John D. Meyer

Construction of early and midlife work trajectories in women and their association with birth weight

OBJECTIVESnWe derived trajectories of the substantive complexity (SC) of work across mid-adult life in women and determined their association with term birth weight. SC is a concept that encompasses decision latitude, active learning, and ability to use and expand ones abilities at work.nnnMETHODSnUsing occupational data from the National Longitudinal Survey of Youth 1979 and O*NET work variables, we used growth mixture modeling (GMM) to construct longitudinal trajectories of work SC from the ages of 18 to 34 years. The association between work trajectories and birth weight of infants born to study participants was modeled using generalized estimating equations, adjusting for education, income, and relevant covariates.nnnRESULTSnGMM yielded a 5-class solution for work trajectories in women. Higher work trajectories were associated with higher term birth weight and were robust to the inclusion of both education and income. A work trajectory that showed a sharp rise after age 24 years was associated with marked improvement in birth weight.nnnCONCLUSIONSnLongitudinal modeling of work characteristics might improve capacity to integrate occupation into a life-course model that examines antecedents and consequences for maternal and child health.

Job strain, occupational category, systolic blood pressure, and hypertension prevalence the multi-ethnic study of atherosclerosis

Objective: To assess associations of occupational categories and job characteristics with prevalent hypertension. Methods: We analyzed 2517 Multi-Ethnic Study of Atherosclerosis participants, working 20+ hours per week, in 2002 to 2004. Results: Higher job decision latitude was associated with a lower prevalence of hypertension, prevalence ratiou200a=u200a0.78 (95% confidence interval 0.66 to 0.91) for the top versus bottom quartile of job decision latitude. Associations, however, differed by occupation: decision latitude was associated with a higher prevalence of hypertension in health care support occupations (interaction Pu200a=u200a0.02). Occupation modified associations of sex with hypertension: a higher prevalence of hypertension in women (vs men) was observed in health care support and in blue-collar occupations (interaction Pu200a=u200a0.03). Conclusions: Lower job decision latitude is associated with hypertension prevalence in many occupations. Further research is needed to determine reasons for differential impact of decision latitude and sex on hypertension across occupations.

0055 Association of occupational trajectories with alcohol use disorders in a longitudinal national survey

Objectives We posited mutually-reinforcing longitudinal pathways between occupation and alcohol use disorders (AUD). Method Longitudinal trajectories of work substantive complexity were constructed by growth mixture modelling (GMM) of occupational data from the National Longitudinal Survey of Youth 1979 and O*NET work variables. AUD was determined using a set of 25 questions that map onto 9 criteria for alcohol dependence. Prevalent AUD was one occurred at or before the first alcohol questionnanire in 1989; an incident AUD was a new case between 1989 and the 1994 survey. The association between work trajectories and AUD was modelled using Poisson regression in a generalised linear model adjusting for covariates. Results Lower work trajectories were associated with higher AUD prevalence (prevalence ratio 1.41; 95% confidence interval 1.04–1.91 for lowest versus highest class). Incident AUDs were associated with risk of a decline in work trajectory class in both high (OR=2.68; 95% CI 1.34–5.35) and low (OR=1.62 95% CI 1.01–2.60) initial classes. Interval educational attainment was not associated with AUD within a specific occupaitonal trajectory class Conclusions Low occupational trajectories are associated with increased AUD prevalence. Incident AUDs may be followed by a decline in work SC. These findings suggest self-reinforcing relations between the development of AUD and both prior and subsequent work.

Association of occupational trajectories with alcohol use disorders in a longitudinal national survey

Objectives: We investigated longitudinal associations between occupation and alcohol use disorders (AUDs) across early- to mid-adult life. Methods: Longitudinal trajectories of work substantive complexity were constructed by growth mixture modeling of occupational data from the National Longitudinal Survey of Youth 1979 and O*NET work variables. The association between work trajectories and AUDs was modeled adjusting for education. Results: Lower work trajectories were associated with higher AUD prevalence and incidence. Incident AUDs were associated with a subsequent decline in work trajectory class for both high and low initial classes, more strongly in women despite lower overall AUD incidence. Conclusions: Low work trajectory is associated with increased AUD prevalence. Development of an AUD may presage risk of decline in work substantive complexity. These findings suggest reinforcing relations between the development of AUD and occupational course at midlife.

Explaining racial/ethnic differences in all-cause mortality in the Multi-Ethnic Study of Atherosclerosis (MESA): Substantive complexity and hazardous working conditions as mediating factors

Research on racial/ethnic health disparities and socioeconomic position has not fully considered occupation. However, because occupations are racially patterned, certain occupational characteristics may explain racial/ethnic difference in health. This study examines the role of occupational characteristics in racial/ethnic disparities in all-cause mortality. Data are from a U.S. community-based cohort study (n=6342, median follow-up: 12.2 years), in which 893 deaths (14.1%) occurred. We estimated mortality hazard ratios (HRs) for African Americans, Hispanics, and Chinese Americans compared with whites. We also estimated the proportion of the HR mediated by each of two occupational characteristics, substantive complexity of work (e.g., problem solving, inductive/deductive reasoning on the job) and hazardous conditions (e.g., noise, extreme temperature, chemicals), derived from the Occupational Information Network database (O*NET). Analyses were adjusted for age, sex, nativity, working status at baseline, and study sites. African Americans had a higher rate of all-cause death (HR 1.41; 95% confidence interval [CI]: 1.19–1.66) than whites. Chinese-American ethnicity was protective (HR 0.59, CI: 0.40–0.85); Hispanic ethnicity was not significantly different from whites (HR 0.88; CI: 0.67–1.17). Substantive complexity of work mediated 30% of the higher rate of death for African Americans compared with whites. For other groups, mediation was not significant. Hazardous conditions did not significantly mediate mortality in any racial/ethnic group. Lower levels of substantive complexity of work mediate a substantial part of the health disadvantage in African Americans. This job characteristic may be an important factor in explaining racial health disparities.

A review of recent literature on materialist and psychosocial models for racial and ethnic disparities in birth outcomes in the US, 2000–2014

ABSTRACT Objective: Material and psychosocial factors exacerbate racial disparities in health outcomes. This review sought to ascertain recent knowledge of the effects of materialist and psychosocial factors on differences in low birthweight (LBW) and preterm delivery (PTD) outcomes between Black and White mothers. Design: Search and review was conducted for studies that examined: (a) neighborhood-level deprivation as an indicator of material conditions, and (b) racial discrimination or occupational stressors as indicators of psychosocial stress. The outcomes of interest were LBW and PTD. Results: Material and psychosocial factors significantly and negatively affected Blacks more than Whites, and were associated with increased adverse outcomes. Of five studies with a homogeneous Black study sample, three reported no effect on outcomes in women exposed to material or psychosocial factors. Conclusion: Through this review we find that in comparison to White women, Black women are at higher risk of adverse outcomes due to both psychosocial stress and meso-level deprivation, after accounting for personal factors. A better understanding of effects on health outcomes of material and psychosocial factors in Black women is needed. Further investigation into materialist and psychosocial factors, will allow us to better understand the factors driving PTD and LBW disparities in the US.

Longitudinal Assessment of Effort-Reward Imbalance and Job Strain Across Pregnancy: A Preliminary Study.

ObjectivesTo assess longitudinal changes in occupational effort–reward imbalance (ERI) and demand-control (DC) scores across pregnancy and examine associations with blood pressure (BP) during pregnancy.MethodsA pilot repeated-measures survey was administered four times to a sample of working women across pregnancy using the ERI and DC instruments. Demographic data and blood pressure measurements were collected at each interval. Growth mixture modeling was used to examine trajectories of change in occupational characteristics. Associations with BP were examined using repeated-measures linear regression models.ResultsERI model components (effort, reward, and overcommitment) all declined across pregnancy while job control remained stable. Increasing ERI trajectory was associated with higher systolic BP (bxa0=xa08.8; pxa0<xa00.001) as was high overcommitment; declining ERI also showed a lesser association with higher BP. Associations between DC trajectories and BP were much smaller, and non-significant once controlled for overcommitment.ConclusionsSelf-assessed efforts, rewards, and overcommitment at work decline across pregnancy in our participants, while job control remains stable. Replication in a more diverse pregnant working population is warranted to confirm these results. These preliminary data suggest that further investigation into the factors that may be linked with improved work psychosocial climate during pregnancy may be useful in order to improve pregnancy outcomes.

Access to properly fitting personal protective equipment for female construction workers

BACKGROUNDnPrevious literature suggests that most personal protective equipment (PPE) for construction is designed for males and does not accommodate female anthropometry. We conducted a pilot study to identify whether female construction workers currently have adequate access to properly fitting PPE.nnnMETHODSnSemi-structured focus group interviews were conducted with union female carpenters, laborers, and ironworkers. Researchers coded focus group transcriptions and extracted major themes using thematic framework analysis.nnnRESULTSnParticipants (nu2009=u200923) had a mean of 15.1 years of construction experience (range 3-34.5 years). A majority reported fit problems for many types of PPE (gloves, harnesses, safety vests, work boots, outerwear), generally noting that the equipment provided by contractors was too large. Other emergent themes included female workers purchasing their own PPE, exposure to various safety hazards from poorly fitted PPE, and perceived indifferent safety culture.nnnCONCLUSIONSnFemale construction workers continue to have difficulty accessing properly fitting PPE. Am. J. Ind. Med. 59:1032-1040, 2016.

Differences in the prevalence of musculoskeletal symptoms among female and male custodians

BACKGROUNDnThe prevalence of musculoskeletal symptoms among custodians is high. We sought to compare musculoskeletal symptoms between female and male custodians and to explore how task might affect this relationship.nnnMETHODSnA cross-sectional study was performed among 712 custodians who completed a survey assessing upper extremity, back, and lower extremity musculoskeletal symptoms and exposure to cleaning tasks. Chi-square tests and logistic regression analyses were used to test for associations between gender, cleaning tasks, and musculoskeletal symptoms.nnnRESULTSnGender was significantly (Pu2009<u20090.05) associated with musculoskeletal symptoms in χ(2) tests and multivariate analyses. The prevalence ratio of symptoms among women was roughly 50% higher than men, regardless of the tasks that workers performed.nnnCONCLUSIONSnThe prevalence of musculoskeletal symptoms differed for female and male custodians and appeared to be consistent across a range of job tasks. Am. J. Ind. Med. 59:841-852, 2016.

Association between effort-reward imbalance and self-reported diabetes mellitus in older U.S. workers

OBJECTIVEnStudies assessing the effects of work stress on health in older adults in the U.S. labor force are scarce. We examined the longitudinal association between work stress as measured by effort-reward imbalance (ERI) and incident diabetes over a 7-year period in U.S. working adults aged 50years and older.nnnMETHODSnWe used longitudinal data from the 2006-2012 waves of the Health and Retirement Study (n=1932). Cox proportional hazard regression was used to examine whether ERI significantly predicted diabetes incidence in older adults who were diabetes-free at baseline.nnnRESULTSnHigh stress level at work (ERI ratio>1.0) was found in participants who worked 55h or more a week (37.3%), had no insurance coverage (35.9%), and those working in blue collar jobs (34.4%). Participants with high ERI had a significantly higher risk of diabetes (HR=1.33, 95%CI=1.04-1.69) relative to those with low ERI, after adjustment for known predictors of adult-onset diabetes.nnnCONCLUSIONnEffort-reward imbalance was associated with increased risk of diabetes incidence after controlling for other known predictive factors, which suggests an independent non-mediated effect of work stressors. More research is required to better understand the effects of work stress in aging populations and how psychosocial disequilibrium in the work environment may impact susceptibility to chronic conditions, and in particular how change in self-assessed reward might vary toward the end of a working lifetime.