Preventing Opioid Use Disorders among Fishing Industry Workers

"The Hotel of 10,000 Stars": The Impact of Social-Structural Determinants of Health Among Im/migrant Shrimpers in the Gulf of Mexico

Objectives. To identify appropriate interventions to prevent injury, we conducted a qualitative study among commercial shrimp fishermen in the Gulf of Mexico. Methods. Using qualitative and participatory research methods, including interviews, photovoice, and workplace observations in southeast Texas and the Rio Grande Valley in Texas, we examined the social‒structural dimensions that contribute to physical and psychological injury. Results. We found that multiple layers of vulnerability and danger exist among shrimpers with interacting themes: (1) recognizing risk, (2) precarious employment, and (3) psychological distress. Conclusions. Our results add to the growing body of knowledge that emphasizes the negative health impacts of underregulated, high-risk, and physically demanding work performed primarily by im/migrants. Public Health Implications. Our findings highlight the larger social‒structural conditions and context of hardships endemic to migrant labor and suggest implications for practice and policy interventions. (Am J Public Health. 2024;114(8):824-832. https://doi.org/10.2105/AJPH.2024.307696).

County-level industrial composition of the labor force and drug overdose mortality rates in the United States in 2018-2021

BACKGROUND

Drug mortality risks vary among industries, creating distinctive geographic patterns across US counties. However, less is known about how local labor market structure relates to drug overdose mortality amid the synthetic opioid era in the United States. This study investigates the relationship between industry-specific job composition and drug overdose mortality at the county level while exploring how fentanyl's presence in illicit drug supplies may moderate the relationship.

METHODS

Data were derived from the National Center for Health Statistics' Multiple Cause of Death files for the rates of drug overdose mortality of any intent, linked with four other sources on industry-specific job shares, drug supply, and county-level sociodemographic characteristics and opioid prescribing rates from the US Census Bureau, the CDC, and the Drug Enforcement Administration. Negative binomial regression models were employed to examine associations between county industry-specific job composition and drug overdose mortality, with tests for moderating effects of state-level fentanyl seizure rates.

RESULTS

Our models indicate negative associations between job shares of manufacturing, retail trade, and educational services industries and drug overdose mortality. Positive associations were found for arts/entertainment/recreation and public administration. State-level fentanyl seizure rates had moderating effects on administrative/support/waste management/remediation (A/S/WM/R) and educational services.

CONCLUSION

Counties with a higher concentration of arts/entertainment/recreation and public administration jobs need targeted efforts to mitigate drug-related overdose risks. Additionally, areas with higher concentrations of A/S/WM/R service jobs, particularly where fentanyl seizure rates are higher, may require proactive harm reduction strategies for reducing overdose risks.

Suicide mortality according to occupation and method of suicide, Massachusetts, 2010-2019

BACKGROUND

Suicide rates in the United States have been increasing. Work-related factors may contribute to risk for suicide. These work-related factors may be reflected in a varied risk for different suicide methods between occupations. This study sought to assess occupational differences in suicide rates according to the method used.

METHODS

Death certificate data about suicide deaths in Massachusetts between 2010 and 2019 were used to calculate mortality rates and rate ratios with univariable and multivariable models controlling for age, sex, race ethnicity, and educational attainment for suicides overall, and for three specific methods of suicide (hanging/strangulation/suffocation, firearms, and poisoning) by occupation.

RESULTS

In multivariate models, the risk for suicide was significantly elevated for workers in arts, design, entertainment, sports, and media (relative risk [RR] = 1.84, 95% confidence interval [CI] = 1.53, 2.22); construction trades (RR = 1.68, 95% CI = 1.53, 1.84); protective services (RR = 1.49, 95% CI = 1.26, 1.77); and healthcare support occupations (RR = 1.55, 95% CI = 1.25, 1.93). Occupational risk for suicide differed across different methods. For hanging/strangulation/suffocation, workers in arts, design, entertainment, sports, and media occupations had the highest RR (2.09, 95% CI = 1.61, 2.71). For firearms, workers in protective service occupations had the highest RR (4.20, 95% CI = 3.30, 5.34). For poisoning, workers in life, physical, and social science occupations had the highest RR (2.32, 95% CI = 1.49, 3.60).

CONCLUSIONS

These findings are useful for identifying vulnerable working populations for suicide. Additionally, some of the occupational differences in the risk for suicide and for specific methods of suicide may be due to workplace factors. Further research is needed to understand these workplace factors so that interventions can be designed for prevention.

Naloxone training and availability in the US commercial fishing industry

INTRODUCTION

Workers in physically demanding jobs with high injury rates, long hours, productivity pressures, and lack of job security, such as commercial fishing, are at higher risk for substance use and misuse. In the United States, the federal government is urging employers to consider having naloxone available to reverse the effects of an opioid overdose, especially in workplaces. This study examined naloxone training, naloxone availability, and level of concern over substance use in commercial fishing.

METHODS

As part of a larger study of commercial fishing vessel captains, we asked participants how worried they are about various potential problems, including substance use by crew members, using a five-point scale. We also asked whether they had completed naloxone training and whether their vessel was equipped with naloxone.

RESULTS

Of the 61 vessel captains who participated, 10 had naloxone training. Most were "not at all worried" about a crew member misusing alcohol (n = 52; 85.2%), a crew member using marijuana (n = 50; 82.0%), a crew member using other drugs (n = 49; 80.3%), or a crew member having a drug overdose (n = 52; 86.7%). Only five fishing vessels were equipped with naloxone.

CONCLUSION

Our results indicate that few fishing vessels are equipped with naloxone or have captains trained in its use. Fishing captains tend not to be worried about substance use in their crew. Given the higher rate of overdose deaths in the fishing industry compared to other industries, having more vessels equipped with naloxone and captains trained to administer it could save lives.

Stressors and Coping Strategies in Rural Farmers: A Qualitative Study

OBJECTIVE

Farmers in rural areas face unique lifestyle stressors which may cause physical and behavioral health issues. Because of external stressors, and often an internal drive to succeed, farmers in rural areas have high rates of prescription drug use, excessive alcohol use, depression, and suicide. These methods of coping may increase prevalence of distress and mental illness in farmers leading to poor health outcomes. Social norms within rural farming populations are influenced by culture, family, friends, and community beliefs which make it difficult to conduct research about substance use and mental health. The purpose of this study is to identify stressors in rural farmers and positive and negative coping strategies for stress in the farming population.

METHODS

In-depth interviews (35 minutes-1 hour) were conducted with full-time rural farmers (n = 15) in ten counties throughout Georgia. Using qualitative analysis, inductive coding was used to identify themes and patterns among transcribed interview recordings.

RESULTS

Stressors reported by farmers included: financial, work-life balance, physical health and disconnect from non-farming populations. Farmers described feeling misperceived by those outside of their community and feeling a distinct lack of control due to external factors. All the farmers identified alcohol use as a primary coping strategy to deal with stressors.

CONCLUSIONS

This study identifies distinct stressors associated with a farming lifestyle and socio-cultural factors that are barriers to care for mental health and substance use in rural farmers. This study can provide information to health practitioners that may lead to a better understanding of the factors influencing farmer's health outcomes.

Working hours, sleep, and fatigue in the agriculture, forestry, and fishing sector: A scoping review

INTRODUCTION

Agriculture, forestry, and fishing industry (AgFF) workers often work extremely long hours during peak production seasons, resulting in sleep deprivation and fatigue. The National Occupational Research Agenda has classified fatigue as a "significant safety issue" and area of concern for many industry sectors, including AgFF. This review explores current research and practice in AgFF and proposes next steps.

METHODS

We conducted a scoping literature review to examine the extent and nature of research in this area. Article inclusion criteria included peer-reviewed journal articles written in English; published after 1989; covering AgFF workers in high-income countries; with data on working hours/schedules and sleep related to safety and health.

RESULTS

Limited research has addressed long hours and sleep deprivation among AgFF workers. We identified 8350 articles for title and abstract review. Among those, 407 underwent full-text review and 96 met all inclusion criteria (67% agriculture, 25% fishing/seafood processing, 8% forestry). The literature provided some evidence fatigue contributes to fatalities, injuries, and illnesses in AgFF. Older, new, young, foreign-born, and female workers, as well as those who work in small organizations or longer hours (40+) may be at higher risk for fatigue-related injury and illness. Few studies have developed or evaluated interventions to control risks.

DISCUSSION

Given that fatigue is a factor in injury and illness for this sector, future AgFF surveillance and research should increase efforts to capture fatigue and sleep data, directly investigate the role of long hours and nonstandard work schedules in the sector, and most importantly, create practical interventions to manage fatigue.

Associations of musculoskeletal disorders with occupational stress and mental health among coal miners in Xinjiang, China: a cross-sectional study

BACKGROUND

Musculoskeletal disorders (MSDs), a common type of occupational diseases, have become the main cause of absenteeism and early retirement in the occupational population, as well as a major risk factor for occupational disability. The purpose of this study was to investigate the effects of occupational stress and mental health on MSDs in coal miners in Xinjiang, China, to provide a theoretical basis for reducing the incidence of MSDs in coal miners and improving their physical and mental health.

METHODS

In this study, stratified cluster random sampling was used to randomly select six coal mining companies in Xinjiang, and 1675 coal miners were surveyed by questionnaire. The status of occupational stress, mental health and MSDs among coal miners was investigated by means of the Effort-Reward Imbalance questionnaire (ERI), Symptom Checklist-90(SCL-90), and Musculoskeletal disorders scale (MSDs) questionnaire.

RESULTS

The prevalence of MSDs among coal miners was higher, and there were statistical differences among different sexes, ages, working years, shifts, types of work, educational level and monthly income (P < 0.001). The prevalence of MSDs in different body parts in the occupational stress group and mental disorder group was higher than that in the normal group. The results of multivariate logistic regression analysis showed that females had an increased risk of developing MSDs (OR = 2.23, 95% CI.:1.50,3.33). The risk of MSDs was higher with age < 30 years (30-39 years,OR = 2.39, 95% CI.,1.68,3.40; 40-49 years,OR = 2.15, 95% CI.:1.52,3.04; 50-60 years:OR = 3.25, 95% CI.:2.09,5.07), and the longer the working years, the higher the risk of MSDs (OR = 1.90, 95% CI.:1.38,2.62). The two shifts group (OR = 2.18, 95% CI.:1.59,2.98) had an increased risk of developing MSDs compared with the fixed day shift group. The risk of MSDs was lower in heading drivers (OR = 0.41, 95% CI.:0.29,0.60,) and transport workers (OR = 0.30, 95% CI.:0.20,0.43). The higher the education level, the lower the risk of MSDs (high school: OR = 0.46, 95% CI.:0.34,0.62, junior college and above: OR = 0.12, 95% CI.:0.08,0.17), and the higher the monthly income, the lower the risk of MSDs (OR = 0.50, 95% CI.:0.34,0.74). Occupational stress (OR = 1.32, 95% CI.:1.05,1.67) and mental disorder(OR = 2.94, 95% CI.:2.25,3.84) increased the risk of MSDs. A Bayesian network diagram showed that occupational stress and MSDs have direct effects on mental disorders, and occupational stress can have indirect effects on mental disorders through MSDs.

CONCLUSION

Our research shows that MSDs are common among coal miners. Occupational stress and psychological disorders can increase the incidence of MSDs.

Commercial Fishing as an Occupational Determinant of Opioid Overdoses and Deaths of Despair in Two Massachusetts Fishing Ports, 2000-2014

The opioid epidemic has had disproportionate effects across various sectors of the population, differentially impacting various occupations. Commercial fishing has among the highest rates of occupational fatalities in the United States. This study used death certificate data from two Massachusetts fishing ports to calculate proportionate mortality ratios of fatal opioid overdose as a cause of death in commercial fishing. Statistically significant proportionate mortality ratios revealed that commercial fishermen were greater than four times more likely to die from opioid poisoning than nonfishermen living in the same fishing ports. These important quantitative findings suggest opioid overdoses, and deaths to diseases of despair in general, deserve further study in prevention, particularly among those employed in commercial fishing.

Deaths of Despair Among Healthcare Workers, Massachusetts, 2011 to 2015

OBJECTIVE

To explore mortality rates and trends according to the occupation of healthcare workers who died from the deaths of despair (DoD).

METHODS

Death certificates for deaths from 2011 to 2015 due to poisonings, suicides, alcholic liver disease and cirrhosis were collected and coded based on the decedent's occupation. Mortality rates and rate ratios were calculated according to occupations for healthcare workers.

RESULTS

There were 540 DoDs among Massachusetts healthcare workers, accounting for an average annual rate of 32.4 deaths per 100,000 workers. The highest mortality rate for DoDs were among medical assistants; nursing, psychiatric, and home health aides; miscellaneous; health technologists and technicians; emergency medical technicians, and paramedics.

CONCLUSIONS

Further research should examine factors contributing to elevated rates for DoDs among healthcare workers. Interventions targeted for these workers should be developed.

Prevalence of musculoskeletal disorders and risk factors in recyclable material waste pickers from the dump of the structural city in Brasília, Brazil

Solid waste management is a global challenge impacting the lives of thousands of people, among them the recyclable materials waste pickers, through the separation and sale of these materials, make a living for themselves. These workers face unhealthy working conditions and are exposed to various occupational risks, which predispose the prevalence of musculoskeletal as chronic back problems.

METHOD

Exploratory cross-sectional study with a semi-structured questionnaire to investigate the prevalence of back pain and related risk factors.

RESULTS

1.025 waste pickers were interviewed, and 970 records of chronic back pain were detected. Among them, 660 were women (68.04%), 310 were men (31.96%), the average age of 40.21 years; 597 were single (61.92%); 629 (64.84%) had over 11 years of work; 942 (97.11%) worked exclusively in the open dump, 899 (92.68%) with bags, 922 (95.05%) on dayshift. We found significant associations between gender (p < 0.001); age (p < 0.001); time at work (p < 0.022) and place at work (p < 0.001). After adjusting, there were higher prevalence of chronic back pain women (OR = 1.7), older age (OR = 2.64); working more than 11 years (OR = 1.09); and working on the open dump (OR = 2.8).

CONCLUSION

The prevalence of subjective symptoms of musculoskeletal disorders was high. Women, over 36 years old, who worked more than 11 h a day in the open dump were more exposed to suffer from chronic back problems. The importance of urgently addressing the labor impacts related to solid waste management in developing countries to protect these workers and, especially, women involved in this work is emphasized.

Linking Datasets to Characterize Injury and Illness in Alaska's Fishing Industry

Limited research has characterized nonfatal injury/illness in Alaska's hazardous fishing industry. This study aimed to determine (a) the utility of linking datasets to conduct surveillance, and (b) injury/illness patterns during 2012-2016. Data were obtained from the Alaska Trauma Registry (ATR), Fishermen's Fund (FF), and US Coast Guard (USCG). Datasets were coded to identify patterns in injury/illness characteristics and circumstances. Probabilistic linkage methods were utilized to identify unique incidents that appeared in more than one dataset. After linking datasets, 3,014 unique injury/illness cases were identified. By dataset, 2,365 cases appeared only in FF, 486 only in USCG, 110 only in ATR, 25 in ATR and FF, 15 in ATR and USCG, 10 in USCG and FF, and 3 in all datasets. FF mainly captured claims submitted by small, independently-owned vessels in Southcentral and Southeastern Alaska. In contrast, USCG mainly captured reports from large, company-owned vessels in Western Alaska. By nature, cases were most frequently sprains, strain, and tears (27%), cuts (15%), and fractures (11%). Across fleets, injuries/illnesses most frequently resulted from contact with objects and equipment (41%), overexertion and bodily reaction (27%), and slips, trips, and falls (20%). Work processes associated with traumatic injuries were most frequently hauling gear (18%) and walking, climbing, and descending (18%). Half of all injuries were of moderate severity (53%). Linking datasets, which capture different segments of Alaska's fishing industry, provides the most comprehensive understanding of nonfatal injury/illness to date. These results, stratified by fleet and severity, will inform prevention strategies.

Promoting Opioid Awareness Through a Union-Based Peer Training Model

Work factors, including physical job demands, appear to be risk factors for opioid overdoses. We collaborated with unions representing workers in high-risk occupations and offered resources to develop tailored educational interventions for their members. An ironworkers' local, a statewide nurses' union, and a Teamsters local union participated, at levels higher than we had anticipated. The three unions trained 285 workers, including apprentices, stewards, and those nearing retirement. Short surveys assessed pre- and post-training knowledge, attitudes, confidence in helping others, and related domains. Seventy percent of respondents reported heavy or very heavy physical demands at work, and one-half had experienced work-related pain. After training, participants reported more knowledge about opioids, less concern about stigma related to help-seeking, and more ability to provide help to a co-worker struggling with opioids. Peers with recovery experience provided a unique contribution to training. Tailored job-specific and peer-delivered educational interventions may be able to reduce the potential impact of opioids on working people.

Substance Abuse and Public Health: A Multilevel Perspective and Multiple Responses

Substance abuse has been a thorny public health concern throughout human history. Manifestly, prevention and treatment are the two main strategies commonly adopted to tackle the problem of substance abuse. They are in fact cross-disciplinary, and they relate to the various domains of heredity, biology, psychology, cognitive science, family, social development and cultural structures. This special issue, "Substance Abuse, Environment and Public Health," has published empirical studies from different regions and countries globally to enhance the international exchange of latest views and findings on the etiology, processes and influences of substance abuse across different domains, through which a multilevel perspective is considered more helpful for analyzing its complex nature, courses and consequences. This in turn suggests the possible need to employ multiple responses dynamically and integratively in the prevention and treatment of substance abuse.

Opioid use disorder, job strain, and high physical job demands in US workers

PURPOSE

Little is known about the work environmental risk factors for opioid use disorder (OUD) in working populations. The purpose of this study is to examine whether adverse physical and psychosocial working conditions are associated with OUD in a working population of the United States (US).

METHODS

Among the participants of the National Survey of Midlife Development in the United States (MIDUS) II Study (2004-2006), 2134 workers (1059 men and 1075 women; mean age, 51 years) were chosen for this study. OUD was measured with self-administered questions in line with the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSD-5). Physical demands (physical efforts, heavy lifting, and crouching/stooping/kneeling) and psychosocial work stressors (skill discretion, decision authority, job control, psychological job demands, supervisor and coworker support at work, job insecurity, and work hours) were measured with a standard questionnaire.

RESULTS

The prevalence of OUD was 3.8%. In multivariate analyses, low skill discretion, high psychological job demands, job strain (a combination of low control and high demands), and high physical job demands were significantly associated with OUD. The multivariate prevalence ratios for OUD by job strain and frequent heavy lifting were 1.98 (1.27-3.10) and 2.23 (1.22-4.10), respectively. Job strain was more strongly associated with OUD in men, while high physical job demands were more strongly associated with OUD in women.

CONCLUSION

This study implies that adverse physical and psychosocial working conditions may be important risk factors for OUD in US working populations. Future longitudinal and mechanistic studies are urgently warranted.

Opioid-related overdose deaths by industry and occupation-Massachusetts, 2011-2015

BACKGROUND

Thousands of people in the United States continue to die from opioid overdoses every year. Work-related injuries and other factors associated with work may increase exposure to opioids and, subsequently, opioid-related overdose deaths (OROD). This study sought to determine whether OROD rates differed by industry and occupation and explored work-related factors that might contribute to these differences.

METHODS

We coded industry and occupation information on death certificates for all OROD among Massachusetts residents from 2011 to 2015. We estimated rates of OROD by industry and occupation using Massachusetts employment data. National survey data were used to explore whether work-related factors known to vary by occupation (occupational injury and illness, job insecurity, and paid sick leave) correlate to observed differences in OROD.

RESULTS

Several industries and occupation groups had rates of OROD that were significantly higher than the rates for other workers. Construction workers and fishing workers stood out for having OROD rates many times higher than the average for all workers. Occupation groups with high rates of occupational injuries and illnesses, high job insecurity, and low availability of paid sick leave had higher rates of OROD.

CONCLUSIONS

These findings underscore the need for policy and educational interventions to reduce OROD tailored to the needs of high rate worker populations. Interventions should address workplace hazards that cause injuries for which opioids are prescribed, as well as best practices in medical management and return to work following injury, safer prescribing, enhanced access to treatment for opioid use disorders, and overdose prevention education.