Disclosure, Privacy and Workplace Accommodation of Episodic Disabilities: Organizational Perspectives on Disability Communication-Support Processes to Sustain Employment.

Purpose Employers increasingly are asked to accommodate workers living with physical and mental health conditions that cause episodic disability, where periods of wellness are punctuated by intermittent and often unpredictable activity limitations (e.g., depression, anxiety, arthritis, colitis). Episodic disabilities may be challenging for workplaces which must comply with legislation protecting the privacy of health information while believing they would benefit from personal health details to meet a worker's accommodation needs. This research aimed to understand organizational perspectives on disability communication-support processes. Methods Twenty-seven participants from diverse employment sectors and who had responsibilities for supporting workers living with episodic disabilities (e.g., supervisors, disability managers, union representatives, occupational health representatives, labour lawyers) were interviewed. Five participants also had lived experience of a physical or mental health episodic disability. Participants were recruited through organizational associations, community networks and advertising. Semi-structured interviews and qualitative content analysis framed data collection and analyses, and mapped communication-support processes. Results Seven themes underpinned communication-support process: (1) similarities and differences among physical and mental health episodic disabilities; (2) cultures of workplace support, including contrasting medical and biopsychosocial perspectives; (3) misgivings about others and their role in communication-support processes; (4) that subjective perceptions matter; (5) the inherent complexity of the response process; (6) challenges arising when a worker denies a disability; and (7) casting disability as a performance problem. Conclusions This study identifies a conceptual framework and areas where workplace disability support processes could be enhanced to improve inclusion and the sustainability of employment among workers living with episodic disabilities.

Examining occupational health and safety vulnerability among Canadian workers with disabilities.

OBJECTIVE: To compare workers with and without disabilities on their reported workplace hazard exposure and the presence of occupational health and safety vulnerability factors. METHODS: Working-aged adults in Ontario or British Columbia were recruited to participate in a cross-sectional survey (n = 1988). Self-reported measures included demographic factors, work-related variables, perceived level of activity limitation at work, and presence of work safety vulnerability factors utilizing a novel framework. RESULTS: Reporting a disability at work was significantly associated with greater hazard exposure than those without a disability. In addition, those reporting a disability at work were more likely to be employed in conditions where hazard exposure was combined with inadequate policies and procedures, or hazard exposures were combined with inadequate empowerment. CONCLUSIONS: Work safety vulnerability is one way that health inequalities can be perpetuated even among those with disabilities who have found work. Our results suggest that employers and policy makers need to focus on assessing and addressing hazard exposures and targeting occupational health and safety resources in the workplace in a way that includes workers with disabilities. Implications for Rehabilitation Workers with disabilities experience greater hazard exposure than those without a disability. Those with moderate and severe disabilities reported occupational health and safety vulnerability, suggesting that workplace accommodations should be available to a broader range of disability levels. It appears that, above and beyond standard safety procedures, providing workplace accommodations for people with disabilities may further reduce their hazard exposure and improve their safety.

Risk of work injury among adolescent students from single and partnered parent families.

BACKGROUND: Parental involvement in keeping their children safe at work has been examined in a handful of studies, with mixed results. Evidence has suggested that non-work injury risk is higher among children from single-parent families, but little is known about their risk for work-related injuries. METHODS: Five survey cycles of the Canadian Community Health Survey were pooled to create a nationally representative sample of employed 15-19-year old students (N = 16,620). Multivariable logistic regression estimated the association between family status and work injury. RESULTS: Risk of work-related repetitive strains (OR:1.24, 95%CI: 0.69-2.22) did not differ by family type. However, children of single parents were less likely to sustain a work injury receiving immediate medical care (OR:0.43, 95%CI: 0.19-0.96). CONCLUSION: Despite advantages and disadvantages related to family types, there is no evidence that work-related injury risk among adolescents from single parent families is greater than that of partnered-parent families. Am. J. Ind. Med. 60:285-294, 2017. © 2017 Wiley Periodicals, Inc.

Course of Depressive Symptoms Following a Workplace Injury: A 12-Month Follow-Up Update.

Introduction To estimate the prevalence, incidence and course of depressive symptoms, their relationship with return-to-work, and prevalence of depression diagnosis/treatment 12 months following a lost-time workplace musculoskeletal injury. Methods In a prospective cohort study, 332 workers' compensation claimants with a back or upper extremity musculoskeletal disorder completed interviews at 1, 6 and 12 months post-injury. Participants self-reported they had not received a depression diagnosis 1 year pre-injury. Cutoff of 16 on the CES-D defined a high level of depressive symptoms. Self-reported data on depression diagnosis and treatment and work status since injury were collected. Results Cumulative incidence of high depressive symptom levels over 12 months was 50.3 % (95 % CI 44.9-55.7 %). At 12 months, 24.7 % (95 % CI 20.1-29.3 %) of workers exhibited high levels. Over 12 months, 49.7 % (95 % CI 44.3-55.1 %) had low levels at all 3 interviews, 14.5 % (95 % CI 10.7-18.2 %) had persistently high levels, and 25.6 % (95 % CI 20.9-30.3 %) demonstrated improvements. Among workers with low baseline levels, incidence of high levels at 12 months was 6.0 % (95 % CI 2.7-9.3 %). For workers with high baseline levels, 36.1 % (95 % CI 27.9-44.3 %) exhibited persistent high symptoms at 6 and 12 months, while 38.4 % (95 % CI 30.1-46.6 %) experienced low levels at 6 and 12 months. Problematic RTW outcomes were common among workers with a poor depressive symptom course. Among workers with persistent high symptoms, 18.8 % (95 % CI 7.7-29.8 %) self-reported receiving a depression diagnosis by 12 months and 29.2 % (95 % CI 16.3-42.0 %) were receiving treatment at 12 months. Conclusions Depressive symptoms are common in the first year following a lost-time musculoskeletal injury and a poor depressive symptom course is associated with problematic RTW outcomes 12 months post-injury. While symptoms appear to improve over time, the first 6 months appear to be important in establishing future symptom levels and may represent a window of opportunity for early screening.

Barriers to the Adoption of Safety-Engineered Needles Following a Regulatory Standard: Lessons Learned from Three Acute Care Hospitals.

BACKGROUND: A number of jurisdictions have introduced regulation to accelerate the adoption of safety-engineered needles (SENs). This study examined the transition to SENs in three acute care hospitals prior to and following the implementation of a regulatory standard in Ontario. This paper focuses on the ongoing barriers to the prevention of needlestick injuries among healthcare workers. METHODS: Information from document review and 30 informant interviews were used to prepare three case studies detailing each organization's implementation activities and outcomes. RESULTS: All three hospitals responded to the regulatory requirements with integrity and needlestick injuries declined. However, needlestick injuries continued to occur during the activation of safety devices, during procedures and during instrument disposal. The study documented substantial barriers to further progress in needlestick injury prevention. CONCLUSIONS: Healthcare organizations should focus on understanding their site-specific challenges that contribute to ongoing injury risk to better understand issues related to product limitations, practice constraints and the work environment.

The development of a conceptual model and self-reported measure of occupational health and safety vulnerability.

Injuries at work have a substantial economic and societal burden. Often groups of labour market participants, such as young workers, recent immigrants or temporary workers are labelled as being "vulnerable" to work injury. However, defining groups in this way does little to enable a better understanding of the broader factors that place workers at increased risk of injury. In this paper we describe the development of a new measure of occupational health and safety (OH&S) vulnerability. The purpose of this measure was to allow the identification of workers at increased risk of injury, and to enable the monitoring and surveillance of OH&S vulnerability in the labour market. The development included a systematic literature search, and conducting focus groups with a variety of stakeholder groups, to generate a pool of potential items, followed by a series of steps to reduce these items to a more manageable pool. The final measure is 29-item instrument that captures information on four related, but distinct dimensions, thought to be associated with increased risk of injury. These dimensions are: hazard exposure; occupational health and safety policies and procedures; OH&S awareness; and empowerment to participate in injury prevention. In a large sample of employees in Ontario and British Columbia the final measure displayed minimal missing responses, reasonably good distributions across response categories, and strong factorial validity. This new measure of OH&S vulnerability can identify workers who are at risk of injury and provide information on the dimensions of work that may increase this risk. This measurement could be undertaken at one point in time to compare vulnerability across groups, or be undertaken at multiple time points to examine changes in dimensions of OH&S vulnerability, for example, in response to a primary prevention intervention.

The demographic and contextual correlates of work-related repetitive strain injuries among Canadian men and women.

BACKGROUND: The study sought to identify gender differences in work-related repetitive strain injuries (RSI), as well as examine the degree to which non-work factors such as family roles interact with gender to modify RSI risk. Another aim is to examine whether there are potential provincial differences in work-related RSI risk. METHODS: The 2003/2005 Canadian Community Health Survey included over 89,000 respondents who reported working in the past 12 months. Separate multi-level models for men and women were used to identify the correlates of work-related RSIs. RESULTS: Women reported sustaining more work-related RSIs than men. Also, having one or more children in the household was associated with lower work-related RSI risk for females. Both men and women in British Columbia reported higher work-related RSI rates than in Ontario. CONCLUSIONS: Gender contributes to RSI risk in multiple and diverse ways based on labor market segregation, non-work exposures, and possibly biological vulnerability, which suggests more tailored interventions. Also, the provincial differences indicate that monitoring and surveillance of work injury across jurisdictions can assist in province-wide prevention and occupational health and safety evaluation.

Geographic variation in work injuries: a multilevel analysis of individual-level data and area-level factors within Canada.

PURPOSE: This study sought to examine provincial variation in work injuries and to assess whether contextual factors are associated with geographic variation in work injuries. METHODS: Individual-level data from the 2003 and 2005 Canadian Community Health Survey was obtained for a representative sample of 89,541 Canadians aged 15 to 75 years old who reported working in the past 12 months. A multilevel regression model was conducted to identify geographic variation and contextual factors associated with the likelihood of reporting an activity limiting work injury [corrected], while adjusting for demographic and work variables. RESULTS: Provincial differences in work injuries were observed, even after controlling for other risk factors. Workers in western provinces such as Saskatchewan (adjusted odds ratio [AOR], 1.30; 95% confidence interval [CI], 1.09-1.55), Alberta (AOR, 1.31; 95% CI, 1.13-1.51), and British Columbia (AOR, 1.46; 95% CI, 1.26-1.71) had a higher risk of work injuries compared with Ontario workers. Indicators of area-level material and social deprivation were not associated with work injury risk. CONCLUSIONS: Provincial differences in work injuries suggest that broader factors acting as determinants of work injuries are operating across workplaces at a provincial level. Future research needs to identify the provincial determinants and whether similar large area-level factors are driving work injuries in other countries.

Examining job tenure and lost-time claim rates in Ontario, Canada, over a 10-year period, 1999-2008.

OBJECTIVE: We sought to examine the association between job tenure and lost-time claim rates over a 10-year period in Ontario, Canada. METHODS: Data were obtained from workers' compensation records and labour force survey data from 1999 to 2008. Claim rates were calculated for gender, age, industry, occupation, year and job tenure group. A multivariate analysis and examination of effect modification were performed. Differences in injury event and source of injury were also examined by job tenure. RESULTS: Lost-time claim rates were significantly higher for workers with shorter job tenure, regardless of other factors. Claim rates for new workers differed by gender, age and industry, but remained relatively constant at an elevated rate over the observed time period. CONCLUSIONS: This study is the first to examine lost-time claim rates by job tenure over a time period during which overall claim rates generally declined. Claim rates did not show a convergence by job tenure. Findings highlight that new workers are still at elevated risk, and suggest the need for improved training, reducing exposures among new workers, promoting permanent employment, and monitoring work injury trends and risk factors.

Examining the decline in lost-time claim rates across age groups in Ontario between 1991 and 2007.

OBJECTIVES: Given the tendency for young people to show elevated work injury rates, this study sought to examine trends in young worker and adult compensation claim rates in a Canadian province. METHODS: Workers' compensation records and labour force survey data from 1991 to 2007 were used to compute claim rates by age group. To examine the contribution of work-related factors to claim rates by age group, multivariate analyses included industry and job tenure. RESULTS: Descriptive analysis showed that age groups had different rates of declines over the time period. Multivariate analyses showed that claim rate declines for older adults were greatest prior to 1999. Young workers showed the largest declines after 1999. There was no indication that changes in industry or job tenure accounted for the trends in claim rates among older or younger workers. CONCLUSIONS: This study is one of the first to show a convergence in youth and adult workers' compensation claims in a North American jurisdiction. Ruling out work-related factors increases the possibility that systemic interventions may have contributed to the convergence. This provides policy makers in occupational health and safety with empirical data to guide targeting of resources.

Assessing occupational health and safety of young workers who use youth employment centers.

BACKGROUND: Adolescents and young adults who are out of school are at elevated risk for a work injury. METHODS: To obtain more information on this "high risk" group of young workers, young people at youth employment centers across Ontario were asked through an online survey about training, unsafe work conditions, work injuries and safety knowledge. RESULTS: The 1,886 youth who completed the survey reported a medically attended work injury rate of 14.45 per 100 FTEs. Also, the most common unsafe work conditions were dust/particles, trip hazards and heavy lifting. In addition, many young workers reported using much of their income for living essentials (e.g., rent). CONCLUSIONS: Though not a representative sample, it appears that youth using employment centers experience many unsafe work conditions and work injuries. While many report safety training, the nature and effectiveness of this training remains to be determined. The large portion of young workers out of school and working for living essentials included in this sample suggest that youth employment centers should be considered in future prevention efforts targeting this vulnerable subgroup of workers.

Effectiveness of health and safety in small enterprises: a systematic review of quantitative evaluations of interventions.

INTRODUCTION: This systematic review was conducted to identify effective occupational health and safety interventions for small businesses. METHODS: The review focused on peer-reviewed intervention studies conducted in small businesses with 100 or fewer employees, that were published in English and several other languages, and that were not limited by publication date. Multidisciplinary members of the review team identified relevant articles and assessed their quality. Studies assessed as medium or high quality had data extracted, which was then synthesized. RESULTS: Five studies were deemed of medium or high quality, and proceeded to data extraction and evidence synthesis. The types of interventions identified: a combination of training and safety audits; and a combination of engineering, training, safety audits, and a motivational component, showed a limited amount of evidence in improving safety outcomes. Overall, this evidence synthesis found a moderate level of evidence for intervention effectiveness, and found no evidence that any intervention had adverse effects. CONCLUSIONS: Even though there were few studies that adequately evaluated small business intervention, several studies demonstrate that well-designed evaluations are possible with small businesses. While stronger levels of evidence are required to make recommendations, these interventions noted above were associated with positive changes in safety-related attitudes and beliefs and workplace parties should be aware of them.

Course, diagnosis, and treatment of depressive symptomatology in workers following a workplace injury: a prospective cohort study.

OBJECTIVES: To estimate prevalence, incidence, and course of depressive symptoms and prevalence of mental health treatment following a workplace injury, and to estimate the association between depressive symptoms and return-to-work (RTW) trajectories. METHOD: In a prospective cohort study, workers filing a lost-time compensation claim for a work-related musculoskeletal disorder of the back or upper extremity were interviewed 1 month (n = 599) and 6 months (n = 430) postinjury. A high level of depressive symptoms was defined as 16 or more on the self-reported Center for Epidemiologic Studies-Depression (CES-D) Scale. The following estimates are reported: prevalence of high depressive symptom levels at 1 and 6 months postinjury; incidence, resolution, and persistence of high depressive symptom levels between 1 and 6 months; and prevalence of self-reported mental health treatment and depression diagnosis at 6 months postinjury. RESULTS: Prevalence of high depressive symptom levels at 1 month and 6 months postinjury were 42.9% (95% CI 38.9% to 46.9%) and 26.5% (95% CI 22.3% to 30.7%), respectively. Among participants reporting high depressive symptom levels at 1 month postinjury, 47.2% (95% CI 39.9% to 54.5%) experienced a persistence of symptoms 6 months postinjury. By 6 months, 38.6% of workers who never returned to work or had work disability recurrences had high depressive symptom levels, compared with 17.7% of those with a sustained RTW trajectory. At 6-month follow-up, 12.9% (95% CI 5.8% to 20.1%) of participants with persistently high depressive symptom levels self-reported a depression diagnosis since injury and 23.8% (95% CI 14.7% to 32.9%) were receiving depression treatment. CONCLUSIONS: Depressive symptoms are pervasive in workers with musculoskeletal injuries, but transient for some, and seldom diagnosed as depression or treated.

Work injury risk among young people with learning disabilities and attention-deficit/hyperactivity disorder in Canada.

OBJECTIVES: We sought to gain a better understanding of the relationship between learning disabilities, attention-deficit/hyperactivity disorder (ADHD), and risk of occupational injury among young workers. METHODS: We assessed 15- to 24-year-old workers (n = 14 379) from cycle 2.1 of the Canadian Community Health Survey (CCHS). We gathered data on demographic characteristics, work-related factors, and presence of learning disabilities or ADHD. We conducted a multivariate logistic regression analysis to assess occurrences of medically attended work injuries. RESULTS: There was an 89% adjusted increase in work injury risk among workers with self-reported dyslexia (a type of learning disability) relative to workers reporting no learning disabilities, although this result did not meet traditional statistical significance criteria. Being out of school, either with or without a high school diploma, was associated with a significantly increased risk of work injury, even after control for a number of demographic and work-related variables. CONCLUSIONS: Our findings underscore the notion that individual differences salient in the education system (e.g., learning disabilities, school dropout) need to be integrated into conceptual models of injury risk among young workers.

Investigating the longer-term health consequences of work-related injuries among youth.

PURPOSE: To investigate the longer-term health consequences of work injuries among youth aged 15-24 years using a population-based, longitudinal study (1991-2001) of merged health care and workers' compensation records. METHODS: A group-based modeling approach was used (1) to identify unique trajectories of health care use defined by general practitioner visits among the study sample stratified by gender, and (2) to determine the injury factors that predict a youth's membership in a trajectory, adjusted for sociodemographic factors. RESULTS: Four long-term trajectories of health care use were identified among young injured workers, for both males and females. Similar trajectories were observed among a comparison, noninjured sample but the magnitude of health care use was consistently higher among the injured worker cohort, especially for females (attributable to general practitioner [GP] visits for symptoms, signs and ill-defined diagnoses), and a notable "spike" in health care use occurred in the year immediately after a work injury for both males and females that was not observed in the comparison population during the matched year (attributable to GP visits for musculoskeletal and injury diagnoses). For males, the type of work injury mattered with an increased odds of belonging to the higher health care trajectories associated with a musculoskeletal injury (odds ratio [OR] = 1.57, 95% CI = .76, 3.23; and OR = 1.61, 95% CI 1.08, 2.41 for the postinjury trajectories), adjusted for age, occupation, socioeconomic status, and geographic location. CONCLUSION: Persistent use of health care services may represent a cumulative burden of morbidity over the life course as a result of a work-related injury in general among young women and as a result of musculoskeletal injuries in particular among males.

Employment patterns and work injury experience among Canadian 12 to 14 year olds.

BACKGROUND: Work participation is a common activity for young adolescents. Yet it may impact upon other aspects of their lives and their health. We sought to provide some of the first Canadian population-based estimates of 12 to 14 year olds' employment and work injury experiences, a group typically excluded from labour force statistics. METHODS: Secondary data analysis of school-based surveys in Ontario (ON) in 2003 and British Columbia (BC) in 2005. Questions provided information on participation in formal and informal work during the school year, number of hours worked, and the occurrence of a medically attended work injury for students 12 to 14 years old. Different sampling strategies were accounted for in the analyses, including the calculation of 95% confidence intervals (CI) on prevalence estimates. RESULTS: Overall, 52.9% (95% CI 48.7-57.1) of ON and 41.5% (39.7-43.3) of BC 12 to 14 year olds reported working during the school year. Mean hours per week ranged from 3.3 (2.5-4.0) among Ontario 12 year olds engaged in non-formal work up to 11.7 (10.0-13.3) among British Columbia 14 year olds engaged in formal work. Work injuries were reported by 6% (4.0-8.9) of ON young workers and 3.5% (2.6-4.8) of BC workers. INTERPRETATION: Our findings point to the active presence of young adolescents in the labour market. Systematic approaches to active surveillance of work participation and work health and safety for young adolescents across Canada should be developed. Differences in work injury patterns by province may be worthy of further investigation.

Educational status and work injury among young people: refining the targeting of prevention resources.

OBJECTIVES: To examine the risk of work injuries among young workers out of school compared to those working while still in school. METHODS: The 12,506 fifteen to twenty-four year old workers were part of a national survey that used a multi-staged, stratified sampling procedure. Respondents were divided into four groups based on current school activity (i.e., out of school vs. in school) and educational level (i.e., not having completed high school vs. completed high school). A multivariate logistic regression was conducted using a weighted bootstrap method for variance estimation on occurrence of a work injury that was medically attended. RESULTS: Those young workers out of school and not having completed high school (8.2 per 100 full-time equivalents [FTEs]) and those out of school with a high school degree (5.1 per 100 FTEs) had higher unadjusted rates of work injuries compared to those workers in school not having completed high school (3.1 per 100 FTEs) or those in school with a high school degree (2.7 per 100 FTEs). These differences persisted in a multivariate regression with demographic and work-related covariates included. In addition, young people out of school reported a different work environment as evidenced by decreased social support at work. CONCLUSIONS: The elevated injury risk of young workers out of school suggests that school-based work safety education programs need to be supplemented with other prevention strategies that improve the fit between these young workers' experience and capabilities and the work environment.

The role of educational level and job characteristics on the health of young adults.

The mediating effect of job characteristics in the socioeconomic status (SES)-health relationship has not been well studied in the young adult population. The early health trajectory is important to study since the health trajectories of young people shape their health in later years. The purpose of this study was to determine whether the education defined SES-health relationship is mediated through job characteristics, controlling for healthy lifestyle factors in young adults. We hypothesize that accounting for differences in job quality would reduce the education-health gradient. Using a sample of 10,215 Canadian workers aged 20-29 years, we used multivariable logistic regressions to examine the associations of sociodemographic, work, and lifestyle factors with two health outcomes, self-perceived health and work-related injury. The key findings indicate that job characteristics partly explain the education gradient observed in work-related injuries, and to a lesser extent in self-perceived health for working young adults. Our results show that increased physical exertion and working in sales and service or manual occupations were job characteristics which were independently associated with work-related injuries, while low work-related social support and irregular shift work were associated with poor self-perceived health. Lifestyle factors have a greater association with the education-self-perceived health relationship. This pattern of findings suggests that work factors related to education have a more specific effect on occupational health early in the health trajectory. These findings have potential practical implications since policies to reduce poor health must be targeted at appropriate age groups, as workers need to be healthy in their younger years in order to stay in the workforce as they age.

The relationship between job tenure and work disability absence among adults: a prospective study.

Little population-based, prospective research has been conducted to examine the demographic and work-related determinants of occupational injury or illness. This study examined the relative contribution of sociodemographic characteristics and work factors to the likelihood of a work-related disability or illness. In a representative sample of adult Canadians 25-70 years old from a prospective survey, a hazard modelling approach of time to work disability absence from the start of a new job was estimated with the following predictors: age, gender, type of job (manual, non-manual, and mixed), hours worked, highest education achieved, multiple concurrent job, job tenure, school activity, union membership and living in a rural or urban area. Workers holding manual or mixed jobs and having a low education level were factors independently associated with the increased likelihood of a work disability absence. Gender was not independently associated with work disability absences. A strong job tenure gradient in the unadjusted work disability absence rates was virtually eliminated when controlling for demographic/individual and other work factors. In multivariate analyses, work-related factors remained predictors of work disability absence whereas individual characteristics such as gender did not. The exception was workers with less education who appeared to be particularly vulnerable, even after controlling of physical demands on the job. This may be due to inadequate job training or increased hazard exposure even in the same broad job category.

Antecedents of work disability absence among young people: a prospective study.

PURPOSE: This study examined the relative contribution of individual factors, job characteristics, and temporal factors to the likelihood of lost days of work due to a work-related disability or illness among Canadians 16 to 24 years old. METHODS: Using a prospective Canadian survey with up to 6 years of follow-up, the job-based analyses included 45,125 job episodes generated from a representative sample of young workers. A hazard model on work disability absence included the following predictors: age, gender, physical demands of the job (manual, nonmanual, and mixed), hours worked, highest education achieved, multiple concurrent job, job tenure, school activity, and living in a rural or urban area. RESULTS: The overall 1-week work disability absence rate was 0.78 per 1000 person-months. In the multivariate model, young workers holding manual jobs were 2.65 times more likely to have a work disability absence compared with young workers with nonmanual jobs. Also, those with less than a high school education were almost 3 times more likely to have a work disability absence. Other demographic factors such as gender were not independently associated with work disability absences. CONCLUSIONS: This prospective study finds that job characteristics are the predominant risk factors for work disability absences for young workers. Young workers with less education appear to be particularly vulnerable, possibly because of inadequate job skills or particularly dangerous job tasks.