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Kaki S, Hawkins D. Drug poisoning deaths by occupation and drug type, Massachusetts 2010-2019. Ann Work Expo Health 2024; 68:243-255. [PMID: 38387605 DOI: 10.1093/annweh/wxae001] [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: 10/01/2022] [Accepted: 01/10/2024] [Indexed: 02/24/2024] Open
Abstract
OBJECTIVE To investigate variation in drug poisoning mortality rates by drug type and occupation in Massachusetts. METHODS Death certificates for deaths by drug poisonings occurring between 2010 and 2019 in Massachusetts were coded based on the decedent's occupation. Mortality rates and rate ratios (with all other occupations as the reference group) were calculated based on the occupation of the workers according to drug type. Poisson regression was used to determine significantly elevated mortality rates and trends in drug poisoning deaths by occupation and drug type. RESULTS The rate of drug poisoning deaths increased from 2010 to 2016 after which they plateaued. With respect to specific substances, fentanyl- and cocaine-related deaths increased throughout the surveillance period. For drug poisoning deaths overall, workers in construction trades (3,017); food preparation and serving (1,116); transportation and material moving (1,062) occupations had the highest number of drug poisoning deaths. When adjusting for age, sex, race/ethnicity, and educational attainment, workers in 7 occupations had significantly elevated mortality rate ratios for drug poisonings overall: farming, fishing, and forestry (3.42, P < 0.001); construction trades (2.58, P < 0.001); health care support (1.61, P < 0.001); community and social service (1.60, P < 0.001); food preparation and serving related (1.54, P < 0.001); personal care and service (1.37, P < 0.001); and arts, design, entertainment, sports, and media (1.21, P = 0.010). In many cases, workers in these same occupations had elevated mortality rate ratios for poisonings from specific substances. Health care practitioners and technical occupation workers only had elevated rates for methadone-related poisonings (1.73, P = 0.010). CONCLUSIONS These findings highlight that workers in certain occupations have an elevated risk for drug poisonings and that the patterns differ with respect to the drug type. These findings can be useful for providing services to workers in high-risk occupations and in identifying occupational factors that may be related to the risk of drug poisoning death. While previous research has begun to uncover work-related factors that may contribute to opioid use, further work is needed to identify occupational factors that may contribute to psychostimulant and benzodiazepine use.
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Affiliation(s)
- Sahith Kaki
- Premedical Health Studies Program, School of Arts and Sciences, MCPHS University, 179 Longwood Ave, Boston, MA 02115, United States
| | - Devan Hawkins
- Public Health Program, School of Arts and Sciences, MCPHS University, 179 Longwood Ave, Boston, MA 02115, United States
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Comfort AB, Krezanoski PJ, Rao L, El Ayadi A, Tsai AC, Goodman S, Harper CC. Mental health among outpatient reproductive health care providers during the US COVID-19 epidemic. Reprod Health 2021; 18:49. [PMID: 33627155 PMCID: PMC7903398 DOI: 10.1186/s12978-021-01102-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 02/09/2021] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Both inpatient and outpatient providers may be at increased risk of stress, anxiety and depression from their roles as health providers during the COVID-19 epidemic. This study explores how the US COVID-19 epidemic has increased feelings of stress, anxiety and depression among outpatient reproductive health providers. METHODS We conducted a survey with open-ended responses among outpatient reproductive health providers across the U.S. engaged in contraceptive care to collect data on their experiences with stress, anxiety and depression during the COVID-19 epidemic. The study population included physicians, nurses, social workers, and other health professions [n = 288]. Data were collected from April 21st-June 24th 2020. We used content analysis of free text responses among providers reporting increased stress, anxiety or depression. RESULTS Two-thirds (184) of providers reported increased stress and one-third (96) reported increased anxiety or depression related to care provision during the COVID-19 epidemic. The major sources of stress, anxiety and depression were due to patient care, worry about becoming infected or infecting family members, work- and home-related concerns, experiencing provider burnout, and fear of the unknown. Concerns about quality of patient care, providers' changing responsibilities, lack of personal protective equipment, and difficulty coping with co-worker illness and absence all contributed to provider stress and anxiety. Worries about unemployment and childcare responsibilities were also highlighted. Providers attributed their stress, anxiety or depression to feeling overwhelmed, being unable to focus, lacking sleep, and worrying about the unknown. CONCLUSIONS US outpatient providers are experiencing significant stress, anxiety, and depression during the US COVID-19 epidemic. Policy and programmatic responses are urgently needed to address the widespread adverse mental health consequences of this epidemic on outpatient providers, including reproductive health providers, across the US. Both inpatient and outpatient providers may be at increased risk of stress, anxiety and depression from their roles as health providers during the COVID-19 epidemic. This study explores how the US COVID-19 epidemic has increased feelings of stress, anxiety and depression among outpatient reproductive health providers across the US. We conducted a survey from April 21st to June 24th, 2020 among outpatient reproductive health providers, including physicians, nurses, social workers and other health professions. We asked open-ended questions to understand why providers reported increased stress, anxiety and/or depression. Two-thirds (184) of providers reported increased stress and one-third (96) reported increased anxiety or depression from care provision during the COVID-19 epidemic. Major sources of stress, anxiety and depression were due to patient care, worry about becoming infected or infecting family members, work- and home-related concerns, experiencing provider burnout, and fear of the unknown. Concerns about quality of patient care, providers' changing responsibilities, lack of personal protective equipment, and difficulty coping with co-worker illness and absence all contributed to provider stress and anxiety. Worries about unemployment and childcare responsibilities were also highlighted. Providers attributed their stress, anxiety or depression to feeling overwhelmed, being unable to focus, lacking sleep, and worrying about the unknown. This study highlights that US outpatient reproductive health providers are experiencing significant stress, anxiety, and depression during the US COVID-19 epidemic. Policy and programmatic responses are urgently needed to address the widespread adverse mental health consequences of this epidemic on outpatient providers, including reproductive health providers, across the US.
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Affiliation(s)
- Alison B. Comfort
- Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco, 550 16th Street, 3rd floor, San Francisco, CA 94143 USA
| | - Paul J. Krezanoski
- Department of Medicine, University of California San Francisco, Zuckerberg San Francisco General Hospital, 1001 Potrero Ave, San Francisco, CA 94110 USA
| | - Lavanya Rao
- Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco, 550 16th Street, 3rd floor, San Francisco, CA 94143 USA
| | - Alison El Ayadi
- Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco, 550 16th Street, 3rd floor, San Francisco, CA 94143 USA
| | - Alexander C. Tsai
- Massachusetts General Hospital, Harvard Medical School, 125 Nashua Street, Suite 722, Boston, MA 02114 USA
| | - Suzan Goodman
- Bixby Center for Global Reproductive Health, Department of Family and Community Medicine, University of California San Francisco, 550 16th Street, 3rd floor, San Francisco, CA 94143 USA
| | - Cynthia C. Harper
- Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco, 550 16th Street, 3rd floor, San Francisco, CA 94143 USA
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Airagnes G, Lemogne C, Kab S, Hoertel N, Goldberg M, Wahrendorf M, Siegrist J, Roquelaure Y, Limosin F, Zins M. Effort-reward imbalance and long-term benzodiazepine use: longitudinal findings from the CONSTANCES cohort. J Epidemiol Community Health 2019; 73:993-1001. [PMID: 31406014 DOI: 10.1136/jech-2019-212703] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 06/28/2019] [Accepted: 07/06/2019] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To examine the association between effort-reward imbalance and incident long-term benzodiazepine use (LTBU). METHODS We included 31 077 employed participants enrolled in the French population-based CONSTANCES cohort between 2012 and 2014 who had not undergone LTBU in the 2 years before enrolment. LTBU was examined using drug reimbursement administrative databases. The effort-reward imbalance was calculated in quartiles. We computed ORs (95% CIs) for LTBU according to effort-reward imbalance over a 2-year follow-up period. We adjusted for age, gender, education, occupational grade, income, marital status, tobacco smoking, risk of alcohol use disorder, depressive symptoms and self-rated health. RESULTS Over the 2-year follow-up, 294 (0.9%) participants experienced incident LTBU. In the univariable analysis, effort-reward imbalance was associated with subsequent LTBU with ORs of 1.79 (95% CI 1.23 to 2.62) and 2.73 (95% CI 1.89 to 3.95) for the third and fourth quartiles, respectively, compared with the first quartile. There was no interaction between effort-reward imbalance and any of the considered variables other than tobacco smoking (p=0.033). The association remained significant in both smokers and non-smokers, with higher odds for smokers (p=0.031). In the fully adjusted model, the association remained significant for the third and fourth quartiles, with ORs of 1.74 (95% CI 1.17 to 2.57) and 2.18 (95% CI 1.50 to 3.16), respectively. These associations were dose dependent (p for trend <0.001). CONCLUSIONS Effort-reward imbalance was linked with incident LTBU over a 2-year follow-up period after adjustment for sociodemographic and health-related factors. Thus, screening and prevention of the risk of LTBU should be systematised among individuals experiencing effort-reward imbalance, with special attention paid to smokers.
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Affiliation(s)
- Guillaume Airagnes
- Department of Psychiatry and Addictology, AP-HP, Hôpitaux Universitaires Paris Ouest, Paris, France .,Faculté de Médecine, Université Paris Descartes, Sorbonne Paris Cité, Paris, France.,UMS 011, Population-based Epidemiological Cohorts, Inserm, Villejuif, France.,UMR 1168, VIMA, Inserm, Villejuif, France
| | - Cédric Lemogne
- Department of Psychiatry and Addictology, AP-HP, Hôpitaux Universitaires Paris Ouest, Paris, France.,Faculté de Médecine, Université Paris Descartes, Sorbonne Paris Cité, Paris, France.,U1266, UMR-S 1266, Institut de Psychiatrie et Neurosciences de Paris, Inserm, Paris, France
| | - Sofiane Kab
- UMS 011, Population-based Epidemiological Cohorts, Inserm, Villejuif, France
| | - Nicolas Hoertel
- Department of Psychiatry and Addictology, AP-HP, Hôpitaux Universitaires Paris Ouest, Paris, France.,Faculté de Médecine, Université Paris Descartes, Sorbonne Paris Cité, Paris, France.,U1266, UMR-S 1266, Institut de Psychiatrie et Neurosciences de Paris, Inserm, Paris, France
| | - Marcel Goldberg
- UMS 011, Population-based Epidemiological Cohorts, Inserm, Villejuif, France
| | - Morten Wahrendorf
- Centre for Health and Society,Institute of Medical Sociology, Medical Faculty, University of Düsseldorf,Universitätsstrasse 1, 40225 Düsseldorf, Germany
| | - Johannes Siegrist
- Senior professorship on work stressresearch, Medical Faculty, University of Düsseldorf, Germany, Düsseldorf, Germany
| | - Yves Roquelaure
- UMR 1085, Ester, Irest Inserm, Université d'Angers, Angers, France
| | - Frédéric Limosin
- Department of Psychiatry and Addictology, AP-HP, Hôpitaux Universitaires Paris Ouest, Paris, France.,Faculté de Médecine, Université Paris Descartes, Sorbonne Paris Cité, Paris, France.,U1266, UMR-S 1266, Institut de Psychiatrie et Neurosciences de Paris, Inserm, Paris, France
| | - Marie Zins
- Faculté de Médecine, Université Paris Descartes, Sorbonne Paris Cité, Paris, France.,UMS 011, Population-based Epidemiological Cohorts, Inserm, Villejuif, France.,UMR 1168, VIMA, Inserm, Villejuif, France
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Prevalence of prescribed benzodiazepine long-term use in the French general population according to sociodemographic and clinical factors: findings from the CONSTANCES cohort. BMC Public Health 2019; 19:566. [PMID: 31088561 PMCID: PMC6518636 DOI: 10.1186/s12889-019-6933-8] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 05/02/2019] [Indexed: 01/10/2023] Open
Abstract
Background Data are lacking regarding the prevalence of benzodiazepine long-term use in the general population. Our aim was to examine the prevalence of prescribed benzodiazepine long-term use (BLTU) according to sociodemographic and clinical factors in the French general population. Methods Data came from 4686 men and 4849 women included in 2015 in the French population-based CONSTANCES cohort. BLTU was examined using drug reimbursement administrative registries from 2009 to 2015. Analyses were weighted to provide results representative of the French general population covered by the general health insurance scheme. Weighted prevalence of BTLU and weighted Odds Ratios (OR) of having BTLU were computed with their 95% Confidence Interval (95% CI) according to age, education level, occupational status, occupational grade, household income, marital status, alcohol use disorder risk and depressive symptoms. All the analyses were stratified for gender. Results Weighted prevalence of BLTU were 2.8%(95% CI:2.3–3.4) and 3.8%(95% CI: 3.3–4.5) in men and women, respectively. Compared to men, women had an increased risk of having benzodiazepine long-term use with OR = 1.34(95% CI = 1.02–1.76). Aging, low education, not being at-work, low occupational grade, low income, being alone and depressive state were associated with increased risks of having BTLU. Conclusions BLTU is widespread in the French general population, however this issue may particularly concern vulnerable subgroups. These findings may help in raising attention on this public health burden as well as targeting specific at-risk subgroups in preventive intervention. Electronic supplementary material The online version of this article (10.1186/s12889-019-6933-8) contains supplementary material, which is available to authorized users.
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