NORA Symposium 2008: Public Market for Ideas and Partnerships

Poster #026

A Proposed National Health Interview Survey Supplement for Occupational Health Surveillance

Sara Luckhaupt, MD, MPH (1); Geoffrey Calvert, MD, MPH (1); Marie Haring Sweeney, PhD, MPH (1); Sang Woo Tak, SciD, MPH (1); Andrea Steege, MPH (1); John Sestitio, JD, MS (1); Aaron Sussell, PhD, MPH (1); Toni Alterman, PhD, MS, MA (1); Suzanne Marsh, MPA (2); Jacek Mazurek, MD, PhD, MS (3)

(1) National Institute for Occupational Safety and Health, Division of Surveillance, Hazard Evaluations, and Field Studies, Cincinnati, OH, USA;
(2) National Institute for Occupational Safety and Health, Division of Safety Research, Morgantown, WV, USA;
(3) National Institute for Occupational Safety and Health, Division of Respiratory Disease Studies, Morgantown, WV, USA

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Abstract

We are proposing an occupational health supplement (OHS) to the National Health Interview Survey (NHIS). Such a supplement was conducted in 1988 but has not been repeated despite dramatic changes in workforce demographics and work organization. The proposed supplement will help fill several data gaps. Prevalence estimates of common work-related conditions (e.g., back pain, hand and wrist disorders) comparable to those from the 1988 NHIS OHS are needed to assess the impact of the many changes in work-related materials, processes, equipment, and practices that have taken place in the past two decades against the backdrop of a changing workforce. In addition to repeating questions from the 1988 OHS, the new supplement will include questions adapted from other validated survey instruments and original questions to address emerging issues. NORA funding, and collaboration and partnerships with stakeholders will be needed to actualize a new supplement.

Expected outputs of this project are: 1) the NHIS occupational health supplement survey instrument will be administered in 2010, 2) a publicly available dataset will be published online in 2011, and 3) communication products will be developed by NIOSH and our partners to disseminate the key findings.

Background

Traditional occupational health surveillance systems such as the Bureau of Labor Statistics (BLS) Annual Survey of Injuries and Illnesses, workers compensation databases, and state-based sentinel event systems have many limitations including exclusion of large proportions of the workforce (e.g., contract workers, government workers), under-reporting and under-ascertainment of chronic work-related conditions. Data from population-based surveys are needed to augment these sources.

Since 1957, the NHIS has been conducted annually by the National Center for Health Statistics (NCHS) in collaboration with the US Census Bureau. The target population is the US civilian, non-institutionalized population. Interviews are conducted on a representative sample of households selected using a multistage cluster sample design and consist of two main parts: 1) a core set of questions that remain basically unchanged from year to year, and 2) supplemental questions that change from year to year to collect additional data pertaining to current issues of national importance.

If NORA funding is received from NIOSH, the proposed occupational health supplement will be administered to all sampled adults in the NHIS who are employed or have been employed in the past year (approximately 20,000 people). We expect these respondents to be representative of the industry and occupation distribution of the US workforce. This will result in a dataset that includes relatively large (N>400), representative samples of 7 of the 8 industry sectors (all except Mining). Thus we can prepare profiles of the prevalence of key psychosocial risk factors and work-related health outcomes for each of these sectors, taking into account each sector’s unique safety and health risks and the need for tailored interventions.

Approach

We have developed a draft NHIS-OHS survey instrument and a proposal for NORA FY09 funding.

Results

The original draft of the proposed new NHIS-OHS contained questions from the 1988 OHS and questions adapted from other validated survey instruments and some original questions.
NCHS provided us with a rough cost estimate of $2.7 million to implement our original draft instrument.
Because NORA funding is limited to $1 million over four years, we shortened the draft instrument to address only the issues given the highest priority by the draft work group.
The supplement will help fill data gaps left by current occupational health surveillance systems
Within the NORA funding limit we can implement a supplement that includes questions from the 1988 supplement about back pain and hand and wrist disorders so that we can examine changes in the frequency of these conditions across industry sectors.
The abridged instrument also contains new questions on work organization (Box 1), psychosocial workplace exposures (Box 2), and attribution of work-relatedness to the priority health conditions (back pain, hand/wrist disorders, respiratory disease, hearing difficulty; Box 3).
Each person who participates in the OHS will have also answered NHIS core questions about many common chronic health conditions (e.g., cardiovascular disease, depression, hypertension, diabetes, asthma).
We will be able to analyze data about workplace exposures (e.g., stress, on-the-job discrimination/harassment, and usual industry and occupation) collected with the OHS for associations with health conditions addressed in the NHIS core survey

Box 1: Work Organization Questions
Which of the following best describes your work arrangement in this job? ___ I work as an independent contractor, independent consultant, or freelance worker ___ I am on-call, and work only when called to work ___ I am paid by a temporary agency ___ I work for a contractor who provides workers and services to others under contract ___ I am a regular, permanent employee (standard work arrangement)
Box 2: Psychosocial Workplace Exposure Questions
1. How easy would it be for you to find a job with another employer with approximately the same income and fringe benefits as you have/had at your job at XXXX? (Choices: Very easy, Somewhat easy, Not easy at all) 2. How often do you find your work stressful? (Choices: Always, Often, Sometimes, Hardly ever, Never) 3. All in all, how satisfied would you say you are with your job? (Choices: Very satisfied, Somewhat satisfied, Not too satisfied, Not at all satisfied 4. How hard is it to take time off during your work to take care of personal or family matters? (Choices: Not at all hard, Not too hard, Somewhat hard, Very hard) 5-7. Do you feel in any way discriminated against on your job because of your age/race or ethnic origin/gender? 8-9. In the last 12 months, were you sexually harassed (threatened or harassed in any other way) by anyone while you were on the job?
Box 3: Work-relatedness Questions (to be asked about specific health conditions reported by respondents)
1. Do you think this problem (back pain, hand/wrist disorders, respiratory disease, hearing difficulty) could have been caused by your work? ___Yes, totally related to work ___Yes, partly related to work ___Not related to work ___Don’t know 2. Have you been told by a medical professional that this problem could be or probably was work-related? ___Yes ___No

Conclusions

If we receive FY09 NORA funding, we will implement the proposed NHIS-OHS in 2010.
If other funding sources can be identified, we can include additional content/questions beyond those proposed in the NORA proposal.
Content for a 2010 supplement is due to NCHS in the fall of 2008 so that questions can be pilot tested.

Expected Impact of the Project:

Intermediate Outcomes

Information on the prevalence of and risk factors for occupational health outcomes will be used by the NORA Sector and NIOSH Cross-Sector Programs, non-governmental agencies and organizations, and other stakeholders in priority setting and tracking. Results will be compared to those from the 1988 occupational health supplement.
Peer-reviewed scientific papers will raise awareness of the epidemiology of occupational health outcomes among researchers and clinicians.

End Outcomes

Evidence-based interventions by stakeholders will reduce work-related diseases and injuries. In addition, the results of this surveillance project will inform future hypothesis-driven research.

Future Directions

If you would like to suggest potential additional funding sources or review the full draft supplement, please contact Dr. Sara Luckhaupt (pks8@cdc.gov) or Dr. Geoff Calvert (jac6@cdc.gov).

Disclaimer

The findings and conclusions in this poster are those of the author(s) and do not necessarily represent the views of the National Institute for Occupational Safety and Health. Citations to Web sites external to NIOSH do not constitute NIOSH endorsement of the sponsoring organizations or their programs or products. Furthermore, NIOSH is not responsible for the content of these Web sites.

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Page last updated:October 22, 2008
Page last reviewed:July 18, 2008
Content Source: National Institute for Occupational Safety and Health (NIOSH) Office of the Director