Alberto J. Caban

Obesity in US Workers: The National Health Interview Survey, 1986 to 2002

OBJECTIVES Obesity has emerged as one of the most important public health issues in the United States. We assessed obesity prevalence rates and their trends among major US occupational groups. METHODS Self-reported weight and height were collected annually on US workers, aged 18 years or older, from the 1986 to 1995 and the 1997 to 2002 National Health Interview Surveys. Overall, occupation-, race-, and gender-specific rates of obesity (defined as a body mass index>30.0 kg/m2) were calculated with data pooled from both study periods (n>600,000). Annual occupation-specific prevalence rates were also calculated, and their time trends were assessed. RESULTS Obesity rates increased significantly over time among employed workers, irrespective of race and gender. The average yearly change increased from 0.61% (+/-.04) during the period from 1986 to 1995 to 0.95% (+/-.11) during the period from 1997 to 2002. Average obesity prevalence rates and corresponding trends varied considerably across occupational groups; pooled obesity prevalence rates were highest in motor vehicle operators (31.7% in men; 31.0% in women). CONCLUSIONS Weight loss intervention programs targeting workers employed in occupational groups with high or increasing rates of obesity are urgently needed.

Smoking rate trends in U.S. occupational groups : The 1987 to 2004 national health interview survey

Objective: It is unknown if the gap in smoking rates observed between United States blue- and white-collar workers over the past four decades has continued into the new millennium. Methods: The National Health Interview Survey is a nationally representative survey of the US civilian population. Smoking and current occupational status were assessed over survey periods 1987 to 1994 and 1997 to 2004 (n= 298,042). Results: There were significant annual reductions in smoking rates for all adult US workers in both survey periods. Several blue-collar groups had greater annual smoking rate reductions in the most recent survey period relative to the earlier survey period. However, the majority of blue-collar worker groups had pooled 1997 to 2004 smoking rates in excess of the 24.5% smoking prevalence noted for all workers. Conclusion: Development of effective smoking prevention strategies specifically targeting blue-collar groups is warranted.

Prevalence of concurrent hearing and visual impairment in US adults: The National Health Interview Survey, 1997-2002.

Analysis of data from a nationally representative sample of US adults (n=195801) showed that concurrent hearing and visual impairment prevalence rates were highest for participants older than 79 years of age (16.6%); a 3-fold increase in age-adjusted rates of reported hearing and visual impairment was observed for Native Americans compared with Asian Americans. Research on preventing concurrent hearing and visual impairment and countering its consequences is warranted, especially in population subgroups, such as Native and older Americans.

Longest held job in U.S. occupational groups: The National Health Interview Survey

Objective:We sought to assess the validity of using current or most recent occupation as surrogate for longest-held job (and its exposures). Methods:The National Health Interview Survey (NHIS) is an annual, probability, cross-sectional U.S. population survey. The 1986 and 1988 NHIS occupational supplements provided information for more than 49,000 workers. Using Cohen’s Kappa, concordance was assessed by occupational group and several subgroups. Results:Statistically significant results were observed for all occupational groups. More than 70% of 13 broad occupations had a Kappa of 50.0 or greater, with variable concordance by subpopulation. Among 206 occupational groups, there was more variability: Kappa ranged from 92.7 (dentists) to 9.2 (farm managers). Conclusions:Moderate-to-high levels of agreement was observed in this large, representative sample of US workers. Therefore, current occupation can be used as a surrogate for longest-held job for many occupational subgroups.

Severity of concurrent visual and hearing impairment and mortality: the 1986-1994 National Health Interview Survey.

Purpose: Visual impairment and, to a lesser extent, hearing impairment are independent predictors of reduced survival in selected studies of community-residing adults. To date, the association of severity of concurrent impairment and mortality has not been examined. Method: The National Health Interview Survey is a continuous, multistage, area probability survey of the U.S. civilian noninstitutionalized population. Mortality linkage with the National Death Index of 116,796 adult participants from 1986 to 1994 with complete impairment data was performed through 1997. Results: Findings indicate that moderate to severe concurrent hearing and visual impairment in women is associated with significantly increased risk of mortality. More modest mortality associations are evident for men and for adults with less severe impairments, irrespective of gender. Discussion: Prevention of severe visual and hearing impairment should be a national public health priority, especially given the aging of the U.S. population.

Visual Impairment and Morbidity in Community-Residing Adults: The National Health Interview Survey 1986-1996

Purpose: To examine the association between visual impairment (VI) and morbidity. Methods: Using pooled, annual population-based household interview survey data (n = 140,366) from the 1986–1996 National Health Interview Survey, covariate-adjusted, gender and age group specific logistic regression analyses were used to examine associations between VI and five morbidity indicators: restricted activity days, bed rest days, doctor visits, hospitalizations, and self-rated health. Results: After controlling for educational status, race and the number of reported non-ocular health conditions, fair or poor health status (compared to excellent, very good, or good health status) was generally more strongly associated with severe, bilateral VI (range of odds ratios [ORs]: 2.14–7.24) than with some VI (ORs: 1.45–2.21). Severe, bilateral VI was also associated with more frequent doctor and hospital visits among adults 18–64 years of age (range of ORs: 1.69–3.34), and restricted activity and bed rest days among males 45 years and older (range of ORs: 1.95–3.69). Conclusions: The present findings, in conjunction with other studies documenting the impact of VI on morbidity outcomes, indicate that an increased focus on the provision of eye care services will be necessary to address the growing burden of VI in aging societies.

Healthcare provider smoking cessation advice among US worker groups

Objective: Among workers in dusty occupations, tobacco use is particularly detrimental to health because of the potential synergistic effects of occupational exposures (for example, asbestos) in causing disease. This study explored the prevalence of smoking and the reported smoking cessation discussion with a primary healthcare provider (HCP) among a representative sample of currently employed US worker groups. Methods: Pooled data from the 1997–2003 National Health Interview Survey (NHIS) were used to estimate occupation specific smoking rates (n = 135 412). The 2000 NHIS Cancer Control Module was used to determine (among employed smokers with HCP visits) the prevalence of being advised to quit smoking by occupation (n = 3454). Results: The average annual prevalence of current smoking was 25% in all workers. In 2000, 84% of smokers reported visiting an HCP during the past 12 months; 53% reported being advised by their physician to quit smoking (range 42%–66% among 30 occupations). However, an estimated 10.5 million smokers were not advised to quit smoking by their HCP. Workers with potentially increased occupational exposure to dusty work environments (including asbestos, silica, particulates, etc), at high risk for occupational lung disease and with high smoking prevalence, had relatively low reported discussions with an HCP about smoking cessation, including farm workers (30% overall smoking prevalence; 42% told to quit), construction and extractive trades (39%; 46%), and machine operators/tenderers (34%; 44%). Conclusion: The relatively low reported prevalence of HCP initiated smoking cessation discussion, particularly among currently employed workers with potentially synergistic occupational exposures and high current smoking prevalence, needs to be addressed through educational campaigns targeting physicians and other HCPs.

Concurrent hearing and visual impairment and morbidity in community-residing adults: The National Health Interview Survey, 1986 to 1996

Objective: To examine the association between the presence and severity of concurrent hearing and visual impairment (HI+VI) and morbidity. Methods: Data for adults 45 years and older were obtained from the National Health Interview Survey, 1986 to 1996 (n = 60,997). Covariate-adjusted logistic regression analyses were used to examine associations between HI+VI and five morbidity indicators: restricted activity days, bed rest days, doctor visits, hospitalizations and self-rated health. Results: Associations with morbidity indicators tended to be stronger in adults with HI+VI, and in particular, among adults with more severe HI+VI, relative to adults reporting no impairment. These associations were somewhat stronger in adults 45 to 64 years versus older adults. Discussion: HI+VI is associated with morbidity, although the strength of these associations varies across subgroups. Findings indicate that an increased focus on the provision of hearing and eye care services is required. Insurance coverage for these services should also be pursued by health policy makers.

Occupational segregation as a determinant of US worker health

BACKGROUND Racial segregation provides a potential mechanism to link occupations with adverse health outcomes. METHODS An African-American segregation index (I(AA)) was calculated for US worker groups from the nationally representative pooled 1986-1994 National Health Interview Survey (n = 451,897). Ranking and logistic regression analyses were utilized to document associations between I(AA) and poor worker health. RESULTS There were consistent positive associations between employment in segregated occupations and poor worker health, regardless of covariate adjustment or stratification (e.g., age, gender, income, education, or geographic region). This association between segregation and poor health was stronger for White as compared to African-American workers. CONCLUSIONS Occupational segregation negatively affects all workers. Potential mechanisms need to be identified through which occupational segregation may adversely impact worker health.

Occupation and Lung Cancer Mortality in a Nationally Representative U.s. Cohort: The National Health Interview Survey (nhis)

Objective: The objective of this study was to assess the risk of lung cancer mortality in a nationally representative sample of U.S. workers by occupation. Methods: National Death Index linkage identified 1812 lung cancer deaths among 143,863 workers who participated in the 1987, 1988, and 1990–1994 National Health Interview Surveys. Results: Current and former smoking status was predictive of lung cancer mortality (hazard ratio [HR] = 15.1 and 3.8, respectively). Occupations with significantly higher risk for age- and smoking-adjusted lung cancer mortality included heating/air/refrigeration mechanics (HR = 3.0); not specified mechanics and repairers (HR = 2.8); financial records processing occupations (HR = 1.8); freight, stock, and materials handlers (HR = 1.5); and precision production occupations (HR = 1.4). Conclusion: Although tobacco use continues to be the single most important risk factor for lung cancer mortality, occupational exposure to lung carcinogens should be targeted as well to further reduce the burden of lung cancer.