The Nature of Employment in a High Socio-economic Hardship Community: Data from the Greater Lawndale Healthy Work Survey.

OBJECTIVES: This cross-sectional survey aimed to examine employment characteristics and their associations with employment precarity in two high socio-economic hardship Chicago neighborhoods. METHODS: We used a community-based participatory approach to develop and administer a survey to residents who perceived their work situations to be precarious. RESULTS: 489 residents were surveyed. Responses were skewed towards the most precarious work situations, with the majority of respondents employed outside of a traditional arrangement. Those in the highest precarity category were most likely to identify as Latinx and born outside of the United States. Unstable, low quality employment conditions were nearly all significantly associated with highest precarity work situations. CONCLUSIONS: Precarious employment is an important predictor of other employment conditions, and characterizing these at a hyperlocal level allows for a nuanced understanding of work as a determinant of health.

Employment Precarity and Increased Risk of Hazardous Occupational Exposures Among Residents of High Socioeconomic Hardship Neighborhoods.

BACKGROUND: While there is evidence that workers in nonstandard employment arrangements are disproportionately exposed to recognized occupational hazards, existing studies have not comprehensively examined associations between employment precarity and exposure to occupational hazards for these workers in the USA. The aim of this study was to examine relationships between employment precarity and occupational hazards in two contiguous high socio-economic hardship neighborhoods in Chicago. METHODS: Using a community-based participatory research approach, community researchers administered a community-developed survey to 489 residents of Greater Lawndale who reported current or recent employment in a job that met at least one characteristic of precarious employment (e.g. unpredictable schedule, insecure work, no living wage/benefits). Employment precarity was calculated using a modified version of the Employment Precarity Index (EPI) developed by the Poverty and Employment Precarity in Southern Ontario group. We modeled the association between employment precarity and occupational exposures using logistic regression models. RESULTS: We identified a high prevalence of precarious employment in this sample, as well as a high prevalence of self-reported exposure to recognized occupational hazards. Increases in relative employment precarity were significantly associated with self-reported exposure to chemical and biological hazards, physical hazards, and slip, trip, strike, fall, trap or crush hazards at work. CONCLUSIONS: Results highlight the importance of using community research approaches and robust measures of employment characteristics, such as the EPI, to evaluate associations between employment precarity and hazardous exposures. These results suggest that variability in employment situations and resultant relative employment precarity are important predictors of exposure to recognized occupational hazards. Findings also suggest that health inequities observed among precariously employed workers may be partly explained by increased risk for exposure to occupational hazards, which has implications for community health and should be investigated in future longitudinal research.

Community Resident Perceptions of and Experiences with Precarious Work at the Neighborhood Level: The Greater Lawndale Healthy Work Project.

Work is a key social determinant of health. Community health and well-being may be impacted in neighborhoods with high proportions of people engaged in precarious work situations compounded by health inequities produced by other social determinants associated with their residential geography. However, little is known about how community residents experience work at the neighborhood level nor how work impacts health at the community-level, particularly in communities with a high proportion of residents engaged in precarious work. We sought to understand, through participatory research strategies, how work is experienced at the community level and to identify community interventions to establish a culture of healthy work. As part of a mixed-methods community health assessment, community researchers conducted focus groups with residents in two high social and economic hardship neighborhoods on Chicago's southwest side. Community and academic researchers engaged in participatory data analysis and developed and implemented member-checking modules to engage residents in the data interpretation process. Twelve focus group discussions (77 community resident participants) were completed. Three major themes emerged: systematic marginalization from the pathways to healthy work situations; contextual and structural hostility to sustain healthy work; and violations in the rights, agency, and autonomy of resident workers. Findings were triangulated with findings from the concept-mapping research component of the project to inform the development of a community health survey focused on work characteristics and experiences. Listening to residents in communities with a high proportion of residents engaging in precarious work allows for the identification of nuanced community-informed intervention points to begin to build a culture of healthy work.

Community daytime noise pollution and socioeconomic differences in Chicago, IL.

Environmental noise may affect hearing and a variety of non-auditory disease processes. There is some evidence that, like other environmental hazards, noise may be differentially distributed across communities based on socioeconomic status. We aimed to a) predict daytime noise pollution levels and b) assess disparities in daytime noise exposure in Chicago, Illinois. We measured 5-minute daytime noise levels (Leq, 5-min) at 75 randomly selected sites in Chicago in March, 2019. Geographically-based variables thought to be associated with noise were obtained, and used to fit a noise land-use regression model to estimate the daytime environmental noise level at the centroid of the census blocks. Demographic and socioeconomic data were obtained from the City of Chicago for the 77 community areas, and associations with daytime noise levels were assessed using spatial autoregressive models. Mean sampled noise level (Leq, 5-min) was 60.6 dBA. The adjusted R2 and root mean square error of the noise land use regression model and the validation model were 0.60 and 4.67 dBA and 0.51 and 5.90 dBA, respectively. Nearly 75% of city blocks and 85% of city communities have predicted daytime noise level higher than 55 dBA. Of the socioeconomic variables explored, only community per capita income was associated with mean community predicted noise levels, and was highest for communities with incomes in the 2nd quartile. Both the noise measurements and land-use regression modeling demonstrate that Chicago has levels of environmental noise likely contributing to the total burden of environmental stressors. Noise is not uniformly distributed across Chicago; it is associated with proximity to roads and public transportation, and is higher among communities with mid-to-low incomes per capita, which highlights how socially and economically disadvantaged communities may be disproportionately impacted by this environmental exposure.

Attitudes and behaviors of chiropractic interns toward occupational history taking.

OBJECTIVE: This study uses a pre- and post-training program evaluation of chiropractic interns to (1) describe changes in their frequency of occupational history taking before and after a 1-hour training and (2) to document the attitudes and beliefs regarding occupational health and history taking. METHODS: All chiropractic interns at 1 clinic location completed questionnaires assessing their attitudes and perceptions regarding documenting the occupational history of their patients each trimester they were enrolled in the study. Each intern enrolled in the study for 2 or more trimesters participated in a 1-hour-long training session on taking an occupational history. The supervising clinician independently evaluated charting behaviors of interns for the duration of the study. RESULTS: The supervising clinician assessed 20 interns' level of documenting occupational history for 202 new patient or reexamination visits. A majority of interns (85% at baseline) were interested in occupational health, and 80% believed that occupational history taking was "very important." Intern charting behaviors increased after training related to documentation of past occupation (62.9% from 32.4%) and relating the chief complaint to work (59.7% from 30.0%). Detailed occupational history taking remained low throughout the study but demonstrated a doubling in documentation after training (16.1% from 8.6%). CONCLUSION: Chiropractic interns and clinicians should be adequately trained in occupational health history documentation practices as they are likely to care for work-related injuries. Short training modules appear to be effective in demonstrating small changes in documentation related to occupational history taking.

Impact of precarious work on neighborhood health: Concept mapping by a community/academic partnership.

OBJECTIVE: As part of community-based participatory research (CBPR) examining precarious employment and community health, academic, and community researchers used concept mapping to explore how residents in two high hardship neighborhoods perceive the impact of work on health. METHODS: Between January and May 2017, 292 individuals who lived or worked in two contiguous Chicago neighborhoods were engaged in brainstorming, sorting, and rating activities. Multidimensional scaling and hierarchical cluster analysis were applied, and findings were interpreted by a community-academic partnership. RESULTS: Brainstorming resulted in 55 unique ways that work impacts health, each of which was rated on its perceived impact on health and prevalence in the neighborhood. Four major themes emerged: Healthy Aspects of Work, Systemic/Structural Injustices, Lack of Control/Exploitation, and Psychological/Physical Stress, which was a multidimensional, cross-cutting theme. CONCLUSION: These findings provide critical insight into community perceptions of the mechanisms by which work influences health, providing a basis for community-driven, sustainable, work-focused interventions that promote community health.

Needs Assessment for a Comprehensive Reemployment Program Among Residents of a Work Rehabilitation Program for Individuals With Unstable or Lack of Housing.

OBJECTIVE: Individuals in transitional housing programs often have a goal of reaching stable employment, but the unique needs and barriers for achieving this warrants further study. METHODS: A structured interview guide was administered orally and descriptive data analysis was done for this exploratory mixed-methods study. RESULTS: Commonly reported reemployment challenges included legal barriers and unmet transportation, housing, and financial needs. More than two-thirds of residents reported no place to live after the program regardless of if they had previous precarious housing. Emerging themes included challenges regarding sufficient time for the transition to being employed, fear of relapse, and lack of long-term goals and planning. CONCLUSIONS: Findings suggest that residential rehabilitation programs are an important resource. While these programs tend to focus on reemployment, their services could be enhanced by assessing individual needs and allowing for variation in reemployment preparation.

Understanding the Role of Academic Partners as Technical Assistance Providers: Results from an Exploratory Study to Address Precarious Work.

Universities may be well poised to support knowledge, skill, and capacity-building efforts to foster the development of multi-level interventions to address complex problems. Researchers at the University of Illinois at Chicago (UIC) engaged organizations interested in developing policy- and systems-level initiatives to address the drivers of precarious work in a six-meeting Action Learning (AL) process, in which the researchers served as technical assistance (TA) providers focused on facilitating learning and promoting critical thinking among participants. This exploratory qualitative study examined the role, facilitators, challenges, and impacts of university facilitation in this context. A total of 22 individuals participated in this study, including UIC TA providers, content expert TA providers from labor-focused organizations, and TA recipients from health-focused organizations. Results from interviews and a focus group highlight the utility of a university connecting organizations from different disciplines that do not traditionally work together, and suggest that the TA provided by UIC helped participants think concretely about precarious work and ways in which their organizations might work collaboratively to bring about sustainable change. Findings from this study suggest that university facilitation using an AL approach may be effective in increasing knowledge to action.

Characterization of size-specific particulate matter emission rates for a simulated medical laser procedure--a pilot study.

Prior investigation on medical laser interaction with tissue has suggested device operational parameter settings influence laser generated air contaminant emission, but this has not been systematically explored. A laboratory-based simulated medical laser procedure was designed and pilot tested to determine the effect of laser operational parameters on the size-specific mass emission rate of laser generated particulate matter. Porcine tissue was lased in an emission chamber using two medical laser systems (CO2, λ = 10,600 nm; Ho:YAG, λ = 2100 nm) in a fractional factorial study design by varying three operational parameters (beam diameter, pulse repetition frequency, and power) between two levels (high and low) and the resultant plume was measured using two real-time size-selective particle counters. Particle count concentrations were converted to mass emission rates before an analysis of variance was used to determine the influence of operational parameter settings on size-specific mass emission rate. Particle shape and diameter were described for a limited number of samples by collecting particles on polycarbonate filters, and photographed using a scanning electron microscope (SEM) to examine method of particle formation. An increase in power and decrease in beam diameter led to an increase in mass emission for the Ho:YAG laser at all size ranges. For the CO2 laser, emission rates were dependent on particle size and were not statistically significant for particle ranges between 5 and 10 µm. When any parameter level was increased, emission rate of the smallest particle size range also increased. Beam diameter was the most influential variable for both lasers, and the operational parameters tested explained the most variability at the smallest particle size range. Particle shape was variable and some particles observed by SEM were likely created from mechanical methods. This study provides a foundation for future investigations to better estimate size-specific mass emission rates and particle characteristics for additional laser operational parameters in order to estimate occupational exposure, and to inform control strategies.

Comparing written programs and self-reported respiratory protection practices in acute care hospitals.

Airborne biological hazards in hospitals require the use of respiratory protection. A well-implemented respiratory protection program can protect health care workers from these exposures. This study examines the relationship between written respiratory programs and reported practices in health care settings. Twenty-eight hospitals in Illinois and Minnesota were recruited to a study of respiratory protection programs and practices in acute care settings. Interviews were conducted with hospital managers, unit managers, and health care workers from departments where respirators are commonly required. Each hospital's written respiratory protection program was scored for the 11 elements required by the Occupational Safety and Health Administration (OSHA), using a standardized tool, for a maximum possible score of 22 (2 pts. per element). Twenty interview questions associated with program practices were also scored by percent correct responses. Written program scores ranged from 2-17 with an average of 9.2. Hospital and unit managers scored on average 82% and 81%, respectively, when compared to the OSHA standard; health care workers scored significantly lower, 71% (p < 0.001). Minnesota written program scores were not significantly higher than Illinois hospitals (p = 0.16), while all Illinois survey respondents scored higher than those in Minnesota (p < 0.001). There was no trend between written programs and interview responses. Written respiratory protection programs in the study sites did not provide the level of detail required OSHA. Interview responses representing hospital practices surrounding respiratory protection indicated that hospitals were aware of and following regulatory guidelines.

Evaluation of Minnesota and Illinois hospital respiratory protection programs and health care worker respirator use.

The objective of this study was to assess respiratory protection programs for aerosol-transmissible diseases in acute care hospitals for conformance with regulatory requirements and public health guidelines. Twenty-eight representative hospitals were selected by size, location, and ownership in Minnesota and Illinois. Interviews were conducted with 363 health care workers and 171 managers from high-risk departments. Written programs from each hospital were reviewed for required elements. Seventy-seven health care workers were observed donning and doffing a FFR. The most serious deficiency in many written programs was failure to identify a program administrator. Most written programs lacked adequate details about medical evaluation, fit-testing, and training and did not include a comprehensive risk assessment for aerosol transmissible diseases; tuberculosis was often the only pathogen addressed. Employees with the highest probability of tuberculosis exposure were most likely to pick a respirator for close contact, but higher levels of respiratory protection were rarely selected for aerosol-generating procedures. Surgical masks were most commonly selected for close contact with droplet disease- or influenza-infected patients; better protection (e.g., respirator) was rarely selected for higher-risk exposures. Most of the observed health care workers had access to a NIOSH-certified N95 FFR, properly positioned the facepiece, and formed the nose clip. The most frequent deficiencies were failure to correctly place straps, perform a user seal check, and remove the respirator using straps.

Occupational stress and subclinical atherosclerosis: a systematic review.

BACKGROUND: Stress is a common hazard in the work environment and is associated with multiple adverse health effects. The association between work-related stress (WRS) and cardiovascular disease has been established in a number of epidemiological studies. METHODS: A systematic review was conducted according to the PRISMA statement of the English literature involving WRS and carotid artery intima media thickness (CIMT). RESULTS: Four cohorts and six cross-sectional studies of occupational stress and CIMT were identified. All cohorts and five of the cross-sectional studies reported a significant positive association, while one reported an inverse association of WRS and CIMT. DISCUSSION: The weight of the evidence that we were able to identify suggests that occupational stress results in an increased risk of atherosclerosis, assessed via CIMT. Studies that include longitudinal measures of stress and intermediate cardiac endpoints, with adequate accounting for confounders, are needed. Interventional studies should also be conducted to determine whether CIMT progression can be prevented with workplace stress reduction.

Respiratory disease mortality among US coal miners; results after 37 years of follow-up.

OBJECTIVES: To evaluate respiratory related mortality among underground coal miners after 37 years of follow-up. METHODS: Underlying cause of death for 9033 underground coal miners from 31 US mines enrolled between 1969 and 1971 was evaluated with life table analysis. Cox proportional hazards models were fitted to evaluate the exposure-response relationships between cumulative exposure to coal mine dust and respirable silica and mortality from pneumoconiosis, chronic obstructive pulmonary disease (COPD) and lung cancer. RESULTS: Excess mortality was observed for pneumoconiosis (SMR=79.70, 95% CI 72.1 to 87.67), COPD (SMR=1.11, 95% CI 0.99 to 1.24) and lung cancer (SMR=1.08; 95% CI 1.00 to 1.18). Coal mine dust exposure increased risk for mortality from pneumoconiosis and COPD. Mortality from COPD was significantly elevated among never [corrected] smokers and former smokers (HR=1.84, 95% CI 1.05 to 3.22; HRK=1.52, 95% CI 0.98 to 2.34, respectively) but not current smokers (HR=0.99, 95% CI 0.76 to 1.28). Respirable silica was positively associated with mortality from pneumoconiosis (HR=1.33, 95% CI 0.94 to 1.33) and COPD (HR=1.04, 95% CI 0.96 to 1.52) in models controlling for coal mine dust. We saw a significant relationship between coal mine dust exposure and lung cancer mortality (HR=1.70; 95% CI 1.02 to 2.83) but not with respirable silica (HR=1.05; 95% CI 0.90 to 1.23). In the most recent follow-up period (2000-2007) both exposures were positively associated with lung cancer mortality, coal mine dust significantly so. CONCLUSIONS: Our findings support previous studies showing that exposure to coal mine dust and respirable silica leads to increased mortality from malignant and non-malignant respiratory diseases even in the absence of smoking.

Concentration and emission of airborne contaminants in a laboratory animal facility housing rabbits.

Characterization of animal housing conditions can determine the frequency of bedding and cage changes, which are not standardized from facility to facility. Rabbits produce noticeable odors, and their excreta can scald and stain cages. Our facility wanted to document measurable airborne contaminants in a laboratory rabbit room in which excreta pans were changed weekly and cages changed biweekly. Contaminants included particulate, endotoxin, ammonia, carbon dioxide, and a rabbit salivary protein as a marker for rabbit allergen. Concentrations were measured daily over a 2-wk period in a laboratory animal facility to determine whether they increased over time and on days considered to be the dirtiest. Except for ammonia, concentrations of all airborne contaminants did not differ between clean and dirty days. Concentrations were lower than occupational health exposure guidelines for all contaminants studied, including ammonia. After measurement of concentration, a model was applied to calculate mean emission factors in this rabbit room. Examples of emission factor utilization to determine airborne contaminant concentration in rabbit rooms under various environmental conditions and housing densities are provided.

Personal dust exposures at a food processing facility.

A field study was performed to quantify personal dust exposures at a food processing facility. A review of the literature shows very little exposure information in the food processing industry. The processing area consisted of a series of four rooms, connected by a closed-loop ventilation system, housed within a larger warehouse-type facility. Workers were exposed to various fruit and vegetable dusts during the grinding, sieving, mixing and packaging of freeze-dried or air-dried products. Eight two-hour periods were monitored over two days. Personal total suspended particulate samples were collected on 37 mm PVC filters with 5 microm pore size according to National Institute for Occupational Safety and Health (NIOSH) Method 0500. The filters were analyzed gravimetrically. The two-hour task sampling personal dust exposures ranged from 0.33-103 mg/m3. For each worker, an eight-hour time weighted average (TWA) concentration was calculated, and these ranged from 3.08-59.8 mg/m3. Although there are no directly appropriate occupational exposure limits that may be used for comparison, we selected the Threshold Limit Value (TLV) for particulates not otherwise classified (PNOC) of 10 mg/m3 for inhalable particles. Neglecting the respiratory protection used, five out of eight of the worker time-weighted averages exceeded the TLV. It should be noted that the TLV is based on the inhalable fraction and in this study total suspended particulate was measured; additionally, the TLV is applicable for dusts that are insoluble or poorly soluble, and have low toxicity, which may have limited protective ability in this case due to the irritant nature of certain dusts (e.g., jalapeno peppers, aloe vera). Sieving resulted in significantly higher exposure than grinding and blending. Measuring area concentrations alone in this environment is not a sufficient method of estimating personal exposures due to work practices for some operations.