Home Health and Community Care Workers' Occupational Exposure to Secondhand Smoke: A Rapid Literature Review

Asthma Among Manitoba Workers: Results from the Manitoba Occupational Disease Surveillance System

Background

This study characterized the risk of new-onset asthma among workers in Manitoba, Canada.

Methods

Accepted time loss claims from the Workers' Compensation Board of Manitoba from 2006 to 2019, containing workers' occupations and industries, were linked with administrative health data from 1996 to 2020. After restricting the cohort to the first claim per person in an occupation and applying age and coverage exclusions, the cohort comprised 142,588 person-occupation combinations. Asthma cases were identified if workers had at least two medical records for asthma (International Classification of Diseases, Ninth Revision, 493) within a 12-month period, within the 2 years before 3 years after cohort entry. New-onset asthma was identified using a 3-year washout period. Asthma hazard ratios by occupation and industry were estimated using Cox proportional hazard models, adjusted for age, and stratified by sex.

Results

Increased asthma risk was observed among workers with known asthmagen exposure, including male veterinary and animal health technologists and technicians (hazard ratio 3.97, 95% CI 1.78-8.86), male fish processing workers (3.40, 1.53-7.57), and male machining tool operators (2.91, 1.72-4.92). Increases were also observed for occupations with unknown or suspected allergens, including gas station attendants, drivers, mail/postal and related workers, public works and maintenance laborers, mine laborers and crane operators, and some indoor worker groups. Decreased risks were observed among nurses and residential and commercial installer and servicers.

Conclusion

This database linkage study successfully identified occupations and industries with known sensitizing agents or irritants, and several occupation and industries not typically associated with work-related asthma, warranting further investigation.

"Why should care workers be any different from prison workers?" A qualitative study of second-hand smoke exposure during home-care visits and potential measures to eliminate exposure

INTRODUCTION

Despite world-leading measures in place to protect employees from second-hand smoke exposure in workplaces in the United Kingdom, workers who deliver health and social care in private homes remain unprotected legally in this setting from second-hand smoke exposure (SHS).

METHODS

Fourteen individuals took part in either an in-depth telephone interview (n = 11) or an online focus group discussion (n = 3), including home-care workers (n = 5) and managers (n = 5) based in Lanarkshire (Scotland) and local/national policy makers (n = 4). Participants were asked about the extent to which exposure to SHS is an issue during home visits and possible additional measures that could be put in place to eliminate exposure.

RESULTS

Participants highlighted the difficulties in balancing the provision of care in a person's own home with the right of workers to be able to breathe clean air and be protected from SHS. Current strategies to reduce staff exposure to SHS during home visits were often reported as inadequate with SHS not a hazard considered by managers beyond protecting pregnant staff or those with pre-existing respiratory conditions such as asthma. Simple respiratory protective equipment (as used during the COVID-19 pandemic) was rightly identified as being ineffective. Methods such as nicotine replacement therapy and e-cigarettes were identified as potential ways to help people who smoke achieve temporary asbstinence prior to a home visit.

CONCLUSION

Implementing appropriate and proportionate measures to protect home-care workers from the harms posed by SHS should be a priority to help protect the health of this often overlooked occupational group.

Coaching Home Care Clients to Prepare Their Homes for Safe Care Visits: A Mixed-Methods Study to Evaluate a Nurse-Led Educational Intervention Process

Assuring home care (HC) workers' safety is challenging because the work environment is a private home. This paper presents the process evaluation for a proof-of-concept safety intervention study to assess whether nurse-led safety coaching, using motivational interviewing and a safety handbook, could enable HC clients to improve safety in their homes. The process evaluation objectives were to (i) document the intervention's implementation progress and (ii) assess the intervention's dose delivery, dose reception, and fidelity. Five agencies employing liaisons (n = 5) and nurse managers (NMs, n = 8) implemented this study's intervention and control arms. NMs assigned to the intervention arm (n = 6) coached 34 clients. Process evaluation metrics were assessed with mixed-methods data from (i) surveys completed by NMs during the intervention, (ii) postintervention audio-recorded and transcribed interviews (n = 6) with NMs and liaisons, and (iii) study progress tracking tools. The delivered dose efficiency was 85%, measured by the distribution of safety handbook copies to clients. About 94% of clients (n = 32) were considered "engaged" or "maybe engaged" during the safety coaching. Most coached clients (n = 30) were reachable for follow-up by NMs to assess intervention progress. Despite challenges, the intervention was implemented with good fidelity. Safety coaching can be applied in many HC contexts in larger populations.

Home Care Aides' Perspectives of Occupational Tobacco Smoke Exposure: A Q Methodology Study

INTRODUCTION

The increased growth of older adults has generated demand for home care aides (HCAs). Occupational tobacco smoke exposure (OTSE) may risk their health which should be paid attention to.

AIMS AND METHODS

This study explored the HCAs' perspectives of OTSE to inform health promotion programs catering to individual needs. A two-stage Q methodology was employed for data collection and analysis. Thirty-nine Q statements were extracted in the first stage and then 51 HCAs with OTSE were recruited to complete Q sorting in the second stage. PQ Method software was used for data analysis. Principal component analysis was performed to determine the most appropriate number of factors.

RESULTS

The five factors identified from HCAs' perspective of OTSE explained 51% of the variance. The HCAs agreed that OTSE could increase cancer risk. The HCAs with factor I did not care about OTSE, tending to complete their work. The HCAs with factor II agreed with the health hazards of OTSE, but did not know how to help their clients stop smoking. The HCAs with factor III cared about OTSE but were afraid of disrupting the client-provider relationship. The HCAs with factor IV regarded OTSE as a priority for occupational interventions whereas the HCAs with factor V did not think OTSE was an issue and believed that they could balance work and OTSE health hazards.

CONCLUSIONS

Our findings will inform the design of home care pre-service and on-the-job training courses. Long-term care policies should be developed to promote smoke-free workplaces.

IMPLICATIONS

There are five types of HCAs' perspectives on OTSE. The tailor interventions can be developed to help them avoid the OTSE (eg, opening windows for ventilation or using air purification equipment) and have an OTSE-free space.

Associations of Education and Income with Secondhand Smoke Exposure Among Non-smoking Pregnant Women in Japan: The Tohoku Medical Megabank Project Birth and Three-Generation Cohort Study

OBJECTIVES

There is accumulating evidence that lower socioeconomic groups are more exposed to secondhand smoke (SHS) than higher ones in the general population. The objective of the study was to examine the associations of education and income with SHS exposure among non-smoking pregnant women in Japan.

METHODS

We analyzed data from 11,615 non-smoking pregnant women in Japan who participated in the Tohoku Medical Megabank Project Birth and Three-Generation Cohort Study from 2013 to 2017. SHS exposure was defined as indoor exposure to someone else's cigarette smoke ≥ 1 day/week during pregnancy. Multiple logistic regression analyses were conducted to examine whether pregnant women's educational attainment or equivalent household income was associated with SHS exposure, adjusting for covariates. Stratified analyses by work status were also conducted.

RESULTS

The prevalence of SHS exposure during pregnancy was 32.6%; 27.6% among non-working women and 35.8% among working women. Lower educational attainment was associated with an increased risk of SHS exposure; the odds ratio of high school education or lower compared with university education or higher was 1.87 (95% confidence interval, 1.66-2.10). Lower equivalent household income was associated with an increased risk of SHS exposure; the odds ratio of the lowest compared with the highest level of income was 1.53 (95% confidence interval, 1.35-1.74). These associations did not differ between non-working women and working women.

CONCLUSIONS FOR PRACTICE

Associations of education and income with SHS exposure imply that educational interventions and financial incentives are needed for pregnant women and their household smokers.

Second-hand Smoke Exposure Among Home Care Workers (HCWs) in Scotland

OBJECTIVES

Second-hand tobacco smoke (SHS) is a serious cause of ill-health, and concern around SHS exposure at work has driven legislation in public places. In Scotland, most workers are now protected from SHS at work. However, home care workers (HCWs) may still be exposed, as they enter private homes where smoking is unregulated. In this study, we aimed to understand the extent, duration and intensity of that exposure among HCWs in Lanarkshire, Scotland.

METHODS

We surveyed HCWs in four organisations involved in providing care at home: a public healthcare agency (NHS Lanarkshire), two local government entities and a private healthcare company. We also conducted personal exposure monitoring (PEM) of exposure to airborne nicotine and SHS-related fine particulate matter (PM2.5) with 32 HCWs.

RESULTS

The vast majority of HCWs surveyed reported being exposed to SHS at work (395/537, 74%), and 50% of those who reported exposure in the home indicated daily exposure. We conducted PEM over 82 home visits, with 21% (17) demonstrating PM2.5 concentrations in excess of the WHO's 2010 air quality guideline limit for 24 h exposure. Duration of exposure to SHS tended to be short and as a result all nicotine samples were below the limit of quantification.

CONCLUSIONS

Most HCWs are exposed to minimal levels of SHS at work. However, a minority may be exposed to concentrations which affect health. Policies to mitigate this exposure should be considered, such as the use of respiratory protective equipment, improved ventilation during visits, and interventions to reduce smoking in homes.

Healthy Aging Requires a Healthy Home Care Workforce: the Occupational Safety and Health of Home Care Aides

PURPOSE OF REVIEW

To identify important home care (HC) aide occupational safety and health (OSH) hazards and examine how addressing these can improve aide health and the delivery of HC services overall. Specifically, this review seeks to answer: Why is HC aide OSH important? What are the most significant OSH challenges? How can improving HC aide OSH also improve the safety and health of their clients? What implications do the findings have for future research?

RECENT FINDINGS

HC is one of the fastest growing US industries. Aides comprise its largest workforce and are increasingly needed to care for the rapidly aging population. There is an aide shortage due in part to instabilities in HC work organization and to serious job-specific hazards, resulting in aides losing work time. Recent social, economic, and technological factors are rapidly changing the nature of HC work, creating OSH hazards similar to those found in nursing homes. At the same time, aides are experiencing social and economic inequities that increase their vulnerability to OSH hazards. These hazards are also a burden on employers who are challenged to recruit, retain, and train aides. OSH injuries and illness interrupt the continuity of care delivery to clients. Many OSH hazards also put HC clients and families at risk. A new framework and methodologies are needed to assess aide and client safety together in order to guide future HC research, policies, and practices. Government, industry, and labor commitment is needed to fund and coordinate a comprehensive, multidisciplinary research program.

Occupational Exposure to Second-Hand Tobacco Smoke: Development of a Job Exposure Matrix

Exposure to second-hand tobacco smoke (SHS) in the workplace has been largely controlled in most workplaces in many countries that have adopted smoke-free laws and regulations. Workers in offices, bars, restaurants, and many other settings have experienced substantial reductions in the frequency and intensity of their exposure to SHS. While current exposure to SHS of most non-smoking adults arises from living with a smoker there are likely to be some jobs where non-negligible exposure to SHS continues to occur. This study describes the development of a simple job exposure matrix (JEM) for SHS exposure for the UK working population in 2020 and identifies that at least 1.04 million workers are likely to be exposed to SHS while performing their job. Occupations with the highest frequency and intensity of exposure include those where workers carry out work tasks in private, domestic settings: including care workers and home carers. This SHS-JEM provides a novel method for assessing occupational exposure to SHS in other countries, and can act as a tool to identify priorities for policies to protect those workers who continue to be at risk from SHS.

Population-level estimates of workplace exposure to secondhand smoke in Canada

OBJECTIVES

Secondhand smoke (SHS) is a known lung carcinogen that is also associated with cardiovascular disease and premature death. An important source of exposure to SHS is the workplace. In the past, efforts have been made to reduce workplace SHS exposure across Canada, with corresponding benefits to public health. This study estimated the number of workers exposed to SHS in Canada in 2006 and 2016 and their level of exposure.

METHODS

The proportion of workers exposed to SHS and the proportion of workers reporting specific workplace smoking restrictions by occupation and province, acquired from the 2007-2009 and 2010-2012 Canadian Tobacco Use Monitoring Surveys, were applied to 2006 and 2016 Canadian census data to estimate population-level exposure. Workers were assigned to exposure levels (possible, moderate, high) using workplace smoking restrictions. Only moderately and highly exposed workers were considered exposed.

RESULTS

The number of exposed workers decreased by 20% from 520,000 in 2006 to 418,000 in 2016. Workers were equally split between moderate and high exposure groups. Trades, transport and equipment operators, and workers in primary industry had the highest rates of overall exposure. The proportion of workers exposed varied by province, with the lowest rates in Ontario (approximately 2% in both years), and the highest in Saskatchewan in 2006 (6%) and Newfoundland in 2016 (4%).

CONCLUSION

Workplace SHS exposure persists. The findings can help prioritize high-risk groups for interventions and inform studies of the burden of occupational disease. Further characterization of exposure is needed to better inform enforcement and prevention.

Assessing progress in protecting non-smokers from secondhand smoke

OBJECTIVE

To examine trends in population exposure to secondhand smoke (SHS) and consider two exposure metrics as appropriate targets for tobacco control policy-makers.

DESIGN

Comparison of adult non-smokers' salivary cotinine data available from 11 Scottish Health Surveys between 1998 and 2016.

METHODS

The proportions of non-smoking adults who had measurable levels of cotinine in their saliva were calculated for the 11 time points. The geometric mean (GM) concentrations of cotinine levels were calculated using Tobit regression. Changes in both parameters were assessed for the whole period and also for the years since implementation of smoke-free legislation in Scotland in 2006.

RESULTS

Salivary cotinine expressed as a GM fell from 0.464 ng/mL (95% CI 0.444 to 0.486 ng/mL) in 1998 to 0.013 ng/mL (95% CI 0.009 to 0.020 ng/mL) in 2016: a reduction of 97.2%. The percentage of non-smoking adults who had no measurable cotinine in their saliva increased by nearly sixfold between 1998 (12.5%, 95% CI 11.5% to 13.6%) and 2016 (81.6%, 95% CI 78.6% to 84.6%). Reductions in population exposure to SHS have continued even after smoke-free legislation in 2006.

CONCLUSIONS

Scotland has witnessed a dramatic reduction in SHS exposure in the past two decades, but there are still nearly one in five non-smoking adults who have measurable exposure to SHS on any given day. Tobacco control strategies globally should consider the use of both the proportion of non-smoking adults with undetectable salivary cotinine and the GM as targets to encourage policies that achieve a smoke-free future.