Perceived discrimination and low back pain among 28,532 workers in South Korea: Effect modification by labor union status

Social Determinants and Consequences of Pain: Toward Multilevel, Intersectional, and Life Course Perspectives

Despite wide endorsement of a biopsychosocial framework for pain, social aspects of pain remain rarely addressed in the context of pain prevention and management. In this review, we aim to 1) examine the broad scope of social determinants and consequences of pain and their interactions across multiple levels of organization, and 2) provide a framework synthesizing existing concepts and potential areas for future work on social aspects of pain, drawing upon socioecological, intersectional, and life course approaches. Integrating interdisciplinary theory and evidence, we outline pathways through which multilevel social factors and pain may affect each other over time. We also provide a brief summary of intrapersonal aspects of pain, which are thought to operate at the interface between individuals and the social context. Progressing from micro- to macrolevel factors, we illustrate how social determinants of pain can directly or indirectly contribute to pain experiences, expression, risk, prognosis, and impact across populations. We consider 1) at the interpersonal level, the roles of social comparison, social relatedness, social support, social exclusion, empathy, and interpersonal conflict; 2) at the group or community level, the roles of intimacy groups, task groups, social categories, and loose associations; and 3) at the societal level, the roles of political, economic, and cultural systems, as well as their policies and practices. We present examples of multilevel consequences of pain across these levels and discuss opportunities to reduce the burden and inequities of pain by expanding multilevel social approaches in pain research and practice. PERSPECTIVE: Despite wide endorsement of a biopsychosocial framework for pain, social aspects of pain are often unclearly defined, hindering their use in pain prevention, management, and research. We summarize the scope of social aspects of pain and provide a framework synthesizing existing concepts and potential areas for future work.

The Pain at Work Toolkit for Employees with Chronic or Persistent Pain: A Collaborative-Participatory Study

Self-management tools for people with chronic or persistent pain tend to focus on symptom reporting, treatment programmes or exercise and do not address barriers to work, facilitators of work ability, or workplace pain self-management strategies. We developed the Pain at Work (PAW) toolkit, an evidence-based digital toolkit to provide advice on how employees can self-manage their pain at work. In a collaborative-participatory design, 4-step Agile methodology (N = 452) was used to co-create the toolkit with healthcare professionals, employers and people with chronic or persistent pain. Step 1: stakeholder consultation event (n = 27) established content and format; Step 2: online survey with employees who have persistent pain (n = 274) showed employees fear disclosing their condition, and commonly report discrimination and lack of line manager support. Step 3: online employer survey (n = 107) showed employers rarely provide self-management materials or education around managing pain at work, occupational health recommendations for reasonable adjustments are not always actioned, and pain-related stigma is common. Step 4: Toolkit development integrated findings and recommendations from Steps 1–3, and iterative expert peer review was conducted (n = 40). The PAW toolkit provides (a) evidence-based guidelines and signposting around work-capacity advice and support; (b) self-management strategies around working with chronic or persistent pain, (c) promotion of healthy lifestyles, and quality of life at work; (d) advice on adjustments to working environments and workplace solutions to facilitate work participation.

Association between labor union presence and return to work after occupational injury or illness: A nationally representative longitudinal study in South Korea

BACKGROUND

This study sought to examine the association between labor union presence and return to work after occupational injury or illness (RTW) among workers in South Korea.

METHODS

We analyzed the first (2018) and second (2019) wave data from the Panel Study of Workers' Compensation Insurance in South Korea. The cohort consisted of 3,294 workers who had suffered occupational injury or illness and completed their convalescence by 2017. We examined whether RTW was associated with the presence of labor unions in the workplace at the time of the occupational injury or illness occurred.

RESULTS

Compared to workers without labor unions, those with labor unions were more likely to report RTW (prevalence ratio: 1.35, 95% confidence interval: 1.20-1.51) after adjusting for potential confounders, including employment status, duration of convalescence, and severity of injury or illness.

CONCLUSION

This study found that labor union presence was associated with RTW among workers who suffered occupational injury or illness in South Korea.

Recommendations for the Development of Socioeconomically-Situated and Clinically-Relevant Neuroimaging Models of Pain

Pain is a complex, multidimensional experience that emerges from interactions among sensory, affective, and cognitive processes in the brain. Neuroimaging allows us to identify these component processes and model how they combine to instantiate the pain experience. However, the clinical impact of pain neuroimaging models has been limited by inadequate population sampling - young healthy college students are not representative of chronic pain patients. The biopsychosocial approach to pain management situates a person's pain within the diverse socioeconomic environments they live in. To increase the clinical relevance of pain neuroimaging models, a three-fold biopsychosocial approach to neuroimaging biomarker development is recommended. The first level calls for the development of diagnostic biomarkers via the standard population-based (nomothetic) approach with an emphasis on diverse sampling. The second level calls for the development of treatment-relevant models via a constrained person-based (idiographic) approach tailored to unique individuals. The third level calls for the development of prevention-relevant models via a novel society-based (social epidemiologic) approach that combines survey and neuroimaging data to predict chronic pain risk based on one's socioeconomic conditions. The recommendations in this article address how we can leverage pain's complexity in service of the patient and society by modeling not just individuals and populations, but also the socioeconomic structures that shape any individual's expectations of threat, safety, and resource availability.

Perceived age discrimination in the workplace: the mediating roles of job resources and demands

Purpose

With a growing number of older workers in the labor force, cultivating an age-friendly working environment becomes increasingly important. Inspired by the job demands–resources (JD-R) model, this study aims to investigate whether the negative effects of perceived age discrimination (PAD) on work-related outcomes would be explained by job resources and demands.

Design/methodology/approach

A total of 333 Hong Kong Chinese employees aged 40 and above (M = 46.62, SD = 6.21; 60% female) completed an online survey that covered measures on workplace age discrimination, job resources and demands, work engagement, intention to stay and work strain.

Findings

PAD at work was associated with reduced job resources and increased job demands. The results of the mediation analyses showed support from supervisor and coworkers could account for the effects of PAD on work engagement and intention to stay, whereas emotional demand or workload could explain the effects of PAD on work engagement and work strain.

Practical implications

The findings of this research unveil the underlying mechanisms between age discrimination and work-related outcomes through job resources and job demands. Cultivating a supportive organizational climate toward older employees and offering awareness-based training programs are necessary to mitigate age biases in the workplace.

Originality/value

Building on the JD-R model, this study revealed the possible mechanism underlying the negative effects of PAD. Perceptions of age discrimination decrease older workers' job resources and increase their job demands, subsequently lower their work engagement and intention to stay and increase their work strain.

The association between union membership and perceptions of safety climate among US adult workers

OBJECTIVES

An individual's perceptions of their workplace safety climate can influence their health and safety outcomes in the workplace. Even though union membership has been declining in the US, union members still comprise 10% of the working population and have higher-than-industry average non-fatal illness and injury rates. Due to limited research focused in this area, this study examined whether union membership was associated with worker perceptions of safety climate.

METHODS

This was a secondary data analysis study utilizing data from the Quality Work Life module from the General Social Survey centered on US workers aged 18 and above. Propensity-score matching was implemented to reduce potential selection bias between unionized and non-unionized workers. Linear regression explored the association between union membership and perceptions of safety climate, controlling for age, sex, education, industry, resource adequacy, supervisor support, co-worker support, and workload.

RESULTS

For perceived safety climate (on a 0-16 scale, the higher the more positive), those in union had a lower mean of perceived safety climate (12.44) compared to those not in a union (13.20). Based on the regression results, those who were in a union reported more negative perceptions of their workplace safety climate in a 12-month period (β = -0.61, p < .001).

CONCLUSIONS

By demonstrating a commitment to proactive injury prevention and bolstering the business's overall safety performance indicators, businesses who are open to collaborations with unions may see some long-term benefits (e.g. return on investment, increased job satisfaction) and enhance union workers' perceptions of safety climate.

The Association of Occupational Psychosocial Factors with the Prevalence of Irritable Bowel Syndrome in the Chilean Working Population

BACKGROUND

Irritable bowel syndrome (IBS) is a stress-related disease linked to psychosocial factors, though knowledge about its occupational psychosocial aspects is scarce.

OBJECTIVE

A cross-sectional study of the prevalence of IBS and its association with occupational psychosocial factors in Chilean workers was conducted.

METHODS

IBS prevalence, using the IBS-Rome IV criteria, in the working population was estimated using data from the National Health Survey of 2009. Data on occupational psychosocial aspects were drawn from the Chilean Survey of Employment, Health, and Work of 2009, and allocated to individual survey participants at the occupation-region level. Data on family and community stressors were available at the individual level. Prevalence ratios (PR) for IBS were computed using generalized linear mixed models to account for variability at the group level.

RESULTS

The IBS prevalence in the overall working population (weighted n = 5 435 253) was 18.4%, but varied substantially by industry sector. Compared with 'professionals' (IBS prevalence = 7.3%), jobs with high prevalence of IBS included 'health and social work activities' [PR = 4.9; 95% confidence interval (CI) = 1.4-16.7], 'household employment' (PR = 4.8; 95% CI = 1.5-15.9), and 'manufacturing' (PR = 3.5; 95% CI = 1.0-11.8). With Karasek Job Demand Control scores assigned to occupations within regions, high job demand doubled the prevalence of IBS (PR = 2.0; 95% CI = 1.4-2.9), whereas high-skill discretion was associated with lower prevalence of IBS (PR = 0.6; 95% CI = 0.4-0.8). There was also evidence that these two factors were not independent; high-skill discretion appeared to buffer the effect of high job demand on IBS prevalence (P < 0.001).

CONCLUSIONS

Occupational factors were associated with IBS prevalence, showing effects as important as those for non-occupational stresses such as civic insecurity or having health problems. High job skill discretion appeared to reduce the prevalence of IBS in the presence of high job demands. Given its high overall prevalence and poorly understood risk factors, further research on occupational psychosocial factors of IBS is warranted.

Assessing the Association Between Emotional Labor and Presenteeism Among Nurses in Korea: Cross-sectional Study Using the 4th Korean Working Conditions Survey

Background

Presenteeism has emerged as an important health-related issue and has been studied in a variety of occupation groups. This study examines the relationship between emotional labor and presenteeism in nurses in Republic of Korea.

Methods

As a cross-sectional study, our study was conducted on 328 female nurses participating in the fourth Korean Working Conditions Survey (2015). Nurses were identified by the Korean Industry Classification Code. Multivariable logistic regression analysis was performed to explore the association between emotional labor and presenteeism.

Results

Female nurses who always or sometimes hide their emotions in the workplace were found to have a high risk for presenteeism compared with female nurses who rarely hide their emotions in the workplace {odds ratio [OR] = 2.40 [95% confidence interval (CI) 1.04–5.54]; OR = 4.12 [95% CI 1.72–9.84], respectively}. Furthermore, the risk of presenteeism was higher in nurses who sometimes engaged with complaining customers compared with nurses who rarely did so, but it lacked statistical significance.

Conclusion

Presenteeism in nurses can cause various negative secondary effects; therefore, an alternative should be sought to mediate nurses' emotional labor to prevent presenteeism.

Association between workplace discrimination and depressive symptoms among firefighters in South Korea

BACKGROUND

Workplace discrimination is associated with poor mental health. However, there is a lack of studies examining the effects of discrimination on depressive symptoms among firefighters.

METHODS

We analyzed a national cross-sectional survey of 6369 firefighters in South Korea. Workplace discrimination during the past year was measured and main reasons for the discriminatory experience (gender, birth region, age, education, field/office work, job division) were identified separately by gender and job division. Depressive symptoms during the previous week were measured by the CES-D11.

RESULTS

Overall, 30.3% of firefighters experienced workplace discrimination and the main reasons for discrimination differed by gender and job division. Firefighters who experienced workplace discrimination had a higher likelihood of depressive symptoms than those who did not after adjusting for potential confounders (PR: 1.73; 95%CI: 1.55, 1.92).

CONCLUSIONS

This finding suggests that experience of workplace discrimination could aggravate the mental health of firefighters who provide an important public service.

Lookism hurts: appearance discrimination and self-rated health in South Korea

BACKGROUND

Despite a growing body of evidence suggesting that discrimination harms health, the association between appearance discrimination and health has been understudied. Our study investigated the association between perceived appearance discrimination and self-rated health among emerging adults using a nationally representative cohort study in South Korea.

METHODS

We analyzed the 2nd-10th (2005-2013) waves of cohort data from the Korean Education Employment Panel (KEEP). KEEP consists of two groups of individuals who were 15 (group I) and 18 (group II) years old at the 1st wave of the survey (2004) and were followed annually. Appearance discrimination was assessed at baseline (19 years old: 5th wave for group I, 2nd wave for group II) and at follow-up (24 years old: 10th wave for group I, 7th wave for group II). Responses of appearance discrimination at the two-time points were classified into four groups: 1) never (no discrimination at both baseline and follow-up); 2) repeated (discrimination at both baseline and follow-up); 3) incident (discrimination only at follow-up); and 4) in error (discrimination only at baseline). Multivariate logistic regression was applied to examine the association between reporting patterns of appearance discrimination and poor self-rated health, adjusting for potential confounders.

RESULTS

Compared to those who did not experience appearance discrimination, 'repeated' (OR: 3.70; 95% CI: 2.19-6.27) and 'incident' (OR: 3.10; 95% CI: 1.99-4.83) groups had a higher odds ratio of poor self-rated health after adjusting for potential confounders including respondents' body mass index change and baseline self-rated health. However, no significant association was observed among those who reported appearance discrimination 'in error'.

CONCLUSIONS

These results suggest that perceived appearance discrimination is associated with the health of Korean emerging adults considering participants' reporting patterns of appearance discrimination.