Nicholas Warren

Workplace health protection and promotion through participatory ergonomics: an integrated approach.

A multidisciplinary team of researchers at the Center for the Promotion of Health in the New England Workplace (CPH-NEW) developed an evidencebased approach to address three recognized challenges to workplace programs designed to improve employee health: establishing employee ownership, integrating with work organization, and sustainability. The two main innovations being introduced in combination were (1) integrating traditional workplace health protection (e.g., ergonomics, industrial hygiene) with health promotion (e.g., assisting workers in improving health behaviors) and (2) introducing a bottom-up participatory model for engaging employees in innovative iterative design efforts to enhance both components of this integrated program. In the program, which was modeled after participatory ergonomics programs, teams of workers engage in the iterative design of workplace interventions to address their prioritized health concerns with the support of a multilevel steering committee. The integrated approach being tested can complement existing worksite safety and health initiatives and promote organizational learning, with expected synergistic effects.

Incorporating work organisation into occupational health research: an invitation for dialogue

The last decade has seen a lively debate emerge about the proper scope of public health research and the value of examining broad social and environmental factors as interacting determinants of morbidity and mortality.1 2 In occupational health and safety, the broader socio-ecological system of most obvious interest is that of the organisations in which workers are employed. However, occupational health researchers have been slow to incorporate broader workplace features into their exposure assessment protocols and epidemiological study designs. The dominant exposure paradigm remains largely confined to the characterisation of risk factors at the job level (fig 1, arrow B). While application of this paradigm has contributed much to our understanding of the association between work and worker health and safety, failure to consider the organisational factors and conditions that are antecedents to job-level hazards could limit our ability to design and implement effective and sustainable hazard controls (affecting arrows A, C, D in fig 1). Examples of this broader perspective already exist within systems safety and macroergonomics models3–7 but we suggest that the importance of the organisational context is relevant for all exposure domains—including chemical hazards. We seek to stimulate dialogue within the occupational health community about the organisational context in which worker injury and illness occurs—and its implications for aetiological research and hazard control. Figure 1 Conceptual pathways that link organisational characteristics with workplace health and safety hazards and worker health outcomes. The box “work organisation” potentially represents multiple levels above the job level. The investigative foci in occupational health and the organisational sciences differ significantly, from job-level to organisational-level.8 While each contributes to our understanding of how working …

Stopping Stress at Its Origins: Addressing Working Conditions

To the Editor: A significant volume of research relates occupational stress to cardiovascular disease.1 Although a variety of methods exists for measuring occupational stress, a consistent feature of these measurements is a focus on environmental and work organization origins as opposed to individual characteristics and responses. This paradigm comes from occupational health with identifying exposure sources as distinct from measuring biological and/or behavioral response to exposure. Eliminating exposure is the preferred prevention, and personal protective equipment is an acceptable alternative when no other option exists. We …

Biomechanical, psychosocial, and organizational risk factors for WRMSD: population-based estimates from the Connecticut upper-extremity surveillance project (CUSP).

In a case-control study of a population-based telephone survey of 3,798 working adults, symptoms of work-related musculoskeletal disorder (WRMSD) were associated with biomechanical, psychosocial, and organizational factors. In several models, biomechanical exposures with strong associations were static postures (odds ratios [ORs] = 2.00-5.45); repeated pushing, pulling, lifting (ORs = 1.86-12.75); and repeated neck bending (ORs = 1.07-12.8). Psychosocial and organizational factors consistently retained in these models were demands (ORs = 1.26-1.59) and organizational support (ORs = 0.53-0.79). Decision latitude entered less frequently (ORs = 0.30-0.49). This research may have implications for intervention strategies. First, reducing both biomechanical and psychosocial risk may be more effective than focusing solely on engineering controls. Second, organizational culture and policy may have strong implications for WRMSD prevalence and control.

Employee working conditions and healthcare system performance: the Veterans Health Administration experience.

Objective: The authors explored the association between health care employees’ perceptions of their organizations and objective measures of system performance. Methods: A national survey of employees conducted in 2001 by the Veterans Administration (VA) assessed employee perceptions of hospital organizational characteristics. The authors analyzed cross-sectional associations between these perceptions and objective measures of health care system performance—employee and patient care outcomes. Results: Employee perceptions of organizational climate (indicators of the organizational culture) were strongly related to overall satisfaction and measures of system performance. Overall, change in perceptions of organizational climate by 1 standard deviation (SD) was potentially associated with changes of 2% to 35% in selected outcomes. Conclusions: Organizational climate, policies, and resultant working conditions in health care institutions appear to be strong drivers of system performance. Interventions directed toward improving care quality and safety should address these factors.

Effects of Psychosocial Characteristics of Work on Pregnancy Outcomes: A Critical Review

Birth outcomes may influence subsequent susceptibility to chronic diseases. With the increased number of women who continue to work during pregnancy, occupational stress has been hypothesized to be a potential contributor to adverse reproductive health outcomes. The Job Demand and Control model has been primarily used in investigating associations between work-related stress and outcomes such as preterm delivery, low birth weight, and spontaneous abortion. A literature review of occupational factors that have been associated with adverse reproductive outcomes was conducted. In studies assessing preterm delivery and low birth weight, some evidence has suggested a modest association with work-related stress but has not been conclusive. In the literature on psychosocial characteristics of work and spontaneous abortion, job strain alone was often not associated with adverse outcomes. However the presence of other risk factors resulted in a synergistic effect which strengthened the odds of an adverse outcome. Future studies should use a prospective design with a large study sample, in which work-related stress exposure data are collected before or in the early stages of the pregnancy. In addition, future research should measure psychosocial characteristics of work both objectively and subjectively.

Depression and work family conflict among corrections officers.

Objective:This article assessed work-to-family conflict (W-FC) and family-to-work conflict (F-WC) and their impact on depression among corrections officers in two correctional facilities in the United States. Methods:The sample consisted of 220 officers who completed questionnaires that included data on demographics, sense of coherence (SOC), physical health, psychosocial job characteristics, and work–family conflict. The Center for Epidemiologic Studies Depression Scale (CES-D-10) assessed depression. Results:The mean CES-D score was 7.8 (SD = 5.2); 31% had scores of 10 or more, indicative of serious psychological distress. The SOC, W-FC, and F-WC were significantly and positively associated with depression; W-FC mediated the effects of SOC on depression. Psychosocial job characteristics were not related to depression. Conclusions:Depressive symptoms were high among officers, and W-FC was a critical factor contributing to psychological distress.

Talking About Health: Correction Employeesʼ Assessments of Obstacles to Healthy Living

Objective: Describe health risks/obstacles to health among correctional employees. Methods: Mixed-methods approach combined results from four focus groups, 10 interviews, 335 surveys, and 197 physical assessments. Results: Obesity levels were higher than national averages (40.7% overweight and 43.3% obese), with higher levels associated with job tenure, male gender, and working off-shift. Despite widespread concern about the lack of fitness, leisure exercise was higher than national norms. Respondents had higher levels of hypertension than national norms, with 31% of men and 25.8% of women hypertensive compared with 17.1% and 15.1% for national norms. Stress levels were elevated. Officers related their stress to concerns about security, administrative requirements, and work/family imbalance. High stress levels are reflected in elevated levels of hypertension. Conclusions: Correctional employees are at high risk for chronic disease, and environmental changes are needed to reduce risk factors.

Maternal occupation and risk for low birth weight delivery: assessment using state birth registry data.

Objective: To determine the effects of employment on low birth weight (LBW) in a service-based economy, we evaluated the association of LBW delivery with occupational data collected in a state birth registry. Methods: Occupational data in the 2000 Connecticut birth registry were coded for 41,009 singleton births. Associations between employment and LBW delivery were analyzed using logistic regression controlling for covariates in the registry data set. Results: Evidence for improved LBW outcomes in working mothers did not persist when adjusted for maternal covariates. Among working mothers, elevated risk of LBW was seen in textile, food service, personal appearance, material dispatching or distributing, and retail sales workers. Conclusions: Improved overall birth outcomes seen in working mothers may arise from favorable demographic and health attributes. Higher LBW risk was seen in several types of service sector jobs and in textile work.

Participatory ergonomics as a model for integrated programs to prevent chronic disease.

Objective: To describe the value of participatory methods for achieving successful workplace health promotion (WHP) programming, and specifically the relevance of participatory ergonomics (PE) for the Total Worker Health (TWH) initiative. Methods: We review the concept of macroergonomics, and how PE is embedded within that framework, and its utility to modern WHP approaches such as “social health promotion.” We illustrate these constructs in practice within TWH. Results and Conclusions: Participatory ergonomics is relevant to WHP because (1) psychosocial stress contributes to individual health behaviors as well as chronic diseases; (2) job stress cannot be addressed without employee involvement in hazard identification and solutions; (3) the interaction of multiple levels within an organization requires attention to needs and constraints at all levels, just as the social-ecological model addresses higher-level determinants of and constraints on individual behaviors.