Should data on gender and ethnicity inform ergonomics interventions? Lessons from four case studies.

Ergonomists intervene to improve work for all workers and adapt jobs to a range of worker characteristics. But their mandate rarely includes explicit attention to the distribution of worker demographics, to divisions among workers, or to discrimination on the basis of sex/gender or racialisation. A decades-long collaboration between ergonomists and the women's committees of three union confederations in Québec, Canada led to several instances where ergonomists had to confront situations involving sexism or racism, not foreseen during their training. This article will explore four problematic situations and suggest solutions, including paying more attention to teamwork, considering gender during ergonomics training, and developing a code of practice for ergonomics interventions.Practitioner summary: Workplace inequities related to sex/gender, racialisation and other sources of social inequity can affect job performance and workers' health. As such, do ergonomists need to consider them during an intervention? How? We analyse four situations encountered during interventions and suggest more attention to understanding workplace dynamics and promoting team function.

Gender and work in ergonomics: recent trends.

Since the establishment of the Gender and Work Technical Committee (TC) of the International Ergonomics Association (IEA) in 2006, many researchers have addressed the role of sex and gender in ergonomics, producing a great deal of new information. This special issue aims to present new ways of viewing women's work and gender differences in work-related injury risks in an era of rapidly changing labour market configurations. It offers innovative methods for integrating sex and gender into ergonomic analysis and for designing work environments. It shares reflections on the intersection of vulnerabilities according to certain identity markers. Finally, it contributes to establishing milestones standards of practice so that the consideration of sex and gender can be more systematically modelled in ergonomics research and interventions, for example, in training ergonomists or in knowledge transfer initiatives.Practitioner summary: This editorial article provides an overview of the background and the content of the Special Issue 'Gender and Work in Ergonomics: Recent trends'.

Integration of sex and gender in interventions by students in ergonomics.

This article aims to analyse the integration of sex and gender (s/g) by ergonomics students during their internship at the master's degree level, following training sessions on s/g issues in the workplace. This exploratory research used a descriptive mixed-methods design, encompassing evaluation of students' intention to use the content from the training (n = 13 students), and a multiple case study (n = 5 ergonomics interventions). The results show that while students found the training relevant, they only minimally integrated s/g in their interventions and when they did, it was primarily from an anthropometric and physiological perspective. In addition to discussing the training format limitations, the article discusses barriers to this integration: combining learning about s/g issues with learning about activity analysis is challenging; employers' and workers' organisations may be reluctant to approach s/g issues; and it is difficult for an ergonomist to integrate these issues when the employer's request does not specify it.Practitioner summary: This article aims to analyse the integration of s/g by ergonomics students during their internships. Findings show that they only minimally considered s/g. The discussion examines s/g training, organisational obstacles to inclusion of s/g during interventions, and how ergonomists can consider s/g in their practice.

Relations between work and upper extremity musculoskeletal problems (UEMSP) and the moderating role of psychosocial work factors on the relation between computer work and UEMSP.

PURPOSE: Computer work has been identified as a risk factor for upper extremity musculoskeletal problems (UEMSP). But few studies have investigated how psychosocial and organizational work factors affect this relation. Nor have gender differences in the relation between UEMSP and these work factors  been studied. We sought to estimate: (1) the association between UEMSP and a range of physical, psychosocial and organizational work exposures, including the duration of computer work, and (2) the moderating effect of psychosocial work exposures on the relation between computer work and UEMSP. METHODS: Using 2007-2008 Québec survey data on 2478 workers, we carried out gender-stratified multivariable logistic regression modeling and two-way interaction analyses. RESULTS: In both genders, odds of UEMSP were higher with exposure to high physical work demands and emotionally demanding work. Additionally among women, UEMSP were associated with duration of occupational computer exposure, sexual harassment, tense situations when dealing with clients, high quantitative demands and lack of prospects for promotion, and among men, with low coworker support, episodes of unemployment, low job security and contradictory work demands. Among women, the effect of computer work on UEMSP was considerably increased in the presence of emotionally demanding work, and may also be moderated by low recognition at work, contradictory work demands, and low supervisor support. CONCLUSIONS: These results suggest that the relations between UEMSP and computer work are moderated by psychosocial work exposures and that the relations between working conditions and UEMSP are somewhat different for each gender, highlighting the complexity of these relations and the importance of considering gender.

First steps for integrating sex and gender considerations into basic experimental biomedical research.

In recent decades there has been an increasing recognition of the need to account for sex and gender in biology and medicine, in order to develop a more comprehensive understanding of biological phenomena and to address gaps in medical knowledge that have arisen due to a generally masculine bias in research. We have noted that as basic experimental biomedical researchers, we face unique challenges to the incorporation of sex and gender in our work, and that these have remained largely unarticulated, misunderstood, and unaddressed in the literature. Here, we describe some of the specific challenges to the incorporation of sex and gender considerations in research involving cell cultures and laboratory animals. In our view, the mainstreaming of sex and gender considerations in basic biomedical research depends on an approach that will allow scientists to address these issues in ways that do not undermine our ability to pursue our fundamental scientific interests. To that end, we suggest a number of strategies that allow basic experimental researchers to feasibly and meaningfully take sex and gender into account in their work.

Is sitting worse than static standing? How a gender analysis can move us toward understanding determinants and effects of occupational standing and walking.

The Yant Award was established in 1964 to honor the contributions of William P. Yant, the first president of the American Industrial Hygiene Association. It is presented annually for outstanding contributions in industrial hygiene or allied fields to an individual residing outside the United States. The 2014 award recipient is Dr. Karen Messing, Professor emeritus, Department of Biological Sciences, Université du Québec à Montréal and Researcher, CINBIOSE Research Centre. Gender (socially determined) differences in occupations, employment, and working conditions, task assignments, and work methods that affect exposure to health risks are increasingly documented. Interactions of (biologically influenced) sex differences with workplace parameters may also influence exposure levels. During field studies, ergonomists learn a lot about gender and sex that can be important when generating and testing hypotheses about the mechanisms that link workplace exposures to health outcomes. Prolonged standing is common in North America; almost half (45%) of Québec workers spend more than three-quarters of their working time on their feet and 40% of these cannot sit at will. This posture has been linked to chronic back pain and musculoskeletal disorders (MSDs) in the lower limbs, but many health professionals suggest workers should stand rather than sit at work. We ask: (1) Given the fact that roughly the same proportion of men and women stand at work, what does a gender-sensitive analysis add to our ability to detect and thus prevent work-related MSDs?; (2) How does ergonomics research inform gender-sensitive analysis of occupational health data?; and (3) What do researchers need to know to orient interventions to improve general working postures? We have sought answers to these questions through collaborative research with specialists in epidemiology, occupational medicine, biomechanics, and physiology, carried out in partnership with public health organisations, community groups, and unions. We conclude that failure to characterize prolonged static standing and to apply gender-sensitive analysis can confuse assessment of musculoskeletal and circulatory effects of working postures. We suggest that prolonged static sitting and standing postures can and should be avoided by changes to workplace organization and environments. Research is needed to define optimal walking speeds and arrive at optimal ratios of sitting, standing, and walking in the workplace.

Underreporting work absences for nontraumatic work-related musculoskeletal disorders to workers' compensation: results of a 2007-2008 survey of the Québec working population.

OBJECTIVES: We examined underestimation of nontraumatic work-related musculoskeletal disorders (WMSDs) stemming from underreporting to workers' compensation (WC). METHODS: In data from the 2007 to 2008 Québec Survey on Working and Employment Conditions and Occupational Health and Safety we estimated, among nonmanagement salaried employees (NMSEs) (1) the prevalence of WMSDs and resulting work absence, (2) the proportion with WMSD-associated work absence who filed a WC claim, and (3) among those who did not file a claim, the proportion who received no replacement income. We modeled factors associated with not filing with multivariate logistic regression. RESULTS: Eighteen percent of NMSEs reported a WMSD, among whom 22.3% were absent from work. More than 80% of those absent did not file a WC claim, and 31.4% had no replacement income. Factors associated with not filing were higher personal income, higher seniority, shorter work absence, and not being unionized. CONCLUSIONS: The high level of WMSD underreporting highlights the limits of WC data for surveillance and prevention. Without WC benefits, injured workers may have reduced job protection and access to rehabilitation.

How to carry out participatory research that takes account of sex and gender issues: a scoping review of guidelines targeting health inequities.

OBJECTIVE: Conducting participatory research (PR) aimed at improving health implies considering inequitable power relations, including those related to sex/gender (S/G). This necessitates specific skills and methods and may be challenging especially since guidelines are scarce. Our objective was to perform a scoping review to provide a typology of existing guidelines for researchers on how to take account of S/G in the context of PR in public health, with a focus on occupational and environmental health. METHODS: All steps of the research were conducted with the collaboration of an advisory committee, following PR principles. Nineteen documents were retained from 513 references identified in nine scientific databases and grey literature between 2000 and 2020. Data on recommendations were extracted and coded qualitatively. Cluster analysis based on similarities in recommendations proposed in the documents identified four types: (1) empowerment-centered; (2) concrete action-centered; (3) macrosystem-centered; and (4) stakeholder-centered. SYNTHESIS: Many sources gave pointers on how to include S/G during data collection and analysis or during the dissemination of findings, but there was a dearth of suggestions for building partnerships with stakeholders and producing sustainable S/G sociopolitical transformations. Occupational health PR showed less similarities with other public health subfields including environmental health PR. Power relationships with workplace stakeholders generated specific obstacles related to S/G integration that require further attention. Intersectionality and reflexive practices emerged as overarching themes. CONCLUSION: This review provides helpful guidelines to researchers at different stages of planning PR, ranging from familiarizing themselves with S/G approaches to anticipating difficulties in their ongoing S/G-transformative PR.

RéSUMé: OBJECTIF: Les recherches participatives (RP) visant l'amélioration de la santé doivent tenir compte de rapports de pouvoir inéquitables, incluant ceux liés au sexe/genre (S/G). Cela peut s'avérer difficile vu les compétences requises et la rareté de recommandations. Notre objectif consistait à réaliser une revue de portée menant à une typologie des recommandations existantes pour les chercheurs.euses sur l'intégration du S/G en contexte de RP en santé publique, particulièrement en santé environnementale ou au travail. MéTHODOLOGIE: Un comité d'encadrement a participé à chaque étape de l'étude. Nous avons retenu 19 documents parmi 513 références identifiées dans neuf bases de données scientifiques et la littérature grise (2000­2020). L'extraction et le codage qualitatif des recommandations a mené à une analyse de clusters basée sur les similitudes identifiant quatre types centrés sur : 1) pouvoir d'agir; 2) actions concrètes; 3) macro-système; et 4) parties prenantes. SYNTHèSE: Plusieurs sources indiquaient comment intégrer le S/G pendant la collecte/analyse des données ou la diffusion des résultats. Peu de recommandations touchaient l'aspect S/G au niveau des partenariats avec des parties prenantes ou des transformations sociopolitiques durables. Les recommandations en santé au travail étaient moins similaires aux autres sous-domaines de santé publique. Les relations de pouvoir en milieu de travail engendrent des obstacles spécifiques liés à l'intégration du S/G et nécessitent une attention particulière. L'intersectionnalité et les pratiques réflexives sont apparues comme des thèmes primordiaux. CONCLUSION: Les recommandations repérées aideront des chercheurs.euses à différents stades de leur parcours d'intégration du S/G dans une RP en cours, allant de la familiarisation à l'anticipation de difficultés.

Work organisation and gender among hospital cleaners in Quebec after the merger of 'light' and 'heavy' work classifications.

In Québec, Canada, cleaning tasks were once divided into 'light' or 'heavy' cleaning, assigned respectively to women and men. These categories are being merged; in principle, both genders are assigned the same tasks. Activity analysis using observations and interviews examined work activity of male and female cleaners in two hospitals. In one hospital, work activity could be compared before (time 1) and after the work reorganisation (time 2). Some gender segregation of tasks appeared to have persisted at time 2, in both hospitals. Some route assignments contained components that were difficult for all cleaners, especially women of average strength. Only about one-third of the recommendations for improvement made at time 1 had been carried out by time 2, 12 years later. In a low-status job, it may be hard to meet equality, health and efficiency goals because commitment to improving equipment and worksite design may be lacking. PRACTITIONER SUMMARY: Current attempts to desegregate jobs should be accompanied by attention to physical job demands in order to protect employee health and access to equal employment. The study also shows the need to follow up ergonomic interventions, particularly in low-status jobs such as cleaning, where recommendations can be forgotten.

How Can Quantitative Analysis Be Used to Improve Occupational Health without Reinforcing Social Inequalities? An Examination of Statistical Methods.

Taking account of sex and gender in occupational health studies poses statistical challenges. Other sociodemographic variables, such as racialization, class, and age, also affect the relations between workplace exposures and health and interact with sex and gender. Our objective was to perform a critical review of conventional and emerging statistical tools, examining whether each analysis takes account of sociodemographic variables (1) in a way that contributes to identification of critical occupational determinants of health (2) while taking account of relevant population characteristics to reflect intersectional approaches to health and (3) using sample sizes and population characteristics available to researchers. A two-step search was conducted: (1) a scientific watch concerning the statistical tools most commonly used in occupational health over the past 20 years; (2) a screening of the 1980-2022 literature with a focus on emerging tools. Our examination shows that regressions with adjustment for confounders and stratification fail to reveal the sociodemographic mechanisms that interact with occupational health problems, endangering the identification of occupational risks. Multilevel (notably MAIHDA) analyses, decision tree, cluster, and latent analyses are useful methods to consider when seeking to orientate prevention. Researchers should consider methods that adequately reveal the mechanisms connecting sociodemographic variables and occupational health outcomes.

Overview of the "Gender & Work" track at the IEA 2021 congress.

BACKGROUND: The International Ergonomics Association (IEA) is an international federation of associations created in 1959, whose mission is to extend the scope of ergonomics research and intervention to all spheres of society in order to improve human well-being. OBJECTIVE: This article presents an overview of the main research papers that were presented at the 21st Triennial IEA 2021 Conference. METHOD: A total of 23 talks, from nine countries, were presented over four sessions. These papers were summarized based on reading the abstracts and taking notes at the time of the oral presentation. RESULTS: The themes of these sessions were: 1) Knowledge Transfer, Gender and Ergonomics 2) Approaching Ergonomic Interventions with a Sex/Gender Lens: Designing Training for Ergonomists 3) Ergonomic Studies of Atypical Work and Vulnerable Population Through a Sex/Gender Lens: Toward Better Understanding of Context and Risks, for Better Prevention and 4) Gender and Occupational Risks (Part 1: Exposure and Risk Perception; Part 2: Strategies to Manage Risk). CONCLUSION: Ergonomists are beginning to understand that they have the qualifications and legitimacy to play a role in reducing workplace health inequities and helping to make workplaces inclusive and rich of all the workers' diversity. The four sessions of the Gender and Ergonomics TC have moved ergonomics practice a step closer to that goal.

Are immigrants, ethnic and linguistic minorities over-represented in jobs with a high level of compensated risk? Results from a Montréal, Canada study using census and workers' compensation data.

OBJECTIVES: Few Canadian data sources allow the examination of disparities by ethnicity, language, or immigrant status in occupational exposures or health outcomes. However, it is possible to document the mechanisms that can create disparities, such as the over-representation of population groups in high-risk jobs. We evaluated, in the Montréal context, the relationship between the social composition of jobs and their associated risk level. METHODS: We used data from the 2001 Statistics Canada census and from Québec's workers' compensation board for 2000-2002 to characterize job categories defined as major industrial groups crossed with three professional categories (manual, mixed, non-manual). Immigrant, visible, and linguistic minority status variables were used to describe job composition. The frequency rate of compensated health problems and the average duration of compensation determined job risk level. The relationship between the social composition and risk level of jobs was evaluated with Kendall correlations. RESULTS: The proportion of immigrants and minorities was positively and significantly linked to the risk level across job categories. Many relationships were significant for women only. In analyses done within manual jobs, relationships with the frequency rate reversed and were significant, except for the relationship with the proportion of individuals with knowledge of French only, which remained positive. CONCLUSIONS: Immigrants, visible, and linguistic minorities in Montréal are more likely to work where there is an increased level of compensated risk. Reversed relationships within manual jobs may be explained by under-reporting and under-compensation in vulnerable populations compared to those with knowledge of the province's majority language.

Full-time homemakers: workers who cannot "go home and relax".

This paper examined how musculoskeletal disorders (MSDs) of female homemakers were studied in the literature. It also presented preliminary findings from field observations of housework and fulltime homemakers in urban settings. PubMed, Ergonomics Abstracts, Sociofile, and PsycINFO databases were used in the literature search. The review focused on comparing demands of housework and paid work. Also, exposure factors found in studies of various occupations were compared with the results of field observations of housework in 4 homes in Beirut, Lebanon. Few studies systematically examined associations between MSDs and risk factors in housework. Some well-known risk factors for MSDs were identified in the Beirut homes; however, other unique factors were noted. Housework activities expose homemakers to known risk factors for MSDs, which calls for further studies to identify appropriate intervention and prevention strategies.

Is sex a proxy for mechanical variables during an upper limb repetitive movement task? An investigation of the effects of sex and of anthropometric load on muscle fatigue.

BACKGROUND: Women report more work-related pain and neck/shoulder musculoskeletal disorders than men. For the same absolute workload, due to lower strength, females generally work at a higher relative intensity, which could induce more fatigue. However, the arm's anthropometric load (AL) of men is higher. Therefore, simply lifting their arm could be more fatiguing. Sex as a variable is formed of many constructs, and analyses can become muddied by their differing responses to fatigue. No studies have considered AL, when comparing how fatigue affects men and women. The purpose was to determine if including the arm's AL in the statistical analysis would impact findings of sex-specific effects of shoulder fatigue on muscle EMG. METHODS: Fifty-five (29m/26f) participants completed a repetitive pointing task (RPT) at shoulder height until they reported fatigue of 8+ on the BORG CR-10 scale. Muscle activities were measured using surface electrodes placed over the anterior deltoid (AD) and upper trapezius (UT) muscles. Muscle activity amplitude was quantified using root mean square (RMS). First- and last-minute data were used to assess change from no-fatigue (NF) to fatigue-terminal (FT) conditions. AL was calculated using sex-specific body parameter equations. General estimating equations (GEE) were used to determine the effects of sex and fatigue on RMS values, while including AL in the GEE. RESULTS: There was no sex difference in time to reach fatigue. A significant main effect of sex on RMS was observed (χ2(1) = 4.17, p = 0.04) when including AL as a covariate. Females displayed a significantly higher percentage change in AD RMS from NF to FT, compared to males (p = 0.03), when AL was included in the GEE. No sex differences in UT were observed. CONCLUSIONS: This sex difference emerged when AL was included as a covariate, suggesting that sex-associated anthropometric differences may contribute to sex differences in the fatigue response. Differences in the impact of AL on AD compared to UT could be explained by differences in their respective mechanical roles or muscle fiber content. Anthropometrics may be useful to include as covariates in future research to separate individual anthropometric differences from sex differences.

Considering sex and gender in ergonomics: Exploring the hows and whys.

At the 2018 IEA conference, the Gender and Work Technical Committee organized three symposia with over 20 presentations. Overall, these contributions positioned ergonomics as a theoretical and pragmatic approach developing innovative methods to integrate sex/gender analysis into the construction and evaluation of interventions. This special issue of Applied Ergonomics includes diverse approaches to the consideration of sex and gender in ergonomics, including methods in accident analysis, musculoskeletal disorders, work-family interactions, work schedule analysis, prevention programs and evaluation of interventions. The contents are summarized in this introduction.

Impacts of considering sex and gender during intervention studies in occupational health: Researchers' perspectives.

The aim of this article is to examine the impacts of incorporating sex and gender (s/g) analysis in integrated knowledge translation (iKT) initiatives in the field of ergonomics and occupational health. The article presents findings based on a retrospective analysis of twelve intervention-research (IR) studies, including a thematic content analysis of in-depth interviews conducted with 15 researchers involved in these IRs. The findings offer an overview of various categories of impacts, such as changes in partners' views, in workplace settings and conditions, in practices and policies, and in economic outcomes. In these types of IR, health effects measurement is not the main objective, and direct health outcomes are difficult to assess. Explicitly talking about sex/gender led more often to system-level changes but less often to workplace-level changes, compared to interventions where sex/gender was not identified as a specific object of the intervention.

Should studies of risk factors for musculoskeletal disorders be stratified by gender? Lessons from the 1998 Québec Health and Social Survey.

OBJECTIVES: Several studies have reported male-female differences in the prevalence of symptoms of work-related musculoskeletal disorders (MSD), some arising from workplace exposure differences. The objective of this paper was to compare two strategies analyzing a single dataset for the relationships between risk factors and MSD in a population-based sample with a wide range of exposures. METHODS: The 1998 Québec Health and Social Survey surveyed 11 735 respondents in paid work and reported "significant" musculoskeletal pain in 11 body regions during the previous 12 months and a range of personal, physical, and psychosocial risk factors. Five studies concerning risk factors for four musculoskeletal outcomes were carried out on these data. Each included analyses with multiple logistic regression (MLR) performed separately for women, men, and the total study population. The results from these gender-stratified and unstratified analyses were compared. RESULTS: In the unstratified MLR models, gender was significantly associated with musculoskeletal pain in the neck and lower extremities, but not with low-back pain. The gender-stratified MLR models identified significant associations between each specific musculoskeletal outcome and a variety of personal characteristics and physical and psychosocial workplace exposures for each gender. Most of the associations, if present for one gender, were also found in the total population. But several risk factors present for only one gender could be detected only in a stratified analysis, whereas the unstratified analysis added little information. CONCLUSIONS: Stratifying analyses by gender is necessary if a full range of associations between exposures and MSD is to be detected and understood.

Distal lower-extremity pain and work postures in the Quebec population.

OBJECTIVES: Standing at work has been associated with discomfort and cardiovascular symptoms. Because standing postures vary in duration, mobility, and constraint, we explored associations between specific postures and pain in the lower extremities. METHODS: We used multiple logistic regression to analyze associations between work factors and pain in the lower extremities during the previous 12 months that interfered with usual activities. We used data from among 7757 workers who were interviewed in the 1998 Quebec Health and Social Survey. RESULTS: Among all respondents, 9.4% reported significant ankle or foot pain, and 6.4% had lower-leg or calf pain. Significantly more women than men had pain at both sites. Both leg or calf and ankle or foot pain were strongly associated with standing postures, whole-body vibration, psychological distress, female gender, and being aged 50 years or older. Constrained standing postures were associated with increased ankle or foot pain for both men and women and with leg or calf pain for women, compared with standing with freedom to sit at will. CONCLUSIONS: Freedom to sit at work may prevent lower-extremity pain. The effects of specific sitting and standing postures on cartilage, muscle, and the cardiovascular system may help explain discomfort in the lower extremities.

Broken English, broken bones? Mechanisms linking language proficiency and occupational health in a Montreal garment factory.

Language barriers are often cited as a factor contributing to ethnic inequalities in occupational health; however, little information is available about the mechanisms at play. The authors describe the multiple ways in which language influences occupational health in a large garment factory employing many immigrants in Montreal. Between 2004 and 2006, individual, semi-structured interviews were conducted with 15 women and 10 men from 14 countries of birth. Interviews were conducted in French and English, Canada's official languages, as well as in non-official languages with the help of colleague-interpreters. Observation within the workplace was also carried out at various times during the project. The authors describe how proficiency in the official languages influences occupational health by affecting workers' ability to understand and communicate information, and supporting relationships that can affect work-related health. They also describe workers' strategies to address communication barriers and discuss the implications of these strategies from an occupational health standpoint. Along with the longer-term objectives of integrating immigrants into the linguistic majority and addressing structural conditions that can affect health, policies and practices need to be put in place to protect the health and well-being of those who face language barriers in the short term.