Trends in severity of work-related traumatic injury and musculoskeletal disorder, Ontario 2004-2017.

OBJECTIVES: Traumatic injury surveillance can be enhanced by describing injury severity trends. This study reports trends in work-related injury severity for males and females over the period 2004-2017 in Ontario, Canada. METHODS: A weighted measure of workers' compensation benefit expenditures was used to define injury severity, obtained from the linkage of workers' compensation claims to emergency department (ED) records where the main injury or illness was attributed to work. Denominator counts were obtained from Statistics Canada's Labor Force Survey. Trends in the annual incidence of injury, classified as low, moderate, or high severity, were examined using regression modeling, stratified by age and sex. RESULTS: Over a 14-year observation period, there were 1,636,866 ED records included in the analyses. Overall, 57.6% of occupational injury records were classified as low severity, 29.5% as moderate severity, and 12.8% as high severity conditions. There was an increase in the incidence of high severity injuries among females (annual percent change (APC): 1.52%; 95% CI: 0.77, 2.28), while the incidence of low and moderate severity injuries generally declined for males and females. Among females, injuries attributed to animate mechanical forces and assault increased as causes of low, moderate, and high severity injuries. The incidence of concussion increased for both males (APC: 10.51%; 95% CI: 8.18, 12.88) and females (APC: 16.37%; 95% CI: 13.37, 19.45). CONCLUSION: The incidence of severe work-related injuries increased among females in Ontario between 2004 and 2017. The methods applied in this surveillance study of traumatic injury severity are plausibly generalizable to applications in other jurisdictions.

The adequacy of workplace accommodation and the incidence of permanent employment separations after a disabling work injury or illness.

OBJECTIVE: This study aimed to estimate the influence of the adequacy of employer accommodations of health impairments in predicting permanent separation from the employment relationship in a cohort of workers disabled by a work-related injury or illness. METHODS: The study used data from a retrospective, observational cohort of 1793 Ontario workers who participated in an interviewer-administered survey 18 months following a disabling injury or illness. The relative risks (RR) of a permanent employment separation associated with inadequate employer accommodations were estimated using inverse probability of treatment weights to reduce confounding. RESULTS: Over the 18-month follow-up, the incidence of permanent separation was 30.1/100, with 49.2% of separations related to health status. Approximately 51% of participants experiencing a separation were exposed to inadequate workplace accommodations, compared to 27% of participants in continuing employment. The propensity score adjusted RR of a health-related separation associated with inadequate accommodation was substantial [RR 2.72; 95% confidence interval (CI) 2.20-3.73], greater than the RR of separations not related to health (RR 1.68; 95% CI 1.38-2.21). CONCLUSIONS: Incidence of permanent separation in this cohort of Ontario labor force participants was approximately two times more frequent than would be expected. The adequacy of employer accommodation was a strong determinant of the risk of permanent separation. These findings emphasize the potential for strengthened workplace accommodation practices in this setting.

An observational study of pain severity, cannabis use, and benefit expenditures in work disability.

OBJECTIVE: This study pools two cohorts of workers in Ontario interviewed 18 months following a disabling work-related injury to estimate the association between pain severity, cannabis use, and disability benefit expenditures. METHODS: Among 1650 workers, disability benefit expenditures obtained from administrative records were combined with self-reported measures of pain symptoms and cannabis use. Disability benefit expenditures comprised wage replacement benefits and expenditures on healthcare services. RESULTS: Past-year cannabis use was reported by 31% of participants, with approximately one third of cannabis use attributed to the treatment of conditions arising from the work-related injury. Condition-related cannabis use was elevated among the 34% of participants reporting severe pain symptoms. In regression models adjusted for age, sex, nature of injury, opioid prescription, and pre-injury chronic conditions, participants reporting condition-related cannabis use had equivalent wage replacement benefit expenditures (ß = 0.254, ns) and higher healthcare benefit expenditures (ß = 0.433, p = 0.012) compared to participants who did not use cannabis. Participants reporting cannabis use unrelated to conditions arising from their work-related injury had lower wage replacement benefit expenditures (ß = - 0.309, p = 0.002) and equivalent healthcare benefit expenditures (ß = - 0.251, ns) compared to participants not using cannabis. CONCLUSION: This novel study of workers' compensation claimants interviewed at 18 months post-injury did not observe a substantial relationship between cannabis use and disability benefit expenditures, suggesting that neither harm nor significant benefit is associated with cannabis use. These findings contribute to understanding the potential benefits and risks associated with cannabis use in settings that have legalized cannabis use.

RéSUMé: OBJECTIF: Cette étude regroupe deux cohortes de travailleurs et travailleuses de l'Ontario interviewés 18 mois après un accident de travail invalidant; elle vise à estimer l'association entre la gravité de la douleur, la consommation de cannabis et les dépenses en prestations d'invalidité. MéTHODE: Les dépenses en prestations d'invalidité de 1 650 travailleurs et travailleuses, obtenues en consultant les dossiers administratifs, ont été combinées aux indicateurs autodéclarés de symptômes de douleur et de consommation de cannabis. Les dépenses en prestations d'invalidité englobaient les prestations de remplacement du salaire et les dépenses en services de soins de santé. RéSULTATS: Une consommation de cannabis au cours de la dernière année a été déclarée par 31 % des participants; environ le tiers de cette consommation de cannabis était imputée au traitement d'affections causées par l'accident de travail. La consommation de cannabis liée à une affection était élevée chez les 34 % de participants ayant déclaré de graves symptômes de douleur. Selon nos modèles de régression ajustés selon l'âge, le sexe, la nature de la blessure, la prescription d'opioïdes et l'existence d'états chroniques avant l'accident, pour les participants ayant déclaré une consommation de cannabis liée à une affection, les dépenses en prestations de remplacement du salaire étaient équivalentes (ß = 0,254, ns) et les dépenses en prestations de soins de santé étaient supérieures (ß = 0,433, p = 0,012) à celles des participants n'ayant pas consommé de cannabis. Pour les participants ayant déclaré une consommation de cannabis sans rapport avec des affections causées par leur accident de travail, les dépenses en prestations de remplacement du salaire étaient inférieures (ß = -0,309, p = 0,002) et les dépenses en prestations de soins de santé étaient équivalentes (ß = -0,251, ns) à celles des participants n'ayant pas consommé de cannabis. CONCLUSION: Cette étude novatrice menée auprès de demandeurs d'indemnités interviewés 18 mois après leur accident n'a pas observé de relation importante entre la consommation de cannabis et les dépenses en prestations d'invalidité, ce qui semble indiquer que ni des préjudices, ni des avantages significatifs ne sont associés à la consommation de cannabis. Ces constats contribuent à la compréhension des avantages et des risques qui pourraient être associés à la consommation de cannabis dans les milieux où cette consommation est légale.

Evaluation of the Ontario Mandatory Working-at-Heights Training Requirement in Construction, 2012‒2019.

The province of Ontario, Canada, implemented mandatory day-long training for construction workers required to use fall-protection equipment. More than 400 000 training sessions were completed by 2017 when the requirement took full effect. The lost-time workers' compensation claim incidence rate attributable to falls targeted by the training was 19% lower in 2017-2019 than in 2012-2014. Rates for two comparator injuries increased or stayed the same. The decline in targeted fall claim incidence rate of the other Canadian provinces was 6%. (Am J Public Health. 2024;114(1):38-41. https://doi.org/10.2105/AJPH.2023.307440).

The working life expectancy of American adults experiencing depression.

OBJECTIVES: To estimate the working life expectancies (WLE) of men and women with depression, examining depression by symptom trajectories from the late 20s to early 50s, and to estimate WLE by race/ethnicity and educational attainment. METHODS: Data from 9206 participants collected from 1979 to 2018 in the US National Longitudinal Survey of Youth 1979 cohort were used. Depression was measured using the Center for Epidemiologic Studies Depression Scale Short Form at four time points (age 28-35, age 30-37, age 40, and age 50). Labor force status was measured monthly starting at age 30 until age 58-62. Depressive symptom trajectories were estimated using growth mixture modeling and multistate modeling estimated WLE from age 30-60 for each gender and depressive symptom trajectory. RESULTS: Five latent symptom trajectories were established: a persistent low symptom trajectory (n = 6838), an episodic trajectory with high symptoms occurring before age 40 (n = 995), an episodic trajectory with high symptoms occurring around age 40 (n = 526), a trajectory with high symptoms occurring around age 50 (n = 570), and a persistent high symptom trajectory (n = 277). The WLE for men at age 30 was 30.3 years for the persistent low symptom trajectory, 22.8 years for the episodic before 40 trajectory, 19.6 years for the episodic around age 40 trajectory, 18.6 years for the episodic around age 50 trajectory, and 13.2 years for the persistent high symptom trajectory. Results were similar for women. WLE disparities between depression trajectories grew when stratified by race/ethnicity and education level. CONCLUSIONS: Roughly a quarter of individuals experienced episodic depressive symptoms. However, despite periods of low depressive symptoms, individuals were expected to be employed ~5-17 years less at age 30 compared to those with low symptoms. Accessible employment and mental health disability support policies and programs across the working life course may be effective in maintaining work attachment and improving WLE among those who experience depression.

Association of persistent pain with the incidence of chronic conditions following a disabling work-related injury.

OBJECTIVES: In a cohort of workers disabled by a work-related injury or illness, this study aimed to: (i) compare pre-injury prevalence estimates for common chronic conditions to chronic condition prevalence in a representative sample of working adults; (ii) calculate the incidence of chronic conditions post-injury; and (iii) estimate the association between persistent pain symptoms and the incidence of common chronic conditions. METHODS: Eighteen months post-injury, 1832 workers disabled by a work-related injury or illness in Ontario, Canada, completed an interviewer-administered survey. Participants reported pre- and post-injury prevalence of seven physician-diagnosed chronic conditions, and demographic, employment, and health characteristics. Pre-injury prevalence estimates were compared to estimates from a representative sample of workers. Multivariable logistic regression was used to examine the association of persistent pain with post-injury chronic condition incidence. RESULTS: Age-standardized pre-injury prevalence rates for diabetes, hypertension, arthritis, and back problems were similar to prevalence rates observed among working adults in Ontario, while prevalence rates for mood disorder, asthma and migraine were moderately elevated. Post-injury prevalence rates of mood disorder, migraine, hypertension, arthritis, and back problems were elevated substantially in this cohort. High persistent pain symptoms were strongly associated with the 18-month incidence of these conditions. CONCLUSIONS: The incidence of five chronic conditions over an 18-month follow-up period post injury was substantial. Persistent pain at 18 months was associated with this elevated incidence, with population attributable fraction estimates suggesting that 37-39% of incident conditions may be attributed to exposure to high levels of persistent pain.

Daily accelerometer-measured physical activity patterns and associations with cardiometabolic health among Canadian working adults.

Background: Previous studies examining the cardiometabolic risks associated with physical activity (PA) in workers have predominantly used self-reported measures. Little is known about workers' distinct daily PA patterns and whether these are linked with cardiometabolic risks. This study examined associations between patterns of workers' accelerometer-measured daily PA and four markers of cardiometabolic health. Data and methods: Working adults (N=8,229; 47% women; average age: 42 years; standard deviation = 0.3) were sampled from the Canadian Health Measures Survey (five cycles: 2007 to 2017). Accelerometer devices measured daily PA, and hierarchical cluster analysis identified distinct activity patterns. Multiple linear regression analyses examined associations between activity patterns and cardiometabolic risk markers (waist circumference, systolic and diastolic blood pressure, and non-high-density lipoprotein [HDL] cholesterol). Results: Workers were classified into six distinct activity patterns. On average, compared with workers classified in the "lowest activity" pattern, workers with the "moderate consistent activity," "fluctuating moderate activity," "high daytime activity" and "highest activity" patterns were associated with lower waist circumferences; workers with the "fluctuating moderate activity" and "highest activity" patterns were associated with lower systolic blood pressure; the "moderate evening activity" pattern was associated with lower diastolic blood pressure; and workers with the "fluctuating moderate activity," "high daytime activity" and "highest activity" patterns were associated with lower non-HDL cholesterol. "High daytime activity" was associated with lower waist circumference in women, compared with men, and the "moderate consistent activity" and "fluctuating moderate activity" patterns were associated with lower diastolic blood pressure in younger workers (40 years or younger). Interpretation: Workers with high daily PA levels tended to have the most optimal cardiometabolic health. Some evidence suggested that there are benefits to moderate levels of PA, particularly for lowering waist circumference and non-HDL cholesterol. Findings may assist in identifying workers for PA initiatives to promote cardiometabolic health benefits.

Workers' Activity Profiles Associated With Predicted 10-Year Cardiovascular Disease Risk.

Background There is a need to explore common activity patterns undertaken by workers and the association between these activity profiles and cardiovascular disease (CVD). This study explored the number and type of distinct profiles of activity patterns among workers and the association between these profiles and predicted 10-year risk for a first atherosclerotic CVD event. Methods and Results Distinct activity patterns from a cross-section of workers' accelerometer data were sampled from Canadian Health Measures Survey participants (5 cycles, 2007-2017) and identified using hierarchical cluster analysis techniques. Covariates included accelerometer wear time, work factors, sociodemographic factors, clinical markers, and lifestyle variables. Associations between activity profiles and high atherosclerotic CVD risk >10% were estimated using robust Poisson regression models. Six distinct activity profiles were identified from 8909 workers. Compared with the "lowest activity" profile, individuals in the "highest activity" and "moderate evening activity" profiles were at 42% lower risk (relative risk [RR], 0.58; 95% CI, 0.47, 0.70) and 33% lower risk (RR, 0.67; 95% CI, 0.44, 0.87) of predicted 10-year atherosclerotic CVD risk of >10%, respectively. "Moderate activity" and "fluctuations of moderate activity" profiles were also associated with lower risk estimates, whereas the "high daytime activity" profile was not statistically different to the reference profile. Conclusions Workers accumulating physical activity throughout the day and during recreational hours were found to have optimal CVD risk profiles. Workers accumulating physical activity only during daytime work hours were not associated with reduced CVD risk. Findings can inform alternative strategies to conferring the cardiovascular benefits of physical activity among workers. Large prospective studies are needed to confirm these findings.

Combined Associations of Work and Leisure Time Physical Activity on Incident Diabetes Risk.

INTRODUCTION: This study examines the separate and combined relationships between occupational physical activity (characterized by nonaerobic activities such as heavy lifting and prolonged standing) and leisure time physical activity on future diabetes incidence. METHODS: Data from Ontario respondents aged 35-74 years from the 2003 Canadian Community Health Survey (N=40,507) were prospectively linked to the Ontario Diabetes Database for diabetes cases until 2017, with statistical analysis performed in 2019. Leisure time physical activity was self-reported and occupational physical activity estimated from occupation titles. The analytical sample consisted of 7,026 employed people without previous diabetes diagnoses, with 846 diabetes cases recorded. Cox proportional hazard models were constructed to evaluate relationships over a median follow-up time of 13.7 years. RESULTS: No relationships were observed between occupational physical activity and diabetes. High leisure time physical activity was associated with lower diabetes risk for low occupational physical activity and stationary jobs (hazard ratio=0.63, 95% CI=0.47, 0.85). No association was found for high leisure time physical activity on diabetes risk for high occupational physical activity (hazard ratio=1.07, 95% CI=0.73, 1.56) or low occupational physical activity with movement (hazard ratio=0.92, 95% CI=0.55, 1.55). CONCLUSIONS: This study suggests that physical activity recommendations exclusively recommending increased physical activity may only be effective for the sedentary part of the working population in reducing diabetes risk. Findings await confirmation in comparable prospective studies in other populations.

Examining the relationship between the demand-control model and incident myocardial infarction and congestive heart failure in a representative sample of the employed women and men in Ontario, Canada, over a 15-year period.

OBJECTIVES: To examine the relationship between job strain and incident myocardial infarction and congestive heart failure in a representative population of men and women in Ontario, Canada, over a 15-year period. METHODS: A total of 14,508 respondents having provided responses to either the 2000/2001, 2002, or 2003 cycles of the Canadian Community Health Survey (CCHS) were aged 35 and older at the time and working. After removing respondents with pre-existing heart disease and missing data, our sample totaled 13,291 respondents. Responses were linked to administrative health care and hospitalization data to capture incident cases of myocardial infarction and congestive heart failure up to March 31, 2017. Job control and psychological demands were assessed using 5 items and 2 items respectively. A series of time-to-event regression models were run, adjusting sequentially for socio-demographic variables and health, other psychosocial work exposures, and health behaviours and body mass index. RESULTS: Over the study period, there were 199,583 person-years of follow-up (median follow-up: 15 years, 233 days). Higher incidence rates were observed for men (6.69 per 100 persons) than for women (2.77 per 100 persons). No clear relationship was observed for demand-control exposures and incidence of myocardial infarction and congestive heart failure in either men or women. After adjustment for socio-demographic factors, pre-existing health conditions, and other psychosocial exposures, the hazard ratio for high strain exposure (compared with low strain exposure) was 0.92 (0.46-1.84) for women and 0.75 (0.44-1.27) for men. CONCLUSION: In this large prospective cohort in Canada, we observed no relationship between components of the demand-control model and incident myocardial infarction and congestive heart failure over a 15-year period.

RéSUMé: OBJECTIFS: Examiner la relation entre les stresseurs psychosociaux au travail (job strain) et la survenue de l'infarctus du myocarde ainsi que de l'insuffisance cardiaque sur une période de 15 ans, dans une population représentative des hommes et des femmes de l'Ontario, Canada. MéTHODES: Au total, 14 508 participants ayant répondu aux cycles de 2000-2001, de 2002 ou de 2003 de l'Enquête sur la santé dans les collectivités canadiennes (ESCC) étaient des travailleurs âgés de 35 ans et plus. Après avoir exclus les répondants ayant une maladie coronarienne préexistante ou des données manquantes, notre échantillon totalisait 13 291 participants. Les réponses de ces participants ont été liées à leur données administratives sur les soins de santé et l'hospitalisation pour identifier les cas incidents d'infarctus du myocarde et d'insuffisance cardiaque jusqu'au 31 mars 2017. Les stresseurs psychosociaux au travail, soit la latitude décisionnelle et la demande psychologique, ont été évalués à l'aide de cinq et de deux items, respectivement. Une série de modèles de régression temporelle a été réalisée, en ajustant séquentiellement pour les variables sociodémographiques et la santé, d'autres expositions psychosociales au travail, les comportements de santé et l'indice de masse corporelle. RéSULTATS: Au cours de la période d'étude, 199 583 personnes-années ont été recensées (suivi médian : 15 ans et 233 jours). Des taux d'incidence plus élevés ont été observés chez les hommes (6,69 pour 100 personnes) par rapport aux femmes (2,77 pour 100 personnes). Aucune relation n'a été observée entre la latitude décisionnelle, la demande psychologique et l'incidence d'infarctus du myocarde et de l'insuffisance cardiaque chez les hommes ou les femmes. Après ajustement pour les variables sociodémographiques, les conditions de santé préexistantes et les autres expositions psychosociales, le rapport de risque pour une exposition au job strain (combinaison d'une latitude faible et d'une demande élevée) était de 0,92 (0,46 - 1,84) pour les femmes et de 0,75 (0,44 - 1,27) pour les hommes. CONCLUSION: Dans cette vaste cohorte prospective canadienne, aucune relation n'a été observée entre les stresseurs psychosociaux au travail du modèle demande-latitude et la survenue de l'infarctus du myocarde et de l'insuffisance cardiaque sur une période de 15 ans.

Preventing fall-from-height injuries in construction: Effectiveness of a regulatory training standard.

INTRODUCTION: A regulatory training standard for construction workers using fall protection equipment became mandatory in 2015 in the province of Ontario, Canada. By the end of the transition period in 2017, 418,000 workers had been trained to the new standard. Two primary research questions were posed: (1) To what extent does the WAH training affect practices at the worksite? and (2) Has there been a change in the incidence of fall-from-height injuries coincident with the introduction of the WAH Training Standard? MATERIALS AND METHODS: A longitudinal survey of 633 learners was conducted in 2017 at one-, four- and seven-week post-training. A quasi-experiment estimated the incidence of lost-time injuries attributed to falls from heights in 2017 compared to 2012-2014 for a census of construction workers insured for work disability in Ontario, Canada. RESULTS: Learners self-reported substantial increases in knowledge of and improvements in safe work practices when working at heights. The incidence rate of lost-time claim injuries attributed to falls targeted by the training declined by 19.6% (95% CI: 10.7, -27.6), compared to corresponding declines of 2.1% (95% CI: -6.3, 9.9) for other fall injuries and 7.2% (95% CI: 1.8, 12.3) for non-fall traumatic injuries. The observed decline was largest among the smallest employers (<5 full-time equivalent employees). CONCLUSION: The evaluation findings provide consistent support for a conclusion that the mandatory training standard was effective in reducing the incidence of injuries targeted by the training. However, the effects were modest and did not eliminate the problem. Practical application: A mandatory training standard should be considered as one approach to preventing traumatic injuries. However, other approaches higher in the hierarchy of risk controls should also be considered.

Retirement Expectations of Older Workers with Arthritis and Diabetes Compared with Those of Workers with No Chronic Diseases.

ABSTRACTWe know little about the retirement plans of adults with chronic diseases. This research recruited Canadian workers 50-67 years of age from a national panel of 80,000 individuals (arthritis, n = 631; diabetes, n = 286; both arthritis and diabetes, n = 111; no chronic disabling conditions, n = 538). A cross-sectional survey asked participants about their expected age of retirement, future work plans, whether they were retiring sooner than planned, and bridged retirement. Chi-square analyses, analyses of variance, and regression analyses examined expectations and factors associated with them. Despite health difficulties, workers with arthritis and diabetes had retirement plans similar to those of healthy controls and consistent with normative expectations of working to a traditional retirement age. However, more respondents with arthritis or diabetes reported bridged retirement than healthy controls. Contrary to predictions, health factors accounted for less of the variance in retirement expectations than other factors. These findings point to the complexity surrounding retirement expectations and highlight person-job fit rather than disease factors alone.

Do Differences in Work Disability Duration Between Men and Women Vary by Province in Canada?

Purpose Research has shown that there are important sex and gender-based differences in the work disability duration of men and women. This research is often limited to single jurisdictions, using different outcome measures, and therefore has limited generalisability of findings. This study examined if differences between work disability of men and women differed by province and by duration of work disability. Methods Cohorts of injured workers in the Canadian provinces of British Columbia (BC), Manitoba (MB) and Ontario (ON) were analysed using workers' compensation data for work-related injuries occurring between 2007 and 2011. Work disability duration was measured using cumulative days in receipt of disability benefits paid during one-year post-injury. Poisson models with restricted cubic splines tested whether differences between men and women in the likelihood of transitioning off disability benefits varied by duration of work disability in each province, adjusting for confounders. Results Men transitioned off disability benefits faster than women for claim durations of up to two to four months, after which women transitioned off disability benefits faster until ten months. Differences between men and women were consistent across all jurisdictions. For claims longer than ten months, men transitioned off work disability benefits faster than women in BC and ON, but there were no significant differences between men and women in MB. Conclusions Differences in the work disability duration between men and women vary by province and duration of work disability. Claims management processes need to be sensitive to differences that men and women face and the timing of interventions.

Are There Differences in Workplace Accommodation Needs, Use and Unmet Needs Among Older Workers With Arthritis, Diabetes and No Chronic Conditions? Examining the Role of Health and Work Context.

The aging of workforces combined with the prevalence of age-related chronic diseases has generated interest in whether large numbers of older workers will need workplace accommodations. This research applied work functioning theory to examine accommodation availability, need and use in workers with arthritis, diabetes, or no chronic disabling diseases; factors associated with accommodation needs; and the relationship of accommodation needs met, unmet or exceeded to job outcomes. Participants were aged 50-67 years, employed, and had arthritis (n = 631), diabetes (n = 286), both arthritis/diabetes (n = 111) or no chronic disabling conditions (healthy controls n = 538). They were recruited from a national panel of 80,000 individuals and a cross-sectional survey was administered online or by telephone. Questionnaires assessed demographics, health, work context, workplace accommodations, and job outcomes. Chi-square analyses, analyses of variance, and regression analyses compared groups. Respondents were similar in many demographic and work context factors. As expected, workers with arthritis and/or diabetes often reported poorer health and employment outcomes. Yet, there were few differences across health conditions in need for or use of accommodations with most participants reporting accommodations needs met. In keeping with work functioning theory, unmet accommodation needs were largely related to work context, not health. Workers whose accommodation needs were exceeded reported better job outcomes than those with accommodation needs met. Findings highlight both work context and health in understanding workplace accommodations and suggest that many older workers can meet accommodation needs with existing workplace practices. However, additional research aimed at workplace support and the timing of accommodation use is needed.

Association between dimensions of the psychosocial and physical work environment and latent smoking trajectories: a 16-year cohort study of the Canadian workforce.

BACKGROUND: This study aimed to determine the number of latent smoking trajectories among Canadians employed in the workforce over a 16-year period, and if latent trajectories in dimensions of the physical and psychosocial work environment were associated with specific smoking trajectories. METHODS: We studied 5461 employed adults from the longitudinal Canadian National Population Health Survey. Daily cigarette consumption was measured biannually from 1994 to 2010. Work environment factors (skill discretion, decision authority, psychological demands, job insecurity, physical exertion and workplace social support) were measured in 1994 and then from 2000 to 2010 using an abbreviated form of the Job Content Questionnaire. Smoking and work environment trajectories were derived using group-based trajectory modelling. Associations between work environment trajectory classes and smoking trajectory classes were estimated using multinomial logistic regression. RESULTS: Four latent smoking trajectories were seen: non-smokers; ceasing smokers (consuming ~14 cigarettes/day in 1994 and 0 in 2008-2010); smokers (consuming ~7 cigarettes/day between 1994 and 2010); and heavy smokers (consuming ~22 cigarettes/day in 1994 and ~14 in 2010). Lower skill discretion, high psychological demands, high physical exertion and low social support trajectories were associated with membership in the heavy smoking trajectory compared with the non-smoking trajectory. Low decision authority, high psychological demands and high physical exertion trajectories were associated with membership in the ceasing compared with the non-smoking trajectory. CONCLUSIONS: Certain physical and psychosocial work environment trajectories were associated with heavy and ceasing smoking behaviours over a 16-year period. The role of the work environment should be further considered in smoking cessation programmes.

The Role of Sex, Gender, Health Factors, and Job Context in Workplace Accommodation Use Among Men and Women with Arthritis.

Background: With the aging of populations in many countries, workers are expected to remain employed longer but may struggle with the onset of common, chronic conditions like arthritis. To date, few studies have examined workplace policies and practices that could help accommodate individuals with arthritis, and fewer still have used a sex and gender-based approach to explore similarities and differences between women and men. Objectives: This study compared the health and work contexts of workers aged ≥50 years to better understand similarities and differences between women and men in accommodation availability, need, use, and unmet needs. Methods: A cross-sectional survey of men and women with osteoarthritis (OA), inflammatory arthritis (IA), or both OA and IA was administered online or by telephone and assessed demographics (e.g. age, education), health (e.g. pain, fatigue, workplace activity limitations), work context factors (e.g. job sector, full/part-time work, job control), and workplace accommodations (e.g. health benefits, flexible hours, special equipment/adaptations, modified duties). Sex and gender-based analyses examined similarities and differences between men and women and included descriptive statistics, multivariable multinomial analyses, and nested regression analyses. Results: There was a 58.9% response rate and final sample of 463 participants (women, n = 266; men, n = 197; OA = 59.0%; IA/both IA and OA = 23.7%; unsure = 17.3%). Women and men were significantly different in a number of health (e.g. fatigue, health variability, workplace activity limitations) and work context factors (e.g. job sector, part-time work, job stress). However, in other respects, they were similar (e.g. pain, job involving physical demands, size of organization, shift work, union membership, job control). There were no differences between men and women in the availability or use of workplace accommodations. However, women reported significantly more accommodation needs and had greater unmet needs. Multivariable multinomial analyses found male/female as a binary variable did not explain differences in accommodation need, use, and unmet need. Nested analyses highlighted that differences in health variables explained male/female differences in accommodation need, while work context differences explained male/female differences in whether needs were met. Conclusions: The findings highlight that women and men draw on a range of existing accommodation policies and practices to help manage their arthritis and that most have their accommodation needs met. Decomposing the context within which men and women with arthritis work suggests that women may face health and work context challenges that differ from men and that are related to greater accommodation needs and unmet need. This highlights potential vulnerabilities in the work of women that need to be addressed.

Association between psychosocial work conditions and latent alcohol consumption trajectories among men and women over a 16-year period in a national Canadian sample.

BACKGROUND: It is unclear how psychosocial working conditions influence future alcohol consumption. Using group-based trajectory modelling, this study aimed to determine: the number of latent alcohol consumption trajectories over 16 years in a representative sample of the Canadian workforce; the association between psychosocial working conditions and longitudinal alcohol consumption; and if the association between psychosocial work factors and longitudinal alcohol consumption differed among men and women. METHODS: We included 5458 employed adults from the longitudinal Canadian National Population Health Survey. Average daily alcohol consumption was measured every 2 years from 1994 to 2010. Psychosocial work factors were measured in 1994 using the Job Content Questionnaire. Group-based trajectory modelling was used to derive the appropriate number of alcohol behaviour trajectories. The association between psychosocial work factors and alcohol trajectory membership was estimated using multinomial logistic regression. Models were stratified by sex to determine if these associations differed among men and women. RESULTS: Three alcohol consumption trajectories were present: non-drinkers, light drinkers (0.5-1 drinks/day) and moderate drinkers (2-3 drinks/day). Higher workplace physical exertion and lower social support levels were associated with membership in the moderate drinking trajectory. Among men, lower psychological demands and higher physical exertion levels were associated with membership in the moderate drinking trajectory. Among women, lower levels of physical exertion were associated with membership in the light drinking trajectory, and higher psychological demand levels were associated with membership in the moderate drinking trajectory. CONCLUSIONS: Our study suggests that workplace physical exertion and psychological demands may be associated with different alcohol consumption trajectories among men and women.

Implementation of a disability management policy in a large healthcare employer: a quasi-experimental, mixed-methods evaluation.

OBJECTIVE: This study describes the process and outcomes of the implementation of a strengthened disability management policy in a large Canadian healthcare employer. Key elements of the strengthened policy included an emphasis on early contact, the training of supervisors and the integration of union representatives in return-to-work (RTW) planning. DESIGN: The study applied mixed methods, combining a process evaluation within the employer and a quasi-experimental outcome evaluation between employers for a 3-year period prior to and following policy implementation in January 2012. PARTICIPANTS: Staff in the implementation organisation (n=4000) and staff in a peer group of 29 large hospitals (n=1 19 000). OUTCOMES: Work disability episode incidence and duration. RESULTS: Both qualitative and quantitative measures of the implementation process were predominantly positive. Over the 6-year observation period, there were 624 work disability episodes in the organisation and 8604 in the comparison group of 29 large hospitals. The annual per cent change in episode incidence in the organisation was -5.6 (95% CI -9.9 to -1.1) comparable to the annual per cent change in the comparison group: -6.2 (-7.2 to -5.3). Disability episode durations also declined in the organisation, from a mean of 19.4 days (16.5, 22.3) in the preintervention period to 10.9 days (8.7, 13.2) in the postintervention period. Reductions in disability durations were also observed in the comparison group: from a mean of 13.5 days (12.9, 14.1) in the 2009-2011 period to 10.5 days (9.9, 11.1) in the 2012-2014 period. CONCLUSION: The incidence of work disability episodes and the durations of work disability declined strongly in this hospital sector over the 6-year observation period. The implementation of the organisation's RTW policy was associated with larger reductions in disability durations than observed in the comparison group.

Mediating pathways and gender differences between shift work and subjective cognitive function.

OBJECTIVES: Increased injury risk among shift workers is often attributed to cognitive function deficits that come about as a result of sleep disruptions. However, little is known about the intermediate influences of other factors (eg, work stress, health) which may affect this relationship. In addition, gender differences in these the complex relationships have not been fully explored. The purpose of this study is to (1) identify the extent to which work and non-work factors mediate the relationship between shift work, sleep and subsequent subjective cognitive function; and (2) determine if the mediating pathways differ for men and women. METHODS: Data from the 2010 National Population Health Survey was used to create a cross-sectional sample of 4255 employed Canadians. Using path modelling, we examined the direct and indirect relationships between shift work, sleep duration, sleep quality and subjective cognitive function. Multigroup analyses tested for significantly different pathways between men and women. Potential confounding effects of age and self-reported health and potential mediating effects of work stress were simultaneously examined. RESULTS: Work stress and sleep quality significantly mediated the effects of shift work on cognition. Age and health confounded the relationship between sleep quality and subjective cognition. No differences were found between men and women. CONCLUSIONS: Occupational health and safety programmes are needed to address stress and health factors, in addition to sleep hygiene, to effectively address cognitive function among shift workers.