Krause N; Ragland DR; Greiner BA; Syme SL; Fisher JM. Psychosocial job factors associated with back and neck pain in public transit operators. Scand J Work Environ Health 1997 Jun;23(3):179-86.
ABSTRACT:
OBJECTIVES: This cross-sectional study examined associations
between psychosocial job factors and the prevalence of nondisabling
back and neck pain in professional drivers after physical work
load was taken into account.
METHODS: A total of 1449 transit vehicle operators completed a
medical examination and a questionnaire yielding information on
demographic and anthropometric variables, health status, and physical
and psychosocial job factors. Company records were used to supplement
information on employment history. Physical work load was measured
in life-time years and current weekly hours of professional driving.
The relation of psychosocial factors with back or neck pain was
analyzed by logistic regression models adjusted for past and current
physical work load, vehicle type, age, gender, body height, and
weight.
RESULTS: The main result of this study was that both physical
work load and psychosocial factors were simultaneously and independently
associated with back or neck pain. Psychosocial factors associated
with back or neck pain included extended uninterrupted driving
driving periods, frequency of job problems, high psychosocial
demands, high job dissatisfaction, and low supervisory support.
An analysis of specific job problems is provided which may be
useful in setting priorities for research and intervention efforts
in this high risk occupation.
CONCLUSION: The results provide support for the role of psychosocial
job characteristics in the etiology of back or neck pain in occupational
settings.
Syme SL. Rethinking disease: where do we go from here? Annals of Epidemiology, 1996 Sep, 6(5):463-8.
North FM; Syme SL; Feeney A; Shipley M; Marmot M. Psychosocial work environment and sickness absence among British civil servants: the Whitehall II study [see comments]. American Journal of Public Health, 1996 Mar, 86(3):332-40.
Marmot M; Feeney A; Shipley M; North F; Syme SL. Sickness absence as a measure of health status and functioning: from the UK Whitehall II study. Journal of Epidemiology and Community Health, 1995 Apr, 49(2):124-30.
Adler NE; Boyce T; Chesney MA; Cohen S; Folkman S; Kahn RL; Syme SL. Socioeconomic status and health. The challenge of the gradient. American Psychologist, 1994 Jan, 49(1):15-24.
Adler NE; Boyce WT; Chesney MA; Folkman S; Syme SL. Socioeconomic inequalities in health. No easy solution. Jama, 1993 Jun 23-30, 269(24):3140-5.
North FM; Syme SL; Feeney A; Shipley M; Marmot M. Psychosocial work environment and sickness absence among British civil servants: the Whitehall II study. American Journal of Public Health, 1996 Mar, 86(3):332-40.
ABSTRACT:
OBJECTIVES. This study sought to examine the association between
the psychosocial work environment and subsequent rates of sickness
absence.
METHODS. The analyses were based on a cohort of male and female
British civil servants (n=9072). Rates of short spells (<or=7
days) and long spells (>7 days) of sickness absence were calculated
for different aspects of the psychosocial work environment, as
measured by self-reports and personnel managers' ratings (external
assessments).
RESULTS. Low levels of work demands, control, and support were
associated with higher rates of short and long spells of absence
in men and, to a lesser extent, in women. The differences were
similar for the self-reports and external assessments. After adjustment
for grade of employment, the differences were diminished but generally
remained significant for short spells. The combination of high
demands and low control was only associated with higher rates
of short spells in the lower grades.
CONCLUSIONS. The psychosocial work environment predicts rates
of sickness absence. Increased levels of control and support at
work could have beneficial effects in terms of both improving
the health and well-being of employees and increasing productivity.
Adler NE; Boyce T; Chesney MA; Cohen S; Folkman S; Kahn RL; Syme SL. Socioeconomic status and health. The challenge of the gradient. American Psychologist, 1994 Jan, 49(1):15-24.
ABSTRACT:
Socioeconomic status (SES) is consistently associated with health outcomes, yet little is known about the psychosocial and behavioral mechanisms that might explain this association. Researchers usually control for SES rather than examine it. When it is studied, only effects of lower, poverty-level SES are generally examined. However, there is evidence of a graded association with health at all levels of SES, an observation that requires new thought about domains through which SES may exert its health effects. Variables are highlighted that show a graded relationship with both SES and health to provide examples of possible pathways between SES and health end points. Examples are also given of new analytic approaches that can better illuminate the complexities of the SES-health gradient.
Adler NE; Boyce WT; Chesney MA; Folkman S; Syme SL. Socioeconomic inequalities in health. No easy solution. Jama, 1993 Jun 23-30, 269(24):3140-5.
ABSTRACT:
OBJECTIVE--Socioeconomic status (SES) is strongly associated
with risk of disease and mortality. Universal health insurance
is being debated as one remedy for such health inequalities. This
article considers mechanisms through which SES affects health
and argues that a broader and more comprehensive approach is needed.
DATA SOURCES--Published articles surveyed using MEDLINE and review
articles and bibliographies.
METHODS AND RESULTS--Research is reviewed on the association of
SES with health outcomes in different countries, including those
with universal health coverage. Socioeconomic status relates to
health at all levels of the SES hierarchy, and access to care
accounts for little of this association. Other mechanisms are
suggested and implications for policy and clinical practice are
discussed.
CONCLUSION--Health insurance coverage alone is not likely to reduce
significantly SES differences in health. Attention should be paid
both in policy decisions and in clinical practice to other SES-related
factors that may influence patterns of health and disease.
North F; Syme SL; Feeney A; Head J; Shipley MJ; Marmot MG. Explaining socioeconomic differences in sickness absence: the Whitehall II Study. Bmj (Clinical Research Ed.), 1993 Feb 6, 306(6874):361-6.
ABSTRACT:
OBJECTIVE--To describe and explain the socioeconomic gradient
in sickness absence.
DESIGN--Analysis of questionnaire and sickness absence data collected
from the first phase of the Whitehall II study. Grade of employment
was used as a measure of socioeconomic status.
SETTING--20 civil service departments in London.
SUBJECTS--6900 male and 3414 female civil servants aged 35-55
years.
MAIN OUTCOME MEASURES--Rates of short spells (<or = 7 days)
and long spells (> 7 days) of sickness absence.
RESULTS--A strong inverse relation between grade of employment
and sickness absence was evident. Men in the lowest grade had
rates of short and long spells of absence 6.1 (95% confidence
interval 5.3 to 6.9) and 6.1 (4.8 to 7.9) times higher than those
in the highest grade. For women the corresponding rate ratios
were 3.0 (2.3 to 3.9) and 4.2 (2.5 to 6.8) respectively. Several
risk factors were identified, including health related behaviours
(smoking and frequent alcohol consumption), work characteristics
(low levels of control, variety and use of skills, work pace,
and support at work), low levels of job satisfaction, and adverse
social circumstances outside work (financial difficulties and
negative support). These risk factors accounted for about one
third of the grade differences in sickness absence.
CONCLUSION--Large grade differences in sickness absence parallel
socioeconomic differences in morbidity and mortality found in
other studies. Identified risk factors accounted for a small proportion
of the grade differences in sickness absence. More accurate measurement
of the risk factors may explain some of the remaining differences
in sickness absence but other factors, as yet unrecognised, are
likely to be important.
Winkleby MA; Ragland DR; Fisher JM; Syme SL. Excess risk of sickness and disease in bus drivers: a review and synthesis of epidemiological studies. Int J Epidemiol 1988 Jun;17(2):255-62.
ABSTRACT:
In an extensive search of available literature, 22 epidemiological studies that have examined health risks of bus drivers were identified. These studies focus on three main disease categories: (1) cardiovascular disease, including hypertension, (2) gastrointestinal illnesses, including peptic ulcer and digestive problems, and (3) musculoskeletal problems including back and neck pain. The studies consistently report that bus drivers have higher raes of mortality, morbidity, and absence due to illness when compared to employees from a wide range of other occupational groups. Increased disease rates have been found for drivers regardless of the use of different research methodologies, measurement techniques and comparison groups. When evaluating the impact of bias on the estimates of risk, it appears likely that findings are conservative: strong systematic selective factors have probably favoured the elimination of those in poorer health both at the time of entry into and exit from the job of bus driving and other sources of bias have most likely caused underestimations of risk. Nevertheless, there remain questions that need careful assessment before firm conclusions can be made about whether increased disease rates result from driving a bus. Such questions, coupled with the consistent findings of heightened risk of disease, make urban bus drivers an appropriate and promising occupational group in which to study further the potential adverse effects of the work environment on employee health.
Sharp DS; Osterloh J; Becker CE; Bernard B; Smith AH; Fisher JM; Syme SL; Holman BL; Johnston T. Blood pressure and blood lead concentration in bus drivers. Environ Health Perspect 1988 Jun;78:131-7.
ABSTRACT:
San Francisco bus drivers have an increased prevalence of hypertension. This study examined relationships between blood lead concentration and blood pressure in 342 drivers. The analysis reported in this study was limited to subjects not on treatment for hypertension (n = 288). Systolic and diastolic pressures varied from 102 to 173 mm Hg and from 61 to 105 mm Hg, respectively. The blood lead concentration varied from 2 to 15 micrograms/dL. The relationship between blood pressure and the logarithm of blood lead concentration was examined using multiple regression analysis. Covariates included age, body mass index, sex, race, and caffeine intake. The largest regression coefficient relating systolic blood pressure and blood lead concentration was 1.8 mm Hg/ln (micrograms/dL) [90% C. I., -1.6, 5.3]. The coefficient for diastolic blood pressure was 2.5 mm Hg/ln (micrograms/dL) [90% C. I., 0.1, 4.9]. These findings suggest effects of lead exposure at lower blood lead concentrations than those concentrations that have previously been linked with increases in blood pressure.
Winkleby MA; Ragland DR; Syme SL; Fisher JM. Heightened risk of hypertension among black males: the masking effects of covariables. Am J Epidemiol 1988 Nov;128(5):1075-83.
ABSTRACT:
This study examines the extent to which a set of 10 demographic, behavioral, and medical risk factors explain black/white differences in hypertension. Data are from a cross-sectional examination of San Francisco transit drivers aged 25-65 years surveyed during 1983-1985 as part of an occupational health study. The inherent restriction of the study population to bus drivers and the further restriction to males in this population (764 blacks and 224 whites) controlled for factors related to occupation and sex. Control of 10 additional potential risk factors, including age, education, body mass index, smoking, and intake of caffeine and alcohol was possible in the analytic phase of the study. The unadjusted prevalence of hypertension (systolic blood pressure greater than or equal to 140 mmHg, diastolic blood pressure greater than or equal to 90 mmHg, or current use of antihypertensive medications) was 36.1 per cent for black males compared with 30.8 per cent for white males. The greatest difference in prevalence was observed for black males aged 55-64 years, for whom the prevalence was 46 per cent higher than for white males the same age. Despite higher rates of hypertension, blacks in all age groups exhibited lower levels of most major risk factors for hypertension. As a result, the independent effect of race on hypertension was increased rather than attenuated when the 10 covariables were taken into account (odds ratio of 1.27 in the unadjusted analysis, increasing to 1.54 in the adjusted, multivariate analysis). That this set of risk factors did not explain the higher rates of hypertension among blacks suggests that racial differences may arise from as yet unrecognized environmental and/or individual factors. The results also indicate that the association between race and blood pressure may have been underestimated in past studies that have relied on unadjusted analyses, in which negative confounding or masking effects of covariables have not been considered.
Ragland DR; Winkleby MA; Schwalbe J; Holman BL; Morse L; Syme SL; Fisher JM. Prevalence of hypertension in bus drivers. Int J Epidemiol 1987 Jun;16(2):208-14.
ABSTRACT:
This paper reports the results of a cross-sectional study conducted to evaluate the prevalence of hypertension in 1500 black and white male bus drivers from a large urban transit system in the US. Data for this study were compiled from the files of an occupational health clinic which conducts biennial medical examinations for drivers' license renewal. To test whether prevalence of hypertension was higher among bus drivers than among employed individuals in general, drivers were compared to three groups: individuals from both a national and local health survey and individuals undergoing baseline health examinations prior to employment as bus drivers. After adjustment for age and race, hypertension rates for bus drivers were significantly greater than rates for each of the three comparison groups. These findings support previous results from international studies of bus drivers suggesting that exposure to the occupation of driving a bus may carry increased health risk. This research has expanded into an on-going study which has the goals of clarifying the extent of hypertension in bus drivers and identifying specific behavioural and occupational factors that may be responsible for increased risk of cardiovascular disease.