Birgit A. Greiner

Legislation for smoke-free workplaces and health of bar workers in Ireland: before and after study.

Abstract Objectives To compare exposure to secondhand smoke and respiratory health in bar staff in the Republic of Ireland and Northern Ireland before and after the introduction of legislation for smoke-free workplaces in the Republic. Design Comparisons before and after the legislation in intervention and control regions. Setting Public houses in three areas in the Republic (intervention) and one area in Northern Ireland (control). Participants 329 bar staff enrolled in baseline survey; 249 (76%) followed up one year later. Of these, 158 were non-smokers both at baseline and follow-up. Main outcome measures Salivary cotinine concentration, self reported exposure to secondhand smoke, and respiratory and sensory irritation symptoms. Results In bar staff in the Republic who did not themselves smoke, salivary cotinine concentrations dropped by 80% after the smoke-free law (from median 29.0 nmol/l (95% confidence interval 18.2 to 43.2 nmol/l)) to 5.1 nmol/l (2.8 to 13.1 nmol/l) in contrast with a 20% decline in Northern Ireland over the same period (from median 25.3 nmol/l (10.4 to 59.2 nmol/l) to 20.4 nmol/l (13.2 to 33.8 nmol/l)). Changes in self reported exposure to secondhand smoke were consistent with the changes in cotinine concentrations. Reporting any respiratory symptom declined significantly in the Republic (down 16.7%, −26.1% to −7.3%) but not in Northern Ireland (0% difference, −32.7% to 32.7%). After adjustment for confounding, respiratory symptoms declined significantly more in the Republic than in Northern Ireland and the decline in cotinine concentration was twice as great. Conclusion The smoke-free law in the Republic of Ireland protects non-smoking bar workers from exposure to secondhand smoke.

Objective stress factors, accidents, and absenteeism in transit operators : a theoretical framework and empirical evidence

The authors used observational job analysis as a conceptually based technique to measure stress factors unbiased by worker appraisal with 81 transit driving tasks on 27 transit lines. Stressor dimensions included work barriers that interfere with task performance due to poor technical-organizational design, time pressure, time binding (autonomy over time management), and monotonous conditions. Line-specific average stressor values were assigned to 308 transit operators who mainly worked the particular line. Logistic regression analyses showed associations for high work barriers and sickness absences (odds ratio [OR] = 3.8, p = .05). There were elevated risks for work accidents for high time pressure operators (OR = 4.0, p = .04) and for the medium time-binding group (OR = 3.3, p = .04) and significant (alpha = .20) unadjusted interaction terms for barriers and time pressure in predicting accidents and absences, and barriers and time binding in predicting absences. Findings suggest guaranteed rest breaks and flexible timing for accident prevention and removal of work barriers for reducing absenteeism.

Objective measurement of occupational stress factors--an example with San Francisco urban transit operators.

Eighty-one observational work analyses were conducted to measure stressors independently of worker appraisal in the San Francisco transit system. On the basis of action regulation theory, stress factors were defined as hindrances for task performance due to poor work organization or technological design. Stressors included (a) work barriers, defined as obstacles that cause extra work or unsafe behavior; (b) time pressure; (c) monotonous conditions; and (d) time binding, defined as control over timing. Reliability, measured as interrater agreement, ranged between 80 and 97%, with kappas of .46-.70. Validity analyses were done with 71 transit operators who participated in the observations and 177 operators who were assigned mean line-specific observational stressor measures. High odds ratios (ORs) were found for barriers and psychosomatic complaints (OR = 3.8, p = .00), time pressure and relaxation time needed after work (OR = 3.1, p = .05), and barriers and smoking to cope (OR = 3.8, p = .02). Using observational data in conjunction with self-report data can reduce confounding and improve interpretability of stress and health studies. Language: en

Physical Workload and Ergonomic Factors Associated With Prevalence of Back and Neck Pain in Urban Transit Operators

Study Design. Back and neck pain was studied crosssectionally in 1,449 urban transit drivers by linking medical data, self‐reported ergonomic factors, and company records on job history. Objectives. The goal was to examine the relation between physical workload, ergonomic factors, and the prevalence of back and neck pain. Summary of Background Data. Researchers, to date, have not found an independent effect of ergonomic factors on back and neck pain while accounting for the effects of past and current physical workload. Methods. Self‐reported ergonomic factors, vehicle type, physical workload (measured as duration of driving), height, weight, age, and gender were analyzed in relation to back and neck pain, using multivariable logistic regression models. Results. Physical workload showed a positive dose‐response relation with back and neck pain after controlling for vehicle type, height, weight, age, and gender. The odds ratio for 10 years of driving was 3.43. Additional adjustment for ergonomic factors decreased this odds ratio to 2.55. Six out of seven ergonomic factors were significantly related to the prevalence of back and neck pain after adjustment for age, gender, height, weight, and physical workload. Problems with adjusting the seat had the largest effect (odds ratio = 3.52). Women had back and neck pain twice as frequently as men. Conclusion. The results support the hypothesis of a causal role of physical workload for the development of back and neck pain. Ergonomic factors partially mediated the risk of back and neck pain associated with driving, suggesting a potential for prevention of back and neck pain by ergonomic redesign of transit vehicles. Elevated risks for back and neck pain for female drivers were not explained by anthropometric and ergonomic factors.

The effect of self-reported and observed job conditions on depression and anxiety symptoms: a comparison of theoretical models.

The demand/control/support and effort/reward imbalance models have relied on self-reported methods to describe how poor psychosocial working conditions lead to harmful health outcomes. The hindrance/utilization model uses an observational methodology to assess these relationships. Cross-sectional observational and self-reported data from 98 civil servants participating in the Whitehall II Study of British civil servants were used to test whether work conditions measured by each of the three theoretical models explained a significant amount of the variance in depression and anxiety symptoms. Observational measures were also used to assess potential common methods variance bias between the self-reported job conditions and the outcomes. Results showed that the demand/control/support model explained the most variance in depression and anxiety symptoms and the associations were not wholly due to common methods variance. Moreover, measures associated with job resources (e.g., skill discretion, social support and skill utilization) had a protective effect on depression and anxiety symptoms. Exertion-related conditions (e.g., demands, effort, over commitment) were not consistently associated with depression or anxiety symptoms.

Alcohol, stress-related factors, and short-term absenteeism among urban transit operators.

Transit operators, relative to workers in many other occupations, experience high levels of work-related stress, as documented through neuroendocrine elevations on the job vis-à-vis resting states (J Occup Health Psychol. 1998;3:122–129). Previous research suggests that self-reported job stress is associated with higher levels of alcohol consumption among transit operators (Alcohol Clin Exp Res. 2000;24:1011–1019) and with absenteeism (Working Environment for Local Public Transport Personnel, Stockholm: Swedish Work Environmental Fund, 1982; Work Stress. 1990;4:83–89). The purpose of this study was to examine the interrelationships between alcohol use, stress-related factors (stressful life events, job stressors, and burnout), and short-term absenteeism among a multiethnic cohort of urban transit operators. Self-reported measures of alcohol, stress-related factors, and short-term absenteeism were obtained from a sample (n=1,446) of San Francisco municipal transit operators who participated in the 1993–1995 Municipal Railway Health and Safety Study. Multivariate logistic regression analyses showed that absenteeism among drinkers was associated with risk for alcohol dependence [odds ratio (OR)=2.46, heavy drinking (OR=1.87), alcohol0related harm (OR=2.17), increased drinking since, becoming a transit operator (OR=1.74), and having any problem drinking indicator (OR=1.72). The association between absenteeism and stress-related factors varied by gender and drinking status. Final multivariate models among drinkers indicated that among males, problem drinking (OR=1.82), stressful life events (OR=1.62), and job burnout (OR=1.22) were independently associated with elevated odds of absenteeism. Among female drinkers, only stressful life events (OR=5.17) was significantly associated with elevated odds of absenteeism. Findings suggest that workplace interventions that address both individual and environmental stressors are most likely to have a positive impact on health-related outcomes, including problem drinking, thereby reducing absenteeism.

Hypertension and years of driving in transit vehicle operators

In this study, data from transit vehicle operators of the San Francisco Municipal Railway (Muni), and a control group of individuals newly hired but not yet working as operators, were used to investigate prevalence of hypertension as a function of exposure to bus driving (years of driving), controlling for alcohol consumption and body mass index. Data were collected from transit vehicle operators in the course of their regular biennial examination during the period November 1983 to October 1985. Groups working as operators fewer than 10 years (n =1137), from 10 to 20 years (n =493), and more than 20 years (n =196) were compared to each other and to a group of individuals with no prior exposure, but who were given a medical examination just before beginning their jobs as transit vehicle operators (n = 226). For hypertension (defined as systolic blood pressure ≤ 140, or diastolic blood pressure ≥90, or taking hypertension medication), the prevalence, adjusted for age, race, and gender, increased in a stepwise fashion from 28.8 percent in the group with no exposure to 38.9 percent in the group of drivers with more than 20 years on the job. A similar pattern was found for moderate to severe hypertension (systolic blood pressure ≤ 160, or diastolic blood pressure ≥95, or hypertension medication). These patterns were diminished, but not eliminated, when body mass index and alcohol consumption were considered. Higher rates of separation from employment for hypertensive operators suggested that the effect of years of employment may be underestimated by this cross-sectional comparison. Prolonged exposure to operating a transit vehicle may be associated with increased hypertension; increased alcohol consumption and body mass index with increased years of driving may account for at least some of the increased hypertension.

Burnout and alcohol problems among urban transit operators in San Francisco

Although occupational burnout has been linked with numerous psychosomatic symptoms and mental health problems, few studies have examined the association between burnout and substance use. This study assessed the contribution of burnout (Emotional Exhaustion--Maslach Burnout Inventory) to the risk of alcohol dependence and alcohol-related harm among a sample of urban transit operators. The study population consisted of 993 current drinkers who participated in the 1993-1995 San Francisco Muni Health and Safety Study. A series of multivariate logistic regression models were developed to analyze the association between burnout and risk of alcohol problems after adjustment for seniority, sociodemographic factors, and mean daily ounces of ethanol. The results indicate that burnout is associated with elevated risk of alcohol dependence (odds ratio [OR] = 1.03; 95% confidence interval [CI] = 1.01, 1.06). The association between burnout and alcohol-related harm, however, was attenuated. These findings suggest that transit operators with higher levels of burnout may be at increased risk for alcohol problems, particularly alcohol dependence. The temporal relationship between the development of burnout and the onset of alcohol problems among occupational cohorts warrants further investigation.

Perceived occupational stress in nurses working in Ireland

BACKGROUND Stress has been seen as a routine and accepted part of the health care workers role. There is a lack of research on stress in nurses in Ireland. AIMS To examine the levels of stress experienced by nurses working in an Irish teaching hospital and investigate differences in perceived stress levels by ward area and associations with work characteristics. METHODS A cross-sectional study design was employed, with a two-stage cluster sampling process. Data collection was by means of a self-administered questionnaire, and nurses were investigated across 10 different wards using the Nursing Stress Scale and the Demand Control Support Scales. RESULTS The response rate was 62%. Using outpatients as a reference ward, perceived stress levels were found to be significantly higher in the medical ward, accident and emergency, intensive care unit and paediatric wards (P < 0.05). There was no significant difference between the wards with regard to job strain; however, differences did occur with levels of support, the day unit and paediatric ward reporting the lowest level of supervisor support (P < 0.01). A significant association was seen between the wards and perceived stress even after adjustment (P < 0.05). CONCLUSIONS The findings suggest that perceived stress does vary within different work areas in the same hospital. Work factors, such as demand and support, are important with regard to perceived stress. Job control was not found to play an important role.

The effect of the Irish smoke-free workplace legislation on smoking among bar workers

BACKGROUND On 29 March 2004, the Republic of Ireland (ROI) became the first EU country to introduce a nationwide ban on workplace smoking. While the focus of this measure was to protect worker health by reducing exposure to second-hand smoke, other effects such as a greater reduction in smoking prevalence and consumption were likely among bar workers. METHODS A random sample of bar workers from Cork city were surveyed before (n = 129) and after (n = 107; 82.9% follow-up rate) implementation of the smoke-free legislation. Self report and combined self report and cotinine concentration were used to determine smoking status. For comparison a cross-sectional random telephone survey of the general population (ROI) was conducted before and 1 year after the smoke-free legislation. There were 1240 pre- and 1221 participants post-ban in the equivalent age and occupational subset of the general population. RESULTS There was a non-significant decline in smoking prevalence among bar workers 1 year post-ban (self report: -2.8% from 51.4% to 48.6%, P = 0.51; combined self report and cotinine: -4.7% from 56.1% to 51.4%, P = 0.13), but a significant decline in consumption of four cigarettes (95% CI 2.21-6.36) per day. Within the occupationally equivalent general population sub-sample there was a significant drop (3.5%, P = 0.06) in smoking prevalence but no significant change in consumption. CONCLUSIONS Irelands smoke-free workplace legislation was accompanied by a drop in smoking prevalence in both bar workers and the general population sub-sample.