Abstract for the Third International Conference on Work Environment
and Cardiovascular Diseases; March, 20-22 2002, University of
Duesseldorf, Germany
Title: Proposal for a university centered initiative for a public
health approach to the surveillance and early detection, treatment
and prevention of workplace related injury and cardiovascular
disease (STEP Program: Surveillance, Treatment and Early Prevention)
Authors: Peter L. Schnall MD, MPH, Karen Belkic MD, PhD, Dean
Baker MD, MPH, and Paul Landsbergis ED, PhD
Overview of Program
Rationale: Psychosocial factors (e.g., job strain, effort-reward
imbalance, work characterized by threat avoidant vigilance) at
the workplace play an important etiologic role in a number of
chronic illness including repetitive motion injuries, psychological
distress (e.g., anxiety, depression, absenteeism, burnout and
demoralization) and cardiovascular disease including hypertension.
See Schnall, Belkic', Landsbergis and Baker, etal. The Workplace
and Cardiovascular Disease, 2000.
A comprehensive program is needed for the improvement of the psychosocial well-being and cardiovascular health (as well as other illnesses) of working people through 1) surveillance, 2) early detection with referral for evaluation and treatment of individuals with early manifestations of CVD, and 3) interventions at the workplace intended to reduce exposures. This proposed program is intended to draw on the resources of the academically based California occupational health centers (COEH) to initiate, coordinate and provide the training, research and services to accomplish these goals. The target population will be the employed labor force of several large corporations in Southern California with reasonable access to the COEH and medical center.
Service - A comprehensive plan of surveillance with detection psychosocial exposures and incipient illness will be initiated in cooperation with interested corporations, health care providers, public agencies, labor unions . Working people with identified problems will be referred to COEH facilities for evaluation and treatment by COEH and medical center staff (e.g., occupational medicine specialists). Secondary prevention/treatment programs will be conducted at the involved worksites utilizing staff (e.g., industrial hygienists, occupational health psychologists (OHP) as well as clinicians) trained in an understanding of the role of workplace psychosocial factors in the etiology of mental, physical, and CVD disease. Knowledge gained over time through ongoing surveillance and by working with employers and employees will be utilized to design, in collaboration with workplaces, primary intervention/prevention programs.
Training - The success of this initiative will require the development of an extensive training program for graduate students and health professionals to enhance their awareness of the role of workplace based psychosocial factors in the etiology of physical injury, hypertension and cvd. Programs for graduate students will provide them with skills in conducting surveillance, detecting psychosocial exposures, and obtaining a psychosocial work history from employed people. Training for health professionals should provide similar skills but focus more heavily on the development of the appropriate clinical skills necessary for the detection (e.g., taking a medically relevant work history of workplace psychosocial exposures), evaluation and treatment of workplace induced CVD.
Research - A research program will be carried out in parallel with the services component of the project with the purpose of evaluating 1) the surveillance and treatment programs and 2) informing subsequent intervention and prevention programs for the target population aimed at reducing the burden of injuries and CVD. Observational studies of "naturally occurring" changes in the workplace can be conducted through ongoing surveillance at the workplace with reevaluation of psychosocial exposures and associated changes in workplace blood pressure.
Primary Prevention - Prevention programs will be developed
that focus on organizational change and changes in job characteristics.
These programs will developed in the closest collaboration with
management and working people with the intent to reduce exposures
to psychosocial risk factors known to play a role in the etiology
of psychological ill-health and CVD. Interventions will be designed
informed by knowledge of the workplace accumulated over time through
ongoing surveillance of the workforce and implemented observational
studies (see research goals above).