Leslie I. Boden

Integration of Health Protection and Health Promotion: Rationale, Indicators, and Metrics

Objective: To offer a definition of an “integrated” approach to worker health and operationalize this definition using indicators of the extent to which integrated efforts are implemented in an organization. Methods: Guided by the question—How will we know it when we see it?—we reviewed relevant literature to identify available definitions and metrics, and used a modified Delphi process to review and refine indicators and measures of integrated approaches. Results: A definition of integrated approaches to worker health is proposed and accompanied by indicators and measures that may be used by researchers, employers, and workers. Conclusions: A shared understanding of what is meant by integrated approaches to protect and promote worker health has the potential to improve dialogue among researchers and facilitate the research-to-practice process.

Income Losses of Women and Men Injured at Work

Women and men injured at work in Wisconsin during 1989 and 1990 have similar levels of lost earnings in the quarter of injury. However, in the three and one-half years after the post-injury quarter, women lose an average of 9.2 percent of earnings, while men lose only 6.5 percent. Even after accounting for covariates with a variant of the Oaxaca-Blinder-Neumark decomposition, the disparity in long-term losses remains. Differences in injury-related nonemployment account for about half the covariate-adjusted gap over the four-year post-injury period. Changes in hours worked may explain all or part of the remaining gap. Gender differences in labor supply appear likely to account for much of the disparity in losses, but discrimination remains a viable explanation.

Occupational injuries among nurses and aides in a hospital setting

BACKGROUND Patient care workers in acute care hospitals are at high risk of injury. Recent studies have quantified risks and demonstrated a higher risk for aides than for nurses. However, no detailed studies to date have used OSHA injury definitions to allow for better comparability across studies. METHODS We linked records from human resources and occupational health services databases at two large academic hospitals for nurses (n = 5,991) and aides (n = 1,543) in patient care units. Crude rates, rate ratios, and confidence intervals were calculated for injuries involving no days away and those involving at least 1 day away from work. RESULTS Aides have substantially higher injury rates per 100 full-time equivalent workers (FTEs) than nurses for both injuries involving days away from work (11.3 vs. 7.2) and those involving no days away (9.9 vs. 5.7). Back injuries were the most common days away (DA) injuries, while sharps injuries were the most common no days away (NDA) injuries. Pediatric/neonatal units and non-inpatient units had the lowest injury rates. Operating rooms and the float pool had high DA injury rates for both occupations, and stepdown units had high rates for nurses. NDA injuries were highest in the operating room for both nurses and aides. CONCLUSIONS This study supports the importance of a continuing emphasis on preventing back and sharps injuries and reducing risks faced by aides in the hospital setting. Uniform injury definitions and work time measures can help benchmark safety performance and focus prevention efforts.

Impact of musculoskeletal and medical conditions on disability retirement-a longitudinal study among construction roofers.

BACKGROUND To assess the intersection of work demands, chronic medical and musculoskeletal conditions, aging, and disability, we initiated a longitudinal study of construction roofers who were current union members between the ages of 40 and 59. METHODS Participants were asked about the presence of medical conditions and musculoskeletal disorders; the Work Limitations Questionnaire, the SF-12, and other validated assessments of social and economic impact of injury were included. RESULTS Factors at baseline that predicted leaving for a health-related reason were older age, lower physical functioning, work limitations, and having missed work. Those who left roofing for a health-related reason were much more likely to have a lower economic score at the 1 year interview. CONCLUSIONS Medical and musculoskeletal conditions are strongly associated with work limitation, missed work, and reduced physical functioning; these factors are also associated with premature departure from the workforce.

The return to work of injured workers: evidence from matched unemployment insurance and workers' compensation data

Abstract This study represents the first analysis of the return to work of an entire population of workers with job-related injuries. Duration estimates indicate that returning to the pre-injury employer is one of the main determinants of the speed of return to work. The workers pre-injury employment history also plays a large role, while the elasticities of the economic incentives vary across injury lengths and model specifications. The length of time off work is an important determinant of the probability of being employed 1 year after the first return to work. Results do not differ by gender.

The Impact of Health and Safety Committees: A Study Based on Survey, Interview, and Occupational Safety and Health Administration Data

In a study conducted to determine if the existence of a joint labor-management health and safety committee (HSC) was correlated with either the number of Occupational Safety and Health Administration (OSHA) complaints or hazardousness, as measured by OSHA serious citations, virtually no effect could be detected in a sample of 127 Massachusetts manufacturing firms. At a sample of 13 firms, interviews of HSC members were conducted. Committee attributes and perceptions about committee effectiveness were compared with the number of OSHA complaints and serious citations. There were fewer complaints and fewer serious citations at firms with HSCs that were perceived as effective. Results of the study suggest that the objective attributes of the committee may be less important to its success than the commitment of management and labor to solving workplace safety problems.

Use of multiple data sources for surveillance of work-related amputations in Massachusetts, comparison with official estimates and implications for national surveillance.

BACKGROUND Accurate surveillance of work-related injuries is needed at national and state levels. We used multiple sources for surveillance of work-related amputations, compared findings with Survey of Occupational Injuries and Illnesses (SOII) estimates, and assessed generalizability to national surveillance. METHODS Three data sources were used to enumerate work-related amputations in Massachusetts, 2007-2008. SOII eligible amputations were compared with SOII estimates. RESULTS 787 amputations were enumerated, 52% ascertained through hospital records only, exceeding the SOII estimate (n = 210). The estimated SOII undercount was 48% (95% CI: 36-61%). Additional amputations were reported in SOII as other injuries, accounting for about half the undercount. Proportionately more SOII estimated than multisource cases were in manufacturing and fewer in smaller establishments. CONCLUSION Multisource surveillance enhanced our ability to document work-related amputations in Massachusetts. While not feasible to implement for work-related conditions nationwide, it is useful in states. Better understanding of potential biases in SOII is needed.

Litigation-generated science: why should we care?

Background In a 1994 Ninth Circuit decision on the remand of Daubert v. Merrell Dow Pharmaceuticals, Inc., Judge Alex Kosinski wrote that science done for the purpose of litigation should be subject to more stringent standards of admissibility than other science. Objectives We analyze this proposition by considering litigation-generated science as a subset of science involving conflict of interest. Discussion Judge Kosinskis formulation suggests there may be reasons to treat science involving conflict of interest differently but raises questions about whether litigation-generated science should be singled out. In particular we discuss the similar problems raised by strategically motivated science done in anticipation of possible future litigation or otherwise designed to benefit the sponsor and ask what special treatment, if any, should be given to science undertaken to support existing or potential future litigation. Conclusion The problems with litigation-generated science are not special. On the contrary, they are very general and apply to much or most science that is relevant and reliable in the courtroom setting.

Worker assessments of organizational practices and psychosocial work environment are associated with musculoskeletal injuries in hospital patient care workers

BACKGROUND Hospital patient care (PC) workers have high rates of workplace injuries, particularly musculoskeletal injuries. Despite a wide spectrum of documented health hazards, little is known about the association between psychosocial factors at work and OSHA-recordable musculoskeletal injuries. METHODS PC-workers (n = 1,572, 79%) completed surveys assessing a number of organizational, psychosocial and psychological variables. Associations between the survey responses and injury records were tested using bivariate and multivariate analyses. RESULTS A 5% of the PC-workers had at least one OSHA-recordable musculoskeletal injury over the year, and the injuries were significantly associated with: organizational factors (lower people-oriented culture), psychosocial factors (lower supervisor support), and structural factors (job title: being a patient care assistant). CONCLUSIONS The results show support for a multifactorial understanding of musculoskeletal injuries in hospital PC-workers. An increased focus on the various dimensions associated with injury reports, particularly the organizational and psychosocial factors, could contribute to more efficient interventions and programs.

Policy evaluation: Better living through research

Public health scientists have produced valuable research about the epidemiology of occupational hazards, their measurement, and engineering controls. Still, many firms do not apply available knowledge to eliminate workplace hazards. Occupational safety and health policy research helps to bridge the gap between current scientific understanding and effective public policies. It focuses on four areas: (1) primary prevention policies, including standards focusing on controlling specific hazards, standards requiring health and safety programs, surveillance, education and training, targeting of enforcement, and nonregulatory safety incentives; (2) secondary prevention policies, including medical care, vocational rehabilitation, and laws and regulations fostering reemployment of injured workers; (3) compensation policies, including the range and level of medical benefits and income benefits to injured workers; and (4) behavioral responses to policies that lead to unintended consequences. This article provides examples of existing research in these areas and discusses the direction of future occupational safety and health policy evaluation research.