Women's occupational health: a critical review and discussion of current issues

Occupational exposure limits for reproductive toxicants - A comparative analysis

We investigated the level of protection of reproductive and developmental toxicity offered through occupational exposure limits (OELs) and Derived No-Effect Levels for workers' inhalation exposure (wDNELs). We compared coverage of substances that have a harmonised classification as reproductive toxicant 1 A or 1B (Repr.1 A/B), numerical values and scientific basis of 12 lists of OELs and wDNELs from REACH Registrants' and the Committee for Risk Assessment. Across the 14 sources of OELs and wDNELs, 53 % of the Repr1A/B-substances had at least one exposure limit (counting groups of metals as one entry). Registrants' wDNELs covered the largest share, 40 %. The numerical values could be highly variable for the same substance across the lists. How often reproductive toxicity is identified as the critical effect varies between the examined lists, both due to different assessments of the same substance and different substance coverage. Reviewing the margin of safety to reproductive toxicity cited in the documents, we found that 15 % of safety margins were lower to reproductive toxicity than the critical effect. To conclude, neither the REACH nor work environment legislation supply wDNELs or OELs for a substantial share of known reproductive toxicants. EU OELs cover among the fewest substances in the range, and in many cases national OELs or wDNELs are set at more conservative levels.

Work and Retirement Among Women: The Health and Employment After Fifty Study

BACKGROUND

Women increasingly work beyond age 50+ but their occupational health is under-researched.

AIMS

To investigate what jobs older contemporary women do, when they exit their jobs and what factors predict job exit.

METHODS

Data came from the Health and Employment After Fifty cohort, which recruited women aged 50-64 at baseline in 2013-14 and has followed them up annually collecting: demographic, lifestyle and work information. Exits from employment were mapped longitudinally over five follow-ups. Time-to-first event Cox regression analyses were used to identify risk factors for job exit.

RESULTS

At baseline, 4436 women participated, 64% of whom were working. The proportions of women working at 50-54, 55-60 and over 60 years were 86%, 79% and 38%, respectively. Amongst all women, after adjustment for age, managing comfortably financially and not coping with the mental demands of the job were associated with exit. Risk factors for job exit differed in the age bands: 50-54; 55-59 and >60 years, reflecting socio-economic status, markers of health (musculoskeletal pain and poor self-rated health) and work factors (under-appreciation, job dissatisfaction, temporary/permanent contracts, coping with work's physical demands).

CONCLUSIONS

Factors contributing to exit from work among older women differ by age group, after controlling for perceived financial position, age and mental demands of the job. A number of work characteristics predict job exit and suggest that employers can play an important role in supporting women to continue working until older ages. Identification and treatment of musculoskeletal pain could also enable work amongst older women.

Occupational safety perceptions of prehospital emergency health services employees: A sample of Sivas central district

BACKGROUND

Prehospital emergency health services ambulance workers are in the risky class in terms of occupational health and safety, and they are faced with more risks due to the fact that they are the first responders to the events, especially regarding COVID-19.

OBJECTIVE

The aim of the present study is to determine the occupational risk perceptions of health care workers and their relations with demographic variables.

METHODS

A literature review was performed to develop a questionnaire. This questionnaire was used in a survey with 250 respondents. The collected data was analysed through factor analysis. Cronbach's Alpha was calculated to verify the reliability of the data.

RESULTS

The risk perceptions of the employees (Factor 1 and Factor 3) differ significantly according to gender. Another important point is that 60.3% of the participants stated that they "agree" with the statement that health workers "experience violence" during work.

CONCLUSION

The risk perception of women was found to be higher, and the reason for this is that women are less physically strong than men along with social gender roles and gender discrimination.

The impact of precarious jobs on mental health: a gender-sensitive literature review

PURPOSE

The aim of this study is to analyse the extent to which research and knowledge production on a key occupational health issue-the impact of precarious employment on health-incorporates, and is sensitive to, a gender perspective.

METHODS

A systematic literature review was carried out to identify studies that analysed the relationship between precarious employment and mental health in the period January 2010-May 2018 through. A minimum of two independent reviewers assessed each article for quality and eligibility. A checklist was used to determine whether the articles included in the review incorporated a gender perspective.

RESULTS

The search retrieved 1522 papers, of which 54 (corresponding to 53 studies) met the inclusion criteria. Of these 54 papers, 22 (40.7%) stratified the analyses by sex. Only 5.4% of the total of articles both stratified by sex and considered variables of household composition and marital status, while only 33.3% incorporated an intersectional perspective. None considered the distribution of domestic work and only a quarter (25.9%) approached the study and interpreted the results in terms of gender.

CONCLUSION

Too few studies researching paid work and health include a gender perspective. This omission necessarily implies a biased interpretation of the reality of precarious employment and its impact on health.

Extension of working life and implications for occupational health in Chile

Chile has one of the highest effective retirement ages among the countries of the Organisation for Economic Cooperation and Development (OECD). This could be associated with retirement at older ages, as low pensions encourage people to remain active in the workforce.People undergo several changes due to the passage of time, and they have an impact on their health from a biological, psychological and social point of view. However, there is not enough knowledge on how these changes impact and interact with working, employment and health conditions of workers as they get older.This article aims to contribute to the critical debate on the extension of working life and its implications for occupational health. Some reflections in this regard are proposed based on a review of the most recent relevant literature.

Work as an Inclusive Part of Population Health Inequities Research and Prevention

Despite its inclusion in models of social and ecological determinants of health, work has not been explored in most health inequity research in the United States. Leaving work out of public health inequities research creates a blind spot in our understanding of how inequities are created and impedes our progress toward health equity. We first describe why work is vital to our understanding of observed societal-level health inequities. Next, we outline challenges to incorporating work in the study of health inequities, including (1) the complexity of work as a concept; (2) work's overlap with socioeconomic position, race, ethnicity, and gender; (3) the development of a parallel line of inquiry into occupational health inequities; and (4) the dearth of precise data with which to explore the relationships between work and health status. Finally, we summarize opportunities for advancing health equity and monitoring progress that could be achieved if researchers and practitioners more robustly include work in their efforts to understand and address health inequities.

What makes pregnant workers sick: why, when, where and how? An exploratory study in the ready-made garment industry in Bangladesh

Background

Bangladesh has made significant progress in reducing maternal mortality. Many factors have contributed to this; one is the socio-economic development of the country. The ready-made garment industry is at the forefront of this development creating employment for many women. However, the work environment has the potential to create health problems, particularly for vulnerable groups such as pregnant women. This paper explores perceptions of health problems during pregnancy of factory workers, in this important industry in Bangladesh.

Methods

This study was conducted in four factories using qualitative research methods to provide a view of pregnant workers’ health risks beyond a bio-medical approach. Data was collected through in-depth interviews of pregnant workers and observations of their homes and workplaces. Further, key informant interviews with factory health care providers, government officials and employers revealed different perspectives and experiences. Data was collected in the local language (Bengali), then transcribed and analysed using a framework analysis approach.

Results

Female workers reported that participation in paid work created an opportunity for them to earn money but pregnancy and the nature of the job, including being pressured to meet the production quota, pressure to leave the job because of their pregnancy and withholding of maternity benefits, cause stress, anxiety and may contribute to hypertensive disorders of pregnancy. This was confirmed by factory doctors who suggested that developing hypertensive disorders during pregnancy was influenced by the nature of work and stress. The employers seemed focused on profit and meeting quotas and the health of pregnant workers appeared to be a lower priority. This study found that the government lacks the resources to understand the extent of the problem or the level of compliance with maternity related regulations.

Conclusions

These results indicate the vulnerability of female workers to physical and mental stress at work and associations with their health problems during pregnancy. It identifies the deficiencies of family, workplace and health service support for these pregnant workers, highlighting the urgent need for government and non-government organisations to work with this important export industry to improve health surveillance and monitoring and the enforcement of existing laws to protect the rights and conditions of pregnant women.

Preventing Occupational Injuries

Perception of injury risk is associated with an individual's propensity to act. This study examined the relationship between women's demographic, occupational, and risk characteristics, and health and occupational stressors as predictors of their perceptions of injury risk to self and other women from occupational musculoskeletal exposures. This cross-sectional study included a random sample of women who were employed in the 12 months prior to survey administration ( N = 123, 27% response rate). A telephone survey consisting of 154 items was administered in English or Spanish. For the perception of injury risk to self, the final multiple regression equation explained approximately 66% of the variance with significant unique contributions identified for bodily pain, occupational exposure to repeated strenuous physical activity or repetitive hand motion, perceived seriousness and controllability of the risk, and perception of risk to other women. Similarly, for perception of injury risk to other women, the final multiple regression equation explained approximately 57% of the variance with significant unique contributions identified for household size, occupational exposure to repetitive hand motion, familiarity of the risk, and perception of injury risk to self. Exposure experiences and risk characteristics were found to increase women's perceptions of risk from occupational musculoskeletal exposures.

Differences in the prevalence of musculoskeletal symptoms among female and male custodians

BACKGROUND

The prevalence of musculoskeletal symptoms among custodians is high. We sought to compare musculoskeletal symptoms between female and male custodians and to explore how task might affect this relationship.

METHODS

A cross-sectional study was performed among 712 custodians who completed a survey assessing upper extremity, back, and lower extremity musculoskeletal symptoms and exposure to cleaning tasks. Chi-square tests and logistic regression analyses were used to test for associations between gender, cleaning tasks, and musculoskeletal symptoms.

RESULTS

Gender was significantly (P < 0.05) associated with musculoskeletal symptoms in χ(2) tests and multivariate analyses. The prevalence ratio of symptoms among women was roughly 50% higher than men, regardless of the tasks that workers performed.

CONCLUSIONS

The prevalence of musculoskeletal symptoms differed for female and male custodians and appeared to be consistent across a range of job tasks. Am. J. Ind. Med. 59:841-852, 2016. © 2016 Wiley Periodicals, Inc.

Quality of life, depression and musculoskeletal pain experience among employed women: A controlled study

OBJECTIVE

The musculoskeletal pain is one of the leading health problems among employed women. The aim of our study was to examine musculoskeletal pain, depression and quality of life (QOL) among employed women and find out the differences with unemployed women.

METHODS

A hundred and fifty employed women and 151 housewives were included in our study. We used visual analog scale (VAS) for the assessment of pain, Beck Depression Inventory (BDI) for the depressive symptoms and Nottingham Health Profile (NHP) for the assessment of QOL.

RESULTS

The ratio of musculoskeletal pain among employed women and unemployed women were found as 42.5% and 57.5% respectively. A mild level of depression was found among employed women whereas moderate and vigorous level of depression were found among unemployed women. There were significant differences in terms of depression and QOL parameters. When the correlations of pain, depression and QOL were analyzed, significant high positive relationships between spinal, lower extremity, upper extremity pain levels and BDI and NHP were found only in housewives.

CONCLUSIONS

Lower levels of depression among employed women can give the idea that social ambience at work place, focusing at work and economic independence play a role in decreasing depression.

The Impact of Physical and Ergonomic Hazards on Poultry Abattoir Processing Workers: A Review

The poultry abattoir industry continues to grow and contribute significantly to the gross domestic product in many countries. The industry expects working shifts of eight to eleven hours, during which workers are exposed to occupational hazards which include physical hazards ranging from noise, vibration, exposure to cold and ergonomic stress from manual, repetitive tasks that require force. A PubMed, Medline and Science Direct online database search, using specific keywords was conducted and the results confirmed that physical and ergonomic hazards impact on abattoir processing workers health, with harm not only to workers’ health but also as an economic burden due to the loss of their livelihoods and the need for treatment and compensation in the industry. This review endeavours to highlight the contribution poultry processing plays in the development of physical agents and ergonomic stress related occupational diseases in poultry abattoir processing workers. The impact includes noise-induced hearing loss, increased blood pressure, menstrual and work related upper limb disorders. These are summarised as a quick reference guide for poultry abattoir owners, abattoir workers, poultry associations, occupational hygienists and medical practitioners to assist in the safer management of occupational health in poultry abattoirs.

"They See Us As Machines:" The Experience of Recent Immigrant Women in the Low Wage Informal Labor Sector

This study explores the organization of work and occupational health risk as elicited from recently immigrated women (n = 8) who have been in the US for less than three years and employed in informal work sectors such as cleaning and factory work in the greater Boston area in Massachusetts. Additional interviews (n = 8) with Community Key Informants with knowledge of this sector and representatives of temporary employment agencies in the area provides further context to the interviews conducted with recent immigrant women. These results were also compared with our immigrant occupational health survey, a large project that spawned this study. Responses from the study participants suggest health outcomes consistent with being a day-laborer scholarship, new immigrant women are especially at higher risk within these low wage informal work sectors. A difference in health experiences based on ethnicity and occupation was also observed. Low skilled temporary jobs are fashioned around meeting the job performance expectations of the employer; the worker's needs are hardly addressed, resulting in low work standards, little worker protection and poor health outcomes. The rising prevalence of non-standard employment or informal labor sector requires that policies or labor market legislation be revised to meet the needs presented by these marginalized workers.

Improved fitness after a workbased physical exercise program

Purpose

– The purpose of this paper is to investigate the effects on fitness outcomes of a work-based physical exercise (PE) intervention among women working in older people’s care. In addition, effects on productivity-related outcomes including work ability and sickness absence were studied.

Design/methodology/approach

– Employees participated in a one-year intervention involving two one-hour weekly mandatory PE sessions. The intervention (n=13) was compared to referents (n=12). Fitness tests and self-reports on work ability and sickness absence were obtained before the intervention (T1), six months into the intervention and after 12 months.

Findings

– Fitness test scores (corrected for age and weight) increased significantly over time in the intervention group but not among referents. Perceived exertion decreased significantly in the intervention group and increased significantly among referents. For self-rated work ability and sickness absence, no significant time or group differences emerged.

Research limitations/implications

– Further research on larger groups of women is needed to delineate the effects of PE on self-rated productivity and performance.

Practical implications

– Work-based PE programs can improve fitness among women in older people’s care.

Social implications

– With previous research having primarily focussed on men, this study shows that women in blue-collar jobs also may benefit from taking part in work-based PE programs.

Originality/value

– This paper makes an important contribution through its focus on the effects of a work-based PE program on fitness and possible relations to productivity, among employed women.

Recruitment for Occupational Research: Using Injured Workers as the Point of Entry into Workplaces

OBJECTIVE

To investigate the feasibility, costs and sample representativeness of a recruitment method that used workers with back injuries as the point of entry into diverse working environments.

METHODS

Workers' compensation claims were used to randomly sample workers from five heavy industries and to recruit their employers for ergonomic assessments of the injured worker and up to 2 co-workers.

RESULTS

The final study sample included 54 workers from the workers' compensation registry and 72 co-workers. This sample of 126 workers was based on an initial random sample of 822 workers with a compensation claim, or a ratio of 1 recruited worker to approximately 7 sampled workers. The average recruitment cost was CND$262/injured worker and CND$240/participating worksite including co-workers. The sample was representative of the heavy industry workforce, and was successful in recruiting the self-employed (8.2%), workers from small employers (<20 workers, 38.7%), and workers from diverse working environments (49 worksites, 29 worksite types, and 51 occupations).

CONCLUSIONS

The recruitment rate was low but the cost per participant reasonable and the sample representative of workers in small worksites. Small worksites represent a significant portion of the workforce but are typically underrepresented in occupational research despite having distinct working conditions, exposures and health risks worthy of investigation.

Work Experiences of Latina Immigrants: A Qualitative Study

Almost half of the Latino immigrants working in the United States are women. However, studies concerning the work experiences of Latinas are almost absent in the literature. This article reports the findings from a qualitative study using eight focus groups (n = 53) of Latina immigrant workers. The focus group transcripts were analyzed using the grounded theory approach in which themes emerge from iterative readings of the transcripts by a group of investigators. This study identified themes related to excessive workload, familiar work/unfamiliar hazards, cultural tensions, lack of health care, pregnancy, sexual harassment, and family obligations/expectations. The responses of the Latina workers in this study clearly indicated that they live within a complex web of stressors, both as workers and as women. The increased economic opportunities that come with immigration to the United States are accompanied by many opportunities for exploitation, especially if they are undocumented. It is hoped that the findings of this study will raise awareness regarding these issues and spur further work in this area.

Occupational Health Issues Among Employees of Home Care Agencies

L'objectif de cette communication est d'explorer les problèmes de santé occupationnelle qui touchent les employés des agences de soins à domicile. Les résultats d'un sondage et de groupes de discussion menés auprès de 892 employés de bureau et employés itinérants de trois agences de soins à domicile sans but lucratif montrent que les employés des agences de soins à domicile présentent un degré élevé de stress, de fatigue et d'épuisement. Ce stress relié au travail est particulièrement ressenti par les cadres, les infirmières et les thérapeutes. Lorsqu'on les compare aux résultats de l'Enquête sur la santé des Canadiens, on note que les employées des agences de soins à domicile sont plus susceptibles que la moyenne des travailleuses de souffrir d'allergies, d'asthme, d'arthrite ou de rhumatismes, de problème de dos, de haute pression, de migraines et de blessures reliées au travail. Plusieurs employées d'agences de soins à domicile signalent des douleurs ou des malaises dans plusieurs parties du corps. Les employées itinérantes de ces agences souffrent d'entorses ou de foulures, de luxations, de fractures et d'ecchymoses consécutives au fait qu'elle doivent soulever ou déplacer des patients, se pencher ou forcer, ou qu'elles font des chutes accidentelles. Elles souffrent également davantage de microtraumatismes répétés et ont davantage d'accidents d'automobiles. Le personnel de bureau des agences souffre de microtraumatismes répétés et de problèmes respiratoires. La communication aborde les conséquences pour l'établissement des politiques et la recherche.

Invisible work, unseen hazards: The health of women immigrant household service workers in Spain

BACKGROUND

Household service work has been largely absent from occupational health studies. We examine the occupational hazards and health effects identified by immigrant women household service workers.

METHODS

Exploratory, descriptive study of 46 documented and undocumented immigrant women in household services in Spain, using a phenomenological approach. Data were collected between September 2006 and May 2007 through focus groups and semi-structured individual interviews. Data were separated for analysis by documentation status and sorted using a mixed-generation process. In a second phase of analysis, data on psychosocial hazards were organized using the Copenhagen Psychosocial Questionnaire as a guide.

RESULTS

Informants reported a number of environmental, ergonomic and psychosocial hazards and corresponding health effects. Psychosocial hazards were especially strongly present in data. Data on reported hazards were similar by documentation status and varied by several emerging categories: whether participants were primarily cleaners or carers and whether they lived in or outside of the homes of their employers. Documentation status was relevant in terms of empowerment and bargaining, but did not appear to influence work tasks or exposure to hazards directly.

CONCLUSIONS

Female immigrant household service workers are exposed to a variety of health hazards that could be acted upon by improved legislation, enforcement, and preventive workplace measures, which are discussed.

Characterization of women's occupational musculoskeletal exposures

Although women are often characterized as having "safe" occupations, they are at risk of experiencing occupational musculoskeletal injuries. This cross-sectional study examined the health status, occupations, and job tasks of a random sample of working women (N = 123) to characterize their risk of occupational injury. The women had been employed, most full-time, in the 12 months prior to administration of the telephone survey. The women tended to cluster into two types of occupational exposures. Overall, the women rated their health as excellent. However, those with diagnosed musculoskeletal disorders had significantly worse scores on two scales of the Short Form Health Survey than those without musculoskeletal disorders. Women are exposed to occupational musculoskeletal stressors that increase their risk of experiencing musculoskeletal injuries.

Correct procedures and cutting corners: a qualitative study of women's occupational health and safety in a beauty therapy industry

OBJECTIVE

To examine the context of occupational health and safety related to blood-borne communicable diseases practice.

METHODS

A case study approach using qualitative semi-structured interviews with five key informants who represented different sectors of the beauty therapy industry in South Australia.

RESULTS

Four main themes were identified: (i) exposure to blood and blood-borne communicable diseases; (ii) prevention in practice; (iii) OH&S problems; and (iv) industry needs.

CONCLUSION

Key OH&S issues in the beauty therapy industry include: power relationships between employers and employees, equipment costs, the need for more continuing education, and monitoring of practitioners.

IMPLICATIONS

Economic constraints, continuing education, and government regulation of the beauty therapy industry are highlighted as significant areas for further consideration in addressing the OH&S needs of practitioners and their clients.

Precarious existence and deteriorating work conditions for women in India: implications for health

The Indian economy has experienced economic growth post-1991 but has demonstrated an inability to generate adequate employment and even less of "quality" employment for much of its labor force. This article is based on data collected from conversations with women workers on the theme of "women, work and health," with an emphasis on, one, task allotment and working conditions in the household; and two, those related to conditions of work at the worksite and the gendered experience of such work. While narratives cannot establish causality between particular work environments and related adverse outcomes, they nevertheless provide crucial insights into what is likely to be blighting these women's lives. Advocates of women's work outside their home need to pay attention to both their remuneration for work and the costs to their health and well-being of such employment, so that policies aimed at employment generation also are sensitive to the adverse outcomes of such employment.

Comparison of nurse, system and quality patient care outcomes in 8-hour and 12-hour shifts

BACKGROUND

Many nurses desire 12-hour shifts. However, there are concerns about implementation.

OBJECTIVE

We sought to compare the effects of 8- and 12-hour shifts on nurse, system, and quality patient care outcomes.

METHODS

We used a cross-sectional design with data collected from multiple sources in 2003-2004, including a nurse survey and administrative and patient records. We studied hospital nurses and patients in general adult wards, with outcomes including burnout, job satisfaction, scheduling satisfaction, preferences, intention to stay, and employee safety. System outcomes included recruitment and turnover, staffing, absenteeism, and related costs. A variety of quality patient care outcomes were measured from the 3 different types of data.

RESULTS

Thirteen New York City hospitals participated; 805 surveys were examined from 99 nursing units (response rate 42%). Compared with nurses working 8-hour shifts, those working 12-hour shifts were on average more satisfied with their jobs, experienced less emotional exhaustion, 10 times more likely to be satisfied with schedules, 2 times as likely to perceive 12-hour schedules as important, and 58% less likely to report missing shifts; units with 12-hour shifts had lower vacancy rates and weeks to fill the position (all P values < or =0.05). There were no differences in patient outcomes.

CONCLUSIONS

Nurses working 12-hour shifts were more satisfied. There were no differences in quality outcomes. Flexibility and choice in shift length are important elements in a positive nurse work environment. This study represents an innovative attempt by a labor-management bargaining group to make an evidence-based decision. We encourage others to conduct similar studies.

Mind over matter: exploring job stress among female blue-collar workers

Although overall health has been defined holistically as the integration of a person's optimal mental, physical, social, intellectual, and spiritual well-being, a mental health focus remains on the fringe of many public health efforts. This report describes recent efforts by the Centers for Disease Control and Prevention (CDC) to explore job stress among female blue-collar workers. Using a more holistic approach to understand its impact on blue-collar women's overall health, health-related quality of life (HRQOL) was used to assess optimal human performance. Attempting to encapsulate how overall health affects one's ability to participate and fulfill daily personal/professional tasks, HRQOL yields a broader understanding of the interaction between psychological well-being (mind) and physical functioning (matter). Embedding CDC HRQOL-4 measures into a questionnaire used as part of a larger mixed methods project, blue-collar women responded to questions about their health, including both mental and physical. For these female workers, mental health appeared to be of greater consequence, which could be interpreted as mind being more significant than matter. This paper highlights the findings related to HRQOL issues experienced by these female blue-collar workers and summarizes recommendations for effective individual and organizational approaches to address job stress.

Low back pain among Iranian industrial workers

BACKGROUND

Most epidemiological data concerning low back pain (LBP) are from high-income countries and there is very little information about LBP in the working population in developing countries.

OBJECTIVES

To determine the prevalence of LBP in Iranian industrial workers. To explore associations between LBP and physical and psychosocial factors at work, as well as lifestyle factors.

METHODS

Cross-sectional study of the largest car-manufacturing group in Iran. The prevalence of LBP, work exposures and lifestyle factors were recorded using the standardized Nordic questionnaire for analysis of musculoskeletal symptoms. Demographic data and lifestyle factors (age, sex, education, weight, work experience, smoking and fitness training) were also collected.

RESULTS

Of the 18,031 employees, 78% participated. The majority of subjects in this study population were young males (<30 years) and a small proportion was female (4%). The 1-year prevalence of self-reported LBP in this Iranian industrial population was 21% (20% males and 27% females). The prevalence rate of absence due to LBP was 5% per annum. The multiple logistic regression models indicated that the following remained risk indicators for LBP in the previous 12 months: increasing age, no regular exercise, heavy lifting, repetitive work and monotonous work.

CONCLUSION

LPB is a common problem in the working population even in a developing country. Age and gender as well as certain work-related physical and psychosocial factors influenced the prevalence of LBP but the differences between different categories of workers were small.

Engendering health disparities

How is gender implicated in our exploration of health disparities in Canada? Set against the backdrop of federal government policy, this review paper examines the ways in which gender intersects with other health determinants to produce disparate health outcomes. An overview of salient issues including the impact of gender roles, environmental exposures, gender violence, workplace hazards, economic disparities, the costs of poverty, social marginalization and racism, aging, health conditions, interactions with health services, and health behaviours are considered. This review suggests health is detrimentally affected by gender roles and statuses as they intersect with economic disparities, cultural, sexual, physical and historical marginalization as well as the strains of domestic and paid labour. These conditions result in an unfair health burden borne in particular by women whose access to health determinants is--in various degrees--limited. While progress has certainly been made on some fronts, the persistence of health disparities among diverse populations of women and men suggests a postponement of the vision of a just society with health for all that was articulated in the Federal Plan on Gender Equality. Commitment, creativity and collaboration from stakeholders ranging from various levels of government, communities, academics, non-governmental agencies and health professionals will be required to reduce and eliminate health disparities between and among all members of our society.

Women and occupational lung disease: sex differences and gender influences on research and disease outcomes

We have attempted to describe the current state of knowledge regarding occupational lung disease in women. A large section of this article was devoted to describing the methodologic challenges that face researchers when evaluating gender differences in occupational lung disease. The findings of the presented studies are likely limited by many of the methodologic problems that were identified earlier. To accurately identify the true risk of occupational lung disease in women workers, these findings must be replicated in future studies with special attention paid to the various aspects of occupational lung disease research that are susceptible to gender-related bias.

The impact of job strain on social isolation: a longitudinal analysis of French workers

Numerous studies have shown that work may have an impact on social identity and social functioning in the community. Since work organisation in our society has gone through some profound changes in the last few decades, it is important to study the effect of these new constraints on the social life of people and, thereby, on their health. Using data from a French longitudinal cohort study on work, health and ageing (ESTEV), this paper analyses the impact of job strain on social isolation, in a sample of 16,950 individuals who were working in 1990 and 1995. The results show that low-decision latitude was associated with a significantly higher level of social isolation in both men and women. When compared with low job strain, active work (high-psychological demand and high-decision latitude) and high job strain were associated among men with a significantly higher level of social isolation. This study shows that a change in psychosocial work conditions (demand and control) had an impact on social isolation and that this impact may be more significant in male workers than in female workers.

Gendered work conditions, health, and work outcomes

This cross-sectional study of nonfaculty university employees examined associations among gendered work conditions (e.g., sexism and discrimination), job demands, and employee job satisfaction and health. Organizational responsiveness and social support were examined as effect modifiers. Comparisons were made by gender and by the male-female ratio in each job category. The relationship of gendered conditions of work to outcomes differed on the basis of respondents' sex and the job sex ratio. Although the same predictors were hypothesized for job satisfaction, physical health, and psychological distress, there were some differing results. The strongest correlate of job satisfaction was social support; perceived sexism in the workplace also contributed for both men and women. Organizational factors associated with psychological distress differed between female- and male-dominated jobs.

Factors associated with women's risk of rape in the military environment

BACKGROUND

Health hazards specific to women workers have not been adequately documented. This study assessed military environmental factors associated with rape occurring during military service, while controlling for pre-military trauma experiences.

METHODS

A national cross-sectional survey of 558 women veterans serving in Vietnam or in subsequent eras was obtained through structured telephone interviews.

RESULTS

Rape was reported by 30% (n = 151) of participants, with consistent rates found across eras [corrected]. Military environmental factors were associated with increased likelihood of rape, including: sexual harassment allowed by officers (P < 0.0001), unwanted sexual advances on-duty (P < 0.0001) and in sleeping quarters (P < 0.0001).

CONCLUSION

Violence towards military women has identifiable risk factors. Work and living environments where unwanted sexual behaviors occurred were associated with increased odds of rape. Officer leadership played an important role in the military environment and safety of women. Assailant alcohol and/or drug abuse at time of rape was notable. Interventions and policies based on modifiable environmental risk factors are needed to increase protection for women in the workplace.

Man works from sun to sun, but woman's work is never done: insights on research and policy

Gender equity and equality in health and human development are key national and international goals. To achieve these goals, the androcentric definition of work needs to be addressed. The current definition is driven by the globalized capitalistic model, which equates "work" with generating income or the production of goods. Indeed, employment in the formal labor force has become the de facto definition of work. Women's work, unpaid and reflecting the gendered role of caring for others, does not fit the economic mold and is, therefore, devalued. The health and social welfare sectors rely heavily on the unremunerated work of women to reduce their budgets, ignoring the unequal burden of care shouldered by women worldwide. Research on women's health has also been hampered by the dichotomous nature of work as employment. Changing the definition of work to value explicitly women's work could significantly impact social, health, and research policies.

Effects of a tailored health promotion program for female blue-collar workers: health works for women

BACKGROUND

This study assessed the effects of the Health Works for Women (HWW) intervention on improving multiple behaviors including nutrition and physical activity among rural female blue-collar employees in North Carolina.

METHODS

Nine small to mid-size workplaces were randomly assigned to either intervention or delayed intervention conditions. After a baseline survey, an intervention consisting of two computer-tailored magazines and a natural helpers program was conducted over 18 months. Delayed worksites received one tailored magazine. Approximately 77 and 76% of baseline respondents completed follow-up surveys at 6 and 18 months, respectively, and 538 women (63%) completed all three surveys.

RESULTS

At the 18-month follow-up, the intervention group had increased fruit and vegetable consumption by 0.7 daily servings compared to no change in the delayed group (P < 0.05). Significant differences in fat intake were observed at 6 months (P < 0.05) but not at 18 months. The intervention group also demonstrated improvements in strengthening and flexibility exercise compared to the delayed group. The rates of smoking cessation and cancer screening did not differ between study groups.

CONCLUSIONS

The HWW project was a successful model for achieving certain health behavior changes among blue-collar women.

Pesticide usage and health consequences for women in developing countries: out of sight, out of mind?

Pesticide exposures of women in developing countries are aggravated by economic policy changes associated with structural adjustment programs and globalization. Women in these countries, particularly in the agricultural sector, are increasingly exposed. Since they are concentrated in the most marginal positions in the formal and informal workforces, and production is organized in a gender-specific way, opportunities for women to control their exposures are limited. Data from developing countries show that: 1) women's exposures to pesticides are significantly higher than is recognized; 2) poisonings and other pesticide-related injuries are greatly underestimated for women; 3) for a given adverse outcome from exposure, the experience of that outcome is gender-discriminatory; 4) erroneous risk perception increases women's exposures. The hiatus in knowledge of gender-specific exposures and effects is related to gender biases in the nature of epidemiologic inquiry and in the literature, and the gendered nature of health workers' practices and surveillance. Recommendations are made for strong, independent organizations that provide opportunities for women to control their environments, and the factors affecting their health, as well as gender-sensitive research to address the particularities of women's pesticide exposures.

Framing personal risk in public health nursing

The purpose of this qualitative study was to conduct a thematic analysis of unanalyzed semistructured interview segments from data that emerged during an earlier exploratory descriptive study on organizational factors and work hazards. The sample consisted of 56 transcribed interviews with staff and managerial public health nurses (PHNs) infive health units of the Province of Alberta before health care restructuring. The frame work that resulted from this secondary analysis describes the ideologies (values, beliefs, concepts, and attitudes) of female PHNs related to their workplace environmental risks. Four categories of the overarching theme, framing personal risk in work environments, emerged: becoming aware, recognizing influences, comparing with others, and knowing rights andfreedoms. Two subthemes also emerged: framing for no action and framing for action. When framing for no action, PHNs were either unconcerned or wanted to avoid trouble. When framing for action, PHNs found humor; took responsibility, used voice, collected support, and struggled for action.

Self-reported musculoskeletal disorders among visiting and office home care workers

This paper examines the associations between self-reported musculoskeletal disorders (MSDs) and work factors and injuries among home care workers. Based on 99 focus group participants and 892 survey respondents, results show a high level of MSDs among both visiting and office home care workers. While visiting home care workers tend to feel pain in the back, office workers tend to report pain in the neck and shoulder. Hazards in clients' homes, injuries moving clients and stress are associated with self-reported MSDs for visiting home care workers. Repetitive tasks and stress are associated with self-reported MSDs for office home care workers. Age and months in the profession have no affect on self-reported MSDs.

Job stress and the occupational gradient in coronary heart disease risk in women. The Stockholm Female Coronary Risk Study

Recent studies of men have shown that job stress is important in understanding the occupational gradient in coronary heart disease (CHD), but these relationships have rarely been studied in women. With increasing numbers of women in the workforce it is important to have a more complete understanding of how CHD risk may be mediated by job stress as well as other biological and behavioural risk factors. The objective of this study was to examine the occupational gradient in CHD risk in relation to job stress and other traditional risk factors in currently employed women. We used data from the Stockholm Female Coronary Risk Study, a population based case-control study, comprising 292 women with CHD aged 65 years or younger and 292 age-matched healthy women (controls). An inversely graded association was observed between occupational class and CHD risk. Compared with the highest (executive/professional), women in the lowest occupational class (semi/unskilled) had a four-fold (95% CI 1.75-8.83) increased age-adjusted risk for CHD. Simultaneous adjustment for traditional risk factors and job stress attenuated this risk to 2.45 (95% CI 1.01-6.14). Neither job control nor the Karasek demand-control model of job stress substantially explained the increased CHD risk of women in the lowest occupational classes. It is likely that lower occupational class working women face multiple and sometimes interacting sources of work and non-work stress that are mediated by behavioural and biological factors that increase their CHD risk.

Parenthood, gender and sickness absence

It is well documented that women have generally higher morbidity rates than men. In line with this women are also more absent from work due to sickness. This paper considers one popular explanation of the morbidity difference in general and of the difference in sickness absence in particular, viz. that women to a greater extent than men are exposed to the 'double burden' of combining paid work with family obligations. We discuss theories of role overload and role conflict, which both assume that the combination of multiple roles may have negative health effects, as well theories of role enhancement, which assume positive health effects of multiple roles. Using two large Norwegian data sets, the relationship between the number of and the age of children on the one hand and sickness absence on the other is examined separately for men and women and for a number of theoretically interesting subpopulations of women defined in terms of marital status (also taking account of unmarried cohabitation), level of education, and working hours. Generally speaking the association between children and sickness absence is weak, particularly for married people of both genders. To the extent that married persons with children are more absent than married persons without children, this is largely due to respiratory conditions. The relationship between children and sickness absence is somewhat stronger for single, never married mothers, but not for single mothers who have been previously married or for women living in unmarried cohabitation. The findings thus provide little support for either role overload/conflict or role enhancement theories. The possibility that these effects are both present and counterbalancing each other or that they are confounded with uncontrolled selection effects can not, however, be ruled out.

Tailoring and targeting a worksite health promotion program to address multiple health behaviors among blue-collar women

PURPOSE

This study examined the relationship between health risks, health behaviors, stages-of-change, and behavior change priorities among blue-collar women participating in a worksite health promotion study.

DESIGN

Cross-sectional.

SETTING

Rural manufacturing worksites in North Carolina.

SUBJECTS

Participants were 859 women aged 18 and over.

MEASURES

The self-administered questionnaire assessed smoking, exercise, nutrition (fat, fruits, and vegetables), and breast and cervical cancer screening behaviors. In addition, demographics, body weight, perceived health, stages-of-change, and priority for behavior change were measured. Chi-square tests and regression analysis were used to assess statistical significance.

RESULTS

Overall, 28% of women smoked, 37% were completely sedentary, 82% consumed less than five daily servings of fruits and vegetables, and the majority were overweight. The dominant stage of change for each of the lifestyle behaviors was contemplation, whereas most women were in the action stage for cancer screening. When asked to prioritize the behavior they most wanted to change, the majority of women chose healthy eating and/or exercise.

CONCLUSIONS

The findings suggest that blue-collar women in this study had multiple health risks and were interested in changing multiple health behaviors. Allowing women to choose the behavior(s) on which they are ready to focus may be a promising approach to tailoring interventions for this population.

Women's reproductive health: some recent developments in occupational epidemiology

Epidemiological research on occupational hazards and reproductive health is an expanding and strongly developing area. This article focuses on some recent areas of occupational reproductive epidemiology that are or seem to be important for the future. Interest in the research on fertility has increased during the past decade, and time to pregnancy has proved to be a useful measure of fertility. The research on menstrual function or early fetal loss is still limited, and further research is desirable. It is important to chart the advantages and disadvantages of various methods for measuring these outcomes. Recently developed methods of exposure assessment provide new possibilities to improve the validity of exposure data. Biological exposure markers can also provide useful dosimeters for reproductive studies. Research on the reproductive effects of job stress and individual susceptibility to reproductive toxicants is also gaining in importance.

Sex as a variable can be a surrogate for some working conditions: factors associated with sickness absence

More than twice as many workdays are lost to illness than for personal or family reasons. We examine possible workplace determinants of sickness absence among French workers in the food processing industry. These workers are exposed to a variety of environmental and organizational constraints: cold, uncomfortable postures, assembly-line work, and irregular schedules. In 1987-1988, a medical examination and questionnaire were administered to 558 men and 790 women as part of a study of 17 poultry slaughterhouses and 6 canning factories. Women's and men's working conditions were very different, and their sickness absences for musculoskeletal and respiratory illnesses were related to some of their specific working conditions: cold exposure, ill-adapted work stations, and problems with their supervisors and co-workers. If male and female workers were combined into a single analysis that adjusted for sex, many of the associations operant for a single sex could no longer be seen.