Job satisfaction and job security as moderators in the relationships among job demands, musculoskeletal symptoms, and work performance.

PURPOSE: This study examined whether job satisfaction and job security moderate the path from physical demands and job strain to impaired work performance via musculoskeletal symptoms in the upper extremities (MSUE). Moderation effects on five paths were examined: (1) from job strain to MSUE; (2) from job strain to work performance; (3) from physical demands to MSUE; (4) from physical demands to work performance; (5) from MSUE to work performance. METHODS: This was a cross-sectional study of 669 full-time workers from 9 manufacturing and 3 healthcare facilities. Data were collected via health interviews, on-site physical exposure assessments, and computation of the Strain Index by ergonomists, and self-administered questionnaires on psychosocial factors. Structural equation modeling and zero-inflated negative binomial regression analysis were performed to examine the moderation effect on each path. RESULTS: Job satisfaction moderated the relationship between MSUE and impaired work performance (B = - 0.09, 95% CI: - 0.15, - 0.04) and job security moderated the relationship between physical demands and MSUE (B = - 0.64, 95% CI: - 1.17, - 0.11). Interaction between job satisfaction and MSUE was significant on both the occurrence (OR: 0.92, 95% CI: 0.87, 0.97) and the degrees of impaired work performance (mean ratio: 0.99, 95% CI: 0.97, 0.99), while the interaction between job security and physical demands was significant only on the degrees of MSUE (mean ratio: 0.94, 95% CI: 0.89, 0.99). CONCLUSION: Job satisfaction and job security can, respectively, mitigate the adverse impacts of working with MSUE and physical demands on work performance. Workplace interventions to improve workers' job satisfaction and job security can contribute to their musculoskeletal health and work performance.

Interaction between physical demands and job strain on musculoskeletal symptoms and work performance.

This study investigated the interaction between physical demands and job strain on musculoskeletal symptoms in upper extremities (MSUE) and work performance. Two years of prospective data were analysed from 713 full-time workers from twelve manufacturing and healthcare facilities in Washington in the United States. Physical exposure was measured by the Strain Index and Threshold Limit Value for hand activity, giving rise to safe, action, and hazardous physical demand groups. Job strain was calculated as the ratio of psychological job demands to job control. Multilevel modelling analysis showed that job strain affected MSUE and limited work performance less in the high physical demand group than the safe group because the protective effect of job control was smaller in these groups. Findings may suggest that high physical demand jobs are structured such that workers have low job control or high physical demand groups experience job strain not adequately captured by psychosocial variables.Practitioner Summary: The effects of job strain and job control on musculoskeletal symptoms in upper extremities and work performance were smaller among workers with higher physical demands. This could imply that high physical demand jobs limit job control or psychosocial variables may not adequately capture job strain among high physical demand groups.

Health of Philippine Emigrants Study (HoPES): study design and rationale.

BACKGROUND: Immigrants to the United States are usually healthier than their U.S.-born counterparts, yet the health of immigrants declines with duration of stay in the U.S. This pattern is often seen for numerous health problems such as obesity, and is usually attributed to acculturation (the adoption of "American" behaviors and norms). However, an alternative explanation is secular trends, given that rates of obesity have been rising globally. Few studies of immigrants are designed to distinguish the effects of acculturation versus secular trends, in part because most studies of immigrants are cross-sectional, lack baseline data prior to migration, and do not have a comparison group of non-migrants in the country of origin. This paper describes the Health of Philippine Emigrants Study (HoPES), a study designed to address many of these limitations. METHODS: HoPES is a dual-cohort, longitudinal, transnational study. The first cohort consisted of Filipinos migrating to the United States (n = 832). The second cohort consisted of non-migrant Filipinos who planned to remain in the Philippines (n = 805). Baseline data were collected from both cohorts in 2017 in the Philippines, with follow-up data collection planned over 3 years in either the U.S. for the migrant cohort or the Philippines for the non-migrant cohort. At baseline, interviewers administered semi-structured questionnaires that assessed demographic characteristics, diet, physical activity, stress, and immigration experiences. Interviewers also measured weight, height, waist and hip circumferences, blood pressure, and collected dried blood spot samples. DISCUSSION: Migrants enrolled in the study appear to be representative of recent Filipino migrants to the U.S. Additionally, migrant and non-migrant study participants are comparable on several characteristics that we attempted to balance at baseline, including age, gender, and education. HoPES is a unique study that approximates a natural experiment from which to study the effects of immigration on obesity and other health problems. A number of innovative methodological strategies were pursued to expand the boundaries of current immigrant health research. Key to accomplishing this research was investment in building collaborative relationships with stakeholders across the U.S. and the Philippines with shared interest in the health of migrants.

Using a digital storytelling assignment to teach public health advocacy.

The need and expectation for advocacy is central to public health nursing practice. Advocacy efforts that effectively call attention to population health threats and promote the well-being of communities rely on strategies that deliver influential messaging. The digital story is a lay method to capture meaningful, impactful stories that can be used to advocate for public health concerns. Readily available, user-friendly digital technologies allow engagement in digital media production to create digital stories. This paper describes how digital story making can be utilized as an academic assignment to teach public health advocacy within an undergraduate nursing curriculum. Providing nursing students this artistic outlet can facilitate meeting academic learning goals, while also equipping them with creative skills that can be applied in future professional practice. Nursing educators can take advantage of institutional resources and campus culture to support the use of novel digital media assignments that facilitate application of advocacy concepts.

Visa type and financial strain on depressive symptoms among Filipino migrants to the United States.

Migrants have been theorized to be healthier than their non-migrant counterparts; however, there is limited examination of health selection using binational data and how selection occurs, particularly for mental health outcomes. This study examines the role of visa status and financial strain as critical factors for mental health selection among Filipino migrants to the U.S. and non-migrants who remain in the Philippines. We used the baseline data from the Health of Philippine Emigrants Study (HoPES; n = 1631) to compare depressive symptoms between non-migrants and migrants who were both surveyed prior to their departure to the U.S. We assessed depressive symptoms using linear regression by migration status, financial strain, and by visa categories including fiancée/marriage, unlimited family reunification, limited family reunification, and employment. Overall, all migrants reported lower depressive symptoms than non-migrants; however, depressive symptoms varied by visa type. Fiancée/marriage migrants had lower depressive symptoms than compared to limited family reunification migrants. Additionally, those who reported financial strain had higher depressive symptoms than those without any financial strain. We find that migrants were positively selected for mental health using a unique sample of Filipino migrants before they left for the U.S.

Association Between Local Boards of Health Authority Over Budgets and PHAB Accreditation Standard Score.

Introduction: This study examined the relationship between local board of health authority and local health departments' budget-related activities and performance scores in the Public Health Accreditation Board standards while considering the governance structure under which the local health agencies operate. Methods: Data from 250 local health departments were obtained from the Public Health Accreditation Board and were combined with data from the 2016 National Association of County and City Officials Profile Survey. Multilevel regression analysis was used to examine the relationship between local board of health authority on local health departments' budget-related activities, using the governance structure as the group-level variable. Results: Analyses identified positive associations between local board of health authority on local health departments' budget-related activities and local health departments' aggregate average performance scores in Public Health Accreditation Board accreditation. No apparent association was found between the type of governance structure under which a local health department operates and performance scores in Public Health Accreditation Board accreditation standards, perhaps attributable to variation in the characteristics and roles of their governing bodies. Conclusions: The analyses suggest that local boards of health with authority related to local health departments' budgets appear to have an influential role in budget-related activities and may improve local health departments' performance scores in Public Health Accreditation Board accreditation standards. However, vast variations in more specific local boards of health roles and characteristics exist across local health departments and for which there are no national data. More research is thus needed to control for or examine the influences of specific local boards of health characteristics before the benefits of expanded local boards of health authority over local health departments' budgetary decision making on local health departments' performance can be fully understood.

Worker versus Employer Perspectives on Safety in the Forestry Services Industry.

Forestry services work presents high risk for injury, illness, and fatality. How worker and employer views of workplace safety compare influences the strategies to address hazardous working conditions. Interviews with forestry services workers and employers revealed themes about occupational hazards and ways to prevent work-related injury. Workers identified hazards related to the social and natural environments, and injury prevention solutions focused on interventions beyond their control and based on employer responsibility. Employers characterized hazards within job task contexts and tied solutions to worker behaviors to improve job task performance. Discordance between worker and employer reports indicates inconsistent views about what safety measures should be provided and pursued to effectively reduce injury risk. Because many workers in the forest services industry are marginalized due to their immigrant documentation status and being racially/ethnically minoritized, power differentials between workers and employers can also influence how workplace safety and health measures are determined and implemented.

Do Different Patterns of Employment Quality Contribute to Gender Health Inequities in the U.S.? A Cross-Sectional Mediation Analysis.

Compared to recent generations, workers today generally experience poorer quality employment across both contractual (e.g., wages, hours) and relational (e.g., participation in decision-making, power dynamics) dimensions within the worker-employer relationship. Recent research shows that women are more likely to experience poor-quality employment and that these conditions are associated with adverse health effects, suggesting employment relations may contribute to gender inequities in health. We analyzed data from the General Social Survey (2002-2018) to explore whether the multidimensional construct of employment quality (EQ) mediates the relationship between gender and health among a representative, cross-sectional sample of U.S. wage earners. Using a counterfactually-based causal mediation framework, we found that EQ plays a meaningful role in a gender-health relationship, and that if the distribution of EQ among women was equal to that observed in men, the probability of reporting poor self-reported health and frequent mental distress among women would be lower by 1.5% (95% Confidence Interval: 0.5-2.8%) and 2.6% (95% CI: 0.6-4.6%), respectively. Our use of a multidimensional, typological measure of EQ allowed our analysis to better account for substantial heterogeneity in the configuration of contemporary employment arrangements. Additionally, this study is one of the first mediation analyses with a nominal mediator within the epidemiologic literature. Our results highlight EQ as a potential target for intervention to reduce gender inequities in health.

Associations Between Local Health Department Expenditures on Foundational Capabilities and PHAB Accreditation Standards Scores.

Context: Foundational Capabilities (FC) are the public health (PH) infrastructure areas that are essential for local health departments (LHDs) to support a "minimum package" of programs and services that promote population health. Despite being a critical component of LHD programs, FC are chronically underfunded, and studies specific to the relationship between LHD FC expenditures and their performance-the LHDs' ability to provide essential PH programs and services to their community-have not been previously reported. Public Health Accreditation Board (PHAB) accreditation is a nationally recognized accreditation program for PH agencies. PHAB accreditation assesses LHDs' performance against sets of standards that are based on the 10 essential PH services. Alignment between FC and the PHAB standards presents a means for assessing LHD FC expenditures relative to their performance in PHAB accreditation standards. Objectives: We examined the association between LHD total FC expenditures, as well as FC funding allocation patterns, and performance score on selected PHAB accreditation standards. Methods: We used Bayesian regression methods to estimate the coefficients for the aggregate performance score, and performance scores on individual PHAB standards. Results: Analyses showed that a dollar increase in total FC expenditures is associated with a 0.2% increase in the aggregate performance score in selected PHAB standards as well as the performance score on most of the standards examined. LHDs that allocated FC budgets more evenly across FC programs were found to be more likely to have higher scores. Conclusions: Investment in FC could improve LHD performance scores in PHAB accreditation standards and support LHDs' capability for improving community health outcomes. Allocating available FC resources across the various FC programs could support better LHD performance, as indicated by accreditation scores. This study contributes to advancing the understanding of public health finances in relation to performance and could help guide effective LHD resource allocation.

Neighborhood Disadvantage, Patterns of Unhealthy Alcohol Use, and Differential Associations by Gender, Race/Ethnicity, and Rurality: A Study of Veterans Health Administration Patients.

OBJECTIVE: Stressful conditions within disadvantaged neighborhoods may shape unhealthy alcohol use and related harms. Yet, associations between neighborhood disadvantage and more severe unhealthy alcohol use are underexplored, particularly for subpopulations. Among national Veterans Health Administration (VA) patients (2013-2017), we assessed associations between neighborhood disadvantage and multiple alcohol-related outcomes and examined moderation by sociodemographic factors. METHOD: Electronic health record data were extracted for VA patients with a routine Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) screen. Patient addresses were linked by census block group to the Area Deprivation Index (ADI), dichotomized at the 85th percentile, and examined in quintiles for sensitivity analyses. Using modified Poisson generalized estimating equations models, we estimated associations between neighborhood disadvantage and five outcomes: unhealthy alcohol use (AUDIT-C ≥ 5), any past-year heavy episodic drinking (HED), severe unhealthy alcohol use (AUDIT-C ≥ 8), alcohol use disorder (AUD) diagnosis, and alcohol-specific conditions diagnoses. Moderation by gender, race/ethnicity, and rurality was tested using multiplicative interaction. RESULTS: Among 6,381,033 patients, residence in a highly disadvantaged neighborhood (ADI ≥ 85th percentile) was associated with a higher likelihood of unhealthy alcohol use (prevalence ratio [PR] = 1.06, 95% CI [1.05, 1.07]), severe unhealthy alcohol use (PR = 1.14, 95% CI [1.12, 1.15]), HED (PR = 1.04, 95% CI [1.03, 1.05]), AUD (PR = 1.14, 95% CI [1.13, 1.15]), and alcohol-specific conditions (PR = 1.21, 95% CI [1.18, 1.24]). Associations were larger for Black and American Indian/Alaska Native patients compared with White patients and for urban compared with rural patients. There was mixed evidence of moderation by gender. CONCLUSIONS: Neighborhood disadvantage may play a role in unhealthy alcohol use in VA patients, particularly those of marginalized racialized groups and those residing in urban areas.

Health selection on self-rated health and the healthy migrant effect: Baseline and 1-year results from the health of Philippine Emigrants Study.

Studies of migration and health focus on a "healthy migrant effect" whereby migrants are healthier than individuals not migrating. Health selection remains the popular explanation of this phenomenon. However, studies are mixed on whether selection occurs and typically examine migrants post-departure. This study used a novel pre-migration dataset to identify which health and social domains differ between migrants and their non-migrant counterparts and their contribution to explaining variance in self-rated health by migrant status at pre-migration and 1-year later. Data were used from the baseline and 1-year follow-up of the Health of Philippine Emigrants Study (HoPES). We used multivariable ordinary least squares regression to examine differences in self-rated health between migrants to the U.S. and a comparable group of non-migrants at baseline (premigration) and one year later, accounting for seven domains: physical health, mental health, health behavior, demographics, socioeconomic factors and healthcare utilization, psychosocial factors, and social desirability. A migrant advantage was present for self-rated health at baseline and 1-year. Accounting for all domains, migrants reported better self-rated health compared to non-migrants both at baseline (ß = 0.32; 95% CI = 0.22, 0.43) and at 1-year (ß = 0.28; 95% CI = 0.10, 0.46). Migrant status, health behavior, and mental health accounted for most of the variance in self-rated health both at baseline and 1-year follow-up. This analysis provides evidence of migrant health selection and nuanced understanding to what is being captured by self-rated health in studies of migrant health that should be considered in future research.

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.

Promoting occupational health nursing training: an educational outreach with a blended model of distance and traditional learning approaches.

In 2009, occupational health nursing faculty and professionals at the University of Washington developed an innovative continuing nursing education offering, the OHN Institute. The OHN Institute was designed to meet the following objectives: (1) extend basic occupational health nursing training to non-occupational health nurses in Federal Region X, (2) target new occupational health nurses or those who possessed little or no advanced education in occupational health nursing, and (3) offer a hybrid continuing nursing education program consisting of on-site and distance learning modalities. Evaluation findings suggested that the various continuing nursing education modalities and formats (e.g., asynchronous vs. synchronous, online modules vs. live modules) were essentially comparable in terms of effectiveness. Perhaps most importantly, the OHN Institute evaluation demonstrated that quality continuing nursing education outcomes for occupational health nurses depended largely on knowledgeable and engaging faculty and a compelling vision of desired outcomes, including the application of learned content to professional practice.

Using problem-based learning for occupational and environmental health nursing education: pesticide exposures among migrant agricultural workers.

Problem-based learning, which emphasizes group collaboration to solve real-world case scenarios, is an instructional approach that is well suited to occupational and environmental health nursing education. Learners actively work through case studies rather than passively receive information presented through lectures. Problem-based learning methods promote critical thinking skills and motivate learning, preparing learners for professional practice in complex, ever-changing environments. Despite these advantages, problem-based learning is under-utilized in nursing education compared to more traditional lecture methods. This article presents key concepts of problem-based learning, discusses problem-based learning in educating occupational and environmental health nurses, and describes the development of a problem-based learning case aimed at increasing occupational and environmental health nurses capacity to address pesticide exposure among migrant and seasonal agricultural workers.

Identifying an Optimal Cut-Off Point for Musculoskeletal Pain in the Upper Extremities to Prevent Lowered Work Performance.

OBJECTIVE: This study identified when musculoskeletal pain (MSP) in the upper extremities indicates lowered work performance to gauge when secondary prevention of musculoskeletal disorders is needed. METHODS: Seven hundred thirty-three subjects from 12 manufacturing or healthcare facilities in Washington state participated. Work performance was measured by the Disabilities of the Arm, Shoulder and Hand work module (DASH-Work). Each DASH-Work score was compared to the mean among U.S. workers to determine if workers had lowered work performance. ROC curve analysis was conducted to find the cut-off in a composite MSP index (summing MSP intensities in shoulders, elbows/forearms, and hands/wrists; range 0 to 24) to detect lowered work performance. RESULTS: The MSP index score of 2 achieved the best balance between sensitivity (0.79) and specificity (0.69) in detecting lowered work performance. CONCLUSIONS: To prevent reduced work performance, moderate or multisite pain may require proper management.

Addressing Positionality Within Case-Based Learning to Mitigate Systemic Racism in Health Care.

BACKGROUND: Case-based learning has historically focused on the individual patient; however, there is often little consideration within this teaching method of how social determinants of health, such as structural racism and its adverse health effects, bear upon patients' health status and consequent patient outcomes. PROBLEM: Implementing case studies necessitates taking into account the positionality of patients, as well as health care providers, to counter the racial oppression and discrimination embedded in existing health care and educational systems. APPROACH: We describe a process for creating an inclusive, antiracist environment for case-based learning within nursing education, outlining steps for preparing students to more effectively examine case studies through social determinants of health framing and lens to mitigate harmful impacts from systemic racism and racial discrimination in clinical care. CONCLUSIONS: Addressing positionality in case-based learning is one antiracist strategy to begin rectifying health disparities and moving health care toward equity.

Smoking and the Asian American workforce in the National Latino and Asian American Study.

BACKGROUND: Smoking among the Asian American workforce has not been extensively researched. This study examines smoking prevalence among a nationally representative sample of Asian Americans with an emphasis on occupational classification. METHODS: Cross-sectional data come from the National Latino and Asian American Study. Multivariate logistic regression analyses were used to determine smoking prevalence by occupation, gender, and nativity, among 1,528 participants self-identifying as in the labor force. RESULTS: Blue collar workers reported the highest smoking prevalence (32%) followed by unemployed (19%), other (17%), service (14%), and white collar (10%). Among both employed males and females, blue collar workers had the highest prevalence (45% and 18%, respectively). By nativity, smoking was highest among blue collar workers for immigrants (25%) and highest among the unemployed for U.S. born (16%). Blue collar employment was significantly associated with being a current smoker (OR = 2.52; 95% CI: 1.23-5.16; P < 0.05) controlling for demographics (e.g., age, gender, ethnic group, nativity, etc.). CONCLUSIONS: Findings reveal that smoking differs by occupation among Asian Americans. Future research should examine factors explaining differences while considering gender and nativity.

Associations of employment frustration with self-rated physical and mental health among Asian American immigrants in the U.S. Labor force.

OBJECTIVE: This study examined the associations between employment frustration and both self-rated physical health (SRPH) and self-rated mental health (SRMH) among Asian American immigrants. DESIGN AND SAMPLE: A cross-sectional quantitative analysis was conducted utilizing data from 1,181 Asian immigrants participating in the National Latino and Asian American Study. MEASURES: Employment frustration was measured by self-report of having difficulty finding the work one wants because of being of Asian descent. SRPH and SRMH were each assessed using a global one-item measure, with responses ranging from poor to excellent. Control variables included gender, age, ethnicity, education, occupation, income, whether immigrated for employment, years in the United States, English proficiency, and a general measure for everyday discrimination. RESULTS: Ordered logistic regression showed that employment frustration was negatively associated with SRPH. This relationship, however, was no longer significant in multivariate models including English proficiency. The negative association between employment frustration and SRMH persisted even when including all control variables. CONCLUSIONS: The findings suggest that Asian immigrants in the United States who experience employment frustration report lower levels of both physical and mental health. However, English proficiency may attenuate the relationship of employment frustration with physical health.

Associations between work schedule characteristics and occupational injury and illness.

BACKGROUND: Nurses often endure working irregular day, night and evening shifts as well as mandatory overtime (i.e. employer-imposed work time in excess of one's assigned schedule). While these work characteristics are examined as potential risks for nurses' safety and health, it is not clear whether negative health impacts occur simply because of working long hours or in combination with other mechanisms. AIM: This study investigates how these work characteristics are associated with nurses' work-related injury and illness over and above long work hours. METHODS: In this cross-sectional study, questionnaire data were collected from a sample of 655 registered nurses in the Philippines. Multiple logistic regression was used to assess associations of shift work and mandatory overtime with four work-related health outcomes. RESULTS: After weekly work hours, shift length and demographic variables were accounted for, non-day shifts were associated with work-related injury [odds ratio (OR) = 1.54; 95% confidence interval (CI): 1.07, 2.24] and work-related illness (OR = 1.48; 95% CI: 1.02, 2.16). Also, frequency of working mandatory overtime was associated with work-related injury (OR = 1.22; 95% CI: 1.06, 1.41), work-related illness (OR = 1.19; 95% CI: 1.04, 1.37) and missing more than 2 days of work because of a work-related injury or illness (OR = 1.25; 95% CI: 1.08, 1.44). CONCLUSIONS: These findings suggest that non-day shifts and mandatory overtime may negatively impact nurses' health independent of working long hours. Mechanisms through which these work characteristics affect health, such as circadian rhythm disturbance, nurse-to-patient ratios and work-family conflict, should be examined in future studies.