Toni Alterman

Worksite Health Promotion Programs in the U.S.: Factors Associated with Availability and Participation

Purpose. To examine how the availability of and participation in worksite health promotion programs varies as a function of individual (e.g., age), organizational (e.g., occupation), and health (e.g., high blood pressure) characteristics. Availability of worksite programs was also compared to that reported in two previous national surveys of private companies. Design. Data analyzed were from the 1994 National Health Interview Survey (NHIS), a national cross-sectional probability sample of the U.S. civilian population. Subjects. Five thousand two hundred nineteen NHIS respondents met the inclusion criteria of (1) being currently employed in a company of at least 50 employees, and (2) completing the NHIS section on worksite health promotion. Measures. Employees indicated the availability of, and their participation in, 33 different types of worksite programs. National Health Interview Survey data were also available regarding general health, blood pressure, body mass index, and medical conditions. Results. Smoking cessation programs had the highest mean availability (43 %), followed by health education programs (31 %) and screening tests (31 %). Overall, availability of worksite programs appeared comparable to that reported in a recent national survey. Participation ranged from 32% for health education programs to 5% for smoking cessation programs. Compared to availability, participation depended less on individual and organizational characteristics. Healthy employees were not consistently more likely to participate in worksite health promotion programs than nonhealthy employees. Conclusions. Although availability of worksite health promotion programs remains high, participation by employees in specific types of programs can vary widely. Attempts to increase participation should look beyond individual, health, and organizational variables, to specific features of the work environment that encourage involvement in health promotion activities.

Prevalence rates of work organization characteristics among workers in the U.S.: data from the 2010 National Health Interview Survey.

BACKGROUND Surveillance is needed to capture work organization characteristics and to identify their trends. METHODS Data from the 2010 National Health Interview Survey (NHIS) were used to calculate prevalence rates for four work organization characteristics (long work hours, non-standard work arrangements, temporary positions, and alternative shifts) overall, and by demographic characteristics, and industry and occupation of current/recent employment. RESULTS Data were available for 27,157 adults, of which 65% were current/recent workers. Among adults who worked in the past 12 months, 18.7% worked 48 hr or more per week, 7.2% worked 60 hr or more per week, 18.7% had non-standard work arrangements, 7.2% were in temporary positions, and 28.7% worked an alternative shift. CONCLUSIONS Prevalence rates of work organization characteristics are provided. These national estimates can be used to help occupational health professionals and employers to identify emerging occupational safety and health risks, allow researchers to examine associations with health, and use the data for benchmarking.

Job insecurity, work‐family imbalance, and hostile work environment: Prevalence data from the 2010 National Health Interview Survey

BACKGROUND Little nationally representative information on job insecurity, work-family imbalance, and hostile work environments experienced by workers in the US is available. METHODS Prevalence rates from the 2010 National Health Interview Survey (NHIS) were calculated for three workplace psychosocial factors (job insecurity, work-family imbalance, bullying/harassment) using SUDAAN to account for the complex NHIS sample design. RESULTS Data were available for 17,524 adults who worked in the 12 months that preceded the interview. Overall prevalence rates were 31.7% for job insecurity, 16.3% for work-family imbalance, and 7.8% for hostile work environment (being bullied or harassed). The highest prevalence rate of job insecurity was found for construction and extraction occupations. Workers in legal occupations had the highest prevalence rate of work-family imbalance. Workers in protective service occupations had the highest prevalence rate of hostile work environment. CONCLUSIONS We identified demographic characteristics along with industries and occupations with the highest prevalence rates for three adverse workplace psychosocial factors. These data can be used for benchmarking and identification of targets for investigation and intervention activities.

Examining associations between job characteristics and health: linking data from the Occupational Information Network (O*NET) to two U.S. national health surveys.

Objective:To determine whether the Occupational Information Network (O*NET) database can be used to identify job dimensions to serve as proxy measures for psychosocial factors and select environmental factors, and to determine whether these factors could be linked to national health surveys to examine associations with health risk behaviors and outcomes. Methods:Job characteristics were obtained from O*NET 98. Health outcomes were obtained from two national surveys. Data were linked using Bureau of Census codes. Multiple logistic regression was used to examine associations between O*NET factors and cardiovascular disease, depression, and health risk factors. Results:Seven of nine work organization or psychosocial factors were significantly associated with health risk behaviors in both the National Health and Nutrition Examination Survey III and National Health Interview Survey. Conclusions:This study demonstrates a method for linking independently obtained health and job characteristic data based on occupational code.

Mortality patterns among female nurses: a 27-state study, 1984 through 1990.

OBJECTIVES This study examined the mortality experience of 50,000 nurses using the National Occupational Mortality Surveillance database of death certificates. METHODS Proportionate mortality ratios adjusted by race (White, Black, or other) and 5-year age groups were calculated for selected causes of death among female nurses vs all workers and white-collar workers. RESULTS Excess deaths among nurses less than 65 years of age were seen in both comparison groups for viral hepatitis, cancer of the nasal cavities, accidental falls, suicide, and drug-related deaths. Among nurses 65 years old or older, deaths due to chronic myeloid leukemia were in excess. Proportionate mortality ratios for breast and colon cancers, diabetes, and heart disease varied by occupational comparison group. CONCLUSIONS These findings confirm results of previous studies and identify new associations. Redoubled efforts are called for in overcoming obstacles to reducing workplace hazards.

Measuring Job Characteristics and Mental Health Among Latino Farmworkers: Results from Cognitive Testing

Background Few research instruments used in occupational stress research have been evaluated for acceptability and validity among immigrant Latino farmworkers. Methods Cognitive testing was completed with 40 migrant and seasonal farmworkers (21 women, 19 men) through two focus groups and 16 one-on-one interviews conducted in Texas and Florida. Participants responded to the K-6, a short form instrument designed to measure psychological distress, selected items from the Job Content Questionnaire (JCQ) and standard health items. Results The K-6 items were characterized as too long and using a higher “class” language than farmworkers use. Further, the cultural connotation of several items in the K-6 was viewed as inappropriate by farmworkers. Demand items from the JCQ were interpreted inconsistently, whereas decision latitude items were consistently understood but viewed as irrelevant to farmworkers. Conclusions The results highlight the difficulties involved in conducting research with immigrant farmworkers, and they suggest that researchers interested in studying antecedents and consequences of farmworker mental health need to select instruments cautiously.

Mental Health Research with Latino Farmworkers: A Systematic Evaluation of the Short CES-D

Mental health research among Latino farmworkers is hampered by the absence of measurement evaluation that ensures farmworkers understand and can consistently and appropriately respond to questions about mental health. Cross-sectional data were obtained from 409 farmworkers via interviewer-administered survey questionnaires. Mental health was operationalized with the short-form Center for Epidemiologic Studies, Depression (CES-D) scale. The structured interviewer-administered survey questionnaires included measures to capture personal and work-related factors that could affect farmworkers’ ability to understand and respond to mental health questions probed by the CES-D. Good variability in item response was observed across the 10 short-form CES-D items. There was no evidence of differential response across sub-groups of farmworkers for six of the 10 items. Responses to four of the 10 items differed by educational attainment, country of origin, and language preference. Overall, the internal consistency of the 10 items exceeded standard conventions, and observed differences in depressive symptoms were as expected. Researchers in farmworker mental health must remain attentive to the strength and validity of available measures for migrants, different ethnic groups and different socioeconomic backgrounds. Nevertheless, the overall pattern suggests that the CES-D is a viable tool for advancing farmworker mental health research.

Job control, psychological demand, and farmworker health: evidence from the national agricultural workers survey.

Objective:Improve understanding of the potential occupational health impact of how agricultural jobs are organized. Exposure to low job control, high psychological demands, and high job strain were hypothesized to have greater risk for poor self-rated physical health and elevated depressive symptoms. Methods:Cross-sectional data (N = 3691) obtained using the Work Organization and Psychosocial Factors module of the US National Agricultural Workers Survey fielded in 2009–2010. Results:More than one fifth (22.4%) of farmworkers reported fair/poor health, and 8.7% reported elevated depressive symptoms. High psychological demand was associated with increased risk of fair/poor health (odds ratio, 1.73; 95% confidence interval, 1.4 to 2.2) and elevated depressive symptoms (odds ratio, 2.6; 95% confidence interval, 1.9 to 3.8). Conclusions:The organization of work in field agriculture may pose risks for poor occupational health outcomes among a vulnerable worker population.

Mortality Among Members of a Truck Driver Trade Association

Previous studies report that truck drivers are at increased risk for illness and on-the-job mortality. It is unknown whether owner-operator truck drivers face the same risks as employee drivers, yet few studies have targeted owner-operators as a study population. This study examined the overall and cause-specific mortality ratios for a cohort with owner-operator truck drivers constituting 69% of the study population. Of the 26 major disease classifications and 92 specific causes of death examined, only mortality due to transportation accidents was significantly elevated (standardized mortality ratio=1.52, 95% confidence interval=1.36-1.70). Leading causes of death were ischemic heart disease and lung cancer, although risk was below that of the general population. Transportation accidents pose a particular hazard for members of the trade association. The absence of excess disease mortality deserves careful interpretation, and may be due to both a strong healthy worker effect and a short monitoring period.

Ethnic, Racial, and Gender Variations in Health Among Farm Operators in the United States

PURPOSE The purpose of this study was to collect baseline prevalence data on the health problems faced by minority, white, and female farm operators. METHODS An occupational health survey of farm operators was conducted by the U.S. Department of Agriculture, National Agricultural Statistics Service between February and August 2000. A stratified random sample of farm operators from 50 U.S. states based on the 1997 Census of Agriculture was selected for telephone interview. Interviews were primarily conducted using a computer assisted telephone instrument system. RESULTS Population prevalences were calculated for 7137 farm operators. Prevalences were greatest for musculoskeletal discomfort, followed by respiratory problems, hearing loss, and hypertension. Generally, Latino and Asian American operators had lower prevalences for health problems than white non-Latino and white operators, respectively. African-American operators had greater prevalences for hypertension, and osteoarthritis, but lower prevalences for hearing loss, skin problems, heart problems, and cancer than white operators. American Indian or Alaska Native operators had higher prevalences for musculoskeletal problems, skin problems, and hypertension. CONCLUSIONS Prevalences for the different ethnicity and race groups are not the same. Studies that combine racial and ethnic groups, or study only white and non-Latino farm operators may overestimate or underestimate the prevalence of health conditions in the entire farm operator population.