Workplace status and risk of hypertension among hourly and salaried aluminum manufacturing employees

Sex and Gender Differences in Occupational Hazard Exposures: a Scoping Review of the Recent Literature

PURPOSE OF REVIEW

Comparative research on sex and/or gender differences in occupational hazard exposures is necessary for effective work injury and illness prevention strategies. This scoping review summarizes the peer-reviewed literature from 2009 to 2019 on exposure differences to occupational hazards between men and women, across occupations, and within the same occupation.

RECENT FINDINGS

Fifty-eight studies retrieved from eight databases met our inclusion criteria. Of these, 30 studies were found on physical hazards, 38 studies on psychological/psychosocial hazards, 5 studies on biological hazards, and 17 studies on chemical hazards. The majority of studies reported that men were exposed to noise, vibration, medical radiation, physically demanding work, solar radiation, falls, biomechanical risks, chemical hazards, and blood contamination; while women were exposed to wet work, bullying and discrimination, work stress, and biological agents. Within the same occupations, men were more likely to be exposed to physical hazards, with the exception of women in health care occupations and exposure to prolonged standing. Women compared to men in the same occupations were more likely to experience harassment, while men compared to women in the same occupations reported higher work stress. Men reported more exposure to hazardous chemicals in the same occupations as women. The review suggests that men and women have different exposures to occupational hazards and that these differences are not solely due to a gendered distribution of the labor force by occupation. Findings may inform prevention efforts seeking to reduce gender inequalities in occupational health. Future research is needed to explain the reasons for sex/gender inequality differences in exposures within the same occupation.

Social Susceptibility to Multiple Air Pollutants in Cardiovascular Disease

INTRODUCTION

Cardiovascular disease (CVD) is the leading cause of death in the United States, and substantial research has linked ambient air pollution to elevated rates of CVD etiology and events. Much of this research identified increased effects of air pollution in lower socioeconomic position (SEP) communities, where pollution exposures are also often higher. The complex spatial confounding between air pollution and SEP makes it very challenging, however, to disentangle the impacts of these very different exposure types and to accurately assess their interactions. The specific causal components (i.e., specific social stressors) underlying this SEP-related susceptibility remain unknown, because there are myriad pathways through which poverty and/or lower-SEP conditions may influence pollution susceptibility - including diet, smoking, coexposures in the home and occupational environments, health behaviors, and healthcare access. Growing evidence suggests that a substantial portion of SEP-related susceptibility may be due to chronic psychosocial stress - given the known wide-ranging impacts of chronic stress on immune, endocrine, and metabolic function - and to a higher prevalence of unpredictable chronic stressors in many lower-SEP communities, including violence, job insecurity, and housing instability. As such, elucidating susceptibility to pollution in the etiology of CVD, and in the risk of CVD events, has been identified as a research priority. This interplay among social and environmental conditions may be particularly relevant for CVD, because pollution and chronic stress both impact inflammation, metabolic function, oxidative stress, hypertension, atherosclerosis, and other processes relevant to CVD etiology. Because pollution exposures are often spatially patterned by SEP, disentangling their effects - and quantifying any interplay - is especially challenging. Doing so, however, would help to improve our ability to identify and characterize susceptible populations and to improve our understanding of how community stressors may alter responses to multiple air pollutants. More clearly characterizing susceptible populations will improve our ability to design and target interventions more effectively (and cost-effectively) and may reveal greater benefits of pollution reduction in susceptible communities, strengthening cost-benefit and accountability analyses, ultimately reducing the disproportionate burden of CVD and reducing health disparities.

METHODS

In the current study, we aimed to quantify combined effects of multiple pollutants and stressor exposures on CVD events, using a number of unique datasets we have compiled and verified, including the following. 1. Poverty metrics, violent crime rates, a composite socioeconomic deprivation index (SDI), an index of racial and economic segregation, noise disturbance metrics, and three composite spatial factors produced from a factor analysis of 27 community stressors. All indicators have citywide coverage and were verified against individual reports of stress and stressor exposure, in citywide focus groups and surveys. 2. Spatial surfaces for multiple pollutants from the New York City (NYC) Community Air Survey (NYCCAS), which monitored multiple pollutants year-round at 150 sites and used land use regression (LUR) modeling to estimate fine-scale (100-m) intra-urban spatial variance in fine particles (PM2.5), nitrogen dioxide (NO2), sulfur dioxide (SO2), and ozone (O3). 3. Daily data and time-trends derived from all U.S. Environmental Protection Agency (EPA) Air Quality System (AQS) monitors in NYC for 2005-2011, which we combined with NYCCAS surfaces to create residence- and day-specific spatiotemporal exposure estimates. 4. Complete data on in- and out-patient unscheduled CVD events presented in NYC hospitals for 2005-2011 (n = 1,113,185) from the New York State (NYS) Department of Health's Statewide Planning and Research Cooperative System (SPARCS). In the study, we quantified relationships between multiple pollutant exposures and both community CVD event rates and individual risk of CVD events in NYC and tested whether pollution-CVD associations varied by community SEP and social stressor exposures. We hypothesized (1) that greater chronic community-level SEP, stressor, and pollution exposures would be associated with higher community CVD rates; (2) that spatiotemporal variations in multiple pollutants would be associated with excess risk of CVD events; and (3) that pollution-CVD associations would be stronger in communities of lower SEP or higher stressor exposures.

RESULTS

To first understand the separate and combined associations with CVD for both stressors and pollutants measured at the same spatial and temporal scale of resolution, we used ecological cross-sectional models to examine spatial relationships between multiple chronic pollutant and stressor exposures and age-adjusted community CVD rates. Using census-tract-level annual averages (n = 2,167), we compared associations with CVD rates for multiple pollutant concentrations and social stressors. We found that associations with community CVD rates were consistently stronger for social stressors than for pollutants, in terms of both magnitude and significance. We note, however, that this result may be driven by the relatively greater variation (on a proportional basis) for stressors than for pollutants in NYC. We also tested effect modification of pollutant-CVD associations by each social stressor and found evidence of stronger associations for NO2, PM2.5, and wintertime SO2 with CVD rates, particularly across quintiles of increasing community violence or assault rates (P trend < 0.0001). To examine individual-level associations between spatiotemporal exposures to multiple pollutants and the risk of CVD events, across multiple lag days, we examined the combined effects of multiple pollutant exposures, using spatiotemporal (day- and residence-specific) pollution exposure estimates and hospital data on individual CVD events in case-crossover models, which inherently adjust for nontime-varying individual confounders (e.g., sex and race) and comorbidities. We found consistent significant relationships only for same-day pollutant exposures and the risk of CVD events, suggesting very acute impacts of pollution on CVD risk. Associations with CVD were positive for NO2, PM2.5, and SO2, as hypothesized, and we found inverse associations for O3 (a secondary pollutant chemically decreased ["scavenged"] by fresh emissions that, in NYC, displays spatial and temporal patterns opposite those of NO2). Finally, to test effect modification by chronic community social stressors on the relationships between spatiotemporal pollution measures and the risk of CVD events, we used individual-level case-crossover models, adding interaction terms with categorical versions of each social stressor. We found that associations between NO2 and the risk of CVD events were significantly elevated only in communities with the highest exposures to social stressors (i.e., in the highest quintiles of poverty, socioeconomic deprivation, violence, or assault). The largest positive associations for PM2.5 and winter SO2 were generally found in the highest-stressor communities but were not significant in any quintile. We again found inverse associations for O3, which were likewise stronger for individuals living in communities with greater stressor exposures.

CONCLUSIONS

In ecological models, we found stronger relationships with community CVD rates for social stressors than for pollutant exposures. In case-crossover analyses, higher exposures to NO2, PM2.5, and SO2 were associated with greater excess risk of CVD events but only on the case day (there were no consistent significant lagged-day effects). In effect-modification analyses at both the community and individual level, we found evidence of stronger pollution-CVD associations in communities with higher stressor exposures. Given substantial spatial confounding across multiple social stressors, further research is needed to disentangle these effects in order to identify the predominant social stressors driving this observed differential susceptibility.

Gender, Depression, and Blue-collar Work: A Retrospective Cohort Study of US Aluminum Manufacturers

BACKGROUND

Industrial blue-collar workers face multiple work-related stressors, but evidence regarding the burden of mental illness among today's blue-collar men and women remains limited.

METHODS

In this retrospective cohort study, we examined health and employment records for 37,183 blue- and white-collar workers employed by a single US aluminum manufacturer from 2003 to 2013. Using Cox proportional hazards regression, we modeled time to first episode of treated depression by gender and occupational class. Among cases, we modeled rates of depression-related service utilization with generalized gamma regression.

RESULTS

Compared with their white-collar counterparts, blue-collar men were more likely to be treated for depression (hazard ratio [HR] = 1.3; 95% confidence interval [CI] = 1.1, 1.4) as were blue-collar women (HR = 1.4; 1.2, 1.6). Blue-collar women were most likely to be treated for depression as compared with white-collar men (HR = 3.2; 95% CI = 2.1, 5.0). However, blue-collar workers used depression-related services less frequently than their white-collar counterparts among both men (rate ratio = 0.91; 95% CI = 0.84, 0.98) and women (rate ratio = 0.82; 95% CI = 0.77, 0.88).

CONCLUSIONS

Blue-collar women were more likely to be treated for depression than white-collar workers, and blue-collar women were most likely to be treated for depression compared with white-collar men. However, blue-collar men and women used depression-related healthcare services less frequently than white-collar workers. These findings underscore that blue-collar women may be uniquely susceptible to depression, and suggest that blue-collar workers may encounter barriers to care-seeking related mental illness other than their insurance status.

Night and rotational work exposure within the last 12 months and risk of incident hypertension

Objectives Shift work, such as alternating day and nights, causes chronobiologic disruptions which may cause an increase in hypertension risk. However, the relative contributions of the components of shift work ‒ such as shift type (eg, night work) and rotations (ie, switching of shift times; day to night) ‒ on this association are not clear. To address this question, we constructed novel definitions of night work and rotational work and assessed their associations with risk of incident hypertension. Methods A cohort of 2151 workers at eight aluminum manufacturing facilities previously studied for cardiovascular disease was followed from 2003 through 2013 for incident hypertension, as defined by ICD-9 insurance claims codes. Detailed time-registry data was used to classify each worker's history of rotational and night work. The associations between recent rotational work and night work in the last 12 months and incident hypertension were estimated using adjusted Cox proportional hazards models. Results Elevated hazard ratios (HR) were observed for all levels of recent night work (>0-5, >5-50, >50-95, >95-100%) compared with non-night workers, and among all levels of rotational work (<1, 1-10, >10-20, >20-30, and >30%) compared with those working <1% rotational work. In models for considering the combination of night and rotational work, workers with mostly night work and frequent rotations (≥50% night and ≥10% rotation) had the highest risk of hypertension compared to non-night workers [HR 4.00, 95% confidence interval (CI )1.69-9.52]. Conclusions Our results suggest recent night and rotational work may both be associated with higher rates of incident hypertension.

Stress management in the workplace for employees with hypertension: a randomized controlled trial

While behavioral interventions can improve blood pressure (BP) in individuals with hypertension, getting such services to people who could benefit remains difficult. Workplace programs have potential as dissemination vehicles. The objective is to evaluate the effectiveness of a standardized stress management program delivered in groups at the workplace for reducing BP compared with enhanced usual care. This randomized controlled trial studied 92 urban medical center employees with hypertension randomized into two groups. The intervention was a 10-week group workshop on cognitive-behavioral coping skills. Enhanced usual care included self-help materials for BP reduction and physician referral. Intervention group participants' systolic BP (SBP) decreased 7.5 mm Hg over controls between baseline and follow-up, from 149.1 (95% CI: 146.0-152.1) to 140.0 (95% CI: 134.7-145.2), p < .001. The differential change between intervention and enhanced usual care groups (Group × Time interaction) was 7.5 mm Hg (t = -2.05; p = .04). Diastolic BP reductions were not significantly different. Scores on measures of emotional exhaustion and depressive rumination showed significant improvements and correlated with reductions in SBP. There was no significant change in the usual care group. A standardized worksite group intervention produced clinically meaningful reductions in SBP in participants with hypertension.

The Relationship between Neonatal Circumcision, Urinary Tract Infection, and Health

The risk-benefit profile of neonatal circumcision is not clear. Most studies have focused on urinary tract infections but other health sequelae have not been evaluated. While evidence supports benefits of circumcision, a lack of randomized trials has been cited as a weakness. National guidelines provide mixed recommendations regarding neonatal circumcision. We review the weight of evidence and utilize current statistical methodology on observational data to examine the risks and benefits of neonatal circumcision.

Social, Psychological, And Physical Aspects Of The Work Environment Could Contribute To Hypertension Prevalence

Studies on the physical and social characteristics of the workplace have begun to provide evidence for the role of specific workplace factors on health. However, the overall contribution of the workplace to health has not been considered. Estimates of the influences on health across domains of the work environment are a critical first step toward understanding what level of priority the workplace should take as the target for public policies to improve health. The influences or contribution of these domains on health in the work environment are particularly useful to study since they are potentially modifiable through changes in policies and environment. Our analysis used detailed data from blue-collar industrial workers at two dozen Alcoa plants. It includes work environmental measures of psychological hazards, physical hazards, and the workplace social environment, to estimate the overall importance of the workplace environment for hypertension. Our findings suggest that social, psychological, and physical aspects of the work environment could contribute to a substantial proportion of hypertension prevalence. These attributes of the workplace could thus be a useful target for improving workforce health.

Aluminum Trichloride Induces Hypertension and Disturbs the Function of Erythrocyte Membrane in Male Rats

Aluminum (Al) is the most abundant metal in the earth's crust. Al accumulates in erythrocyte and causes toxicity on erythrocyte membrane. The dysfunction of erythrocyte membrane is a potential risk to hypertension. The high Al content in plasma was associated with hypertension. To investigate the effect of AlCl3 on blood pressure and the function of erythrocyte membrane, the rats were intragastrically exposed to 0, 64(1/20 LD50), 128(1/10 LD50), and 256(1/5 LD50) mg/kg body weight AlCl3 in double distilled water for 120 days, respectively. Then, we determined the systolic and mean arterial blood pressures of rats, the osmotic fragility, the percentage of membrane proteins, the activities of Na(+)/K(+)-ATPase, Mg(2+)-ATPase, Ca(2+)-ATPase, catalase (CAT), superoxide dismutase (SOD) and glutathione peroxidase (GSH-pX), and malondialdehyde (MDA) content of the erythrocyte membrane in this experiment. The results showed that AlCl3 elevated the systolic and mean arterial blood pressure of rats, increased the osmotic fragility, decreased the percentage of membrane protein, inhibited the activities of Na(+)/K(+)-ATPase, Mg(2+)-ATPase, Ca(2+)-ATPase, CAT, SOD and GSH-pX, and increased the MDA content of erythrocyte membrane. These results indicate that AlCl3 may induce hypertension by disturbing the function of erythrocyte membrane.

Socioeconomic status and hypertension: a meta-analysis

BACKGROUND

The relationship between socioeconomic status (SES) and hypertension has been studied in a number of reviews. However, the impact of SES on hypertension has been reported in several studies with conflicting results.

METHODS

A systematic search was performed in PubMed, Proquest and Cochrane databases for observational studies on hypertension prevalence and SES, published in English, until March 2014. Hypertension was defined as a mean SBP of at least 140 mmHg or a DBP of at least 90 mmHg, or use of antihypertensive medication. The inverse variance method with a random-effects model was used to pool the risk estimates from the individual studies. Data abstraction was conducted independently by two authors.

RESULTS

Among the 2404 references, 51 studies fulfilled the inclusion criteria. An overall increased risk of hypertension among the lowest SES was found for all three indicators: income [pooled odds ratio (OR) 1.19, 95% confidence interval (CI) 0.96-1.48], occupation (pooled OR 1.31, 95% CI 1.04-1.64) and education (pooled OR 2.02, 95% CI 1.55-2.63). The associations were significant in high-income countries, and the increased risk of hypertension for the lowest categories of all SES indicators was most evident for women, whereas men revealed less consistent associations.

CONCLUSION

Low SES is associated with higher blood pressure, and this association is particularly evident in the level of education. It is important to identify and monitor hypertension to reduce the risk of this disease among the most vulnerable groups in different countries and among different societies.

Individual-level and plant-level predictors of acute, traumatic occupational injuries in a manufacturing cohort

Objectives

Workplace and contextual factors that may affect risk for worker injury are not well described. This study used results from an employee job satisfaction survey to construct aggregate indicators of the work environment and estimate the relative contribution of those factors to injury rates in a manufacturing cohort.

Methods

Principal components analysis was used to construct four plant-level factors from responses to a 32 question survey of the entire workforce, administered in 2006. Multilevel Poisson regression was used to evaluate the relationship between injury rate, individual-level and plant-level risk factors, unionisation and plant type.

Results

Plant-level ‘work stress’ (incident rate ratio (IRR)=0.50, 95% CI 0.28 to 0.90) was significant in the multilevel model, indicating the rate of injury for an average individual in that plant was halved (conditional on plant) when job stress decreased by a tertile. ‘Overall satisfaction’, ‘work environment’ and ‘perception of supervisor’ showed the same trend but were not significant. Unionisation was protective (IRR=0.40, 95% CI 0.17 to 0.95) as was any plant type compared with smelter.

Conclusions

We demonstrated utility of data from a human resources survey to construct indicators of the work environment. Our research suggests that aspects of the work environment, particularly work stress and unionisation, may have a significant effect on risk for occupational injury, emphasising the need for further multilevel studies. Our work would suggest monitoring of employee perceptions of job stress and the possible inclusion of stress management as a component of risk reduction programmes.

Contribution of health status and prevalent chronic disease to individual risk for workplace injury in the manufacturing environment

Objectives

An ‘information gap’ has been identified regarding the effects of chronic disease on occupational injury risk. We investigated the association of ischaemic heart disease, hypertension, diabetes, depression and asthma with acute occupational injury in a cohort of manufacturing workers from 1 January 1997 through 31 December 2007.

Methods

We used administrative data on real-time injury, medical claims, workplace characteristics and demographics to examine this association. We employed a piecewise exponential model within an Andersen–Gill framework with a frailty term at the employee level to account for inclusion of multiple injuries for each employee, random effects at the employee level due to correlation among jobs held by an employee, and experience on the job as a covariate.

Results

One-third of employees had at least one of the diseases during the study period. After adjusting for potential confounders, presence of these diseases was associated with increased hazard of injury: heart disease (HR 1.23, 95% CI 1.11 to 1.36), diabetes (HR 1.17, 95% CI 1.08 to 1.27), depression (HR 1.25, 95% CI 1.12 to 1.38) and asthma (HR 1.14, 95% CI 1.02 to 1.287). Hypertension was not significantly associated with hazard of injury. Associations of chronic disease with injury risk were less evident for more serious reportable injuries; only depression and a summary health metric derived from claims remained significantly positive in this subset.

Conclusions

Our results suggest that chronic heart disease, diabetes and depression confer an increased risk for acute occupational injury.

Healthy worker survivor bias: implications of truncating follow-up at employment termination

OBJECTIVES

The healthy worker survivor effect is a bias that occurs in occupational studies when less healthy workers are more likely to reduce their workplace exposures. When variables on the pathway from health status to exposure are measured, g-methods can avoid this bias. However, studies in which follow-up ends at employment termination have additional potential for selection bias. This paper examines the structure of the healthy worker survivor effect, compares results with and without censoring at employment termination, and addresses how to prevent bias when such censoring occurs.

METHODS

G-estimation of structural accelerated failure time models was applied in the United Autoworkers-General Motors cohort study to examine relationships between metalworking fluid exposure and cause-specific mortality. Subjects were followed from hire through 1994, regardless of employment status. To answer the central question, g-estimation analysis was repeated after truncating at employment termination and censoring outcomes that occurred thereafter, with adjustment for censoring by inverse probability weighting.

RESULTS

Using full follow-up time, HRs were estimated for all-cause mortality (1.09), ischaemic heart disease death (1.19), and death from any cancer (1.09), comparing 5 years of metalworking fluid exposure to no exposure. For all three outcomes, the HR estimates based on data censored at termination of employment were below 1 (respectively, 0.92, 0.97, 0.79).

CONCLUSIONS

In this application, g-estimation together with weighting did not prevent selection bias due to employment termination. However, the bias might be avoided in studies with measured health-related variables on the pathway from health status to employment termination.

Nursing leadership in addressing the social determinants of health

Social determinants of health have a profound impact on health status and the prevalence of health disparities in the United States. Significant improvements in national health indices are not possible without addressing social determinants of health. Drawing on their historical legacy as patient advocates, patient care expertise, and community focused education, nurses are ideally positioned to lead the nation in strategies to promote health equity. Nurses can embrace this new leadership role through the use of interdisciplinary collaboration, advocacy, political involvement, and community partnerships.

Health consequences of the 'Great Recession' on the employed: evidence from an industrial cohort in aluminum manufacturing

While the negative effects of unemployment have been well studied, the consequences of layoffs and downsizing for those who remain employed are less well understood. This study uses human resources and health claims data from a large multi-site fully insured aluminum company to explore the health consequences of downsizing on the remaining workforce. We exploit the variation in the timing and intensity of layoff to categorize 30 plants as high or low layoff plants. Next, we select a stably employed cohort of workers with history of health insurance going back to 2006 to 1) describe the selection process into layoff and 2) explore the association between the severity of plant level layoffs and the incidence of four chronic conditions in the remaining workforce. We examine four health outcomes: incident hypertension, diabetes, asthma/COPD and depression for a cohort of approximately 13,000 employees. Results suggest that there was an increased risk of developing hypertension for all workers and an increased risk of developing diabetes for salaried workers that remain at the plants with the highest level of layoffs. The hypertension results were robust to a several specification tests. In addition, the study design selected only healthy workers, therefore our estimates are likely to be a lower bound and suggest that adverse health consequences of the 2007-2009 recession may have affected a broader proportion of the population than previously expected.

Linking Life Dissatisfaction to Health Behaviors of Older African Americans Through Psychological Competency and Vulnerability

The objective of this study was to examine the influence of life dissatisfaction on health behaviors of older African Americans and the linking role of psychological competency (e.g., control and agency) and psychological vulnerability (e.g., negative affect). A structural equation model using baseline data from a larger intervention study of older African Americans was examined. Respondents included 207 (153 females and 54 males with a median age of 60) older African Americans. Life dissatisfaction was directly associated with respondents’ daily fat consumption and sleep and indirectly associated with receiving regular physical exams, physical activity, and fruit and vegetable consumption through their psychological processes. The association between life dissatisfaction and respondents’ health behaviors varied depending on the behavior under consideration. Programs and services designed to improve older African Americans’ health behaviors should address their psychological processes, as this research suggests these psychological processes are associated with different health behaviors.

Are low wages risk factors for hypertension?

OBJECTIVE

Socio-economic status (SES) is strongly correlated with hypertension. But SES has several components, including income and correlations in cross-sectional data need not imply SES is a risk factor. This study investigates whether wages-the largest category within income-are risk factors.

METHODS

We analysed longitudinal, nationally representative US data from four waves (1999, 2001, 2003 and 2005) of the Panel Study of Income Dynamics. The overall sample was restricted to employed persons age 25-65 years, n = 17 295. Separate subsamples were constructed of persons within two age groups (25-44 and 45-65 years) and genders. Hypertension incidence was self-reported based on physician diagnosis. Our study was prospective since data from three base years (1999, 2001, 2003) were used to predict newly diagnosed hypertension for three subsequent years (2001, 2003, 2005). In separate analyses, data from the first base year were used to predict time-to-reporting hypertension. Logistic regressions with random effects and Cox proportional hazards regressions were run.

RESULTS

Negative and strongly statistically significant correlations between wages and hypertension were found both in logistic and Cox regressions, especially for subsamples containing the younger age group (25-44 years) and women. Correlations were stronger when three health variables-obesity, subjective measures of health and number of co-morbidities-were excluded from regressions. Doubling the wage was associated with 25-30% lower chances of hypertension for persons aged 25-44 years.

CONCLUSIONS

The strongest evidence for low wages being risk factors for hypertension among working people were for women and persons aged 25-44 years.

Life dissatisfaction and eating behaviors among older African Americans: the protective role of social support

OBJECTIVES

To examine (a) the influences of life dissatisfaction and dietary social support on eating behaviors (a high-fat diet and fruit/vegetable consumption) of older African Americans and (b) the moderating role of perceived dietary social support on the association between their life dissatisfaction and unhealthy eating behaviors.

DESIGN

Baseline data from a larger intervention study of mid-life and older African Americans. The study incorporated a quasi-experimental design with random selection of participants, stratifying for age and gender.

SETTING

Six churches in North Florida.

PARTICIPANTS

One hundred and seventy-eight (132 females and 46 males with a median age of 60) older African Americans.

MEASUREMENTS

A structured questionnaire elicited personal data as well as information on eating behaviors, life dissatisfaction, and perceived dietary social support.

RESULTS

Older African Americans with more cumulative life adversity, as reflected by high life dissatisfaction, had significantly poorer eating behaviors including the consumption of a high-fat diet and low intake of fruits and vegetables. Older African Americans' dietary choices were also associated with their perceived social support. More importantly, perceived social support acted as a buffer to mitigate the influence of life dissatisfaction on older African Americans' eating behaviors.

CONCLUSION

Life dissatisfaction places older African Americans at risk for unhealthy eating behaviors. However, high levels of dietary social support can protect older African Americans from the influence of life dissatisfaction on unhealthy eating behaviors. There are practical implications of this research for health interventions and programming.

A growing role for gender analysis in air pollution epidemiology

Epidemiologic studies of air pollution effects on respiratory health report significant modification by sex, although results are not uniform. Importantly, it remains unclear whether modifications are attributable to socially derived gendered exposures, to sex-linked physiological differences, or to some interplay thereof. Gender analysis, which aims to disaggregate social from biological differences between males and females, may help to elucidate these possible sources of effect modification. Studies of children suggest stronger effects among boys in early life and among girls in later childhood. The qualitative review describes possible sources of difference in air pollution response between women and men, which may vary by life stage, coexposures, hormonal status, or other factors. The sources of observed effect modifications remain unclear, although gender analytic approaches may help to disentangle gender and sex differences in pollution response. A framework for incorporating gender analysis into environmental epidemiology is offered, along with several potentially useful methods from gender analysis.

Blood pressure and working conditions in hospital nurses and nursing assistants. The ORSOSA study

BACKGROUND

Healthcare workers often are unsatisfied with their working conditions despite declaring to like their jobs. Psychosocial constraints in the workplace have increased recently due to changes in work organization. These psychosocial constraints are linked to cardiovascular diseases.

AIM

To analyze the relationship between blood pressure levels and organizational occupational risk factors in female hospital workers, using a new questionnaire (the Nursing Work Index-Extended Organization [NWI-EO] questionnaire), which quantifies psychological and organizational work factors.

METHODS

The ORSOSA study is a national, multicentre, cohort study conducted in seven voluntary French university hospitals, including 214 work units with a total of 2307 nurses and 1530 nursing assistants.

RESULTS

Systolic and diastolic blood pressure appeared to be significantly associated with age (P<0.001) and excess weight (P<0.001). The difference between systolic blood pressure in day-shift and night-shift workers was 2.5mmHg (P<0.001). The NWI-EO dimension most strongly correlated with systolic and diastolic blood pressure was poor team relationships (P<0.01 for both). For a one-point difference in the NWI-EO stress score, systolic blood pressure was higher by a mean of 0.2mmHg.

CONCLUSION

These results suggest that poor relationships within teams are related to high blood pressure among hospital workers. They add to the evidence that working conditions should be considered and investigated further among other risk factors as a pathway to primary prevention of hypertension and cardiovascular diseases.

Gender and sex differences in job status and hypertension

OBJECTIVES

Studies have shown greater health risks associated with blue-collar manufacturing employment for women than men. It remains challenging, however, to distinguish gendered job status (affected by family composition and other personal characteristics) from sex-linked biological differences influencing physiological response to workplace physical hazards.

METHODS

We examined the effects of hourly (blue-collar) status on incident hypertension among men and women, using health claims data for 14, 618 white- and blue-collar aluminium manufacturing employees in eight US states. To explore gender differences in job status, we developed sex-stratified propensity score models identifying key socioeconomic predictors of hourly status for men and women. To examine the effects of hourly employment on hypertension risk, after adjusting for gender differences in job status, we applied time-weighted logistic regression models, stratified by propensity score, with additional adjustment for socioeconomic confounders.

RESULTS

Family structure (partnership, parity) influenced job status for both sexes; single mothers were more likely to hold hourly jobs (OR 2.02; 95% CI 1.37 to 2.97) and partnered men with children less likely (OR 0.68; 95% CI 0.56 to 0.83). Education, age at hire and race influenced job status for both sexes. The effect of hourly status on hypertension was significant only among women predicted to be hourly (OR 1.78; 95% CI 1.34 to 2.35).

CONCLUSIONS

Our results indicate significant risks of hypertension associated with hourly status for women, possibly exacerbated by sociodemographic factors predicting hourly status (eg, single parenthood, low education). Greater attention to gender differences in job status, and finer exploration of sex-linked biological differences influencing responsivity to workplace exposures, is warranted.

Work and its role in shaping the social gradient in health

Adults with better jobs enjoy better health: job title was, in fact, the social gradient metric first used to study the relationship between social class and chronic disease etiology, a core finding now replicated in most developed countries. What has been less well proved is whether this correlation is causal, and if so, through what mechanisms. During the past decade, much research has been directed at these issues. Best evidence in 2009 suggests that occupation does affect health. Most recent research on the relationship has been directed at disentangling the pathways through which lower-status work leads to adverse health outcomes. This review focuses on six areas of recent progress: (1) the role of status in a hierarchical occupational system; (2) the roles of psychosocial job stressors; (3) effects of workplace physical and chemical hazard exposures; (4) evidence that work organization matters as a contextual factor; (5) implications for the gradient of new forms of nonstandard or "precarious" employment such as contract and shift work; and (6) emerging evidence that women may be impacted differently by adverse working conditions, and possibly more strongly, than men.

A growing role for gender analysis in air pollution epidemiology

OBJECTIVE

Epidemiologic studies of air pollution effects on respiratory health report significant modification by sex, although results are not uniform. Importantly, it remains unclear whether modifications are attributable to socially derived gendered exposures, to sex-linked physiological differences, or to some interplay thereof. Gender analysis, which aims to disaggregate social from biological differences between males and females, may help to elucidate these possible sources of effect modification.

DATA SOURCES AND DATA EXTRACTION

A PubMed literature search was performed in July 2009, using the terms "respiratory" and any of "sex" or "gender" or "men and women" or "boys and girls" and either "PM2.5" (particulate matter <or= 2.5 microm in aerodynamic diameter) or "NO2" (nitrogen dioxide). I reviewed the identified studies, and others cited therein, to summarize current evidence of effect modification, with attention to authors' interpretation of observed differences. Owing to broad differences in exposure mixes, outcomes, and analytic techniques, with few studies examining any given combination thereof, meta-analysis was not deemed appropriate at this time.

DATA SYNTHESIS

More studies of adults report stronger effects among women, particularly for older persons or where using residential exposure assessment. Studies of children suggest stronger effects among boys in early life and among girls in later childhood.

CONCLUSIONS

The qualitative review describes possible sources of difference in air pollution response between women and men, which may vary by life stage, coexposures, hormonal status, or other factors. The sources of observed effect modifications remain unclear, although gender analytic approaches may help to disentangle gender and sex differences in pollution response. A framework for incorporating gender analysis into environmental epidemiology is offered, along with several potentially useful methods from gender analysis.