Summary Background Adverse mental health effects were reported following oil spills but few studies identified specific responsible attributes of the clean-up experience. Methods We evaluated the impact of multiple oil spill response and clean-up (OSRC) exposures following the Deepwater Horizon disaster on the mental health using data from the GuLF STUDY which includes 8,968 workers and 2,225 non-workers who completed an exam with depression and post-traumatic stress (PTS) screeners. Findings OSRC work was associated with increased prevalence of depression, PRDepression=1·22 (1·08, 1·37) and PTS, PRPTS =1·35 (1·07, 1·71). Among workers, those who reported smelling oil, dispersants or cleaning chemicals had an elevated prevalence of depression, PRDepression=1·58 (1·38, 1·81) and PTS, PRPTS=2·29 (1·71, 3·07). Other factors associated with depression and PTS included stopping work because of the heat (PRDepression=1·36 [1·22, 1·52] and PRPTS =1·41 [1·14, 1·74]) and working as a commercial fisherman prior to the spill (PRDepression=1·36 [1·19, 1·56]; PRPTS =1·86 [1·46, 2·38]). Increasing exposure to total hydrocarbons (TH) appeared associated with depression and PTS but after taking into account work experiences, only the association between the highest TH level and PTS remained, PRPTS=1·75 (1·11, 2·76). Interpretation Workers with high levels of TH exposure or potentially stressful work experiences had increased prevalence of depression and PTS.
Purpose: We investigated the impact of elements of a workplace culture of health (COH) on employees’ perceptions of employer support for health and lifestyle risk. Design: We used 2013 and 2015 survey data from the National Healthy Worksite Program, a Centers for Disease Control and Prevention (CDC)-led initiative to help workplaces implement health-promoting interventions. Setting: Forty-one employers completed the CDC Worksite Health Scorecard to document organizational changes. Participants: Eight hundred twenty-five employees provided data to evaluate changes in their health and attitudes. Measures: We defined elements of a COH as environmental, policy, and programmatic supports; leadership and coworker support; employee engagement (motivational interventions); and strategic communication. Outcomes included scores of employees’ perceptions of employer support for health and lifestyle risk derived from self-reported physical activity, nutrition, and tobacco use. Analysis: We estimated effects using multilevel regression models. Results: At the employee level and across time, regression coefficients show positive associations between leadership support, coworker support, employee engagement, and perceived support for health (P < .05). Coefficients suggest a marginally significant negative association between lifestyle risk and the presence of environmental and policy supports (P < .10) and significant associations with leadership support in 2015 only (P < .05). Conclusion: Relational elements of COH (leadership and coworker support) tend to be associated with perceived support for health, while workplace elements (environmental and policy supports) are more associated with lifestyle risk. Employers need to confront relational and workplace elements together to build a COH.
Health care organizations increasingly employ community health workers (CHWs) to help address growing provider shortages, improve patient outcomes, and increase access to culturally sensitive care among traditionally inaccessible or disenfranchised patient populations. Scholarly interest in CHWs has grown in recent decades, but researchers tend to focus on how CHWs affect patient outcomes rather than whether and how CHWs fit into the existing health care workforce. This paper focuses on the factors that facilitate and impede the integration of the CHWs into health care organizations, and strategies that organizations and their staff develop to overcome barriers to CHW integration. We use qualitative evaluation data from 13 awardees that received Health Care Innovation Awards from the Centers of Medicare and Medicaid Innovation to enhance the quality of health care, improve health outcomes, and reduce the cost of care using programs involving CHWs. We find that organizational capacity, support for CHWs, clarity about health care roles, and clinical workflow drive CHW integration. We conclude with practical recommendations for health care organizations interested in employing CHWs.
Disaster recovery work increases risk for mental health problems, yet the mechanisms underlying this association are unclear. We explored links from recovery work to posttraumatic stress (PTS), major depression (MD) and generalized anxiety disorder (GAD) symptoms through physical health symptoms and household income in the aftermath of the Deepwater Horizon oil spill. As part of the NIEHS GuLF STUDY, participants (N = 10,141) reported on cleanup work activities, spill-related physical health symptoms, and household income at baseline, and mental health symptoms an average of 14.69 weeks (SD = 16.79) thereafter. Cleanup work participation was associated with higher physical health symptoms, which in turn were associated with higher PTS, MD, and GAD symptoms. Similar pattern of results were found in models including workers only and investigating the influence of longer work duration and higher work-related oil exposure on mental health symptoms. In addition, longer worker duration and higher work-related oil exposure were associated with higher household income, which in turn was associated with lower MD and GAD symptoms. These findings suggest that physical health symptoms contribute to workers’ risk for mental health symptoms, while higher household income, potentially from more extensive work, might mitigate risk.
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