Labor union programs to reduce or prevent occupational stress in the United States

The association between janitor physical workload, mental workload, and stress: The SWEEP study

BACKGROUND

Approximately 2.38 million janitors are employed in the U.S. While high physical workload may explain a lost-work days rate 2.7 times greater than other occupations, little is known about the association between janitors' physical workload, mental workload, and stress.

OBJECTIVE

The objective of this study was to assess the associations between physical (ergonomic) and mental workload exposures and stress outcomes among janitors.

METHODS

Questionnaire data, focused on ergonomic workload, mental workload and stress, were collected from Minnesota janitors for a one-year period. Physical workload was assessed with Borg Scales and Rapid Entire Body Assessments (REBA). Mental workload assessment utilized the NASA Task Load Index (TLX). Stress assessments utilized single-item ordinal stress scale (SISS) and Perceived Stress Scale-4 (PSS-4) measures. Descriptive and multivariable analyses, including bias adjustment, were conducted.

RESULTS

Odds ratios (OR) and 95% confidence intervals (CI) for ergonomic workload (task frequency) effects on SISS were: REBA (1.18 OR, 1.02-1.37 CI); Borg (1.25 OR, 1.00-1.56 CI); combined REBA and Borg (1.10 OR, 1.01-1.20 CI). Mental workload was associated with higher PSS-4 levels (0.15 Mean Difference, 0.08-0.22 CI) and a 3% increased risk for each one-unit increase in the SISS scale (1.03 OR, 1.02-1.05 CI).

CONCLUSIONS

This research demonstrated a moderate effect of physical and mental workloads on stress among janitors.

Organizational Policies and Programs to Reduce Job Stress and Risk of Workplace Violence Among K-12 Education Staff

We examine strategies, programs, and policies that educators have developed to reduce work stressors and thus health risks. First, we review twenty-seven empirical studies and review papers on organizational programs and policies in K-12 education published from 1990 to 2015 and find some evidence that mentoring, induction, and Peer Assistance and Review programs can increase support, skill development, decision-making authority, and perhaps job security, for teachers-and thus have the potential to reduce job stressors. Second, we describe efforts to reduce workplace violence in Oregon, especially in special education, including legislation, collective bargaining, research, and public awareness. We conclude that to reduce workplace violence, adequate resources are needed for staffing, training, equipment, injury/assault reporting, and investigation. Third, we discuss collective bargaining initiatives that led to mentoring and Peer Assistance and Review and state legislation on prevention of bullying and harassment of school staff. Finally, we present a research agenda on these issues.

Globalization, Work, and Cardiovascular Disease

Cardiovascular disease (CVD), a global epidemic, is responsible for about 30% of all deaths worldwide. While mortality rates from CVD have been mostly declining in the advanced industrialized nations, CVD risk factors, including hypertension, obesity, and diabetes, have been on the increase everywhere. Researchers investigating the social causes of CVD have produced a robust body of evidence documenting the relationships between the work environment and CVD, including through the mechanisms of psychosocial work stressors. We review the empirical evidence linking work, psychosocial stressors, and CVD. These work stressors can produce chronic biologic arousal and promote unhealthy behaviors and thus, increased CVD risk. We offer a theoretical model that illustrates how economic globalization influences the labor market and work organization in high-income countries, which, in turn, exacerbates job characteristics, such as demands, low job control, effort-reward imbalance, job insecurity, and long work hours. There is also a growing interest in “upstream” factors among work stress researchers, including precarious employment, downsizing/restructuring, privatization, and lean production. We conclude with suggestions for future epidemiologic research on the role of work in the development of CVD, as well as policy recommendations for prevention of work-related CVD.

One Step Forward, Two Steps Back: Worker Representation and Health and Safety in the United Kingdom

There is now quite strong evidence for a set of preconditions that help determine the effectiveness of worker representation and consultation in improving health and safety outcomes. One of these preconditions is a regulatory framework that defines workers' rights to representation and employers' obligations to respond. Using the United Kingdom as its focus, this article explores developments at the national policy level. It shows how long-awaited legislative reforms to improve provisions for worker representation in health and safety have so far failed to materialize and, instead, government strategy has concentrated on promoting voluntary approaches. The author reviews the evidence of what makes worker representation in health and safety effective and suggests that, far from abandoning approaches to legislative reform, the U.K. agencies should be seeking to make improvements to the British provisions if they are to provide the necessary stimulus and support for worker representation in health and safety at work. Such improvements need to address long-standing weaknesses in existing provisions and their relevance to the changing world of work. The arguments presented here apply to the essential role of regulatory support for worker participation in all advanced market economies if it is to improve health and safety outcomes.

Advocacy for health equity: a synthesis review

Context

Health inequalities are systematic differences in health among social groups that are caused by unequal exposure to—and distributions of—the social determinants of health (SDH). They are persistent between and within countries despite action to reduce them. Advocacy is a means of promoting policies that improve health equity, but the literature on how to do so effectively is dispersed. The aim of this review is to synthesize the evidence in the academic and gray literature and to provide a body of knowledge for advocates to draw on to inform their efforts.

Methods

This article is a systematic review of the academic literature and a fixed-length systematic search of the gray literature. After applying our inclusion criteria, we analyzed our findings according to our predefined dimensions of advocacy for health equity. Last, we synthesized our findings and made a critical appraisal of the literature.

Findings

The policy world is complex, and scientific evidence is unlikely to be conclusive in making decisions. Timely qualitative, interdisciplinary, and mixed-methods research may be valuable in advocacy efforts. The potential impact of evidence can be increased by “packaging” it as part of knowledge transfer and translation. Increased contact between researchers and policymakers could improve the uptake of research in policy processes. Researchers can play a role in advocacy efforts, although health professionals and disadvantaged people, who have direct contact with or experience of hardship, can be particularly persuasive in advocacy efforts. Different types of advocacy messages can accompany evidence, but messages should be tailored to advocacy target. Several barriers hamper advocacy efforts. The most frequently cited in the academic literature are the current political and economic zeitgeist and related public opinion, which tend to blame disadvantaged people for their ill health, even though biomedical approaches to health and political short-termism also act as barriers. These barriers could be tackled through long-term actions to raise public awareness and understanding of the SDH and through training of health professionals in advocacy. Advocates need to take advantage of “windows of opportunity,” which open and close quickly, and demonstrate expertise and credibility.

Conclusions

This article brings together for the first time evidence from the academic and the gray literature and provides a building block for efforts to advocate for health equity. Evidence regarding many of the dimensions is scant, and additional research is merited, particularly concerning the applicability of findings outside the English-speaking world. Advocacy organizations have a central role in advocating for health equity, given the challenges bridging the worlds of civil society, research, and policy.

Labor unions: a public health institution

Using a social-ecological framework, we drew on a targeted literature review and historical and contemporary cases from the US labor movement to illustrate how unions address physical and psychosocial conditions of work and the underlying inequalities and social determinants of health. We reviewed labor involvement in tobacco cessation, hypertension control, and asthma, limiting articles to those in English published in peer-reviewed public health or medical journals from 1970 to 2013. More rigorous research is needed on potential pathways from union membership to health outcomes and the facilitators of and barriers to union-public health collaboration. Despite occasional challenges, public health professionals should increase their efforts to engage with unions as critical partners.

Effectiveness of a comprehensive stress management program to reduce work-related stress in a medium-sized enterprise

Objectives

To assess the effectiveness of a comprehensive workplace stress management program consisting of participatory action-oriented training (PAOT) and individual management.

Methods

A comprehensive workplace stress management program was conducted in a medium-sized enterprise. The baseline survey was conducted in September 2011, using the Korean Occupational Stress Scale (KOSS) and Worker’s Stress Response Inventory (WSRI). After implementing both organizational and individual level interventions, the follow up evaluation was conducted in November 2011.

Results

Most of the workers participated in the organizational level PAOT and made Team-based improvement plans. Based on the stress survey, 24 workers were interviewed by a researcher. After the organizational and individual level interventions, there was a reduction of several adverse psychosocial factors and stress responses. In the case of blue-collar workers, psychosocial factors such as the physical environment, job demands, organizational system, lack of rewards, and occupational climate were significantly improved; in the case of white-collar workers, the occupational climate was improved.

Conclusions

In light of these results, we concluded that the comprehensive stress management program was effective in reducing work-related stress in a short-term period. A persistent long-term follow up is necessary to determine whether the observed effects are maintained over time. Both team-based improvement activities and individual interviews have to be sustainable and complementary to each other under the long-term plan.

Does church participation facilitate tobacco control? A report on Korean immigrants

Background This study explores hypotheses linking church attendance to smoking prevalence, cessation, exposure to environmental tobacco smoke (ETS), and household smoking bans among Korean immigrants in California. Methods Data were drawn from telephone interviews with Korean adults (N = 2085) based on a probability sample during 2005–2006 in which 86% of those contacted completed interviews. Results Koreans who reported that they had attended church were less likely to be current smokers and to be exposed to ETS, and more likely to have quit smoking and to have a complete smoking ban than non-attenders after statistical controls for behavioral covariates. Discussion Whether or not participants reported attending church was associated with increased tobacco control practices. Public health interventions may profit by seeking to expand cooperation with religious congregations to facilitate efforts to promote healthy lifestyles among immigrant populations beyond the influences of church attendance.

Organisational justice and change in justice as predictors of employee health: the Whitehall II study

OBJECTIVE

Organisational justice has been proposed as a new way to examine the impact of psychosocial work environment on employee health. This article studied the justice of interpersonal treatment by supervisors (the relational component of organisational justice) as a predictor of health.

DESIGN

Prospective cohort study. Phase 1 (1985-88) measured relational justice, job demands, job control, social support at work, effort-reward imbalance, and self rated health. Relational justice was assessed again at phase 2 (1989-90) and self rated health at phase 2 and phase 3 (1991-93).

SETTING

20 civil service departments originally located in London.

PARTICIPANTS

10 308 civil servants (6895 men, 3413 women) aged 35-55.

OUTCOME MEASURE

Self rated health.

MAIN RESULTS

Men exposed to low justice at phase 1 or adverse change in justice between phase 1 and phase 2 were at higher risk of poor health at phase 2 and phase 3. A favourable change in justice was associated with reduced risk. Adjustment for other stress indicators had little effect on results. In women, low justice at phase 1 predicted poor health at phase 2 and phase 3 before but not after adjustment for other stress indicators. Adverse change in justice was associated with worse health prospects irrespective of adjustments.

CONCLUSIONS

The extent to which people are treated with justice in workplaces seems to predict their health independently of established stressors at work. Evidence on reduced health risk after favourable change in organisational justice implies a promising area for health interventions at workplace.

Reducing social disparities in tobacco use: a social-contextual model for reducing tobacco use among blue-collar workers

In the United States in 1997, the smoking prevalence among blue-collar workers was nearly double that among white-collar workers, underscoring the need for new approaches to reduce social disparities in tobacco use. These inequalities reflect larger structural forces that shape the social context of workers' lives. Drawing from a range of social and behavioral theories and lessons from social epidemiology, we articulate a social-contextual model for understanding ways in which socioeconomic position, particularly occupation, influences smoking patterns. We present applications of this model to worksite-based smoking cessation interventions among blue-collar workers and provide empirical support for this model. We also propose avenues for future research guided by this model.

[Improvement of work environment]

As a result of a literature review on methodology and the effectiveness of work-environment oriented workplace stress reduction, it is suggested that improvement of the work environment is effective in reducing workers' job stressors and psychological and physiological stress reaction, from a limited number of controlled studies including RCT, as well as a number of case studies and before-after comparison studies. An expert-guided, supervisor and worker participated approach also seems effective. The author proposes five practical steps toward an effective improvement of the work environment based on the review. Remaining topics include the need for more well-designed studies, investigation of the relationship between intervention type and outcome, as well as modifying effects according to social situations, and instruments for implementation.