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Workplace stress, lifestyle and social factors as correlates of back pain: a representative study of the German working population.

OBJECTIVES: To investigate the prevalence of back pain in the German working population and the relationship between back pain and workplace stresses, lifestyle and social factors. METHODS: The first National Health Survey of the Federal Republic of Germany was carried out between October 1997 and March 1999. It comprised a representative epidemiological cross-sectional study of the working population, with a total sample of 3,488 persons between the ages of 18 and 69 years. The participants took part in a medical examination and answered a self-rating questionnaire. The relationship between subjective back pain and workplace stresses and social and lifestyle factors was investigated with bivariate tests and multiple logistical regression analyses. RESULTS: The 7-day prevalence for back pain in the German working population was found to be 34%, and the 1-year prevalence was 60%. The odds ratios were significantly higher in women, persons of lower socioeconomic status, married and depressed persons and non-athletes. Carrying heavy loads or maintaining a single working posture were the most significant work-related correlates of back pain, for members of both the female and male working population, while environmental stress and psychological stress correlated significantly with back pain in men only. CONCLUSIONS: This study reports the first representative epidemiological prevalence data for back pain, and its correlates and potential risk factors, for the German working population. To reduce the negative impact of back pain the most promising behavioural and conditional prevention measures in the workplace would be to reduce carrying stress and to vary working posture. In addition, a more active, athletic lifestyle, plus the avoidance of being overweight, should provide an additional protective or preventive effect.

Adolescent↗

Effectiveness and benefit-cost of peer-based workplace substance abuse prevention coupled with random testing.

Few studies have evaluated the impact of workplace substance abuse prevention programs on occupational injury, despite this being a justification for these programs. This paper estimates the effectiveness and benefit-cost ratio of a peer-based substance abuse prevention program at a U.S. transportation company, implemented in phases from 1988 to 1990. The program focuses on changing workplace attitudes toward on-the-job substance use in addition to training workers to recognize and intervene with coworkers who have a problem. The program was strengthened by federally mandated random drug and alcohol testing (implemented, respectively, in 1990 and 1994). With time-series analysis, we analyzed the association of monthly injury rates and costs with phased program implementation, controlling for industry injury trend. The combination of the peer-based program and testing was associated with an approximate one-third reduction in injury rate, avoiding an estimated $48 million in employer costs in 1999. That year, the peer-based program cost the company $35 and testing cost another $35 per employee. The program avoided an estimated $1850 in employer injury costs per employee in 1999, corresponding to a benefit-cost ratio of 26:1. The findings suggest that peer-based programs buttressed by random testing can be cost-effective in the workplace.

Accidents, Occupational↗

Retirement and drinking outcomes: lingering effects of workplace stress?

This study assesses the degree to which sexual harassment (SH), generalized workplace abuse (GWA), and psychological workload (PWL) impact drinking behaviors in retirement. A mail survey was completed at four points in time by a cohort of 1654 employees initially drawn from a university workplace. Questionnaires assessed experiences of SH, GWA, PWL and drinking behaviors. Hypotheses were tested involving (1) the extent to which SH, GWA, and PWL experienced while working were associated with frequency and quantity of drinking in retirement, (2) the extent to which drinking levels of retirees differed from those of current employees experiencing similar stress levels, and (3) the extent to which gender moderated these relationships. Retirees reporting earlier stressful work environments report higher levels of alcohol consumption during retirement compared to those retirees reporting less stressful earlier work environments. Gender moderated these relationships. The findings of this study suggest that there may be a residual effect of workplace stress during retirement.

Alcohol Drinking↗

Cross-sectional and prospective associations between passive smoking and respiratory symptoms at the workplace.

PURPOSE: The purpose of the study is to investigate the cross-sectional and prospective relation between workplace secondhand smoke (SHS) exposure and respiratory symptoms. METHODS: Cross-sectional data for workplace SHS exposure and respiratory symptoms were collected by using random digit dialing from 7336 never-smoking Hong Kong workers 15 years or older in 1997 to 1998. In the 2000 to 2001 follow-up, 2213 workers who remained never smoking, had the same SHS exposure status, worked at the same job for at least 2 years, and were not exposed to SHS at home at follow-up were included for prospective analysis. RESULTS: Cross-sectionally, SHS was associated significantly with frequent colds, cough and phlegm, throat problems, and the presence of any respiratory symptoms with adjusted odds ratios of 1.89 (95% confidence interval [CI], 1.66-2.15), 1.65 (95% CI, 1.35-2.02), 1.88 (95% CI, 1.63-2.15), and 1.96 (95% CI, 1.75-2.20) at baseline, each having significant linear associations with duration of exposure. SHS was not associated with rhinitis. Prospectively, consistent SHS exposure increased the risk for cough and phlegm and any respiratory symptoms by 48% (12% to 97%) and 54% (13% to 109%), respectively. CONCLUSIONS: This first non-Western population-based prospective study shows that workplace SHS exposure is associated significantly with frequent respiratory symptoms, both cross-sectionally and prospectively, thus providing strong evidence that the association is causal.

Adolescent↗

Evaluation of a modified contingency management intervention for consistent attendance in therapeutic workplace participants.

In a therapeutic workplace business, drug abuse patients are hired as data entry operators and paid to perform data entry work contingent upon documented drug abstinence. Reliable attendance has been difficult to maintain despite the opportunity for operators to earn a living wage, 6 h per day, 5 days per week. A within-subject reversal design experiment evaluated a contingency management intervention that allowed for flexibility regarding when operators could arrive to work, yet maintained a contingency for reliable workplace attendance. Results from a within-subject reversal design experiment demonstrated the contingency management intervention to be effective in increasing the frequency of completed work shifts in four of five operators. Repeated measures ANOVA and Tukey's post-hoc tests of grouped data showed that the contingency management intervention significantly (P < 0.05) increased the mean percent of days that operators completed work shifts (5% baseline; 63% contingency management; 7% baseline). This study demonstrates an effective procedure for maintaining attendance in therapeutic workplace participants.

Adult↗

A person-centered workplace: the foundation for person-centered caregiving in long-term care.

OBJECTIVE: This study seeks to understand what role managers and the work setting they create play in a nursing facility that seeks to make a transition to person-centered care. DESIGN: The study uses a human-relations framework to test 3 propositions: Managers play a critical role in the satisfaction, loyalty and commitment (ie, the engagement) of their staff; managers construct a person-centered workplace that deepens staff engagement; and engaged staff promote the well-being of the residents. SETTING AND PARTICIPANTS: The study draws on responses of Certified Nurse Assistants (CNAs) and families of residents collected in 2 satisfaction surveys conducted in 156 nursing facilities. It also uses state inspection survey data from the same facilities. MEASUREMENTS: The analysis uses measures of satisfaction, loyalty, and commitment as well as 6 scales of quality; 3 as they pertain to staff and 3 as they pertain to families. Data reduction, correlational, and risk analyses assess how managers and the work environment affect CNA engagement and the quality of caregiving. RESULTS: Management approach and the work environment are powerful predictors of CNA satisfaction, loyalty, and commitment. The work environment also correlates with how families and state surveyors evaluate quality in a nursing facility. CONCLUSION: The managers and the work setting they create hold primacy in the work life of the CNAs. Caring managers fashion a person-centered workplace conducive to turn workers into devoted caregivers. When the workplace adds quality to the life of caregivers, the caregivers add quality to the life of the resident.

Analysis of Variance↗

A survey of wind speeds in indoor workplaces.

The applicability of the inhalable convention for sampling aerosols relies on its being a valid model for typical sampling environments. The current convention is based on measurements carried out in external wind speeds between 1 and 4 m.s-1. However these measurements show a degree of wind speed dependence, and it is uncertain at present how valid the convention is for describing human aspiration efficiency outside these wind speed limits. Following concerns that wind speeds in many indoor workplaces may be significantly below this range, measurements have been made in 55 work areas covering a wide range of workplaces. Measurements have concentrated on 'background' wind speeds where the influence of specific air movement sources is minimised. The pooled wind speed measurements show a highly skewed distribution with an arithmetic mean of approximately 0.3 m.s-1. Approximately 85% of all individual measurements were below this mean value. No obvious correlation was found between wind speed distribution parameters and industry type, room size or ventilation type. A limited number of comparisons were made between static anemometers and devices mounted on workers. It was found that modal wind speeds experience by workers were typically 0.05 m.s-1 higher than those measured using a static anemometer. These measurements agreed well with previously published data for similar workplaces as well as houses.

Air Movements↗

Computer-aided ergonomics: a case study of incorporating ergonomics analyses into workplace design.

One of the primary goals of computer-aided ergonomics is to develop software tools that allow ergonomics information to be accessed at the earliest stages of design. This case study discusses a PC-based software program that allows a designer to quantify a worker's biomechanical risk for injury based on a proposed workplace design. The program couples an established software tool for biomechanical analysis, the Three-Dimensional Static Strength Prediction Program (3DSSPP), with a widely used computer-aided design software package, AutoCAD. The use of this "3DSSPP/AutoCAD interface" in the proactive analysis of an automotive assembly task is described and the results compared with an independent assessment using observations of workers performing the same task. Both studies yield similar conclusions, suggesting that proactive use of software such as the 3DSSPP/AutoCAD interface may be a valid tool in evaluating proposed workplace designs. In this context, issues in the analysis of workplace designs regarding the use of supporting ergonomic tools, assumptions, and posture selection are discussed.

Accidents, Occupational↗

An intervention strategy for workplace stress.

This article explores a range of sources of workplace stress and a three-prong intervention strategy for managing pressures at work. The three approaches highlighted are primary, secondary, and tertiary prevention interventions. Primary is concerned with stressor reduction, secondary with stress management and tertiary with remedial support. In addition, a number of wider policy issues are suggested, such as risk assessment, economic incentives, and specific measures to help small- and medium-sized workplaces in managing workplace stress.

Humans↗

An assessment of heavy metals and boron contamination in workplace atmospheres from ceramic factories.

The occupational exposure in workplace atmospheres of ceramic factories to some metals (Ba, Cd, Co, Cr, Cu, Ni, Zn) and boron has been studied. During 1994 samples were collected at several ceramic factories from the Comunitat Valenciana (Spain) in a random fashion to avoid correlation problems regarding data analysis; factories were sampled to provide a representative cross-section. Powdered samples were treated with concentrated nitric acid according to the National Institute for Occupational Safety and Health (NIOSH) digestion procedure for the analysis of metals in air samples. Heavy metals were analyzed by AAS and boron by UV/Visible spectrophotometry using the Azomethine-H method. Concentrations found for Cd, Cr, Cu, Ni and Zn were considered very low in the environment of this industrial sector. However, Co, Ba and B were detected in several samples with concentrations above the threshold limit value (TLV), referred to airborne concentrations of substances in workplace atmospheres. Principal component analysis (PCA) has also been carried out in order to classify the workplaces studied and their potential hazard to the workers.

Air Pollutants, Occupational↗

To test or not to test: do workplace drug testing programs discourage employee drug use?

Workplace drug testing programs are often met with intense criticism. Despite resistance among labor and consumer groups and a lack of rigorous empirical evidence regarding effectiveness, drug testing programs have remained popular with employers throughout the 1990s and into the current century. The present study analyzed nationally representative data on over 15,000 US households to determine whether various types of workplace drug testing programs influenced the probability of drug use by workers. The study estimated several empirical specifications using both univariate and bivariate probit techniques. The specification tests favored the bivariate probit model over the univariate probit model. Estimated marginal effects of drug testing on any drug use were negative, significant, and relatively large, indicating that drug testing programs are achieving one of the desired effects. The results were similar when any drug use was replaced with chronic drug use in the models. These results have important policy implications regarding the effectiveness and economic viability of workplace anti-drug programs.

History, 20th Century↗

A comparison sample validation of "your workplace": an instrument to measure perceived alcohol support and consequences from the work environment.

This paper addresses the psychometric properties of Your Workplace (YWP), an instrument developed to measure perceived influence of workplace norms and attitudes on alcohol involvement and the experience of adverse consequences. Data were collected from a large, geographically dispersed sample of aftercare and outpatients recruited for a multisite clinical trial of alcoholism treatments, Project MATCH. Administration of YWP at the baseline assessment was restricted to workforce participants. A confirmatory factor analysis addressed instrument structure. Internal consistency and concurrent association between measures of general social support, alcohol specific support, and alcohol involvement were examined. YWP scales were found to have adequate internal consistency reliability. Correlation between YWP scales and concurrent measures of alcohol involvement were among the strongest found. Identification of workplace influences on alcohol involvement allows refined assessment and fosters a comprehensive approach to treatment of alcoholism.

Adult↗

[The French version of the Leymann's questionnaire on workplace bullying: the Leymann Inventory of Psychological Terror (LIPT)].

BACKGROUND: Workplace bullying is considered as a major job stress factor and is associated with mental disorders. To date, there was no validated French version of the "Leymann Inventory of Psychological Terror" (LIPT), considered to be the instrument of reference. The objective of this study was to elaborate this French version and to explore its factorial, convergent and predictive validity. METHODS: The present study was based on a large sample of men and women of the working population asked to participate to a cross-sectional survey by a network of 143 occupational physicians in the South-East of France. This study included 7694 subjects, 3132 men and 4562 women, who responded to the anonymous self-questionnaire including the French version of the LIPT. This version was obtained by a standard forward/backward translation procedure. RESULTS: The LIPT allows to evaluate the 12-month prevalence of exposure to 45 forms of bullying. The analysis of an open question asking for other potentially missing forms of bullying underlined the satisfactory coverage of the LIPT. The study of the factorial validity showed a satisfactory coherence in the interpretation of the factors obtained. Leymann defined workplace bullying by the exposure to at least one form of bullying, weekly or more, and for at least six months. The convergent and predictive validity were increased when this definition was combined with the self-report of being exposed to bullying. CONCLUSION: This study is the first one elaborating and validating the French version of the LIPT by Leymann. This step of development and validation of the French version of questionnaires seems crucial to set up future high-quality studies, and to allow comparisons at the international level. Workplace bullying seems to be a serious problem in the French working life given the prevalence observed here (around 10%). Forthcoming studies should prefer using such validated questionnaire to better understand and prevent this occupational risk factor.

Adult↗

Legislation and regulations addressing workplace violence in the United States and British Columbia.

OVERVIEW: For as long as workers have had contact with customers, coworkers, the public, and others, they have faced risk of assault. However, in the 1980s and 1990s, a number of highly publicized incidents occurred that involved multiple fatalities, and reliable statistics showed homicide to be a major cause of worker deaths. As a result, violence in the workplace became a subject of concern among the public and policymakers. This article reviews a number of legislative and regulatory efforts from the past decade that were designed to prevent violence against employees. Some states and localities have enacted legislation to address specific types of violence in the workplace, such as robbery-related violence, and violence against health care workers and taxi drivers. In addition, the U.S. Occupational Safety and Health Administration (OSHA), as well as a number of state OSHA programs, has attempted to reduce the risk of assault to workers through new and existing statutes and administrative regulations. To provide a contrast with developments in the United States, the author will also discuss requirements for prevention of assault in the workplace in the Canadian province of British Columbia.

British Columbia↗

Effect of individual counseling on physical activity fitness and health: a randomized controlled trial in a workplace setting.

BACKGROUND: Physical inactivity and obesity are major public health problems. Our objective was to investigate the effectiveness of an individual counseling intervention at the workplace on physical activity fitness and health. Counseling content derived from the Patient-centered Assessment and Counseling for Exercise and Nutrition (PACE) program. METHODS: A total of 299 employees of three municipal services in the Dutch town of Enschede were randomly allocated into intervention (n =131) and control group (n =168). Over a 9-month period, intervention group subjects were offered seven counseling sessions. Counseling was based on the individual's stage of behavioral change using PACE physical activity and nutrition protocols. Subjects in both the intervention and control group received written information about several lifestyle factors. Primary outcome measures were physical activity (total energy expenditure, during sports activities, during physical activity leisure time other than sports, and meeting the moderate-intensity public health recommendations); cardiorespiratory fitness; and prevalence of musculoskeletal symptoms. Secondary outcome measures were body composition (body mass index [BMI], and percentage of body fat measured via skinfold thicknesses); blood pressure; and blood cholesterol. RESULTS: There were significant positive effects on total energy expenditure, physical activity during sports, cardiorespiratory fitness, percentage of body fat, and blood cholesterol. No effects were found for the proportion of subjects meeting the public health recommendation of moderate-intensity physical activity, physical activity during leisure time other than sports, prevalence of musculoskeletal symptoms, body mass index, and blood pressure. CONCLUSIONS: Individual face-to-face counseling at the workplace based on PACE protocols positively influenced physical activity levels and some components of physical fitness. The implementation of workplace counseling programs for individuals should therefore be promoted.

Adult↗

Evaluation of a workplace hemochromatosis screening program.

Hemochromatosis is a common inherited disorder of iron metabolism with significant health consequences for the employed population. Although screening for hemochromatosis has been recommended, workplace screening programs remain uncommon. In the first year of a newly initiated corporate screening program, 1968 employees were tested. The screening algorithm included measurement of serum iron and transferrin and subsequent ferritin levels in those employees with elevated iron/transferrin ratios. Thirteen percent of men and 21% of women had elevated iron/transferrin ratios. Of these, 14 men and 2 women had elevated ferritin levels. Of these 16, three had liver biopsies and all three have hemochromatosis. The cost of the screening program was $27,850. The cost per diagnosis was $9283 and the cost per year of life saved was $928. These costs compare very favorably with other common workplace screening programs. Several barriers to obtaining definitive diagnoses on all patients with a positive screening result were identified; strategies to overcome these barriers would further enhance the cost effectiveness of the program. We conclude that workplace hemochromatosis screening is highly cost effective and should be incorporated into health promotion/disease prevention programs.

Adult↗

[Depression in the workplace].

Depression is the object of a dense literature, and synthesizing it is more of a utopian ideal rather than a concrete possibility. Several specific risk factors for mental health are found in the workplace: work overloads, defective communications, role conflicts, competitive climate, and tolerance of violence. At the same time, few preventive measures have been implemented against mental disorders at work, nor are many protective factors present. One worker in ten suffers from depression, anxiety, stress, or overwork. To be distinguished from "burnout", depressive symptoms must induce clinically significant suffering with substantial deterioration in functioning at work. For depression to be recognized as a workplace accident, the employee must show that it was triggered by an unforeseen and sudden event (or at least one certainly) due to or at work. The causal link between an event at work and the depression must be shown (in particular by expert medical testimony about stress factors and indicators of vulnerability to depression). Its recognition as an occupational disease can be based on the presence of psychosocial factors described by models of workplace stress and on its description by the occupational physician.

Depression↗

Implementing information technology to improve workplace health: a web-based information needs assessment of managers in Fraser Health, British Columbia.

A web-based questionnaire-survey was administered primarily to determine what information is useful to managers in Fraser Health, of British Columbia to support decision-making for workplace health and safety. The results indicated that managers prefer electronic quarterly reports, with targets, goals, and historical trends rated as "very important." Over 85.7% "agree" that if information was readily available in the "most beneficial" format, they would be able to improve workplace health. Recommendations include that managers be presented with clear and concise workplace health reports that facilitate analysis for decision-making.

Administrative Personnel↗