Promising Occupational Safety, Health, and Well-Being Approaches to Explore the Future of Work in the USA: An Editorial

The future of work continues to undergo profound and fundamental changes in response to shifting social, technological, economic, environmental, and political contexts [...].

Envisioning the future of work to safeguard the safety, health, and well-being of the workforce: A perspective from the CDC's National Institute for Occupational Safety and Health

The future of work embodies changes to the workplace, work, and workforce, which require additional occupational safety and health (OSH) stakeholder attention. Examples include workplace developments in organizational design, technological job displacement, and work arrangements; work advances in artificial intelligence, robotics, and technologies; and workforce changes in demographics, economic security, and skills. This paper presents the Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health's Future of Work Initiative; suggests an integrated approach to address worker safety, health, and well-being; introduces priority topics and subtopics that confer a framework for upcoming future of work research directions and resultant practical applications; and discusses preliminary next steps. All future of work issues impact one another. Future of work transformations are contingent upon each of the standalone factors discussed in this paper and their combined effects. Occupational safety and health stakeholders are becoming more aware of the significance and necessity of these factors for the workplace, work, and workforce to flourish, merely survive, or disappear altogether as the future evolves. The future of work offers numerous opportunities, while also presenting critical but not clearly understood difficulties, exposures, and hazards. It is the responsibility of OSH researchers and other partners to understand the implications of future of work scenarios to translate effective interventions into practice for employers safeguarding the safety, health, and well-being of their workers.

Potential Scenarios and Hazards in the Work of the Future: A Systematic Review of the Peer-Reviewed and Gray Literatures

It would be useful for researchers, practitioners, and decision-makers to anticipate the hazards that workers will face in the future. The focus of this study is a systematic review of published information to identify and characterize scenarios and hazards in the future of work. Eleven bibliographic databases were systematically searched for papers and reports published from 1999 to 2019 that described future of work scenarios or identified future work-related hazards. To compile a comprehensive collection of views of the future, supplemental and ad hoc searches were also performed. After screening all search records against a set of predetermined criteria, the review yielded 36 references (17 peer-reviewed, 4 gray, and 15 supplemental) containing scenarios. In these, the future of work was described along multiple conceptual axes (e.g. labor market changes, societal values, and manual versus cognitive work). Technology was identified as the primary driver of the future of work in most scenarios, and there were divergent views in the literature as to whether technology will create more or fewer jobs than it displaces. Workforce demographics, globalization, climate change, economic conditions, and urbanization were also mentioned as influential factors. Other important themes included human enhancement, social isolation, loneliness, worker monitoring, advanced manufacturing, hazardous exposures, sustainability, biotechnology, and synthetic biology. Pandemics have not been widely considered in the future of work literature, but the recent COVID-19 pandemic illustrates that was short-sighted. Pandemics may accelerate future of work trends and merit critical consideration in scenario development. Many scenarios described 'new' or 'exacerbated' psychosocial hazards of work, whereas comparatively fewer discussed physical, chemical, or biological hazards. Various preventive recommendations were identified. In particular, reducing stress associated with precarious work and its requirements of continual skill preparation and training was acknowledged as critical for protecting and promoting the health and well-being of the future workforce. In conclusion, the future of work will be comprised of diverse complex scenarios and a mosaic of old and new hazards. These findings may serve as the basis for considering how to shape the future of work.

Research Methodologies for Total Worker Health®: Proceedings From a Workshop

OBJECTIVE

There is growing interest in the NIOSH Total Worker Health program, specifically in the process of designing and implementing safer, health-promoting work and workplaces. A Total Worker Health (TWH) Research Methodology Workshop was convened to discuss research methods and future needs.

METHODS

Twenty-six experts in occupational safety and health and related fields reviewed and discussed current methodological and measurement issues and those showing promise.

RESULTS

TWH intervention studies face the same challenges as other workplace intervention studies and some unique ones. Examples are provided of different approaches and their applications to TWH intervention studies, and desired developments in the TWH literature.

CONCLUSIONS

This report discusses and outlines principles important to building the TWH intervention research base. Rigorous, valid methodologic, and measurement approaches are needed for TWH intervention as well as for basic/etiologic, translational, and surveillance research.

Effect of stressful life events on changes in smoking among the French: longitudinal findings from GAZEL

BACKGROUND

Changes in life events may play a contributing role in changes in smoking behaviors. The objective was to examine the impact of stressful life events (SLEs) on smoking among French adults.

METHODS

We examined smoking prevalence in 20 625 employees of the French GAZEL cohort for up to 5 years before and after a SLE during three time periods (years -1 vs. -5; years +1 vs. -1; years +5 vs. +1). Repeated measures analysis of time series data indexed to events were used, employing generalized estimating equations.

RESULTS

For women, comparing 1 year after vs. 1 year before SLEs, decreased odds of smoking were found for employment promotion (OR: 0.80; 95% CI = 0.67-0.95), marriage (OR: 0.57; 95% CI = 0.48-0.68) and divorce (OR: 0.78; 95% CI = 0.68-0.90). Comparing 5 years after to 1 year after SLEs, women had decreased odds of smoking for important purchase (OR: 0.87; 95% CI = 0.79-0.96), children leaving home (OR: 0.83; 95% CI = 0.74-0.93), retirement (OR: 0.73; 95% CI = 0.64-0.83) and death of loved one (OR: 0.86; 95% CI = 0.79-0.93). For men, decreased odds of smoking were observed in all three time periods for all SLEs except when comparing 1 year before to 5 years before marriage (OR: 1.66; 95% CI = 1.09-2.52) and divorce (OR: 1.49; 95% CI = 1.25-1.77).

CONCLUSION

Time surrounding SLEs during which individuals are susceptible to changing smoking behaviors may be an important consideration.

Promoting Changes in Obesogenic Behaviors: Does Coworker Social Support Play a Role?

Purpose.

To examine the association between worksite social support and changes in diet, physical activity, and body mass index (BMI).

Design.

Cohort analysis of an underlying randomized, controlled weight gain prevention worksite trial: Promoting Activity and Changes in Eating.

Setting.

The trial occurred in the greater Seattle area.

Subjects.

Baseline and follow-up data were obtained on a nested cohort of employees (n = 958–1078) from 33 small- to medium-sized worksites.

Measures.

Worksite social support, diet, physical activity, and BMI measures were assessed using a self-reported questionnaire.

Analysis.

To adjust for multilevel data and multiple time points, we used generalized estimating equations and logistic mixed models.

Results.

Higher baseline worksite social support was associated with greater changes in fruit and vegetable intake (p= .001; summary food-frequency questions).

Conclusion.

This study does not support a conclusive relationship between worksite social support and health behavior change.

Does concern motivate behavior change? Exploring the relationship between physical activity and body mass index among low-income housing residents

OBJECTIVE

To explore relationships between concerns and physical activity and body mass index (BMI) among a racially/ethnically diverse low-income population.

METHOD

A cross-sectional survey documented behavioral risks among racially/ethnically diverse low-income residents in the Boston area (2005-2009). Multivariable logistic regressions were conducted in 2012 for each concern, using SAS version 9.2.

RESULTS

Those very/moderately concerned about weight were more likely to have higher BMIs, be in the preparation/action stage, received behavioral counseling, participated in a weight management program, and be interested in participating in one in the future. Those very/moderately concerned about physical activity were more likely to have higher BMIs, received behavioral counseling, and participated in a physical activity program.

CONCLUSION

Individuals with elevated BMIs or low levels of physical activity are concerned. While level of concern is important, these findings suggest that it is not likely to be a sufficient catalyst to behavior change.

Occupational injury among hospital patient-care workers: what is the association with workplace verbal abuse?

OBJECTIVE

To test the association between workplace abuse exposure and injury risk among hospital workers. We hypothesized that exposed workers would have higher injury rates than unexposed workers.

METHODS

Survey of direct-care workers (n = 1,497) in two hospitals. Exposure to workplace abuse was assessed through self-report; occupational injury reports were extracted from employee records. We tested associations between non-physical workplace violence and injury using log-binomial regression and multilevel modeling.

RESULTS

Adjusted prevalence ratio (PR) for injury associated with being yelled at was 1.52 (95% CI 1.19, 1.95); for experiencing hostile/offensive gestures 1.43 (1.11, 1.82); and for being sworn at 1.41 (1.09, 1.81). In analyses by injury subtypes, musculoskeletal injuries were more strongly associated with abuse than were acute traumatic injuries. Associations operated on group and individual levels and were most consistently associated with abuse perpetrated by patients.

CONCLUSION

Exposure to workplace abuse may be a risk factor for injuries among hospital workers.

The impact of stressful life events on excessive alcohol consumption in the French population: findings from the GAZEL cohort study

Background

Major life changes may play a causative role in health through lifestyle factors, such as alcohol. The objective was to examine the impact of stressful life events on heavy alcohol consumption among French adults.

Methods

Trajectories of excessive alcohol consumption in 20,625 employees of the French national gas and electricity company for up to 5 years before and 5 years after an event, with annual measurements from 1992. We used repeated measures analysis of time series data indexed to events, employing generalized estimating equations.

Results

For women, excessive alcohol use increased before important purchase (p = 0.021), children leaving home (p<0.001), and death of loved ones (p = 0.03), and decreased before widowhood (p = 0.015); in the year straddling the event, increased consumption was observed for important purchase (p = 0.018) and retirement (p = 0.002); at the time of the event, consumption decreased for marriage (p = 0.002), divorce, widowhood, and death of loved one (all p<0.001), and increased for retirement (p = 0.035). For men, heavy alcohol consumption increased in the years up to and surrounding the death of loved ones, retirement, and important purchase (all p<0.001), and decreased after (all p<0.001, except death of loved one: p = 0.006); at the time of the event, consumption decreased for all events except for children leaving home and retirement, where we observed an increase (all p<0.001). For women and men, heavy alcohol consumption decreased prior to marriage and divorce and increased after (all p<0.001, except for women and marriage: p = 0.01).

Conclusion

Stressful life events promote healthy and unhealthy alcohol consumption. Certain events impact alcohol intake temporarily while others have longer-term implications. Research should disentangle women's and men's distinct perceptions of events over time.

Undertaking Cancer Research in International Settings: Report from the American Society for Preventive Oncology Special Interest Group on International Issues in Cancer

The mission of the American Society for Preventive Oncology Special Interest Group in International Issues in Cancer is to serve as a worldwide cancer prevention resource. At the 2013 annual meeting, we presented three early career investigators who conducted research with international collaborators as part of postdoctoral studies. We present a synopsis of each of the scientific presentations. The investigators also highlight useful strategies to encourage a more successful international collaboration, including seeking out existing collaborations between colleagues and international researchers, maintaining awareness and sensitivity of cultural norms, establishing clear communication about investigator roles and expectations, and persevering in the face of potential challenges due to the nature of these collaborations. Incorporation of these key elements could prove useful for researchers interested in pursuing cross-country projects. Cancer Epidemiol Biomarkers Prev; 22(9); 1638–41. ©2013 AACR.

Intention to quit smoking and concerns about household environmental risks: findings from the Health in Common Study in low-income housing

PURPOSE

To assess the association between intention to quit smoking and perceptions of household environmental risks among racially/ethnically diverse residents of low-income housing.

METHODS

Baseline data were collected from 2007 to 2009 for the Health in Common Study, which assessed social and physical determinants of cancer risk-related behaviors among residents of 20 low-income housing developments in the Greater Boston metropolitan area. Participants were surveyed about their tobacco use and concerns about household exposures. Household environmental inspections were also conducted to identify conditions associated with increased risk of exposure to indoor environmental agents, including pesticides, mold, and cleaning products.

RESULTS

Intention to quit smoking was associated with a greater degree of concern about exposures in the home, yet not with the actual presence of household hazards, as identified by home inspections and survey findings.

CONCLUSIONS

An ecological approach targeting multiple levels of influence may help to highlight the importance of both quitting tobacco and reducing potential household environmental exposures as part of comprehensive efforts to promote individual and household health.

Are social relationships a healthy influence on obesogenic behaviors among racially/ethnically diverse and socio-economically disadvantaged residents?

OBJECTIVE

To examine associations between social support and ties (family, friend, and neighbors) individually and jointly with diet and physical activity among an ethnically-diverse, low-income population.

METHODS

The Health in Common study (2005-2009) was designed to examine risk factors among individuals residing in low-income housing in the Boston, MA area. Cross-sectional surveys (n = 828) were administered in residents' homes. Linear/logistic multivariable analyses were employed with clustering of individuals within housing sites controlled as a random effect.

RESULTS

In multivariable analyses, total social support was significantly associated with higher red meat consumption per day (p = 0.029). Having more friends was significantly associated with more daily fruit and vegetable intake (p = 0.007) and higher levels of daily vigorous physical activity (p = 0.011). Those who reported having a greater number of family ties also reported higher daily consumption of sugary drinks (p = 0.013) and fast food (p = 0.011). More neighbor social ties were associated with more fast food per day (p = 0.024).

CONCLUSIONS

Social relationships can have both positive and negative associations with health behaviors. Understanding these relationships could help to inform the design of interventions that promote healthy behavior change among vulnerable populations.

Household food insufficiency, financial strain, work-family spillover, and depressive symptoms in the working class: the Work, Family, and Health Network study

OBJECTIVES

We evaluated the association of household-level stressors with depressive symptoms among low-wage nursing home employees.

METHODS

Data were collected in 2006 and 2007 from 452 multiethnic primary and nonprimary wage earners in 4 facilities in Massachusetts. We used logistic regression to estimate the association of depressive symptoms with household financial strain, food insufficiency, and work-family spillover (preoccupation with work-related concerns while at home and vice versa).

RESULTS

Depressive symptoms were significantly associated with household financial strain (odds ratio [OR] = 1.82; 95% confidence interval [CI] = 1.03, 3.21) and food insufficiency (OR = 2.10; 95% CI = 1.10, 4.18). Among primary earners, stratified analyses showed that food insufficiency was associated with depressive symptoms (OR = 3.60; 95% CI = 1.42, 9.11) but financial strain was not. Among nonprimary wage earners, depressive symptoms correlated with financial strain (OR = 3.65; 95% CI = 1.48, 9.01) and work-family spillover (OR = 3.22; 95% CI = 1.11, 9.35).

CONCLUSIONS

Household financial strain, food insufficiency, and work-family spillover are pervasive problems for working populations, but associations vary by primary wage earner status. The prevalence of food insufficiency among full-time employees was striking and might have a detrimental influence on depressive symptoms and the health of working-class families.

The association between worksite social support, diet, physical activity and body mass index

OBJECTIVE

Social support may be associated with improved diet and physical activity-determinants of overweight and obesity. Wellness programs increasingly target worksites. The aim was to evaluate the relationship between worksite social support and dietary behaviors, physical activity, and body mass index (BMI).

METHOD

Baseline data were obtained on 2878 employees from 2005 to 2007 from 34 worksites through Promoting Activity and Changes in Eating, a group-randomized weight reduction intervention in Greater Seattle. Worksite social support, diet, physical activity, and BMI were assessed via self-reported questionnaire. Principal component analysis was applied to workgroup questions. To adjust for design effects, random effects models were employed.

RESULTS

No associations were found with worksite social support and BMI, or with many obesogenic behaviors. However, individuals with higher worksite social support had 14.3% higher (95% CI: 5.6%-23.7%) mean physical activity score and 4% higher (95% CI: 1%-7%) mean fruit and vegetable intake compared to individuals with one-unit lower support.

CONCLUSION

Our findings do not support a conclusive relationship between higher worksite social support and obesogenic behaviors, with the exception of physical activity and fruit and vegetable intake. Future studies are needed to confirm these relationships and evaluate how worksite social support impacts trial outcomes.

US and France adult fruit and vegetable consumption patterns: an international comparison

BACKGROUND/OBJECTIVES

To observe fruit and vegetable consumption as it relates to body mass index (BMI) and other variables, by analyzing the health surveys of two countries -- the United States and France -- with traditionally distinct diets, and identifying factors that may explain the differences.

SUBJECTS/METHODS

Two nationally representative surveys that assess food intake via 24-h diet recalls. Respondents include 2126 women and 1911 men from the US National Health and Nutrition Examination Survey, and 1572 women and 1141 men from the French Nutrition Barometer Survey. Standard linear regression models and t-tests of both simple and predictive marginal means were run employing the software package SUDAAN.

RESULTS

Americans appear to consume fruits and vegetables less often than their French counterparts (1.04 vs 1.33 times per day fruits; 1.98 vs 2.29 times per day vegetables). American men consume fruits and vegetables least often (0.98 times per day fruits; 1.88 times per day vegetables) than do American women or French men (1.10 vs 1.25 times per day fruits; 2.07 vs 2.18 times per day vegetables). French women consume fruits and vegetables most often (1.41 times per day fruits; 2.41 times per day vegetables). The French have lower mean BMI than Americans (23.34 vs 28.22 women; 25.20 vs 28.02 men). Regression analyses showed that age, BMI and educational attainment are strongly associated with frequency of consumption.

CONCLUSIONS

These results support our hypothesis that the French tend to eat fruits and vegetables more often than Americans. This study proves to be an important first step in determining some of the influential factors that may affect various populations' consumption of fruits and vegetables.