Conceptual heuristic models of the interrelationships between obesity and the occupational environment

Occupational Disease in New York State: An Update

An assessment of occupational disease in New York State was undertaken that partially replicated and expanded earlier work from 1987. Utilizing an expanded conception of occupational disease, the assessment used a variety of data sources and methods to provide estimates of mortality and morbidity of occupational disease; workers exposed to specific workplace hazards; disparities in occupational disease among racial/ethnic groups and gender; costs and distribution of costs of occupational disease; and accessible occupational medical resources. Examples of the pathways work may impact health in some of the major health issues of current import including stress-related health conditions; substance use; and overweight/obesity were included. The report contains recommendations for addressing the problem of occupational disease in New York State and advocates for the convening of a statewide group to develop an occupational disease prevention agenda.

Expanding the Focus of Occupational Safety and Health: Lessons from a Series of Linked Scientific Meetings

There is widespread recognition that the world of work is changing, and agreement is growing that the occupational safety and health (OSH) field must change to contribute to the protection of workers now and in the future. Discourse on the evolution of OSH has been active for many decades, but formalized support of an expanded focus for OSH has greatly increased over the past 20 years. Development of approaches such as the National Institute for Occupational Safety and Health (NIOSH)'s Total Worker Health® concept and the World Health Organization (WHO)'s Healthy Workplace Framework are concrete examples of how OSH can incorporate a new focus with a wider view. In 2019, NIOSH initiated a multi-year effort to explore an expanded focus for OSH. This paper is a report on the outputs of a three-year cooperative agreement between NIOSH and The University of Texas School of Public Health, which led to subject matter expert workshops in 2020 and an international conference of global interest groups in 2021. This article traces the background of these meetings and identifies and assesses the lessons learned. It also reviews ten thematic topics that emerged from the meetings: worker health inequalities; training new OSH professionals; future OSH research and practice; tools to measure well-being of workers; psychosocial hazards and adverse mental health effects; skilling, upskilling and improving job quality; socioeconomic influences; climate change; COVID-19 pandemic influences; and strategic foresight. Cross-cutting these themes is the need for systems and transdisciplinary thinking and operationalization of the concept of well-being to prepare the OSH field for the work of the future.

Climate Adaptation Heuristic Planning Support System (HPSS): Green-Blue Strategies to Support the Ecological Transition of Historic Centres

The issue of climate has posed major and urgent challenges for the global community. The European Green Deal sets out a new growth strategy aimed at turning the European Union into a just and prosperous society, with a modern, resource-efficient, and competitive economy, which will no longer generate net greenhouse gas emissions by 2050. Cities in this context are committed on several fronts to rapid adaptation to improve their resilience capacity. The historic centre is the most vulnerable part of a city, with a reduced capacity for adaptation, but also the densest of values, which increase the complexity of the challenge. This study proposes an integrated tool, Heuristic Planning Support System (HPSS), aimed at exploring green-blue strategies for the historic centre. The tool is integrated with classic Planning Support System (PSS), a decision process conducted from the perspective of heuristic approach and Geographic Information System (GIS). It comprises modules for technical assessment, environmental assessment Life Cycle Assessment (LCA), economic assessment Life Cycle Cost (LCC), Life Cycle Revenues (LCR), and Discounted Cash Flow Analysis (DCFA) extended to the life cycle of specific interventions, the Multi-Attribute Value Theory (MAVT) for the assessment of energy, environmental, identity, landscape, and economic values. The development of a tool to support the ecological transition of historic centres stems from the initiative of researchers at the University of Catania, who developed it based on the preferences expressed by a group of decision makers, that is, a group of local administrators, scholars, and professionals. The proposed tool supports the exploration of green-blue strategies identified by decision makers and the development of the plan for the historic district of Borgata di Santa Lucia in Syracuse.

2022 Prevention of chronic non-communicable diseases in Of the Russian Federation. National guidelines

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Ethics and Total Worker Health®: Constructs for Ethical Decision-Making and Competencies for Professional Practice

Work has become increasingly technologically driven and fast paced, with long work hours, new/emerging hazards, and rising health care costs. Threats to worker safety, health, and well-being including non-traditional work arrangements and practices, precarious work, uncertain hazardous exposures, and work organization issues, such as heavy workloads, design of work, uneven work hours, and difficult interpersonal relationships among workers and managers are apparent. Furthermore, the relationship between personal health risk factors and workplace risks and exposures has drawn increased attention and concern. As employer economic pressures continue to build, it is anticipated that ethical dilemmas for practitioners will become increasingly complex. A review of relevant Total Worker Health® (TWH) literature, related ethical constructs and competencies, an examination of codes of ethics for occupational safety and health and health promotion/education disciplines was conducted. A case study for TWH utilizing an ethical decision-making model for the analysis of key ethical issues and solutions was completed. TWH approaches to protecting safety, promoting health, and advancing well-being are increasingly being adopted. These approaches can reveal ethical dilemmas, and ethical constructs are needed to guide decision-making. A core set of proposed ethical competencies for TWH professionals are identified as a transdisciplinary framework to support workplace ethical culture.

Work Characteristics, Body Mass Index, and Risk of Obesity: The National Quality of Work Life Survey

OBJECTIVES

To examine work characteristics in relation to body mass index (BMI) and risk of obesity.

METHODS

We analyzed data from 1150 participants working 20+ h week-1 from the 2014 National NIOSH Quality of Work Life Survey, based on a representative sample of US workers. We used multiple linear regression for BMI and multiple logistic regression for obesity to estimate associations with 19 different work characteristics plus one set of occupational categories controlling for age, gender, race/ethnicity, education, marital status, job physical exertion, and television watching.

RESULTS

We found significant positive linear associations between BMI and night shift (versus day shift) schedule (B = 2.28, P = 0.008) and blue-collar (versus management/professional) work (B = 1.75, P = 0.008). Night shift schedule [odds ratio (OR) = 2.19, P = 0.029], sales/office work (OR = 1.55, P = 0.040), and blue-collar work (OR = 2.63, P = 0.006) were associated with increased risk of obesity versus 'healthy weight'. No other statistically significant associations between work characteristics and BMI or obesity were observed.

CONCLUSIONS

Night shift schedule and blue-collar work were related to increased BMI and obesity risk in US workers in 2014. Identifying risk factors in blue-collar work and redesigning jobs to reduce those risk factors, and reducing night shift work, could play a role in reducing the prevalence of obesity in the USA.

Toward an Expanded Focus for Occupational Safety and Health: A Commentary

Powerful and ongoing changes in how people work, the workforce, and the workplace require a more holistic view of each of these. We argue that an expanded focus for occupational safety and health (OSH) is necessary to prepare for and respond rapidly to future changes in the world of work that will certainly challenge traditional OSH systems. The WHO Model for Action, various European efforts at well-being, and the Total Worker Health concept provide a foundation for addressing changes in the world of work. However, a paradigm expansion to include the recognition of worker and workforce well-being as an important outcome of OSH will be needed. It will also be vital to stimulate transdisciplinary efforts and find innovative ways to attract and train students into OSH professions as the paradigm expands. This will require active marketing of the OSH field as vibrant career choice, as a profession filled with meaningful, engaging responsibilities, and as a well-placed investment for industry and society. An expanded paradigm will result in the need for new disciplines and specialties in OSH, which may be useful in new market efforts to attract new professionals. Ultimately, to achieve worker and workforce well-being we must consider how to implement this expanded focus.

Edmonton Obesity Staging System (EOSS) and Work Ability in the Evaluation of Workers Affected by Obesity: A Preliminary Report

OBJECTIVE

Obesity and work-ability may be influenced by reduced performance, associated diseases, and obesogenic environment.

METHODS

Two hundred seventy-six male (46.7 ± 10.6 years; BMI 33.3 ± 4.4 kg/m) and 658 female (48.4 ± 9.7 years; BMI 33.6 ± 5.4 kg/m) were enrolled. They were classified by Edmonton Obesity Staging System (EOSS) and interviewed for "perceived" work-ability.

RESULTS

Total work ability score was 1.3 ± 2.1 in EOSS 0, 1.2 ± 1.5 in EOSS 1, 1.8 ± 2 in EOSS 2, 2.0 ± 2.2 in EOSS 3. Work-ability, in relation to EOSS adjusted for sex, age, work categories referred to EOSS 0, was highest in EOSS stage 3 (P < 0.001 for trend) and with reference to Administration; Industries showed the worst score (P < 0.001) followed by Health (P = 0.001) and Service (P = 0.01).

CONCLUSION

The relation between EOSS and work-ability empowers clinical decision-making and helps to assess the impact of overweight on health and fitness for work.

Framework for Considering Productive Aging and Work

OBJECTIVES

The U.S. population is experiencing a demographic transition resulting in an aging workforce. The objective of this article is to elucidate and expand an approach to keep that workforce safe, healthy, and productive.

METHODS

This article elucidates the framework for the National Center for Productive Aging at Work of the National Institute for Occupational Safety and Health. Subject matter experts used a snowball method to review published literature to substantiate elements in the framework.

RESULTS

Evidence-based literature supports a productive aging framework for the workforce involving the following elements: 1) life span perspective; 2) comprehensive and integrated approaches to occupational safety and health; 3) emphasis on positive outcomes for both workers and organizations; and 4) supportive work culture for multigenerational issues.

CONCLUSION

The productive aging framework provides a foundational and comprehensive approach for addressing the aging workforce.

Characterizing the Interrelationships of Prescription Opioid and Benzodiazepine Drugs With Worker Health and Workplace Hazards

OBJECTIVE

Prescription opioid and benzodiazepine drug use, which has risen significantly, can affect worker health. Exploration of the scientific literature assessed (1) interrelationships of such drug use, occupational risk factors, and illness and injury, and (2) occupational and personal risk factor combinations that can affect their use.

METHODS

The scientific literature from 2000 to 2015 was searched to determine any interrelationships.

RESULTS

Evidence for eight conceptual models emerged based on the search yield of 133 articles. These models summarize interrelationships among prescription opioid and benzodiazepine use with occupational injury and illness. Factors associated with the use of these drugs included fatigue, impaired cognition, falls, motor vehicle crashes, and the use of multiple providers.

CONCLUSION

Prescription opioid and benzodiazepine drugs may be both a personal risk factor for work-related injury and a consequence of workplace exposures.

Occupational Differences in BMI, BMI Trajectories, and Implications for Employment Status among Older U.S. Workers

We examined associations between employment and obesity, arguing that risk for unhealthy weight may vary across occupational groups because they shape workplace exposures, social class standing, material resources, and norms and expectations about healthy behaviors and weight. We used a large sample of 51-61-year-old workers from the Health and Retirement study, tracking their body mass index (BMI) over time while accounting for potentially confounding influences of socioeconomic status and gender and exploring whether gender modified associations between occupational group, BMI, and retirement timing. Compared with women in professional occupations, women managers were less likely to be obese at baseline and were less likely to be in the obese upward trajectory class, while female professionals and operators and laborers were less likely than women in farm and precision production to be in the normal stable trajectory. Male professionals were less likely than men in sales, service, and operator and laborer positions to be obese at baseline and more often followed the normal upward trajectory than most other groups, though they and farm and precision production men were more likely to be in the overweight to obese trajectory than men in service occupations. Adjustment for sociodemographic and lifestyle characteristics reduced associations more for men than for women. While retirement risk differed across occupational groups, most of these differences were explained by socioeconomic, demographic, and lifestyle characteristics, especially for men. Obesity at baseline was an independent predictor of retirement but did not further explain differences in the timing of retirement by occupational group.

Work organization, health, and obesity in urban transit operators: A qualitative study

BACKGROUND

Urban transit operators have high rates of obesity, hypertension, and other cardiovascular risk-factors compared to other occupations. There have been few qualitative studies exploring the interrelationships between the organization of transit work, stress, and health including obesity, from the perspective of operators.

METHODS

Five focus groups were conducted at five Divisions in a transit authority in Southern California and included 65 bus and rail operators.

RESULTS

Operators reported a great deal of stress related to their work, including 1) time pressures and lack of recovery time; 2) long work shifts and overtime; 3) feeling unsafe when dealing with the public; 4) lack of respect from supervisors and management. Operators believed stressful working conditions negatively impacted their health and weight.

CONCLUSION

This qualitative study yielded new as well as confirmatory data about stress and transit work organization, health, and weight in operators. This study will add to future survey research and interventions in this population.

Using systematic review in occupational safety and health

Evaluation of scientific evidence is critical in developing recommendations to reduce risk. Healthcare was the first scientific field to employ a systematic review approach for synthesizing research findings to support evidence-based decision-making and it is still the largest producer and consumer of systematic reviews. Systematic reviews in the field of occupational safety and health are being conducted, but more widespread use and adoption would strengthen assessments. In 2016, NIOSH asked RAND to develop a framework for applying the traditional systematic review elements to the field of occupational safety and health. This paper describes how essential systematic review elements can be adapted for use in occupational systematic reviews to enhance their scientific quality, objectivity, transparency, reliability, utility, and acceptability.

A socioecological framework for research on work and obesity in diverse urban transit operators based on gender, race, and ethnicity

Urban transit (bus and rail) operators, totaling nearly 700,000 persons, are one of the heaviest occupational groups in the United States (US). Little is known about occupational risk factors for weight gain and obesity and their interrelationship with health-related behaviors, particularly among female minority (African Americans and Hispanics) transit operators who are at greater risk for obesity. As a step towards developing successful obesity interventions among urban transit operators, this paper aims to present a new socioecological framework for studying working conditions, chronic strain, health-related behaviors, weight gain/obesity, and obesity disparity in diverse urban transit operators based on gender, race, and ethnicity. Our framework is a synthesis of several different theories and disciplines: the resource-work load model (work stress), occupational ergonomics, the theory of intersectionality, and worksite health promotion. The framework was developed utilizing an extensive literature review, results from our on-going research on obesity, input from focus groups conducted with Los Angeles transit operators as well as interviews and meetings with transit operator stakeholders (management, unions, and worksite transit wellness program), and ride-along observations. Our hypotheses highlighted in the framework (see Fig. 1) are that adverse working conditions, largely characterized as a combination of high demands and low resources, will increase the risk for weight gain/obesity among transit operators directly through chronic strain and hypothalamic dysfunction (hyper-and hypo-activations), and indirectly through health-related behaviors and injuries/chronic severe pain. We also hypothesize that the observed increase in adiposity among female minority operators is due to their greater exposure to adverse occupational and non-occupational conditions that reflect their intersecting social identities of lower social class and being a minority woman in the US. Our proposed framework could greatly facilitate future transit worksite obesity studies by clarifying the complex and important roles of adverse working conditions in the etiology of weight gain/obesity and obesity disparity among transit operators and other working populations.

Entry Body Mass and Earnings: Once Penalized, Ever Penalized?

It has previously been reported that an individual's body mass index (BMI) contemporaneously penalizes wages for women, but has no effect and sometimes rewards wages for men. In young adults, we estimate the association of BMI status with initial wages to assess whether initial BMI at the beginning of an individual's career affects initial and later earnings. We pooled data from 388 men and 305 women, aged 20-40 years, with BMI information for the first year of employment, using the Korean Labor and Income Panel Study. A labor market penalty for a higher BMI among women was found only for overweight or obese segments, particularly those with relatively higher monthly wages. Meanwhile, a higher BMI in underweight or normal weight segments could reward employment probability for women and monthly wages for men. Such rewards of relatively higher monthly wages were also estimated for men in the overweight segment. Our findings suggest discrimination as one factor penalizing higher BMI in the labor market.

The Impact of Obesity in the Workplace: a Review of Contributing Factors, Consequences and Potential Solutions

This narrative review summarized findings from previous reviews and the most recently published studies, regarding the following: (1) the association between two occupational risk factors-shift work and sedentary work-and obesity, (2) the effects of obesity on workplace productivity and (3) the effectiveness of workplace interventions aimed at preventing or reducing obesity. Despite some inconsistencies in findings, there is convincing evidence that shift work increases the risk of obesity, while most studies did not show a significant association between sedentary work and obesity. Overweight and obesity were found to be associated with absenteeism, disability pension and overall work impairment, whilst evidence of their relationship with presenteeism, unemployment and early retirement was not consistent. Due to the vast heterogeneity in the types of workplace-based interventions to prevent or treat obesity, no sound conclusions can as yet be drawn about their overall effectiveness and best practice recommendations for their implementation.

24-hour work shifts, sedentary work, and obesity in male firefighters

BACKGROUND

Little is known about the occupational risk factors for obesity in US firefighters.

METHODS

308 male California firefighters, who participated in a work and obesity project, were chosen. Working conditions were measured with a firefighter-specific occupational health questionnaire. Adiposity was clinically assessed using body mass index (BMI), waist circumference (WC), and body fat percent.

RESULTS

In a multivariate analysis, the prevalence of obesity by all measures was significantly higher (PRs = 3.69-6.03, P < 0.05) in the firefighters who reported seventeen to twenty-one shifts than those who reported eight to eleven shifts in the past month. Prolonged sedentary work was also a risk factor for obesity by BMI (PR = 4.18, P < 0.05). Furthermore, there was a linear dose-response relationship of obesity by BMI and WC with the number of 24-hr shifts and sedentary work.

CONCLUSIONS

Many additional 24-hr shifts and prolonged sedentary work substantially increased the risk for obesity in male firefighters. Am. J. Ind. Med. 59:486-500, 2016. © 2016 Wiley Periodicals, Inc.

The Perils of Integrating Wellness and Safety and Health and the Possibility of a Worker-Oriented Alternative

Integration of workplace wellness with safety and health has gained momentum on the initiative of the state allied with a segment of large employers and some health and safety professionals. Integration has a dual potential: to fundamentally reshape occupational health in ways that profoundly benefit workers, or to serve neoliberal corporate goals. A focus on the workplace and the ways work and health interact broaden the definition of a work-related injury or illness and emphasize and challenge the employer decisions that create hazards and determine risk. However, the implementation of integration is taking place in a context of corporate dominance and the aggressive pursuit of a neoliberal agenda. Consequently, in practice, integration efforts have emphasized individual worker responsibility for health and fail to actually integrate wellness with safety and health in a meaningful way. Can an alternative be envisioned and pursued that realizes the promise of integration for workers?

Overweight, obesity and work functioning: the role of working-time arrangements

BACKGROUND

Obesity is associated with productivity loss, but little is known about how obese workers function at work and also the role of working-time arrangements on this association is lacking. Therefore, the aim of this study was to examine the association of overweight and obesity with work functioning (WF), and to determine whether the associations differ between workers with different working-time arrangements.

METHODS

A cross-sectional study was conducted within the sampling frame of the 'Shift Your Work' study that examined the effect of irregular working-times in relation to health and functioning at work. We included N = 622 Dutch employees, of which N = 384 (62%) were shift-workers, N = 171 (27%) on-call workers and N = 67 (11%) day-workers. Overweight and obesity were defined as BMI 25-30 and ≥30, respectively. WF was assessed using the Work-Role Functioning Questionnaire.

RESULTS

The prevalences of overweight and obesity were 48% and 10% in all workers, 49% and 11% in shift-workers, 45% and 10% in on-call workers, and 49% and 6% in day workers, respectively. In all workers, obesity was associated with lower WF scores for physical demands (adjusted estimate, aB = -5.5). In shift-workers, obesity was associated with lower WF scores for output and physical demands (aB = -8.8 and -6.8, respectively). In day and on-call workers, overweight and obesity were not associated with WF.

CONCLUSIONS

Overweight and obesity are highly prevalent in the working population. Obesity might reduce the executive function performance beyond physical limitations, and limit the ability to accomplish tasks successfully, especially in shift workers.

Demographic, health-related, and work-related factors associated with body mass index and body fat percentage among workers at six Connecticut manufacturing companies across different age groups: a cohort study

BACKGROUND

Effective workplace interventions that consider the multifactorial nature of obesity are needed to reduce and prevent obesity among adults. Furthermore, the factors associated with obesity may differ for workers across age groups. Therefore, the objective of this study was to identify demographic, health-related, and work-related factors associated with baseline and changes in body mass index (BMI) and body fat percentage (BFP) and among Connecticut manufacturing workers acrossage groups.

METHODS

BMI and BFPof 758 workers from six Connecticut manufacturing companies were objectively measuredat two time points approximately 36 months apart. Demographic, health-related, and work-related factors wereassessed via questionnaire. All variables were included in linear regression models to identify factors associated with baseline and changes in BMI and BFP for workers in 3 age groups: <45 years (35 %), 45-55 years (37 %), >55 years (28 %).

RESULTS

There were differences in baseline and changes in BMI and BFP among manufacturing workers across age groups. Being interested in changing weight was significantly (p < 0.01) associated with higher baseline BMI and BFP across all age categories. Other factors associated with higher baseline BMI and BFP differed by age group and included: male gender (BMI p = 0.04), female gender (BFP p < 0.01), not having a college education (BMI p = 0.01, BFP p = 0.04), having childcare responsibilities (BMI p = 0.04), and working less overtime (p = 0.02) among workers in the <45 year age category, male gender (BMI p = 0.02), female gender (BFP p < 0.01) and reporting higher stress in general (BMI p = 0.04) among workers in the 45-55 year age category, and female gender (BFP p < 0.01) and job tenure (BFP p = 0.03) among workers in the >55 year age category. Few factors were associated with change in BMI or BFP across any age category.

CONCLUSIONS

Among manufacturing workers, we identified associations between individual, health-related, and work-related factors and baseline BMIand BFP that differed by age. Such results support the use of strategies tailored to the challenges faced by workers in specific age groups rather than adopting a one size fits all approach. Effective interventions should consider a full range of individual, health-related, and work-related factors. More work must be done to identify factors or strategies associated with changes in obesity over time.

Considerations for Incorporating "Well-Being" in Public Policy for Workers and Workplaces

Action to address workforce functioning and productivity requires a broader approach than the traditional scope of occupational safety and health. Focus on "well-being" may be one way to develop a more encompassing objective. Well-being is widely cited in public policy pronouncements, but often as ". . . and well-being" (e.g., health and well-being). It is generally not defined in policy and rarely operationalized for functional use. Many definitions of well-being exist in the occupational realm. Generally, it is a synonym for health and a summative term to describe a flourishing worker who benefits from a safe, supportive workplace, engages in satisfying work, and enjoys a fulfilling work life. We identified issues for considering well-being in public policy related to workers and the workplace.

Contribution of daily and seasonal biorhythms to obesity in humans

While the significance of obesity as a serious health problem is well recognized, little is known about whether and how biometerological factors and biorhythms causally contribute to obesity. Obesity is often associated with altered seasonal and daily rhythmicity in food intake, metabolism and adipose tissue function. Environmental stimuli affect both seasonal and daily rhythms, and the latter are under additional control of internal molecular oscillators, or body clocks. Modifications of clock genes in animals and changes to normal daily rhythms in humans (as in shift work and sleep deprivation) result in metabolic dysregulation that favours weight gain. Here, we briefly review the potential links between biorhythms and obesity in humans.

The longitudinal joint effect of obesity and major depression on work performance impairment

OBJECTIVES

We examined the longitudinal effect of obesity, major depression, and their combination on work performance impairment (WPI).

METHODS

We collected longitudinal data (2004-2013) on 1726 paid employees from the Netherlands Study of Depression and Anxiety at baseline and 2-, 4-, and 6-year follow-up. We defined obesity with body mass index and waist circumference. We diagnosed major depression with the Composite International Diagnostic Interview 2.1. We assessed work performance impairment with a questionnaire for illness-associated costs. We used generalized estimating equations for modeling, and estimated interaction on the additive scale.

RESULTS

Obesity, abdominal obesity, and major depression were longitudinally associated with increased risk of high WPI. The combinations of obesity and major depression, and of abdominal obesity and major depression were associated with increased risk of high WPI (odds ratios of 2.36 [95% confidence interval = 1.61, 3.44] and 1.88 [95% confidence interval = 1.40, 2.53], respectively), but the relative excess risks attributable to interaction were nonsignificant.

CONCLUSIONS

The longitudinal joint effect of obesity and major depression on high WPI implies that obesity intervention may be more beneficial for individuals with major depression than those without regarding risk of high WPI, if confirmed in a large, representative sample.

Aggregate Exposure and Cumulative Risk Assessment--Integrating Occupational and Non-occupational Risk Factors

Occupational exposure limits have traditionally focused on preventing morbidity and mortality arising from inhalation exposures to individual chemical stressors in the workplace. While central to occupational risk assessment, occupational exposure limits have limited application as a refined disease prevention tool because they do not account for all of the complexities of the work and non-occupational environments and are based on varying health endpoints. To be of greater utility, occupational exposure limits and other risk management tools could integrate broader consideration of risks from multiple exposure pathways and routes (aggregate risk) as well as the combined risk from exposure to both chemical and non-chemical stressors, within and beyond the workplace, including the possibility that such exposures may cause interactions or modify the toxic effects observed (cumulative risk). Although still at a rudimentary stage in many cases, a variety of methods and tools have been developed or are being used in allied risk assessment fields to incorporate such considerations in the risk assessment process. These approaches, which are collectively referred to as cumulative risk assessment, have potential to be adapted or modified for occupational scenarios and provide a tangible path forward for occupational risk assessment. Accounting for complex exposures in the workplace and the broader risks faced by the individual also requires a more complete consideration of the composite effects of occupational and non-occupational risk factors to fully assess and manage worker health problems. Barriers to integrating these different factors remain, but new and ongoing community-based and worker health-related initiatives may provide mechanisms for identifying and integrating risk from aggregate exposures and cumulative risks from all relevant sources, be they occupational or non-occupational.

Does obesity modify the relationship between exposure to occupational factors and musculoskeletal pain in men? Results from the GAZEL cohort study

Objective

To analyze relationships between physical occupational exposures, post-retirement shoulder/knee pain, and obesity.

Methods

9 415 male participants (aged 63–73 in 2012) from the French GAZEL cohort answered self-administered questionnaires in 2006 and 2012. Occupational exposures retrospectively assessed in 2006 included arm elevation and squatting (never, <10 years, ≥10 years). “Severe” shoulder and knee pain were defined as ≥5 on an 8-point scale. BMI was self-reported.

Results

Mean BMI was 26.59 kg/m² +/−3.5 in 2012. Long-term occupational exposure to arm elevation and squatting predicted severe shoulder and knee pain after retirement. Obesity (BMI≥30 kg/m²) was a risk factor for severe shoulder pain (adjusted OR 1.28; 95% CI 1.03, 1.90). Overweight (adjusted OR 1.71; 1.28,2.29) and obesity (adjusted OR 3.21; 1.90,5.41) were risk factors for severe knee pain. In stratified models, associations between long-term squatting and severe knee pain varied by BMI.

Conclusion

Obesity plays a role in relationships between occupational exposures and musculoskeletal pain. Further prospective studies should use BMI in analyses of musculoskeletal pain and occupational factors, and continue to clarify this relationship.

Risk factors for nonwork-related adult-onset asthma and occupational asthma: a comparative review

PURPOSE OF REVIEW

To identify the similarities and differences between nonwork-related adult-onset and occupational asthma from various literature sources published between 2010 and 2013, with respect to the epidemiology, phenotypic manifestations, and risk factors for the disease.

RECENT FINDINGS

The incidence of adult-onset asthma from pooled population studies is estimated to be 3.6 per 1000 person-years in men and 4.6 cases per 1000 person-years in women. In adults with new-onset asthma, occupational asthma is a common asthma phenotype. Work-related factors are estimated to account for up to 25% of adult cases of asthma and occupational asthma comprising about 16% of adult-onset asthma cases. The review finds that nonwork-related adult-onset asthma is a heterogenous entity and that environmental exposure factors (aside from occupational exposures) appear to have a lesser role than host factors when compared with occupational asthma.

SUMMARY

Large-scale general population studies are needed to identify the similarities and differences between nonwork-related adult-onset and occupational asthma, which may enable a better understanding of these entities and promote efforts towards holistic management approaches for these asthma phenotypes.

Prevalence of obesity among U.S. workers and associations with occupational factors

BACKGROUND

Along with public health and clinical professionals, employers are taking note of rising obesity rates among their employees, as obesity is strongly related to chronic health problems and concomitant increased healthcare costs. Contributors to the obesity epidemic are complex and numerous, and may include several work characteristics.

PURPOSE

To explore associations between occupational factors and obesity among U.S. workers.

METHODS

Data from the 2010 National Health Interview Survey were utilized to calculate weighted prevalence rates and prevalence ratios (PRs) for obesity in relation to workweek length, work schedule, work arrangement, hostile work environment, job insecurity, work-family imbalance, and industry and occupation of employment. Data were collected in 2010 and analyzed in 2012-2013.

RESULTS

Overall, 27.7% of U.S. workers met the BMI criterion for obesity. Among all workers, employment for more than 40 hours per week and exposure to a hostile work environment were significantly associated with an increased prevalence of obesity, although the differences were modest. Employment in health care and social assistance and public administration industries, as well as architecture and engineering, community and social service, protective service, and office and administrative support occupations was also associated with increased obesity prevalence.

CONCLUSIONS

Work-related factors may contribute to the high prevalence of obesity in the U.S. working population. Public health professionals and employers should consider workplace interventions that target organization-level factors, such as scheduling and prevention of workplace hostility, along with individual-level factors such as diet and exercise.