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Kyung M, Lee SJ, Dancu C, Hong O. Underreporting of workers' injuries or illnesses and contributing factors: a systematic review. BMC Public Health 2023; 23:558. [PMID: 36959647 PMCID: PMC10037763 DOI: 10.1186/s12889-023-15487-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 03/21/2023] [Indexed: 03/25/2023] Open
Abstract
BACKGROUND Accurate identification of work-related health problems is important to understand workplace safety issues and develop appropriate interventions. Although workers' reporting of work-related injuries or illnesses is the very first step of the reporting process, many workers may encounter challenges in reporting them to their management or workers' compensation (WC) programs. This systematic review aimed to identify the level of workers' underreporting of work-related injuries and illnesses and the contributing factors and reasons for underreporting among US workers. METHODS This study searched PubMed (Medline), PsycINFO (ProQuest), CINAHL (EBSCOhost), EMBASE (Embase.com), and Social Science Citation Index (Web of Science) using search terms related to underreporting of work-related injury or illness. RESULTS Twenty studies (17 quantitative and three mixed methods studies) were identified. The studies investigated reporting to management (n = 12), WC programs (n = 6), multiple organizations (n = 1), and not specified (n = 1). The timeframe used to measure reporting prevalence varied from three months to entire careers of workers, with the most common timeframe of 12 months. This review indicated that 20-91% of workers did not report their injuries or illnesses to management or WC programs. From quantitative studies, contributing factors for injury or illness underreporting were categorized as follows: injury type and severity, sociodemographic factors (e.g., age, gender, education, and race/ethnicity), general health and functioning, worker's knowledge on reporting, job and employment characteristics (e.g., work hour, job tenure, work shift, type of occupation, and physical demand), psychosocial work environment (e.g., supervisor support, coworker support, and safety climate), and health care provider factors. From the review of qualitative studies, the reasons for underreporting included the following: fear or concern, cumbersome time and effort in the reporting process, lack of knowledge regarding reporting, perceptions of injuries as not severe or part of the job, and distrust of reporting consequences. CONCLUSIONS The review findings indicated that low wage earners, racial/ethnic minority workers, and workers who perceive a poor psychosocial work environment encounter more barriers to reporting a work-related injury or illness. This review also identified variations in the measurement of work-related injury reporting across studies and a lack of standardized measurement. TRIAL REGISTRATION The review was registered in the PROSPERO, an international database of prospectively registered systematic reviews in health and social care (CRD42021284685).
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Affiliation(s)
- MinJung Kyung
- Department of Community Health Systems, School of Nursing, University of California San Francisco, 2 Koret Way, Suite #N-505, San Francisco, CA, 94143, USA.
| | - Soo-Jeong Lee
- Department of Community Health Systems, School of Nursing, University of California San Francisco, 2 Koret Way, Suite #N-505, San Francisco, CA, 94143, USA
| | - Caroline Dancu
- Department of Community Health Systems, School of Nursing, University of California San Francisco, 2 Koret Way, Suite #N-505, San Francisco, CA, 94143, USA
| | - OiSaeng Hong
- Department of Community Health Systems, School of Nursing, University of California San Francisco, 2 Koret Way, Suite #N-505, San Francisco, CA, 94143, USA
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Alexander BM, Wurzelbacher SJ, Zeiler RJ, Naber SJ, Kaur H, Grosch JW. The Role of Worker Age in Ohio Workers' Compensation Claims in the Landscaping Services Industry. J Occup Environ Med 2022; 64:766-776. [PMID: 35673251 PMCID: PMC9444967 DOI: 10.1097/jom.0000000000002579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE This study employed analysis of workers' compensation (WC) claims in the landscaping services industry to identify occupational factors associated with claims from workers of different ages. METHODS Private sector claims for 2005 to 2017 to the Ohio Bureau of Workers' Compensation (OHBWC) and their free-text descriptions were used along with data from the US Census Bureau American Community Survey to examine rates and types of WC claims by worker age. RESULTS Although the claim rate for younger workers was higher than that for older workers overall (593 vs 261 per 10,000 full-time equivalent employees, P < 0.001), claims from older workers had higher nonzero median cost ($1002 vs $522, P < 0.001). CONCLUSIONS Analysis of WC claim rates shows significant differences between claims in different age groups. These differences can be used to target safety interventions for the greatest impact.
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Affiliation(s)
- Barbara M Alexander
- From the National Institute for Occupational Safety and Health, Division of Field Studies and Engineering, Cincinnati, Ohio (Dr Alexander, Dr Wurzelbacher, Ms Zeiler); Ohio Bureau of Workers' Compensation, Strategy Division, Columbus, Ohio (Dr Naber); and National Institute for Occupational Safety and Health, Division of Science Integration, Cincinnati, Ohio (Dr Kaur, Dr Grosch)
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Torres IR, Shklanko S, Haq C, LeBrón AMW. Occupational health within the bounds of primary care: Factors shaping the health of Latina/o immigrant workers in federally qualified health centers. Am J Ind Med 2022; 65:468-482. [PMID: 35426145 DOI: 10.1002/ajim.23356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 02/18/2022] [Accepted: 03/25/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Many workers seek care for work-related medical conditions in primary care settings. Additionally, occupational medicine training is not consistently addressed in primary care professional training. These patterns raise concerns about the health outcomes of low-wage Latina/o immigrant workers who make use of primary care settings to obtain care for work-related injuries and illnesses. The objective of this qualitative study was to investigate how primary care clinicians assessed and addressed the role of occupational exposures on the health and well-being of Latina/o immigrant workers. METHODS We conducted semistructured in-depth interviews with 17 primary care clinicians (physicians, resident physicians, and nurse practitioners) employed in an urban federally qualified health center (FQHC) with two sites located in Orange County, CA. RESULTS Using a constructivist grounded theory approach, we determined that primary care clinicians had a general understanding that employment influenced the health and well-being of their Latina/o immigrant patients. Clinicians delivered care to Latina/o immigrant workers who feared reporting their injury to their employer and to Latina/o immigrants whose workers' compensation claim was terminated before making a full recovery. Clinicians were responsive to patients' work-related concerns and leveraged the resources available within the FQHC. Although some clinicians offered suggestions to improve occupational health in the FQHC, a few clinicians raised concerns about the feasibility of additional health screenings and clinic-based interventions, and pointed to the importance of interventions outside of the healthcare system. CONCLUSION This study underscores the complexities of addressing occupational health concerns in urban FQHCs.
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Affiliation(s)
- Ivy R Torres
- Department of Health, Society, and Behavior, Program in Public Health, University of California, Irvine, Irvine, California, USA
| | - Sarah Shklanko
- Department of Population Health and Disease Prevention, Program in Public Health, University of California, Irvine, Irvine, California, USA
| | - Cynthia Haq
- Department of Family Medicine, School of Medicine, University of California, Irvine, Irvine, California, USA
| | - Alana M W LeBrón
- Department of Health, Society, and Behavior, Program in Public Health, University of California, Irvine, Irvine, California, USA
- Department of Chicano/Latino Studies, School of Social Sciences, University of California, Irvine, Irvine, California, USA
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Wurzelbacher SJ, Meyers AR, Lampl MP, Timothy Bushnell P, Bertke SJ, Robins DC, Tseng CY, Naber SJ. Workers' compensation claim counts and rates by injury event/exposure among state-insured private employers in Ohio, 2007-2017. JOURNAL OF SAFETY RESEARCH 2021; 79:148-167. [PMID: 34847999 PMCID: PMC9026720 DOI: 10.1016/j.jsr.2021.08.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 03/23/2021] [Accepted: 08/30/2021] [Indexed: 06/13/2023]
Abstract
INTRODUCTION This study analyzed workers' compensation (WC) claims among private employers insured by the Ohio state-based WC carrier to identify high-risk industries by detailed cause of injury. METHODS A machine learning algorithm was used to code each claim by U.S. Bureau of Labor Statistics (BLS) event/exposure. The codes assigned to lost-time (LT) claims with lower algorithm probabilities of accurate classification or those LT claims with high costs were manually reviewed. WC data were linked with the state's unemployment insurance (UI) data to identify the employer's industry and number of employees. BLS data on hours worked per employee were used to estimate full-time equivalents (FTE) and calculate rates of WC claims per 100 FTE. RESULTS 140,780 LT claims and 633,373 medical-only claims were analyzed. Although counts and rates of LT WC claims declined from 2007 to 2017, the shares of leading LT injury event/exposures remained largely unchanged. LT claims due to Overexertion and Bodily Reaction (33.0%) were most common, followed by Falls, Slips, and Trips (31.4%), Contact with Objects and Equipment (22.5%), Transportation Incidents (7.0%), Exposure to Harmful Substances or Environments (2.8%), Violence and Other Injuries by Persons or Animals (2.5%), and Fires and Explosions (0.4%). These findings are consistent with other reported data. The proportions of injury event/exposures varied by industry, and high-risk industries were identified. CONCLUSIONS Injuries have been reduced, but prevention challenges remain in certain industries. Available evidence on intervention effectiveness was summarized and mapped to the analysis results to demonstrate how the results can guide prevention efforts. Practical Applications: Employers, safety/health practitioners, researchers, WC insurers, and bureaus can use these data and machine learning methods to understand industry differences in the level and mix of risks, as well as industry trends, and to tailor safety, health, and disability prevention services and research.
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Affiliation(s)
- Steven J Wurzelbacher
- National Institute for Occupational Safety and Health, 1090 Tusculum Ave, Cincinnati, OH 45226-1998, United States.
| | - Alysha R Meyers
- National Institute for Occupational Safety and Health, 1090 Tusculum Ave, Cincinnati, OH 45226-1998, United States.
| | - Michael P Lampl
- Ohio Bureau of Workers' Compensation, 30 W Spring St Ste L1, Columbus, OH 43215, United States.
| | - P Timothy Bushnell
- National Institute for Occupational Safety and Health, 1090 Tusculum Ave, Cincinnati, OH 45226-1998, United States.
| | - Stephen J Bertke
- National Institute for Occupational Safety and Health, 1090 Tusculum Ave, Cincinnati, OH 45226-1998, United States.
| | - David C Robins
- Ohio Bureau of Workers' Compensation, 30 W Spring St Ste L1, Columbus, OH 43215, United States.
| | - Chih-Yu Tseng
- National Institute for Occupational Safety and Health, 1090 Tusculum Ave, Cincinnati, OH 45226-1998, United States.
| | - Steven J Naber
- Ohio Bureau of Workers' Compensation, 30 W Spring St Ste L1, Columbus, OH 43215, United States.
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Alexander BM, Wurzelbacher SJ, Zeiler RJ, Naber SJ. Lessons learned from Ohio workers' compensation claims to mitigate hazards in the landscaping services industry. Am J Ind Med 2021; 64:699-713. [PMID: 34076900 DOI: 10.1002/ajim.23261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 04/13/2021] [Accepted: 05/13/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND The landscaping services industry is one of the more dangerous in the United States, with higher rates of both fatal and nonfatal injuries than the all-industry average. This study uses claims from the Ohio Bureau of Workers' Compensation (OHBWC) database to identify high rates of occupational injuries and illnesses in this industry in Ohio. The causes of those illnesses and injuries are highlighted to identify common factors. METHODS The OHBWC database includes injured-worker industry identification, occupation, business size, demographics, diagnoses, and free-text descriptions of injury circumstances. We identified landscaping service industry claims from 2001 to 2017, and describe annual claim counts and rates. RESULTS Over the 17-year period, 18,037 claims were accepted, with "Struck by object or equipment" and "Overexertion involving outside sources" being the most common events or exposures. Sprains and fractures were the most prevalent of the more serious lost-time (LT) injuries. Free-text descriptions of claims indicate that arborist work and loading/unloading of work vehicles and trailers are particularly hazardous. Younger and shorter-tenured workers were injured most frequently, although the average workers' age was higher for LT claims. The total cost of claims to the OHBWC from the landscaping services industry for 2001-2017 was over $226,000,000. Almost $214,000,000, or 94.4%, was for LT injuries and illnesses, even though LT claims comprise only 18% of total claims. CONCLUSIONS Targeted improvements in landscaper safety could come from controlling events leading to LT claims. Engineering controls and improved training are strongly recommended to reduce falls, overexertion, and struck-by injuries.
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Affiliation(s)
- Barbara M. Alexander
- Division of Field Studies and Engineering National Institute for Occupational Safety and Health Cincinnati Ohio USA
| | - Steven J. Wurzelbacher
- Division of Field Studies and Engineering National Institute for Occupational Safety and Health Cincinnati Ohio USA
| | - Rachel J. Zeiler
- Division of Field Studies and Engineering National Institute for Occupational Safety and Health Cincinnati Ohio USA
| | - Steven J. Naber
- Division of Safety and Hygiene Ohio Bureau of Workers' Compensation Columbus Ohio USA
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Ash JS, Chase D, Baron S, Filios MS, Shiffman RN, Marovich S, Wiesen J, Luensman GB. Clinical Decision Support for Worker Health: A Five-Site Qualitative Needs Assessment in Primary Care Settings. Appl Clin Inform 2020; 11:635-643. [PMID: 32998170 DOI: 10.1055/s-0040-1715895] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Although patients who work and have related health issues are usually first seen in primary care, providers in these settings do not routinely ask questions about work. Guidelines to help manage such patients are rarely used in primary care. Electronic health record (EHR) systems with worker health clinical decision support (CDS) tools have potential for assisting these practices. OBJECTIVE This study aimed to identify the need for, and barriers and facilitators related to, implementation of CDS tools for the clinical management of working patients in a variety of primary care settings. METHODS We used a qualitative design that included analysis of interview transcripts and observational field notes from 10 clinics in five organizations. RESULTS We interviewed 83 providers, staff members, managers, informatics and information technology experts, and leaders and spent 35 hours observing. We identified eight themes in four categories related to CDS for worker health (operational issues, usefulness of proposed CDS, effort and time-related issues, and topic-specific issues). These categories were classified as facilitators or barriers to the use of the CDS tools. Facilitators related to operational issues include current technical feasibility and new work patterns associated with the coordinated care model. Facilitators concerning usefulness include users' need for awareness and evidence-based tools, appropriateness of the proposed CDS for their patients, and the benefits of population health data. Barriers that are effort-related include additional time this proposed CDS might take, and other pressing organizational priorities. Barriers that are topic-specific include sensitive issues related to health and work and the complexities of information about work. CONCLUSION We discovered several themes not previously described that can guide future CDS development: technical feasibility of the proposed CDS within commercial EHRs, the sensitive nature of some CDS content, and the need to assist the entire health care team in managing worker health.
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Affiliation(s)
- Joan S Ash
- Department of Medical Informatics and Clinical Epidemiology, School of Medicine, Oregon Health & Science University, Portland, Oregon, United States
| | - Dian Chase
- Department of Medical Informatics and Clinical Epidemiology, School of Medicine, Oregon Health & Science University, Portland, Oregon, United States
| | - Sherry Baron
- Department of Urban Studies, Barry Commoner Center for Health and the Environment, Queens College, City University of New York, New York, New York, United States
| | - Margaret S Filios
- National Institute for Occupational Safety and Health/Centers for Disease Control and Prevention, Cincinnati, Ohio and Morgantown, West Virginia, United States
| | - Richard N Shiffman
- Yale Center for Medical Informatics, Yale University School of Medicine, New Haven, Connecticut, United States
| | - Stacey Marovich
- National Institute for Occupational Safety and Health/Centers for Disease Control and Prevention, Cincinnati, Ohio and Morgantown, West Virginia, United States
| | - Jane Wiesen
- Department of Medical Informatics and Clinical Epidemiology, School of Medicine, Oregon Health & Science University, Portland, Oregon, United States
| | - Genevieve B Luensman
- National Institute for Occupational Safety and Health/Centers for Disease Control and Prevention, Cincinnati, Ohio and Morgantown, West Virginia, United States
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Wurzelbacher SJ, Lampl MP, Bertke SJ, Tseng CY. The effectiveness of ergonomic interventions in material handling operations. APPLIED ERGONOMICS 2020; 87:103139. [PMID: 32501244 PMCID: PMC8669597 DOI: 10.1016/j.apergo.2020.103139] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 01/31/2020] [Accepted: 04/22/2020] [Indexed: 05/30/2023]
Abstract
This study evaluated the effectiveness of ergonomic interventions in material handling operations involving 33 employers and 535 employees from 2012 to 2017. Outcomes included employee-reported low back/upper extremity pain and safety incidents at baseline, every three months, and annually for up to two years. A total of 32.5% of employees completed at least one survey, while 13.6% completed all nine surveys over two years. Among highly exposed employees (who reported handling >= 50 lbs. > 33% of the time), upper extremity pain frequency and severity were lower among those who reported using the intervention routinely versus those that reported using their body strength alone to handle objects >= 50 lbs. After excluding from analyses one employer that used anti-fatigue mats, low back pain frequency was also significantly lower among highly exposed intervention users. In conclusion, there was some evidence that the interventions were effective in reducing employee-reported pain for highly exposed employees.
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Affiliation(s)
- Steven J Wurzelbacher
- National Institute for Occupational Safety and Health, 1090 Tusculum Ave, MS R-14, Cincinnati, OH, 45226-1998, USA.
| | - Michael P Lampl
- Ohio Bureau of Workers' Compensation, Division of Safety & Hygiene, 13430 Yarmouth, Dr.Pickerington, OH, 43147, USA.
| | - Stephen J Bertke
- National Institute for Occupational Safety and Health, 1090 Tusculum Ave, MS R-13, Cincinnati, OH, 45226-1998, USA.
| | - Chih-Yu Tseng
- National Institute for Occupational Safety and Health, 1090 Tusculum Ave, MS R-13, Cincinnati, OH, 45226-1998, USA.
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Al‐Tarawneh IS, Wurzelbacher SJ, Bertke SJ. Comparative analyses of workers' compensation claims of injury among temporary and permanent employed workers in Ohio. Am J Ind Med 2020; 63:3-22. [PMID: 31541504 DOI: 10.1002/ajim.23049] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 08/16/2019] [Accepted: 09/03/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND A small but increasing number of studies have examined the risk of injury among temporary workers compared to that among workers in permanent employer arrangements. The purpose of this study was to conduct a comparative analysis of injury risk among temporary and permanent employer workers using a large dataset of workers' compensation (WC) claims of injury. METHODS Over 1.3 million accepted WC claims in Ohio during the years 2001 to 2013 were analyzed, including 45 046 claims from workers employed by temporary services agencies. General descriptive statistics, injury rates and rate ratios (temporary to permanent workers) were calculated by injury type and event, industry group, and industry manual classes. RESULTS Injured temporary workers were younger and had less tenure compared to injured permanent workers. Temporary workers had higher injury rates, and lower lost-time and medical costs. Differences in injury rates between temporary and permanent workers varied by injury event, industry, and manual class. CONCLUSION Temporary workers had higher overall injury rates than permanent workers, controlling for industry manual class. These differences were pronounced for certain industries and injury events. We were not able to control for age and tenure of the worker, so it is not clear how these factors affected observed results. These findings were mostly similar to those from other studies using WC data from the states of Washington and Illinois. Together, these studies provide insights to improve injury prevention among temporary workers, however, additional research is still needed to improve safety and health programming for this group of workers.
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Affiliation(s)
| | - Steven J. Wurzelbacher
- Division of Field Studies and EngineeringNational Institute for Occupational Safety and HealthCincinnati Ohio
| | - Stephen J. Bertke
- Division of Field Studies and EngineeringNational Institute for Occupational Safety and HealthCincinnati Ohio
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Sears JM, Edmonds AT, Coe NB. Coverage Gaps and Cost-Shifting for Work-Related Injury and Illness: Who Bears the Financial Burden? Med Care Res Rev 2019; 77:223-235. [PMID: 31018756 DOI: 10.1177/1077558719845726] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The heavy economic burden of work-related injury/illness falls not only on employers and workers' compensation systems, but increasingly on health care systems, health and disability insurance, social safety net programs, and workers and their families. We present a flow diagram illustrating mechanisms responsible for the financial burden of occupational injury/illness borne by social safety net programs and by workers and their families, due to cost-shifting and gaps in workers' compensation coverage. This flow diagram depicts various pathways leading to coverage gaps that may shift the burden of occupational injury/illness-related health care and disability costs ultimately to workers, particularly the most socioeconomically vulnerable. We describe existing research and important research gaps linked to specific pathways in the flow diagram. This flow diagram was developed to facilitate more detailed and comprehensive research into the financial burden imposed by work-related injury/illness, in order to focus policy efforts where improvement is most needed.
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Affiliation(s)
- Jeanne M Sears
- University of Washington, Seattle, WA, USA.,Harborview Injury Prevention and Research Center, Seattle, WA, USA.,Institute for Work and Health, Toronto, Ontario, Canada
| | | | - Norma B Coe
- University of Washington, Seattle, WA, USA.,University of Pennsylvania, Philadelphia, PA, USA.,National Bureau of Economic Research, Cambridge, MA, USA
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Outreach to Low-Wage and Precarious Workers: Concept Mapping for Public Health Officers. J Occup Environ Med 2018; 60:e610-e617. [PMID: 30256304 DOI: 10.1097/jom.0000000000001462] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To explore concept mapping (CM) as a participatory methodology that can be used by public health officials to strategize approaches to reducing health inequities among low wage workers and workers with unstable employment. METHODS In a workshop of 68 occupational health officers, mainly from government agencies, CM was demonstrated through gathering and prioritizing ideas for reaching underserved, at-risk working populations. RESULTS Prior to the workshop, occupational health officers generated 99 brainstormed ideas on how to reach underserved workers. These were reduced to 39 unique items, which workshop participants then sorted into themes and prioritized based on perceived effectiveness and feasibility. Twelve specific approaches covering enhanced surveillance methods, occupational safety and health (OSH) training, and partnering with employers, other agencies, and community groups were considered most actionable by occupational/public health officers to address the health of low-wage, and precarious workers. In a follow-up session 1 year later, a subset of participants discussed the findings. CONCLUSION Concept mapping can be used to elucidate actionable approaches by government agencies to better address occupational health inequities experienced by low wage and precarious workers.
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Simmons JM, Liebman AK, Sokas RK. Occupational Health in Community Health Centers: Practitioner Challenges and Recommendations. New Solut 2018; 28:110-130. [PMID: 29310509 DOI: 10.1177/1048291117749937] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Primary care clinicians may be the only source of occupational healthcare for many low-wage, high-risk workers who experience disproportionate occupational hazards. The authors explored barriers to providing occupational healthcare and recommendations for overcoming these challenges. The team conducted six focus groups and eleven key-informant interviews in two community health centers and among clinicians, community health workers, and other personnel from similar settings. Clinicians reported not utilizing occupational information during clinical encounters and identified competing priorities, limited appointment time, and lack of training as key barriers. They cited workers' compensation as a source of confusion and frustration. However, most participants recognized occupation as an important social determinant of health and expressed interest in additional training and resources. Participants agreed that referral mechanisms for occupational medicine specialists and worker centers and changes in quality performance measures and electronic health records would be useful and that workers' compensation and immigration policies need reform.
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Affiliation(s)
| | | | - Rosemary K Sokas
- 2 Department of Human Science, Georgetown University School of Nursing and Health Studies
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Topete L, Forst L, Zanoni J, Friedman L. Workers' compensation and the working poor: Occupational health experience among low wage workers in federally qualified health centers. Am J Ind Med 2018; 61:189-197. [PMID: 29388222 DOI: 10.1002/ajim.22813] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2017] [Indexed: 11/06/2022]
Abstract
BACKGROUND The working poor are at highest risk of work-related injuries and have limited access to occupational health care. OBJECTIVES To explore community health centers (CHCs) as a venue for accessing at risk workers; and to examine the experience, knowledge, and perceptions of workers' compensation (WC) among the working poor. METHODS Key informant interviews were conducted among patients in waiting rooms of rural and urban CHCs. RESULT Fifty-one interviews of minority workers across sectors identified 23 prior work-related injuries and mixed experiences with the WC system. Barriers to reporting and ways to overcome these barriers were elucidated. CONCLUSIONS Patients in CHCs work in jobs that put them at risk for work-related injuries. CHCs are a good site for accessing at-risk workers. Improving occupational healthcare and appropriate billing of WC insurance should be explored, as should best practices for employers to communicate WC laws to low wage workers.
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Affiliation(s)
- Liza Topete
- University of Illinois at Chicago School of Public Health; Chicago Illinois
| | - Linda Forst
- University of Illinois at Chicago School of Public Health; Chicago Illinois
| | - Joseph Zanoni
- University of Illinois at Chicago School of Public Health; Chicago Illinois
| | - Lee Friedman
- University of Illinois at Chicago School of Public Health; Chicago Illinois
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Prado JB, Mulay PR, Kasner EJ, Bojes HK, Calvert GM. Acute Pesticide-Related Illness Among Farmworkers: Barriers to Reporting to Public Health Authorities. J Agromedicine 2017; 22:395-405. [PMID: 28762882 DOI: 10.1080/1059924x.2017.1353936] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2022]
Abstract
Farmworkers are at high risk of acute occupational pesticide-related illness (AOPI) and AOPI surveillance is vital to preventing these illnesses. Data on such illnesses are collected and analyzed to identify high-risk groups, high-risk pesticides, and root causes. Interventions to address these risks and root causes include farmworker outreach, education, and regulation. Unfortunately, it is well known that AOPI is underreported, meaning that the true burden of this condition remains unknown. This article reviews the barriers to reporting of farmworker AOPI to public health authorities and provides some practical solutions. Information is presented using the social-ecological model spheres of influence. Factors that contribute to farmworker AOPI underreporting include fear of job loss or deportation, limited English proficiency (LEP), limited access to health care, lack of clinician recognition of AOPI, farmworker ineligibility for workers' compensation (WC) benefits in many states, insufficient resources to conduct AOPI surveillance, and constraints in coordinating AOPI investigations across state agencies. Solutions to address these barriers include: emphasizing that employers encourage farmworkers to report safety concerns; raising farmworker awareness of federally qualified health centers (FQHCs) and increasing the availability of these clinics; improving environmental toxicology training to health-care students and professionals; encouraging government agencies to investigate pesticide complaints and provide easy-to-read reports of investigation findings; fostering public health reporting from electronic medical records, poison control centers (PCCs), and WC; expanding and strengthening AOPI state-based surveillance programs; and developing interagency agreements to outline the roles and responsibilities of each state agency involved with pesticide safety.
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Affiliation(s)
| | - Prakash R Mulay
- b Florida Department of Health , Tallahassee , Florida , USA
| | - Edward J Kasner
- c Department of Environmental and Occupational Health Sciences , University of Washington School of Public Health , Seattle , Washington , USA
| | - Heidi K Bojes
- d Texas Department of State Health Services , Austin , Texas , USA
| | - Geoffrey M Calvert
- e Division of Surveillance, Hazard Evaluations, and Field Studies , National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention , Cincinnati , Ohio , USA
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Wurzelbacher SJ, Al-Tarawneh IS, Meyers AR, Bushnell P, Lampl MP, Robins DC, Tseng CY, Wei C, Bertke SJ, Raudabaugh JA, Haviland TM, Schnorr TM. Development of methods for using workers' compensation data for surveillance and prevention of occupational injuries among State-insured private employers in Ohio. Am J Ind Med 2016; 59:1087-1104. [PMID: 27667651 DOI: 10.1002/ajim.22653] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2016] [Indexed: 11/09/2022]
Abstract
BACKGROUND Workers' compensation (WC) claims data may be useful for identifying high-risk industries and developing prevention strategies. METHODS WC claims data from private-industry employers insured by the Ohio state-based workers' compensation carrier from 2001 to 2011 were linked with the state's unemployment insurance (UI) data on the employer's industry and number of employees. National Labor Productivity and Costs survey data were used to adjust UI data and estimate full-time equivalents (FTE). Rates of WC claims per 100 FTE were computed and Poisson regression was used to evaluate differences in rates. RESULTS Most industries showed substantial claim count and rate reductions from 2001 to 2008, followed by a leveling or slight increase in claim count and rate from 2009 to 2011. Despite reductions, there were industry groups that had consistently higher rates. CONCLUSION WC claims data linked to employment data could be used to prioritize industries for injury research and prevention activities among State-insured private employers. Am. J. Ind. Med. 59:1087-1104, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Steven J. Wurzelbacher
- Division of Surveillance, Hazard Evaluations, and Field Studies, Center for Workers’ Compensation Studies; National Institute for Occupational Safety and Health; Cincinnati Ohio
| | | | - Alysha R. Meyers
- Division of Surveillance, Hazard Evaluations, and Field Studies, Center for Workers’ Compensation Studies; National Institute for Occupational Safety and Health; Cincinnati Ohio
| | - P.Timothy Bushnell
- Division of Surveillance, Hazard Evaluations, and Field Studies, Center for Workers’ Compensation Studies; National Institute for Occupational Safety and Health; Cincinnati Ohio
| | - Michael P. Lampl
- Division of Safety and Hygiene; Ohio Bureau of Workers’ Compensation; Columbus Ohio
| | - David C. Robins
- Division of Safety and Hygiene; Ohio Bureau of Workers’ Compensation; Columbus Ohio
| | - Chih-Yu Tseng
- Division of Surveillance, Hazard Evaluations, and Field Studies, Center for Workers’ Compensation Studies; National Institute for Occupational Safety and Health; Cincinnati Ohio
| | - Chia Wei
- Division of Surveillance, Hazard Evaluations, and Field Studies, Center for Workers’ Compensation Studies; National Institute for Occupational Safety and Health; Cincinnati Ohio
| | - Stephen J. Bertke
- Division of Surveillance, Hazard Evaluations, and Field Studies, Center for Workers’ Compensation Studies; National Institute for Occupational Safety and Health; Cincinnati Ohio
| | | | - Thomas M. Haviland
- Division of Surveillance, Hazard Evaluations, and Field Studies, Center for Workers’ Compensation Studies; National Institute for Occupational Safety and Health; Cincinnati Ohio
| | - Teresa M. Schnorr
- Division of Surveillance, Hazard Evaluations, and Field Studies, Center for Workers’ Compensation Studies; National Institute for Occupational Safety and Health; Cincinnati Ohio
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Lipscomb HJ, Schoenfisch AL, Cameron W, Kucera KL, Adams D, Silverstein BA. Contrasting patterns of care for musculoskeletal disorders and injuries of the upper extremity and knee through workers' compensation and private health care insurance among union carpenters in Washington State, 1989 to 2008. Am J Ind Med 2015; 58:955-63. [PMID: 25939759 DOI: 10.1002/ajim.22455] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND Musculoskeletal symptoms and disorders (MSDIs) are common reasons for visits to medical providers in the general population and they are common work-related complaints. Prior reports raise concerns as to whether declines in workers' compensation (WC) rates represent true improvement in occupational health and safety or shifting of care to other payment systems. METHODS By linking administrative records, we compared patterns of WC claims and private health care utilization for disorders of the upper extremity (UE) and knee among a large cohort of union carpenters over a 20-year period. RESULTS As WC claim rates declined, private health care utilization increased. The increase was muted somewhat but sustained when adjusting for other patterns of health care utilization. CONCLUSIONS Findings suggest the decline of WC claim rates do not solely represent improved occupational safety in this population, but also a considerable shifting of care to their private insurance coverage over time.
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Affiliation(s)
- Hester J. Lipscomb
- Division of Occupational and Environmental Medicine; Duke University Medical Center; Durham North Carolina
| | - Ashley L. Schoenfisch
- Division of Occupational and Environmental Medicine; Duke University Medical Center; Durham North Carolina
| | - Wilfrid Cameron
- Strategic Solutions for Safety, Health and Environment; Seattle Washington
| | - Kristen L. Kucera
- Department of Exercise and Sport Science; University of North Carolina; Chapel Hill North Carolina
| | - Darrin Adams
- Safety and Health Assessment and Research Program (SHARP); Department of Labor and Industries; State of Washington; Olympia Washington
| | - Barbara A. Silverstein
- Safety and Health Assessment and Research Program (SHARP); Department of Labor and Industries; State of Washington; Olympia Washington
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Davis LK, Grattan KM, Tak S, Bullock LF, Ozonoff A, Boden LI. Use of multiple data sources for surveillance of work-related amputations in Massachusetts, comparison with official estimates and implications for national surveillance. Am J Ind Med 2014; 57:1120-32. [PMID: 24782244 DOI: 10.1002/ajim.22327] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2014] [Indexed: 11/10/2022]
Abstract
BACKGROUND Accurate surveillance of work-related injuries is needed at national and state levels. We used multiple sources for surveillance of work-related amputations, compared findings with Survey of Occupational Injuries and Illnesses (SOII) estimates, and assessed generalizability to national surveillance. METHODS Three data sources were used to enumerate work-related amputations in Massachusetts, 2007-2008. SOII eligible amputations were compared with SOII estimates. RESULTS 787 amputations were enumerated, 52% ascertained through hospital records only, exceeding the SOII estimate (n = 210). The estimated SOII undercount was 48% (95% CI: 36-61%). Additional amputations were reported in SOII as other injuries, accounting for about half the undercount. Proportionately more SOII estimated than multisource cases were in manufacturing and fewer in smaller establishments. CONCLUSION Multisource surveillance enhanced our ability to document work-related amputations in Massachusetts. While not feasible to implement for work-related conditions nationwide, it is useful in states. Better understanding of potential biases in SOII is needed.
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Affiliation(s)
- Letitia K. Davis
- Occupational Health Surveillance Program, Massachusetts Department of Public Health; Boston Massachusetts
| | - Kathleen M. Grattan
- Occupational Health Surveillance Program, Massachusetts Department of Public Health; Boston Massachusetts
| | - Sangwoo Tak
- Southern California NIOSH Education and Research Center, UCLA; Los Angeles California
| | - Lucy F. Bullock
- Occupational Health Surveillance Program, Massachusetts Department of Public Health; Boston Massachusetts
| | - Al Ozonoff
- Center for Patient Safety and Quality Research; Boston Children's Hospital; Boston Massachusetts
| | - Leslie I. Boden
- Professor of Environmental Health; Boston University School of Public Health; Boston Massachusetts
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