Benjamin C. Amick

The Job Content Questionnaire (JCQ): an instrument for internationally comparative assessments of psychosocial job characteristics.

Part I discusses the Job Content Questionnaire (JCQ), designed to measure scales assessing psychological demands, decision latitude, social support, physical demands, and job insecurity. Part II describes the reliability of the JCQ scales in a cross-national context using 10,288 men and 6,313 women from 6 studies conducted in 4 countries. Substantial similarity in means, standard deviations, and correlations among the scales, and in correlations between scales and demographic variables, is found for both men and women in all studies. Reliability is good for most scales. Results suggest that psychological job characteristics are more similar across national boundaries than across occupations.

The Work Limitations Questionnaire.

Objective.The objective of this work was to develop a psychometrically sound questionnaire for measuring the on-the-job impact of chronic health problems and/or treatment (“work limitations”). Research Design.Three pilot studies (focus groups, cognitive interviews, and an alternate forms test) generated candidate items, dimensions, and response scales. Two field trials tested the psychometric performance of the questionnaire (studies 1 and 2). To test recall error, study 1 subjects were randomly assigned to 2 different questionnaire groups, a questionnaire with a 4-week reporting period completed once or a 2-week version completed twice. Responses were compared with data from concurrent work limitation diaries (the gold standard). To test construct validity, we compared questionnaire scores of patients with those of healthy job-matched control subjects. Study 2 was a cross-sectional mail survey testing scale reliability and construct validity. Subjects.The study subjects were employed individuals (18–64 years of age) from several chronic condition groups (study 1, n = 48; study 2, n = 121) and, in study 1, 17 healthy matched control subjects. Measures.Study 1 included the assigned questionnaires and weekly diaries. Study 2 included the new questionnaire, SF-36, and work productivity loss items. Results.In study 1, questionnaire responses were consistent with diary data but were most highly correlated with the most recent week. Patients had significantly higher (worse) limitation scores than control subjects. In study 2, 4 scales from a 25-item questionnaire achieved Cronbach alphas of ≥0.90 and correlated with health status and self-reported work productivity in the hypothesized manner (P ≤0.05). Conclusions.With 25 items, 4 dimensions (limitations handling time, physical, mental-interpersonal, and output demands), and a 2-week reporting period, the Work Limitations Questionnaire demonstrated high reliability and validity.

Relationship of employee-reported work limitations to work productivity.

Background. Work limitation rates are crucial indicators of the health status of working people. If related to work productivity, work limitation rates may also supply important information about the economic burden of illness. Objective. Our objective was to assess the productivity impact of on-the-job work limitations due to employees’ physical or mental health problems. Research Design. Subjects were asked to complete a self-administered survey on the job during 3 consecutive months. Using robust regression analysis, we tested the relationship of objectively-measured work productivity to employee-reported work limitations. Subjects. We attempted to survey employees of a large firm within 3 different jobs. The survey response rate was 2245 (85.9%). Full survey and productivity data were available for 1827 respondents. Measures. Each survey included a validated self-report instrument, the Work Limitations Questionnaire (WLQ). The firm provided objective, employee-level work productivity data. Results. In adjusted regression analyses (n = 1827), employee work productivity (measured as the log of units produced/hour) was significantly associated with 3 dimensions of work limitations: limitations handling the job’s time and scheduling demands (P = 0.003), physical job demands (P = 0.001), and output demands (P = 0.006). For every 10% increase in on-the-job work limitations reported on each of the 3 WLQ scales, work productivity declined approximately 4 to 5%. Conclusion. Employee work limitations have a negative impact on work productivity. Employee assessments of their work limitations supply important proxies for the economic burden of health problems.

Workplace interventions to prevent musculoskeletal and visual symptoms and disorders among computer users: A systematic review

Background: The literature examining the effects of workstation, eyewear and behavioral interventions on musculoskeletal and visual symptoms among computer users is large and heterogeneous. Methods: A systematic review of the literature used a best evidence synthesis approach to address the general question “Do office interventions among computer users have an effect on musculoskeletal or visual health?” This was followed by an evaluation of specific interventions. Results: The initial search identified 7313 articles which were reduced to 31 studies based on content and quality. Overall, a mixed level of evidence was observed for the general question. Moderate evidence was observed for: (1) no effect of workstation adjustment, (2) no effect of rest breaks and exercise and (3) positive effect of alternative pointing devices. For all other interventions mixed or insufficient evidence of effect was observed. Conclusion: Few high quality studies were found that examined the effects of interventions in the office on musculoskeletal or visual health.

A Review of Health-Related Work Outcome Measures and Their Uses, and Recommended Measures

Despite the growing recognition that work can contribute to the development of musculoskeletal disorders, there are almost no data on whether and how physicians investigate the contribution of work to patients’ health status or the influence of health status on work performance. This is particularly true of primary care, where much of the medical care for patients with work-related low back pain is provided. As more patients with musculoskeletal injuries show up in primary care settings, it will become important to document health-related work outcomes and incorporate into practice outcome tools that enable the physician to obtain a quick and accurate accounting of needed information about patients’ work. Health-related work outcomes relate to a person’s labor market status: Is a person working or not working? How well is he or she working? Did the person return to a job of pay and skill comparable to the preinjury job? Outcomes can incorporate time: How long has a person been out of work? How many hours, days, or weeks has a person been reported absent? Is the person working fullor part-time? How many hours does the person perform at full effectiveness? Finally, health-related work outcomes can capture the interplay between a person’s health status and work role performance: How difficult is it for a person with a given health status to perform work activities? Typically, health-related work outcomes have not specifically referred to unpaid work activities, such as volunteer work or household labor. The authors support the importance of capturing both paid and unpaid work outcomes, but in this article, paid work is the focus. Multiple publications in the literature contribute conceptually and methodologically to the health-related work outcomes field. These range from industrial psychology and labor economics to health services research, epidemiology, and pharmacoeconomics. In this paper, a window into health-related work outcomes research is created by considering the reasons for measuring these outcomes and briefly reviewing and illustrating several classes of measures. The advantages and limitations of each measure will be discussed, as the authors draw examples from own work. Although prior work has focused on upper extremity musculoskeletal disorders, the general principles for using health-related work outcomes are similar for researchers studying back injuries and disorders. In addition, a new work-related health outcome tool for measuring successful return to work (RTW) is discussed to illustrate a new class of measures. Hereafter, health-related work outcomes as are referred to as work outcomes.

Measuring the Impact of Organizational Behaviors on Work Disability Prevention and Management

Increased rates of work disability and its associated costs have prompted businesses to develop innovative approaches to managing the health and productivity of the work force. The paper 1) provides practitioners with the results of research that demonstrates the importance of employer organizational factors in preventing and resolving work disability, and 2) provides researchers with measures that can efficiently assess organizational factors and advance clinical research by incorporating contextual factors involved in occupational rehabilitation. Data from a series of studies in Michigan are reviewed and it is concluded that employer reports of organizational policies and practices (OPPs) are important in reducing the number of work-related disabilities and their consequences for the employee and for the company. We test the hypothesis that employee reports of OPPs are reliable and valid. To test the reliability and validity of an employee version of the same instrument, we used data from a prospective community-based study of 198 workers with carpal tunnel syndrome. Four OPPs were identified as important: people-oriented culture (α = .88), safety climate (α = .88), disability management policies and practices (α = .88), and ergonomic practices (α = .88). These four scales were shown to have strong test–retest reliabilities and predictive validity. It was concluded that the conceptual model guiding the research in Michigan was supported with research from another State, Maine, using an individual-level measure of OPPs.

Smoking behavior in a low-income multiethnic HIV/AIDS population

The aim of this study was to describe smoking prevalence and smoking behavior in a multiethnic low-income HIV/AIDS population. A cross-sectional survey design was used. The study site was Thomas Street Clinic, an HIV/AIDS care facility serving a medically indigent and ethnically diverse population. Demographic, disease status, behavioral, and psychosocial variables were assessed by participant self-report. Surveys were collected from 348 study participants. Demographic composition of the sample was 78% male, 25% White, 44% Black, and 29% Hispanic. Study participants had a mean age of 40.2 years (SD=7.8). The HIV exposure profile of the sample was diverse: 46% men who have sex with men, 35% heterosexual contact, and 11% injection drug use. Prevalence of current cigarette smoking in the sample was 46.9%. Among participants with a lifetime history of smoking 100 or more cigarettes (62.8%), only 26.6% were currently abstinent, lower than the 48.8% rate seen in the general population. Multiple logistic regression analysis indicated that race/ethnicity, education level, age, and heavy drinking were significantly associated with smoking status. Hispanics were less likely than Whites were to smoke, younger participants were less likely than older participants were to be current smokers, and heavy drinkers were more likely to be current smokers than were those who were not heavy drinkers. As education level increased, the likelihood of smoking decreased and the likelihood of quitting increased. The high smoking prevalence in this HIV/AIDS population demonstrates the need for smoking cessation interventions targeted to the special needs of this patient group.

Relationship between all-cause mortality and cumulative working life course psychosocial and physical exposures in the United States labor market from 1968 to 1992.

Objective To examine the relationship between cumulative exposures to psychosocial and physical work conditions and mortality in a nationally representative sample. Methods A working cohort was created using the U.S. Panel Study of Income Dynamics. Information on psychosocial and physical work conditions were imputed using the Job Characteristics Scoring System exposure matrix for the period 1968 through 1991 to construct working life courses. Deaths were ascertained from 1970 through 1992. Results Working in low-control jobs for a working life was associated with a 43% increase in the chance of death (OR, 1.43, 1.13–1.81) assuming a 10-year time lag. No significant effect was found for high-strain work (ie, high psychosocial job demands and low job control), but a relationship was found between passive work (ie, low psychosocial job demands and low job control) and mortality (OR, 1.35, 1.06–1.72). No significant risk of death was found for psychosocial or physical job demands, job security, or work-related social support. Retirement (OR, 2.85, 1.59–5.11) and unemployment (OR, 2.26, 1.65–3.10) transitions and baseline disability (OR, 1.38, 1.06–1.79) predicted mortality. Conclusions The results support the importance of job control to health. The passive work effect suggests that job content may be important in shaping a worker’s health over the life course. Future research should focus on modeling stressors over the life course to capture the dynamic interplay of life transitions, stressor intensity and duration and the role of health in the interplay.

Occupational Safety and Health Interventions to Reduce Musculoskeletal Symptoms in the Health Care Sector

Introduction Health care work is dangerous and multiple interventions have been tested to reduce the occupational hazards. Methods A systematic review of the literature used a best evidence synthesis approach to address the general question “Do occupational safety and health interventions in health care settings have an effect on musculoskeletal health status?” This was followed by an evaluation of the effectiveness of specific interventions. Results The initial search identified 8,465 articles, for the period 1980–2006, which were reduced to 16 studies based on content and quality. A moderate level of evidence was observed for the general question. Moderate evidence was observed for: (1) exercise interventions and (2) multi-component patient handling interventions. An updated search for the period 2006–2009 added three studies and a moderate level of evidence now indicates: (1) patient handling training alone and (2) cognitive behavior training alone have no effect on musculoskeletal health. Few high quality studies were found that examined the effects of interventions in health care settings on musculoskeletal health. Conclusions The findings here echo previous systematic reviews supporting exercise as providing positive health benefits and training alone as not being effective. Given the moderate level of evidence, exercise interventions and multi-component patient handling interventions (MCPHI) were recommended as practices to consider. A multi-component intervention includes a policy that defines an organizational commitment to reducing injuries associated with patient handling, purchase of appropriate lift or transfer equipment to reduce biomechanical hazards and a broad-based ergonomics training program that includes safe patient handling and/or equipment usage. The review demonstrates MCPHI can be evaluated if the term multi-component is clearly defined and consistently applied.

Prevalence of upper extremity musculoskeletal disorders in college students

Upper extremity musculoskeletal disorders are the fastest growing source of disability in the US workplace (1,2), affecting workers of all ages, including those less than 25 years old (3). Computer work for 4 or more hours per day doubles the risk of these disorders (4). The association of upper extremity disorders with prolonged computer work and their emergence in younger workers (3) suggest that college students may also be at risk.