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Dear Colleagues,

Many jobs in America today are making people sick.

From the lowest to the highest-paying jobs, workers are suffering from a variety of illnesses stemming from exposure to stressful work environments.

Job stressors of many kinds such as insecure contracts, lack of respect, lack of control, long hours, shortened or skipped breaks, fear of layoff, unpaid time, diminished benefits including health insurance and pension, all contribute significantly to mental health problems such as burnout and depression and to chronic illnesses such as diabetes, hypertension, and coronary artery disease. Many of these illnesses could be prevented if we acknowledge their causes and act now.

Workers sometimes have a sense that their jobs are making them sick though the serious and life- threatening nature of these health consequences may only become apparent after years of exposure. Job-related health problems are also frequently dismissed as being individual problems or personal weakness rather than as predictable outcomes of the way work is organized. The medical profession frequently contributes to this misunderstanding by ignoring working conditions as it sees most illness as the result of individual differences and/or unhealthy behaviors.

We need to change all this.

We want to make workers aware of this major threat to their health and quality life. Workers need to know that stressful jobs are making them sick but also that the jobs are becoming more and more stressful in recent years.

It doesn’t have to be this way. Individually and collectively, people can bring about positive change – for working people, and for the organizations they work for.

We are making a full-length documentary film and a companion book that will expose this mostly hidden threat to the wellbeing of working people from all walks of life. We will show how working people are negatively impacted by today’s conditions of work. We will explain the role of globalization and companies’ need for ever-increasing profits and how this contributes to creating unhealthy working conditions worldwide that facilitate the exploitation of working people from all walks of life in what is actually a race to the bottom. We will do this, in part, by telling the stories of real working people, nurses, hotel housekeepers, assembly line workers, bus drivers, software developers and technology workers as well as cashiers.

We are asking for your help getting out this important message. Here are some things you can do:

• We are looking for people to be interviewed in the film. If you are or know of a worker who may be interested in discussing his/her personal work story, please ask them to contact us.

• We are looking for forums where we can spread our message. If your organization has meetings where we can make a presentation, please let us know.

• We are looking for examples of organizations that are actively working to better the lives, and particularly the health, of working people. Fight of 15 is one such example. If your organization has upcoming activities that we can film which address these concerns, please contact us.

• We are also looking for funding as film-making is expensive. Any help would be appreciated. We are a 501(c) 3 – a non-profit charitable organization – and therefore, contributions are tax deductible.

Who are we? This effort begins with the Center for Social Epidemiology and includes researchers, activists, and veteran filmmakers.

We hope you will join us in this important, difficult, and yet very hopeful project that has the intention and promise of improving the lives of millions of people suffering or who will be suffering from preventable work-related illness unless a major change takes place.

International Bus Driver Study Proposal

I. Introduction

Rationale – Bus drivers are well documented to have higher rates of bodily injury, psychological disorders and increased prevalence of hypertension. Yet, the specific causes of these health outcomes are still not well understood particularly with regard to obesity, and cardiovascular illnesses. Drivers are exposed to multiple risk factors on the job while driving that impact their health including noxious chemicals, demanding schedules, potentially dangerous environments including both driving and passengers, as well as a number of psychosocial work stressors such as job strain (work high in demands and low in control) inter alia. (See Special Issue of Studies of Urban Mass-Transit Operators of the Journal of Occupational Health Psychology Vol 3 Nº2, April 1998).

We are particularly interested in the role of work hours, scheduling, deadlines, constraints and organizational psychosocial stressors as they might contribute to fatigue, mental exhaustion, obesity, elevated blood pressure and safety issues. We believe the presence of many of these stressors negatively impacts on the drivers mental functioning and ability to carry out their jobs properly thus contributing to accidents.

I. Possible Goals of this proposed research project

1) To identify and compare the prevalence of accidents, cardio-metabolic risks factors and psychosocial work factors among the country participants
2) To examine the associations between work stressors, in particular psychosocial stressors and accidents, cardio-metabolic risks factors in bus drivers samples from Colombia, México, Switzerland, Poland and the USA.
3) To determine the statistical contribution of different aspects of work, individual factors, job stress (e.g. as explained by the job strain and effort-reward imbalance models) in accidents and cardio-metabolic indicators (e.g. obesity, blood pressure, heart rate) in bus drivers from different countries.

Question to discuss:

It is understood among us that the research goals in each country will reflect the specific problems and needs of each particular country. Nonetheless, the challenge for us is it possible to define a common goal (or goals) for all participant researchers that will allow valuable comparisons between countries. What exposures and outcomes as well as methods should be selected as common? This would be a central issue for discussion at our meeting Saturday am May 18th at 8am.

II. Possible Methods and Procedures

A common design for the International Study could be a cross-sectional study.

A, Outcomes of Interest:

1) Accidents. This variable could be measured by records of the organization or self-report of bus drivers
2) Fatigue and Emotional Exhaustion
3) Metabolic Syndrome: Includes Obesity, Blood Pressure, Glucose, Triglycerides and Cholesterol (depending of selected criteria). Self reported and objective measures of these variables should be discussed.
4) Hearth rate, HRV cardiovascular symptoms.
5) Self reported health and compensation and health insurance claims.

B. Exposures of interest:

1) Universal work place stressors: Job strain, ERI, Job insecurity
Specific work stressors: route, clerical requirements, type of passengers, etc.
2) Work hours
3) Scheduling
4) Shifts
5) Other

C. Methods of common interest

A. Qualitative methods including focus groups.
B. Ambulatory monitoring
One approach we wish to explore with transit drivers would involve ambulatory monitoring of bus drivers including measuring cortisol, blood pressure, heart rate, heart rate variability and activity with simple and inexpensive monitors that can be worn during working hours. 

For this procedure a feasibility study should be carried out or could be completed in sub-samples if it is not possible to do it in the complete sample.

Example of a Bus Driver Feasibility Pilot Study :

Goal: Demonstrate feasibility defined as safety and comfort of collecting ambulatory physiological data in a small group of firefighters.

Complete approvals

Ambulatory measures
1) Ambulatory bp (Spacelabs or Omron devices)
2) Cortisol (oral swab)
3) Activity monitor (worn on body)
4) Heart rate and heart rate variability (chest strap). This methodology is highly recojmmended due to ease of use and value of outcome data.

We would need 5-10 volunteers per project to wear equipment.

Key question. Can a Spacelabs ambulatory BP monitor be worn safely while driving?

1) Safety – automated monitor will grab and squeeze are for 45 seconds
2) Can Spacelab’s device obtain a reliable reading while driving?

Need 5-8 readings in a workday of blood pressure to get a reliable estimate of an individual’s bp.

An alternative a to Spacelab’s device would be an automated wrist device. This could be put on, triggered and bp collected in 60 seconds. Would need a repeated window during the day in which to obtain these readings. Drivers would need to be trained in its use. When do such opportunities present themselves during the day? Red lights, traffic jams, rest breaks (how many of these occur during the work day). If they occur every 2 hours this is not enough intervals to collect 5-8 readings.


Invitation to Participate in the California Local Organizing Committee

Also see our pages on LOC ParticipantsLOC Meeting Minutes and Panels.
California Colleagues,
As many of you know the 2013 Work Stress, and Health (WSH) Conference, co-sponsored by the American Psychological Association (APA), the Society for Occupational Health Psychology (SOHP), and the National Institute for Occupational Safety and Health (NIOSH) will be held in Los Angeles May 16-19th 2013 at the Westin Bonaventure Hotel and Suites.  The conference title is Work, Stress, and Health 2013: Protecting and Promoting Total Worker Health. The broad goal of this year’s conference is to highlight the concept of Total Worker HealthTM – a new approach to safeguarding the health and safety of workers. In accordance with this conference theme and in addition to usual conference topics (see below), the conference will give special attention to:
– Case reports and controlled studies on the effects of integrated health protection and health promotion interventions;
– Studies investigating the joint contribution of occupational and non-occupational factors to health and safety problems facing workers today;
– Strategies and best practices for implementing and evaluating integrated or holistic prevention programs;
– Merits, challenges, future directions, etc., relating to integrated prevention strategies;
– Training needs in order to advance research and practice relating to Total Worker HealthTM.
More information about the conference is available at http://www.apa.org/wsh/
The CSE has been asked by the conference planners to help organize a Local Organizing Committee (LOC). The charge to the local organizing committee is open-ended and below is a potential list of things to do that have been suggested by Gwen Keita, Ted Scharf and Wes Baker. 
This meeting gives us a wonderful opportunity to focus local, state and national attention on issues of occupational health and safety confronting Californians. 
We are planning several conference related activities and will use these to build a state-wide coalition of interested persons committed to improvements in occupational health in California.
Possible activities for the next year include:
                1) Identifying the occupational health needs of California now and for 2020
                2) Develop panels for inclusion in next year’s conference including:
                         A) Labor views on the workplace and occupational health
                         B) Minority needs
                         C) An occupational health agenda for 2020
                         D) A debate over Total Worker Health (the conference theme) and the best ways to introduce change at the workplace
                3) Expand and develop a network of individuals and companies committed to positive changes in California.
                        A) Examining the impact of austerity measures on California Occupational Health
                4) Work on items from the list below suggested by APA/NIOSH
We have held meetings in Southern California and  Northern California in conjunction with the California Work and Health Study Group to discuss these possibilities (see LOC Meeting Minutes). 
Please get back to me with your thoughts about all this and your interests.
Peter Schnall and Marnie Dobson for the CSE 

CWA Studies

The CSE’s research efforts are supported entirely by funds raised by contributions to the CSE or through contracts to evaluate worker health. The Center has developed and conducted occupational health projects with the support of 5 different unions and associated management groups over the last decade: HERE; UAW; CWA; IAFF; Orange County Fire Authority (Management).

The CSE recently finished a study conducted in November 2009 with Communications Workers of America (CWA) members employed as line-workers/technicians by Verizon in Southern California. Marnie Dobson (CSE Associate Director) prepared and presented a report to Verizon management and CWA representatives during a collective bargaining session in Southern Californian March 2010 and are in the mist of preparing a new proposal outlining a study to be conducted in collaboration with CWA and AT&T to further study line and call-center workers in Northern California. 

In 2011 the CSE submitted a proposal to Communications Workers of America (CWA) for a cross-sectional survey of AT&T technicians in California. We estimate the survey should be completed by approximately 600-800 technicians at 16-20 randomly selected worksites. This will give us sufficient statistical power to find credible associations between workplace stressors and self-reported health outcomes such as hypertension, cholesterol, obesity, burnout and psychological distress. We also recommend a random sample of N=200, among the participants of the survey population to collect physiological measurements such as work-site blood pressures, and height and weight. These “hard” outcomes are well established risk factors for CVD and are associated with work-related stressors and will add credibility to the study.

Our approach in previous research with CWA has included close consultation with CWA representatives and technicians and we strongly urge that this be repeated in a California study. Participatory Action Research (PAR) is an approach to conducting research which involves fostering a partnership between researchers and working people whereby the interests and knowledge of working people inform the research questions and process. PAR de-centers the research process to involve and empower those being studied to prioritize their concerns, gain knowledge about research processes from the academic researchers, foster successful participation among colleagues, and help interpret findings and develop recommendations for workplace change.

UCI Firefighter Obesity Research Project: Workplace Assessment to Reduce Disease (FORWARD)

Visit the FORWARD Study Website at: http://www.coeh.uci.edu/forward/

Firefighter Obesity Research: Workplace Assessment to Reduce Disease (FORWARD) is a 2-year project of the UCI-COEH, funded by the Center for Disease Control and Prevention/National Institute for Occupational Safety and Health (Award #: 1 R21 OH009911-01). The study will consider the unique working conditions and health behaviors of firefighters who work on a 24 hour-shift system. This will allow in the end to develop a firefighter-relevant work and health questionnaire along with several recommendations to reduce the obesity risk of firefighters. We propose this as an exploratory study which meets the public safety sub-sector strategic goals 1.4 and 1.5 of the National Occupational Research Agenda (NORA) and the Research to Practice (r2P) initiatives at the National Institute for Occupational Safety and Health.

NIOSH Exploratory and/or Developmental Grant Program (R21) 


PI: Choi, BongKyoo

Co-investigators: Schnall Peter MD, Leslie Israel MD, Marnie Dobson PhD, Pietro Galassetti MD, Dean Baker MD, Paul Landsbergis PhD (consultant).

Project Summary/Abstract

Among 41 male-dominated occupations, firefighters have the third highest prevalence rate of obesity. Few studies have examined the roles of working conditions and health behaviors of firefighters in obesity. In addition, few validated instruments — a methodological prerequisite for obesity studies in firefighters — are available that specifically assess the unique working conditions and health behaviors of firefighters who work on a 24 hour-shift system. Our long-term goals are to elucidate the roles of working conditions and health behaviors in the development of obesity among firefighters and to use this information to design and conduct intervention studies that lower CVD risk factors among firefighters by changing working conditions and health behaviors. The main aims of this proposal are a) to develop and validate a firefighter-relevant work and health questionnaire using qualitative and quantitative methods in firefighters enrolled in the Orange County Fire Authority (OCFA) Wellness Fitness (WEFIT) Program, b) to use this questionnaire in an epidemiological study to explore whether adverse working conditions and health behaviors are risk factors for obesity in firefighters, and c) to explore the interrelations between working conditions and health behaviors as they relate to obesity. A supplementary objective is to evaluate the strengths and weaknesses of Body Mass Index (BMI) as a measurement (commonly used as a surveillance measure of obesity in many WEFIT programs for firefighters) in comparison with skinfold-based body fat percent. For the purposes of this study, we will use a participatory action research (PAR) approach to build a work group of firefighters and researchers to develop and validate a questionnaire for assessing working conditions and health behaviors of firefighters. The developed questionnaire will be completed by about 350 OCFA firefighters over 15 months. A subsample of the firefighters (n=80) will be recruited to complete a 3-day food record and to wear an accelerometer during the same 3 days, and to fill in a short-form of the questionnaire for a one-week test and retest reliability. In addition, for analyses, the records of the WEFIT medical and fitness exams (Body Mass Indexes, body fat %, VO2 max, blood pressures, and blood lipid profiles) of the participants and archival records of 2004-2011 annual calls by each local OCFA fire station will be linked to the exposure profiles. At the end of this project a firefighter-relevant work and health questionnaire will have been developed, along with several recommendations to reduce the obesity risk of OCFA firefighters. We propose this as an exploratory study which meets the public safety sub-sector strategic goals 1.4 and 1.5 of the National Occupational Research Agenda (NORA) and the Research to Practice (r2P) initiatives at the National Institute for Occupational Safety and Health.

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