Linda M. Goldenhar

The Intervention Research Process in Occupational Safety and Health: An Overview From the National Occupational Research Agenda Intervention Effectiveness Research Team

The goal of occupational safety and health intervention effectiveness research is to determine whether specific interventions work to prevent work-related injury and illness. But that is not the whole story. It is also important that the development and implementation of the intervention be evaluated. All three phases (development, implementation, and effectiveness) are central to a model of intervention research proposed by the National Occupational Research Agenda Intervention Effectiveness Research team. Areas for future research are also presented.

Modelling relationships between job stressors and injury and near-miss outcomes for construction labourers

Construction work is an inherently dangerous occupation and exposure to additional job stressors is likely to exacerbate the level of danger, increasing workers’ risk for injury. Thus, it is important to identify and then reduce worker exposure to extraneous job stressors. This study examines the relationships between a variety of job stressors and injury or near-miss outcomes among construction workers. Self-reported questionnaire data collected from 408 construction labourers (male and female) via telephone interview were analysed using structural equation modelling. A theoretical model was tested whereby work stressors, classified into three groups, could be related, either directly or indirectly through the mediating effects of physical or psychological symptoms/strain, to self-reported injuries and near misses. Ten of the 12 work-related stressors were found to be directly related to either injury or near misses, including: job demands, job control, job certainty, training, safety climate, skill under-utilization, responsibility for the safety of others, safety compliance, exposure hours, and job tenure. Other stressors (i.e. harassment/discrimination, job certainty, social support, skill under-utilization, safety responsibility, safety compliance, tenure in construction) were indirectly related to injuries through physical symptoms or indirectly related to near misses through psychological strain. There was no support for the modelled gender differences. Implications for health and safety on construction sites are discussed.

Health and safety training in a sample of open-shop construction companies

Problem: Compared to other industries, construction has the third-highest death rate. Many agree, and research has shown, that one way to change these statistics is through effective worker safety and health training. Little is known about the quality and nature of safety and health training available to open-shop (nonunion) construction workers. Method: It was the goal of this preliminary study to provide some initial background information about the nature and quality of safety and training in open-shop construction operations. Results: While the majority of contractors surveyed did provide safety and health training, most did not quantitatively evaluate their training programs in terms of reduction in hazardous behaviors or exposures, or increased job satisfaction or productivity. Impact on Industry: Learning about the major parameters (e.g., methods, policies, barriers, company/worker perceptions, etc.) influencing nonunion construction safety training will help guide future construction safety-related research and intervention strategies on a national basis.

The “Goldilocks model” of overtime in construction: not too much, not too little, but just right ☆

PROBLEM Little research exists on the relationship between working overtime and possible adverse health and safety outcomes for construction workers. METHOD Five focus-group discussions were conducted with construction workers from around the United States. From the analyzed transcripts, a model of overtime was developed. RESULTS The model includes three dominant themes: (1) work organization issues [(a) definitions of overtime, (b) scheduling, and (c) economic conditions], (2) why workers choose to work overtime [(a) management expectations, (b) career, and (c) money], and (3) the effects of working overtime [(a) health and safety, including sleep deprivation, injury, fatigue, and stress, and (b) productivity]. DISCUSSION Health and safety is only one of the adverse outcomes related to working too much overtime. A list of worker-inspired recommendations for addressing overtime issues is provided. IMPACT ON THE INDUSTRY Both employers and workers need to better understand the potential adverse effects of working too much overtime.

Worksite Health Programs: Working Together to Advance Employee Health

The workplace is a common context within which health promotion, disease prevention, and injury prevention programs are conducted.1,2 Health educators have been important contributors to the burgeoning area of worksite health promotion (WHP), with its traditional focus on individual behavior change of personal risk factors (e.g., smoking, lack of exercise, unhealthy diet). Recently, health educators and health behavior specialists are taking a more active role in occupational safety and health (OSH) programs that address the influence of physical, chemical, and psychosocial work exposures on employee health. For WHP efforts, the worksite serves as a convenient venue for health programs, providing access to adult populations that might otherwise be hard to reach and providing organizational structures and norms that can facilitate successful individual behavior change (e.g., employer-provided incentives and the social influence of coworkers) 3 In contrast, OSH interventions attempt to reduce exposure to aspects of the worksite that are deleterious to employee health. OSH interventions may involve engineering strategies (e.g., making physical modifications to the worksite or work process), administrative strategies (e.g., management initiatives that modify the work process or environment), and individual behavior change strategies (e.g., educational training to increase personal protective equipment use) 4 4

A National Survey on the Current Status of General Internal Medicine Residency Education in Geriatric Medicine

OBJECTIVES: The dramatic increase in the U.S. elderly population expected over the coming decades will place a heavy strain on the current health care system. General internal medicine (GIM) residents need to be prepared to take care of this population. In this study, we document the current and future trends in geriatric education in GIM residency programs.DESIGN, SETTING, PARTICIPANTS: An original survey was mailed to all the GIM residency directors in the United States (N=390).RESULTS: A 53% response rate was achieved (n=206). Ninety-three percent of GIM residencies had a required geriatrics curriculum. Seventy one percent of the programs required 13 to 36 half days of geriatric medicine clinical training during the 3-year residency, and 29% required 12 half days or less of clinical training. Nursing homes, outpatient geriatric assessment centers, and nongeriatric ambulatory settings were the predominant training sites for geriatrics in GIM. Training was most often offered in a block format. The average number of physician faculty available to teach geriatrics was 6.4 per program (2.8 full-time equivalents). Conflicting time demands with other curricula was ranked as the most significant barrier to geriatric education.CONCLUSIONS: A required geriatric medicine curriculum is now included in most GIM residency programs. Variability in the amount of time devoted to geriatrics exists across GIM residencies. Residents in some programs spend very little time in specific, required geriatric medicine clinical experiences. The results of this survey can guide the development of future curricular content and structure. Emphasizing geriatrics in GIM residencies helps ensure that these residents are equipped to care for the expanding aging population.

Operationalizing Theoretical Constructs in Bloodborne Pathogens Training Curriculum

This article describes how the protection motivation theory (PMT) was used to inform the production of video curriculum for a bloodborne pathogens training program for hospital nurses. Although hospital nurses are well acquainted with the work practices designed to prevent bloodborne pathogen exposures (universal precautions), there is evidence that they do not always follow them. First, the onginal PMT is adapted to reflect what is currently known about the role of affect in health behavior prediction. Second, the authors show how the four PMT message constructs—probability of occurrence, magnitude of noxiousness, response efficacy, and self—efficacy—guided the planning, shooting, and editing of the videotapes. Incidental to this process was the operationalization of these message constructs in such a way that affective reactions would result. The results show that this video curriculum successfully aroused negative affect in the target audience. Only by carefully planning and documenting how message constructs are operationalized in health education materials can one be sure of achieving theory-based (and thus the most replicable) message design.

Cigarette Advertising and Magazine Coverage of the Hazards of Smoking: A Statistical Analysis

BACKGROUND Health professionals have charged that magazines that depend on revenues from cigarette advertising are less likely to publish articles on the dangers of smoking for fear of offending cigarette manufacturers. Special concern has focused on magazines directed to women. Restricted coverage of smoking hazards could lead readers to underestimate the risks of smoking in relation to other health risks. METHODS Using logistic-regression analysis of a sample of 99 U.S. magazines published during 25 years (1959 through 1969 and 1973 through 1986), we analyzed the probability that the magazines would publish articles on the risks of smoking in relation to whether they carried advertisements for cigarettes and in relation to the proportion of their advertising revenues derived from cigarette advertisements. We controlled for other factors that might influence coverage. RESULTS The probability of publishing an article on the risks of smoking in a given year was 11.9 percent for magazines that did not carry cigarette advertisements, as compared with 8.3 percent for those that did publish such advertisements (adjusted odds ratio, 0.73; 95 percent confidence interval, 0.42 to 1.30). For womens magazines alone, the probabilities were 11.7 percent and 5.0 percent, respectively (adjusted odds ratio, 0.13; 95 percent confidence interval, 0.02 to 0.69). When the proportion of revenues derived from cigarette advertising was the independent variable, the probability of publishing an article on the risks of smoking in a given year was reduced by 38 percent (95 percent confidence interval, 18 percent to 55 percent) for magazines with the average proportion of total advertising revenues derived from cigarette advertising for the entire sample of magazines (6 percent) as compared with magazines with no cigarette advertising. This relation was particularly strong in the case of womens magazines. An increase of 1 percent in the share of advertising revenue derived from cigarette advertisements decreased the probability of covering the risks of smoking by three times as much as in other magazines. CONCLUSIONS This study provides strong statistical evidence that cigarette advertising in magazines is associated with diminished coverage of the hazards of smoking. This is particularly true for magazines directed to women.