school vs. completed high school). A multivariate logistic regression was conducted using a weighted bootstrap method for variance estimation on occurrence of a work injury that was medically attended. RESULTS: Those young workers out of school and not having completed high school (8.2 per 100 full-time equivalents [FTEs]) and those out of school with a high school degree (5.1 per 100 FTEs) had higher unadjusted rates of work injuries compared to those workers in school not having completed high school (3.1 per 100 FTEs) or those in school with a high school degree (2.7 per 100 FTEs). These differences persisted in a multivariate regression with demographic and work-related covariates included. In addition, young people out of school reported a different work environment as evidenced by decreased social support at work. CONCLUSIONS: The elevated injury risk of young workers out of school suggests that school-based work safety education programs need to be supplemented with other prevention strategies that improve the fit between these young workers' experience and capabilities and the work environment.

Employment patterns and work injury experience among Canadian 12 to 14 year olds.

BACKGROUND: Work participation is a common activity for young adolescents. Yet it may impact upon other aspects of their lives and their health. We sought to provide some of the first Canadian population-based estimates of 12 to 14 year olds' employment and work injury experiences, a group typically excluded from labour force statistics. METHODS: Secondary data analysis of school-based surveys in Ontario (ON) in 2003 and British Columbia (BC) in 2005. Questions provided information on participation in formal and informal work during the school year, number of hours worked, and the occurrence of a medically attended work injury for students 12 to 14 years old. Different sampling strategies were accounted for in the analyses, including the calculation of 95% confidence intervals (CI) on prevalence estimates. RESULTS: Overall, 52.9% (95% CI 48.7-57.1) of ON and 41.5% (39.7-43.3) of BC 12 to 14 year olds reported working during the school year. Mean hours per week ranged from 3.3 (2.5-4.0) among Ontario 12 year olds engaged in non-formal work up to 11.7 (10.0-13.3) among British Columbia 14 year olds engaged in formal work. Work injuries were reported by 6% (4.0-8.9) of ON young workers and 3.5% (2.6-4.8) of BC workers. INTERPRETATION: Our findings point to the active presence of young adolescents in the labour market. Systematic approaches to active surveillance of work participation and work health and safety for young adolescents across Canada should be developed. Differences in work injury patterns by province may be worthy of further investigation.

Examining occupational health and safety vulnerability among Canadian workers with disabilities.

OBJECTIVE: To compare workers with and without disabilities on their reported workplace hazard exposure and the presence of occupational health and safety vulnerability factors. METHODS: Working-aged adults in Ontario or British Columbia were recruited to participate in a cross-sectional survey (n = 1988). Self-reported measures included demographic factors, work-related variables, perceived level of activity limitation at work, and presence of work safety vulnerability factors utilizing a novel framework. RESULTS: Reporting a disability at work was significantly associated with greater hazard exposure than those without a disability. In addition, those reporting a disability at work were more likely to be employed in conditions where hazard exposure was combined with inadequate policies and procedures, or hazard exposures were combined with inadequate empowerment. CONCLUSIONS: Work safety vulnerability is one way that health inequalities can be perpetuated even among those with disabilities who have found work. Our results suggest that employers and policy makers need to focus on assessing and addressing hazard exposures and targeting occupational health and safety resources in the workplace in a way that includes workers with disabilities. Implications for Rehabilitation Workers with disabilities experience greater hazard exposure than those without a disability. Those with moderate and severe disabilities reported occupational health and safety vulnerability, suggesting that workplace accommodations should be available to a broader range of disability levels. It appears that, above and beyond standard safety procedures, providing workplace accommodations for people with disabilities may further reduce their hazard exposure and improve their safety.

Antecedents of work disability absence among young people: a prospective study.

PURPOSE: This study examined the relative contribution of individual factors, job characteristics, and temporal factors to the likelihood of lost days of work due to a work-related disability or illness among Canadians 16 to 24 years old. METHODS: Using a prospective Canadian survey with up to 6 years of follow-up, the job-based analyses included 45,125 job episodes generated from a representative sample of young workers. A hazard model on work disability absence included the following predictors: age, gender, physical demands of the job (manual, nonmanual, and mixed), hours worked, highest education achieved, multiple concurrent job, job tenure, school activity, and living in a rural or urban area. RESULTS: The overall 1-week work disability absence rate was 0.78 per 1000 person-months. In the multivariate model, young workers holding manual jobs were 2.65 times more likely to have a work disability absence compared with young workers with nonmanual jobs. Also, those with less than a high school education were almost 3 times more likely to have a work disability absence. Other demographic factors such as gender were not independently associated with work disability absences. CONCLUSIONS: This prospective study finds that job characteristics are the predominant risk factors for work disability absences for young workers. Young workers with less education appear to be particularly vulnerable, possibly because of inadequate job skills or particularly dangerous job tasks.

Non-agricultural work injuries among youth: a systematic review.

BACKGROUND: To systematically review the quantitative literature on factors associated with youth non-agricultural work injury. METHODS: Seven electronic databases were searched for studies published between 1980 and 2005. In addition, reference lists from each potentially eligible study were checked and experts in the field contacted for additional studies. Studies had to meet relevance and quality appraisal criteria. RESULTS: Nine cross-sectional studies using multivariate analyses met the inclusion and quality appraisal criteria. This best evidence synthesis found that work injury varied significantly with job and workplace factors such as hazard exposure and perceived work overload. Visible minority status was also associated with likelihood of a work injury. The lack of youth work injury studies assessing the following factors was also identified: physical and cognitive development, safety training, supervision, social environment of the workplace, and intervention studies. CONCLUSIONS: This review has potential implications for prevention of work injuries. First, interventions need to target modifiable risk factors. This systematic review pointed to two job/workplace factors that are potentially modifiable: hazard exposure and work pace pressure. Second, the multiple determinants of work injury highlight the need to develop interventions and policies that focus on multiple factors rather than one-dimensional approaches that target a specific factor.

Association between the decline in workers' compensation claims and workforce composition and job characteristics in Ontario, Canada.

We examined associations between workforce demographics and job characteristics, grouped by industrial sector, and declines in workers' compensation claim rates in Ontario, Canada, between 1990 and 2003. Gender, age, occupation, and job tenure were predictors for claim rates in 12 industrial sectors. The decline in claims was significantly associated with a decline in the proportion of employment in occupations with high physical demands. These findings should generate interest in economic incentives and regulatory policies designed to encourage investment in safer production processes.

Work disability absence among young workers with respect to earnings losses in the following year.

OBJECTIVES: The primary objective of this study was to evaluate the earnings losses that young workers experience in the year after a work disability absence. METHODS: The sample consisted of workers aged 16 to 24 years from a longitudinal survey of a representative sample of Canadians. Young workers who lost > or =5 days of work due to work disability or illness (ie, work disability absence) were matched to uninjured controls on the basis of age, gender, preabsence earnings, and student status. This matching procedure resulted in 173 cases and 795 controls. The outcome measure was the difference in earnings the year after the work disability episode between injured cases and their uninjured controls. RESULTS: An analysis of variance indicated that young workers experiencing a work disability absence had significantly fewer earnings than their controls in the year after the absence (P<0.05). This earnings loss was not due to between-group differences in school activity or workhours in the year after the work absence. CONCLUSIONS: No study to date has estimated the impact of work-related disability on earnings trajectories among young workers. The findings of the present study indicate that earnings losses can occur among young workers even during their transition into the labor market. Documenting the economic impacts of work injuries early in one's worklife can provide information for policy debates on the allocation of resources to control workplace hazards where teenagers and young adults work and debates on the determination of fair and adequate benefits for young workers.

An ecological study of regional variation in work injuries among young workers.

BACKGROUND: The investigation of geographic variation in occupational injuries has received little attention. Young workers 15 to 24 years are of particular concern because they consistently show elevated occupational injury rates compared to older workers. The present study sought to: (a) to describe the geographic variation of work injuries; (b) to determine whether geographic variation remained after controlling for relevant demographic and job characteristics; (c) to identify the region-level factors that correlate with the geographic variation. METHODS: Using workers compensation claims and census data, we estimated claim rates per 100 full-time equivalents for 15 to 24 year olds in 46 regions in Ontario. A total of 21 region-level indicators were derived primarily from Census and Labour Force Survey data to reflect social and material deprivation of the region as well as demographic and employment characteristics of youth living in those areas. RESULTS: Descriptive findings showed substantial geographic variation in young worker injury rates, even after controlling for several job and demographic variables. Region-level characteristics such as greater residential stability were associated with low work injury rates. Also, regions with the lowest claim rates tended to have proportionally fewer cuts and burns than high-claim-rate regions. CONCLUSION: The finding of substantial geographic variation in youth claim rates even after controlling for demographic and job factors can aid in targeting prevention resource. The association between region-level indicators such as residential stability and youth work injury suggests that work injury prevention strategies can be integrated with other local economic development measures. The findings partially support the notion that work safety measures may be unevenly distributed with respect to regional socio-economic factors.