The Healthy Work Survey: A Standardized Questionnaire for the Assessment of Workplace Psychosocial Hazards and Work Organization in the United States.

OBJECTIVES: Work-related psychosocial stressors have been recognized as occupational hazards and assessed in workplaces in many countries for decades. Identifying tools to measure work-related psychosocial hazards to increase awareness in the United States about the impact on employees' health and safety is critical ( J Occup Environ Med. 2021;63:e245-e249). METHODS: We describe the development and psychometric validation of an online tool, the Healthy Work Survey, utilizing items from the National Institute for Occupational Safety and Health Quality of Work Life questionnaire. RESULTS: There are 55 items in the final core work section of the HWS. Factor analyses confirmed nine factors, and the subsequent multi-item scales had acceptable internal consistency. A user-friendly, online system and automated report compares individual's and organization's scores to distributions from a representative US working population (General Social Survey Quality of Work Life). DISCUSSION: The HWS is a reliable, valid tool for organizations and individuals to assess psychosocial work hazards.

Evaluation of workplace opioid prevention and response training for union and employer instructors and leadership.

OBJECTIVE: Opioids and the Workplace Prevention and Response (OWPR) Train-the-Trainer (TTT) and Leadership programs were piloted to improve trainees' abilities to conduct opioid awareness training and to introduce policies and programs in their workplaces. METHODS: The TTT (N = 54) and Leadership (N = 19) pilot trainees were administered voluntary pre- and post-training surveys and observed for discussion on knowledge and confidence regarding teaching and on workplace policies and workplace injury prevention related to opioids. RESULTS: Percentage agreement with correct responses for all TTT and 10 out of 14 (71.4 percent) Leadership knowledge and confidence questions increased significantly from pre- to post-test. CONCLUSION: We found some evidence that the OWPR TTT and Leadership training programs and materials were effective in improving trainee's abilities to conduct opioid awareness training and to introduce policies and programs to address opioids and the workplace.

Improving Awareness of Workplace Opioid Use and Addiction Prevention: A Train-the-Trainer Approach.

BACKGROUND: The National Institute of Environmental Health Sciences Worker Training Program developed instructor curriculum, a training tool, and materials to prepare trainees to conduct opioids workplace awareness training. Opioids and the Workplace Prevention and Response (OWPR) Train-the-Trainer (TTT) courses were held during three instructor-led online programs. METHODS: The OWPR TTT was evaluated using an online pre- and posttest among registered participants, and an assessment of discussion among trainees during the training program. RESULTS: A total of 31 pretests and 24 posttests were completed for the three TTT courses conducted. Quantitative and qualitative data complemented each other in supporting the conclusion that the training achieved intended objectives. CONCLUSION/APPLICATIONS TO PRACTICE: The evaluation illustrated that the training was effective in increasing knowledge and confidence in conducting awareness training on opioid use and addiction prevention.

Recognizing careworkers' contributions to improving the social determinants of health: A call for supporting healthy carework.

Workers engaged in reproductive labor-the caring work that maintains society and supports its growth-contribute to societal health while also enduring the harms of precarious labor and substantial work stress. How can we conceptualize the effects of reproductive labor on workers and society simultaneously? In this commentary, we analyze four types of more relational and less relational careworkers-homeless shelter workers, school food workers, home care aides, and household cleaners-during the COVID-19 pandemic. We then make a case for a new model of societal health that recognizes the contributions of careworkers and healthy carework. Our model includes multi-sectoral social policies supporting both worker health and societal health and acknowledges several dimensions of work stress for careworkers that have received insufficient attention. Ultimately, we argue that the effects of reproductive labor on workers and society must be considered jointly, a recognition that offers an urgent vision for repairing and advancing societal health.

Opioids and the Workplace Prevention and Response Train-the-Trainer and Leadership Training Mixed Methods Follow-up Evaluation.

OBJECTIVES: This study was designed to evaluate the outcomes of a national summer 2020 'Opioids and the Workplace' Prevention and Response (OWPR) Train-the-Trainer (TTT) and Leadership training tool and program at 6-month follow-up. The TTT program goal is to help instructors plan and conduct education and training on opioids and the workplace awareness. The Leadership program goal is to help trainees, who are in a position to take organizational level actions, implement policies, and programs related to opioid and substance use and injury prevention. METHODS: Trainees were from various backgrounds, such as labor unions, academic consortiums, health and safety professionals, government, and community organizations. About 6 months following each individual course date a follow-up survey was sent to each available participants' e-mail (n = 53 TTT, n = 28 Leadership) with a response rate of 47.2% for the TTT (n = 25) and 63.2% for Leadership (n = 12). Trainees were asked about individual or workplace level actions taken; any obstacles that prevented them or their coworkers from being involved in or conducting activities; if the OWPR training tool was used in their workplace for a training program; and whether the pandemic impacted their ability to address opioids in the workplace. RESULTS: Among TTT trainees, about half of follow-up survey respondents from the 2020 training reported planning and conducting training and education, reaching out to coworkers to see how they are doing, sharing factsheets and information from the opioid training with coworkers, and re-focusing on self-care. Among Leadership trainees, about two-fifths of follow-up survey respondents from the 2020 training reported sharing factsheets and information from the opioid training. Some trainees described the COVID-19 pandemic as limiting their ability to take actions in addressing opioids and the workplace. CONCLUSIONS: Evidence supports that the 'Opioids and the Workplace' Train-the-Trainer program and materials have contributed to helping trainees plan and conduct opioids awareness training at their organizations. Evidence supports that the Opioids in the Workplace Leadership program helped contribute to trainees taking workplace level actions to implement policies and programs.

Introduction to the Special Issue: Opioids and the Workplace - Risk Factors and Solutions.

The workplace has been a neglected element in the national response to the opioid crisis. This ignores that workplace safety and health and drug policies have become important factors in opioid use disorder among workers. This results from physical or emotional pain related to workplace injuries, illnesses, and stress, and through punitive workplace drug policies, failure to address stigma, and inadequate access to treatment and recovery resources. This comprehensive New Solutions special issue encompasses timely cutting-edge research, commentaries, activism, and calls for action on primary prevention in the workplace and intervention research. It also addresses the convergence of the COVID-19 and the opioid crises, high-risk occupations and industries, health inequalities, employer and union programs, peer advocacy and member assistance programs, worker training, health parity for addiction treatment and recovery services, protection of first responders and site clean-up workers, working conditions of substance use treatment workers, and calls for necessary funding.

Predicting new major depression symptoms from long working hours, psychosocial safety climate and work engagement: a population-based cohort study.

OBJECTIVES: This study sought to assess the association between long working hours, psychosocial safety climate (PSC), work engagement (WE) and new major depression symptoms emerging over the next 12 months. PSC is the work climate supporting workplace psychological health. SETTING: Australian prospective cohort population data from the states of New South Wales, Western Australia and South Australia. PARTICIPANTS: At Time 1, there were 3921 respondents in the sample. Self-employed, casual temporary, unclassified, those with working hours <35 (37% of 2850) and participants with major depression symptoms at Time 1 (6.7% of 1782) were removed. The final sample was a population-based cohort of 1084 full-time Australian employees. PRIMARY AND SECONDARY OUTCOME MEASURES: The planned and measured outcomes were new cases of major depression symptoms. RESULTS: Long working hours were not significantly related to new cases of major depression symptoms; however, when mild cases were removed, the 41-48 and ≥55 long working hour categories were positively related to major depression symptoms. Low PSC was associated with a threefold increase in risk for new major depression symptoms. PSC was not related to long working hours, and long working hours did not mediate the relationship between PSC and new cases of major depression symptoms. The inverse relationship between PSC and major depression symptoms was stronger for males than females. Additional analyses identified that WE was positively related to long working hours. Long working hours (41-48 and ≥55 hours) mediated a positive relationship between WE and major depression symptoms when mild cases of major depression were removed. CONCLUSION: The results suggest that low workplace PSC and potentially long working hours (41-48; ≥55 hours/week) increase the risk of new major depression symptoms. Furthermore, high WE may increase long working hours and subsequent major depression symptoms.

Upper extremity musculoskeletal disorders and work exposures among railroad maintenance-of-way workers.

BACKGROUND: Our objective was to examine occupational risk factors for musculoskeletal disorders of the shoulders, elbows, wrists, and hands among railroad maintenance-of-way (MOW) workers. Little systematic research on musculoskeletal disorders has been conducted in this occupational group. METHODS: In total, 3995 active members of the Brotherhood of Maintenance of Way Employes Division (BMWED) completed a standardized survey focusing on disorders caused by hand-transmitted vibration. We computed adjusted prevalence ratios (aPRs) using Poisson regression for shoulder, elbow, carpal tunnel syndrome, and vibration white finger musculoskeletal symptoms by work exposures, adjusted for age, region, race/ethnicity, smoking, potential second job, and spare time vehicle vibration exposure, and other work exposures. RESULTS: Among active male BMWED members, we found associations between >5.2 years (vs. 0.0-0.7 years) duration of full-time equivalent power tool use and shoulder pain (aPR = 2.01; 95% confidence interval [CI], 1.43-2.85), elbow pain (aPR = 2.88; 95% CI, 1.86-4.46), vibration white finger symptoms (aPR = 2.49; 95% CI, 1.06-5.85), hand/wrist pain (aPR = 2.40; 95% CI, 1.74-3.32), finger numbness or tingling (aPR = 1.86; 95% CI, 1.38-2.50) and self-reported carpal tunnel syndrome diagnosis (aPR = 2.16; 95% CI, 1.24-3.77). Associations were not consistent across outcomes for the duration of non-powered hand tool use and "repeated lifting, pushing, pulling, or bending." Positive gradients were observed for most outcomes. CONCLUSIONS: Hand-arm vibration and some other biomechanical exposures were associated with shoulder, elbow, wrist, hand, and finger symptoms. Prevention programs should address occupational risk factors for upper extremity musculoskeletal disorders among MOW workers.

Opioids and the Workplace Prevention and Response Awareness Training: Mixed Methods Follow-Up Evaluation.

The National Institute of Environmental Health Sciences Worker Training Program piloted an Opioids and the Workplace: Prevention and Response training tool and program in 2019. The pilot trainees (N = 97) were surveyed (n = 27) and interviewed (n = 6) six months posttraining, and those who downloaded the training tool from the Worker Training Program website (n = 87) were surveyed (n = 19) and interviewed (n = 1) two to six months postdownload, to evaluate the impact of the training program. Workplace policy and program-level actions were reported less frequently than individual-level actions by trainees, except for planning and conducting training and education. Barriers to taking actions included not being able to make changes on their own without supervisor support and lack of upper management support and approval. We found some evidence that the Opioids in the Workplace training program and materials contributed to helping workers introduce policies and programs related to opioids within their workplace or union.

Expanding the Conceptualization of Support in Low-Wage Carework: The Case of Home Care Aides and Client Death.

Home care aides are a rapidly growing, non-standard workforce who face numerous health risks and stressors on the job. While research shows that aides receive limited support from their agency employers, few studies have explored the wider range of support that aides use when navigating work stress and considered the implications of these arrangements. To investigate this question, we conducted 47 in-depth interviews with 29 home care aides in New York City, focused specifically on aides' use of support after client death. Theories of work stress, the social ecological framework, and feminist theories of care informed our research. Our analysis demonstrates aides' extensive reliance on personal sources of support and explores the challenges this can create in their lives and work, and, potentially, for their communities. We also document aides' efforts to cultivate support stemming from their home-based work environments. Home care aides' work stress thus emerges as both an occupational health and a community health issue. While employers should carry responsibility for preventing and mitigating work stress, moving toward health equity for marginalized careworkers requires investing in policy-level and community-level supports to bolster employer efforts, particularly as the home care industry becomes increasingly fragmented and non-standard.

Work Characteristics, Body Mass Index, and Risk of Obesity: The National Quality of Work Life Survey.

OBJECTIVES: To examine work characteristics in relation to body mass index (BMI) and risk of obesity. METHODS: We analyzed data from 1150 participants working 20+ h week-1 from the 2014 National NIOSH Quality of Work Life Survey, based on a representative sample of US workers. We used multiple linear regression for BMI and multiple logistic regression for obesity to estimate associations with 19 different work characteristics plus one set of occupational categories controlling for age, gender, race/ethnicity, education, marital status, job physical exertion, and television watching. RESULTS: We found significant positive linear associations between BMI and night shift (versus day shift) schedule (B = 2.28, P = 0.008) and blue-collar (versus management/professional) work (B = 1.75, P = 0.008). Night shift schedule [odds ratio (OR) = 2.19, P = 0.029], sales/office work (OR = 1.55, P = 0.040), and blue-collar work (OR = 2.63, P = 0.006) were associated with increased risk of obesity versus 'healthy weight'. No other statistically significant associations between work characteristics and BMI or obesity were observed. CONCLUSIONS: Night shift schedule and blue-collar work were related to increased BMI and obesity risk in US workers in 2014. Identifying risk factors in blue-collar work and redesigning jobs to reduce those risk factors, and reducing night shift work, could play a role in reducing the prevalence of obesity in the USA.

Job Stress and Health of Elementary and Secondary School Educators in the United States.

Elementary and secondary school educators face many work stressors, which appear to be increasing due to economic, political, and social trends. Therefore, we analyzed data from a 2017 national American Federation of Teachers survey of U.S. education staff, including data from two New York School districts that have adopted collaborative labor-management practices. The national American Federation of Teachers sample of educators reported significantly higher prevalences of several work stressors and poorer physical and mental health compared to the U.S. workers overall, adjusted for age, gender, and race/ethnicity. Compared with educators nationally, educators in districts with collaborative labor-management practices did not have a consistently higher or lower prevalence of work stressors or poorer health. Findings suggest the importance of reducing work stressors among U.S. educators. Results should be interpreted with caution due to the low educator survey response rate.

Powered-hand tools and vibration-related disorders in US-railway maintenance-of-way workers.

Maintenance-of-way workers in North America who construct railroad tracks utilize specialized powered-hand tools, which lead to hand-transmitted vibration exposure. In this study, the maintenance-of-way workers were surveyed about neuro-musculoskeletal disorders, powered-hand tools and work practices. Information about vibration emission data of trade specific powered-hand tools for the North American and European Union markets was searched online to obtain respective user information of manufacturer and compared to non-commercial international data banks. The survey showed that maintenance-of-way workers frequently reported typical hand-transmitted vibration-related symptoms, and appear to be at a risk for neuro-musculoskeletal disorders of the upper extremity. Of all of the powered-hand tools used by this trade, 88% of the selected tools exceeded a=5 m/s2 and were above vibration magnitudes of common tools of other comparable industries. This may create a risk if these tools are used throughout an 8-h work day and management of vibration exposure may be needed. In the North-American market, limited or no vibration emission data is available from manufacturers or distributors. Vibration emission information for powered-hand tools, including vibration emission levels (in m/s2), uncertainty factor K, and the applied testing standard/norm may assist employers, users and occupational health providers to better assess, compare and manage risk.

The effect of exposure to long working hours on ischaemic heart disease: A systematic review and meta-analysis from the WHO/ILO Joint Estimates of the Work-related Burden of Disease and Injury.

BACKGROUND: The World Health Organization (WHO) and the International Labour Organization (ILO) are developing Joint Estimates of the work-related burden of disease and injury (WHO/ILO Joint Estimates), with contributions from a large network of experts. Evidence from mechanistic data suggests that exposure to long working hours may cause ischaemic heart disease (IHD). In this paper, we present a systematic review and meta-analysis of parameters for estimating the number of deaths and disability-adjusted life years from IHD that are attributable to exposure to long working hours, for the development of the WHO/ILO Joint Estimates. OBJECTIVES: We aimed to systematically review and meta-analyse estimates of the effect of exposure to long working hours (three categories: 41-48, 49-54 and ≥55 h/week), compared with exposure to standard working hours (35-40 h/week), on IHD (three outcomes: prevalence, incidence and mortality). DATA SOURCES: We developed and published a protocol, applying the Navigation Guide as an organizing systematic review framework where feasible. We searched electronic databases for potentially relevant records from published and unpublished studies, including MEDLINE, Scopus, Web of Science, CISDOC, PsycINFO, and WHO ICTRP. We also searched grey literature databases, Internet search engines and organizational websites; hand-searched reference lists of previous systematic reviews; and consulted additional experts. STUDY ELIGIBILITY AND CRITERIA: We included working-age (≥15 years) workers in the formal and informal economy in any WHO and/or ILO Member State but excluded children (aged < 15 years) and unpaid domestic workers. We included randomized controlled trials, cohort studies, case-control studies and other non-randomized intervention studies which contained an estimate of the effect of exposure to long working hours (41-48, 49-54 and ≥55 h/week), compared with exposure to standard working hours (35-40 h/week), on IHD (prevalence, incidence or mortality). STUDY APPRAISAL AND SYNTHESIS METHODS: At least two review authors independently screened titles and abstracts against the eligibility criteria at a first stage and full texts of potentially eligible records at a second stage, followed by extraction of data from qualifying studies. Missing data were requested from principal study authors. We combined relative risks using random-effect meta-analysis. Two or more review authors assessed the risk of bias, quality of evidence and strength of evidence, using Navigation Guide and GRADE tools and approaches adapted to this project. RESULTS: Thirty-seven studies (26 prospective cohort studies and 11 case-control studies) met the inclusion criteria, comprising a total of 768,751 participants (310,954 females) in 13 countries in three WHO regions (Americas, Europe and Western Pacific). The exposure was measured using self-reports in all studies, and the outcome was assessed with administrative health records (30 studies) or self-reported physician diagnosis (7 studies). The outcome was defined as incident non-fatal IHD event in 19 studies (8 cohort studies, 11 case-control studies), incident fatal IHD event in two studies (both cohort studies), and incident non-fatal or fatal ("mixed") event in 16 studies (all cohort studies). Because we judged cohort studies to have a relatively lower risk of bias, we prioritized evidence from these studies and treated evidence from case-control studies as supporting evidence. For the bodies of evidence for both outcomes with any eligible studies (i.e. IHD incidence and mortality), we did not have serious concerns for risk of bias (at least for the cohort studies). No eligible study was found on the effect of long working hours on IHD prevalence. Compared with working 35-40 h/week, we are uncertain about the effect on acquiring (or incidence of) IHD of working 41-48 h/week (relative risk (RR) 0.98, 95% confidence interval (CI) 0.91 to 1.07, 20 studies, 312,209 participants, I2 0%, low quality of evidence) and 49-54 h/week (RR 1.05, 95% CI 0.94 to 1.17, 18 studies, 308,405 participants, I2 0%, low quality of evidence). Compared with working 35-40 h/week, working ≥55 h/week may have led to a moderately, clinically meaningful increase in the risk of acquiring IHD, when followed up between one year and 20 years (RR 1.13, 95% CI 1.02 to 1.26, 22 studies, 339,680 participants, I2 5%, moderate quality of evidence). Compared with working 35-40 h/week, we are very uncertain about the effect on dying (mortality) from IHD of working 41-48 h/week (RR 0.99, 95% CI 0.88 to 1.12, 13 studies, 288,278 participants, I2 8%, low quality of evidence) and 49-54 h/week (RR 1.01, 95% CI 0.82 to 1.25, 11 studies, 284,474 participants, I2 13%, low quality of evidence). Compared with working 35-40 h/week, working ≥55 h/week may have led to a moderate, clinically meaningful increase in the risk of dying from IHD when followed up between eight and 30 years (RR 1.17, 95% CI 1.05 to 1.31, 16 studies, 726,803 participants, I2 0%, moderate quality of evidence). Subgroup analyses found no evidence for differences by WHO region and sex, but RRs were higher among persons with lower SES. Sensitivity analyses found no differences by outcome definition (exclusively non-fatal or fatal versus "mixed"), outcome measurement (health records versus self-reports) and risk of bias ("high"/"probably high" ratings in any domain versus "low"/"probably low" in all domains). CONCLUSIONS: We judged the existing bodies of evidence for human evidence as "inadequate evidence for harmfulness" for the exposure categories 41-48 and 49-54 h/week for IHD prevalence, incidence and mortality, and for the exposure category ≥55 h/week for IHD prevalence. Evidence on exposure to working ≥55 h/week was judged as "sufficient evidence of harmfulness" for IHD incidence and mortality. Producing estimates for the burden of IHD attributable to exposure to working ≥55 h/week appears evidence-based, and the pooled effect estimates presented in this systematic review could be used as input data for the WHO/ILO Joint Estimates.

Occupational risk factors for musculoskeletal disorders among railroad maintenance-of-way workers.

BACKGROUND: Our objective was to examine occupational risk factors for musculoskeletal disorders of the neck, back, and knee among railroad maintenance-of-way (MOW) workers. METHODS: Four thousand eight-hundred sixteen active, retired, and disabled members of the Brotherhood of Maintenance of Way Employes Division (BMWED) completed a survey. We computed adjusted prevalence ratios (aPRs) using Poisson regression for neck, back, and knee musculoskeletal symptoms by work exposures, adjusted for age, region, race/ethnicity, smoking, and potential second job and spare time vehicle vibration exposure. RESULTS: Among active male BMWED members, we found associations between use of high-vibration vehicles and neck pain (aPR = 1.47, 95% confidence interval (CI): 1.07-2.03) and knee pain (aPR = 1.38, 95% CI: 1.04-1.82) for more than 1.9 years (vs 0) of full-time equivalent use; but not back pain. Back pain radiating below the knee (sciatica indicator) was associated with high-vibration vehicle use greater than 0.4 and less than 1.9 years (aPR = 1.58, 95% CI: 1.15-2.18). We also found significant associations between often or always lifting, pushing, pulling, or bending on the job (vs seldom or never) and neck pain (aPR = 2.43, 95% CI: 1.20-4.90), back pain (aPR = 1.94, 95% CI: 1.24-3.03), the sciatica indicator (aPR = 5.18, 95% CI: 1.28-20.95), and knee pain (aPR = 2.84, 95% CI: 1.47-5.51), along with positive gradients in the outcome by exposure time. CONCLUSIONS: Biomechanical work exposures, including force and nonneutral postures, were associated with neck, lower back, and knee pain. Whole-body vibration, as measured by the duration of use of high-vibration vehicles, was associated with neck pain, knee pain, and sciatica. Prevention programs should address occupational risk factors for musculoskeletal disorders among MOW workers.