Developing a Job Exposure Matrix of Work Organization Hazards in the United States: A Review on Methodological Issues and Research Protocol

Working Conditions in Complementary and Integrative Healthcare Professions

OBJECTIVE

The study aimed to describe working conditions among complementary and integrative healthcare (CIH) providers, specifically acupuncturists, chiropractors, massage therapists, midwives, and naturopathic doctors.

METHODS

We used cross-sectional Occupational Information Network data (2013-2021) for five CIH occupations. We examined means and 95% confidence intervals (CIs) for 10 variables that represented positive conditions, ergonomic demands, psychosocial demands, and schedule demands. We compared CIH to conventional healthcare and non-healthcare occupations.

RESULTS

CIH occupations had relatively high degrees of positive conditions, moderate degrees of psychosocial demands, and moderate hours/scheduling. Massage therapists, chiropractors, and acupuncturists reported more ergonomic hazards (eg, 1-5 scale where 5 is the highest, mean bending/twisting frequency for chiropractors is 3.43 [95% CI, 3.80-4.05] compared to 2.17 for midwives [95% CI, 1.97-2.36] and 1.96 for managers [95% CI, 1.42-2.51]).

CONCLUSIONS

CIH occupations generally had healthy working conditions, although ergonomic hazards were prominent.

Relationship between exposure to metalworking fluids and nonalcoholic fatty liver disease

OBJECTIVE

The relationship between metalworking fluids (MWFs) and nonalcoholic fatty liver disease (NAFLD) has not been previously explored. We aim to investigate the relationship between occupational exposure to MWFs and the prevalence of NAFLD and to determine the cumulative exposure threshold per day.

METHODS

In 2020, 2079 employees were selected randomly from one computer numerical control machining factory in Wuxi for a questionnaire survey, and occupational health examinations were conducted at the affiliated branch of Wuxi Eighth People's Hospital. MWF samples were collected within the factory using the National Institute for Occupational Safety and Health (NIOSH) 5524 method. NAFLD was defined as having a hepatic steatosis index (HSI) ≥ 36 without significant alcohol consumption. The relationship between NAFLD and MWFs was analyzed using logistic regression, and the daily exposure threshold was calculated using R software.

RESULTS

MWF exposure was found to be a risk factor for NAFLD in exposed workers compared to the non-exposed group. The OR for NAFLD in workers exposed to MWFs compared to controls was 1.42 (95% CI: 1.04-1.95). An increased risk of NAFLD was shown to be associated with an increasing dose. The daily exposure dose threshold to MWFs was found to be 6.54 mg/m3 (OR = 2.09, 95% CI: 1.24-3.52).

CONCLUSION

An association between occupational exposure to MWFs and NAFLD was found. As the concentration of exposure rose, the prevalence of NAFLD was also escalated.

Association of primary lifetime occupational cognitive complexity and cognitive decline in a diverse cohort: Results from the KHANDLE study

INTRODUCTION

Higher occupational complexity has been linked to favorable cognitive outcomes, but rarely examined in racially and ethnically diverse populations.

METHODS

In a diverse cohort (n = 1536), linear mixed-effects models estimated associations between main lifetime occupational complexity and domain-specific cognitive decline (z-standardized). Occupational complexity with data, people, and things were classified using the Dictionary of Occupational Titles.

RESULTS

For occupational complexity with data, highest tertile (vs. lowest) was associated with higher baseline executive function (β = 0.11; 95% confidence interval [CI] 0.00-0.22) and slower annual rate of decline (β = 0.03; 95% CI 0.01-0.06), and higher baseline semantic memory (β = 0.14; 95% CI 0.04-0.25). Highest tertile of occupational complexity with people was associated with higher baseline executive function (β = 0.29; 95% CI 0.18-0.40), verbal episodic memory (β = 0.12; 95% CI 0.00-0.24), and semantic memory (β = 0.23; 95% CI 0.12-0.34).

DISCUSSION

In a diverse cohort, higher occupational complexity is associated with better cognition. Findings should be verified in larger cohorts.

HIGHLIGHT

Few studies have examined associations of occupational complexity with cognition in diverse populations. Racial and ethnic minorities are disproportionately exposed to lower occupational complexity. Occupational complexity with data and people are associated with better cognition.

Exploring the employment determinants of job insecurity in the French working population: Evidence from national survey data

Studies are lacking on the employment determinants of job insecurity, that may be helpful to determine highly exposed groups and to assess the feasibility of constructing job-exposure matrices (JEMs) for this occupational exposure. The objectives were to explore the employment determinants of job insecurity in a nationally representative sample of the French working population. The study was based on the cross-sectional data of the 2013 national French working conditions survey including a sample of 28,293 employees, 12,283 men and 16,010 women. Job insecurity was assessed using one single item related to the fear of job loss in the next 12 months. Gender, age, and educational level were studied as well as the following employment variables: temporary/permanent work contract, full/part time work, job seniority, occupation, economic activity of the company, public/private sector, and company size. The associations with job insecurity were studied using bivariate and multivariate analyses. One quarter of the study sample was exposed to job insecurity, without any difference between genders. Lower age and lower educational levels were associated with job insecurity. Employees who had a temporary work contract, lower job seniority, who were working in low-skilled occupational groups, in manufacturing (for both genders) and construction (among men), and in the private sector had a higher prevalence of exposure to job insecurity. The two major employment variables associated with job insecurity were temporary work contract (prevalence ratios>2) and private sector (prevalence ratios>1.4) for the whole sample and for both men and women. Our findings suggested that intervention/prevention measures could be oriented towards specific highly exposed groups of the working population, especially those exposed to temporary work contract and/or working in the private sector. Our study also underlined that constructing JEMs for job insecurity may be possible and could be a useful tool for large-scale occupational health studies.

Constructing and validating an Occupational Mechanical Job Exposure Index based on five Norwegian nationwide Surveys of Living Conditions on work environment

Background

The overall aim of this study was to examine essential aspects of reliability and validity of a constructed Occupational Mechanical Job Exposure Index for use in analyses of Norwegian register data. 

Methods

We utilized data from the Norwegian nationwide Survey of Living Conditions on work environment in 2006, 2009, 2013, 2016 and 2019. Occupations were classified on a 4-digit level based on the Norwegian version of the International Standard Classification of Occupations (ISCO-88). We constructed a 4-digit correspondence table between the occupational codes used in the 2006 and 2009 surveys (STYRK-98) and the codes used in 2013, 2016 and 2019 (STYRK-08). The mechanical exposures were collected by Statistics Norway using telephone interviews. As for reliability, we examined the agreement between the individual- and the occupational-based mechanical exposures using Cohen’s kappa, sensitivity and specificity measures. Construct, concurrent and predictive validity pertaining to the Occupational Mechanical Job Exposure Index were analysed using both survey data and nationwide register data.

Results

The analysis shows a fair-to-moderate overlap between occupational-based mechanical exposures and the individually reported exposures. Construct validity of the Occupational Mechanical Job Exposure Index, as estimated by a confirmatory factor analysis using the occupational-based mechanical exposures, showed that the 8 exposures formed one underlying factor. When assessing the concurrent value of the Occupational Mechanical Job Exposure Index to the index based on the individual reported exposures, the occupational mechanical index showed lower and reproducible associations with lower back pain for both men and women. For long-term sick leave, the occupational mechanical index showed higher and reproducible associations for both genders. As for predictive validity, the register data analysis shows that the occupational mechanical index was associated with disability and a higher number of long-term sickness benefits periods for both men and women. For men the index also predicted higher mortality.

Conclusion

Our tests of reliability and validity of the Occupational Mechanical Job Exposure Index indicate that the index overall has acceptable statistical properties and will be useful in analyses of Norwegian register data where individual information on these types of exposures is missing.

Reliability of O*NET physical exposures between Italian and US databases

BACKGROUND

Comparison between cross-national job-exposure matrices (JEMs) may provide indications of their reliability, particularly if created using the same items. This study evaluated concordance between two JEMs created from United States (US) and Italian O*NET data, using job codes linked through international job codes.

METHODS

Twenty-one physical exposures were obtained from the US and Italian O*NET databases. Italian O*NET items were direct translations of US O*NET items. Six hundred and eighty-four US and 586 Italian job codes were linked via crosswalks to 281 ISCO-08 job codes. A sensitivity study also assessed concordance on 258 jobs matched one-to-one across the two national job classifications. Concordance of US and Italian O*NET exposures was estimated by intraclass correlation coefficients (ICC) in multilevel models adjusted and not adjusted for country.

RESULTS

ICCs showed moderate to poor agreement for all physical exposures in jobs linked through ISCO-08 codes. There was good to moderate agreement for 14 out of 21 exposures in models with one-to-one matched jobs between countries; greater agreement was found in all models adjusted for country. Exposure to whole-body vibration, time standing, and working outdoor exposed to weather showed the highest agreement.

CONCLUSIONS

These results showed moderate to good agreement for most physical exposures across the two JEMs when US and Italian jobs were matched one-to-one and the analysis was adjusted for country. Job code assignments through crosswalks and differences in exposure levels between countries might greatly influence the observed cross-country agreement. Future multinational epidemiological studies should consider the quality of the cross-national job matching, and potential cross-national differences in exposure levels.

Low Job Control and Racial Disparities in Breastfeeding

BACKGROUND

Low job control may predict shorter breastfeeding (BF) among working mothers and may contribute to racial disparities in BF.

METHODS

We used demographic, employment, and health data for n = 631 observations from the Panel Study of Income Dynamics. Job control scores came from a job-exposure matrix.Using path analysis, we assessed whether job control predicted BF and mediated Black-White BF differences. We controlled for education, working hours, marital status, and low birthweight.

RESULTS

Lower job control predicted decreased odds of BF for at least 6 months (odds ratio, 0.61; 95% confidence interval, 0.31-0.90; reference, no BF). Low job control explained 31% of the Black-White difference for both shorter-term and longer-term BF.

CONCLUSIONS

Low job contributes to shorter BF and to BF disparities by race. Intervening to enhance job control could improve BF.

Job-Exposure Matrix: A Useful Tool for Incorporating Workplace Exposure Data Into Population Health Research and Practice

Workplace exposures to physical, chemical, and psychosocial factors account for a large burden of chronic diseases. Obtaining useful estimates of current and past workplace exposures is challenging, particularly in large general population studies. Job-exposure matrices (JEMs) are a useful tool for exposure assessment, particularly when no individual level exposure data are available. A JEM provides a cross-tabulation of job titles (sometimes combined with industry) and estimated exposures to workers carrying out these jobs during different time periods. The major limitation of JEMs is that they do not account for individual variation in exposures within the same job. This limitation is offset by the advantages of low cost, wide applicability, lack of bias from self-reporting, and the ability to estimate exposures based on job titles when no other exposure data exist. There is growing use of JEMs in research examining the role of workplace exposures in the development of chronic diseases, and interest in their application to public health practice. This paper provides a scoping review of JEM use, some examples of JEMs, and brief guidance for the application of JEMs in epidemiological research. In conclusion, JEMs provide a useful tool for researchers and public health practitioners to estimate occupational exposures in large scale epidemiological studies relevant to many health conditions.