Changing in the face of change.
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Accidents, Occupational↗
Biomedical subjects
Charles Levenstein
Publications and source records attributed to Charles Levenstein.
Results of a union-based smoking cessation intervention for apprentice iron workers (United States).
OBJECTIVE: Blue-collar workers are more likely to smoke, smoke more heavily, and have less success in quitting compared to white-collar workers, and this occupational gap is growing over time. Effective smoking cessation interventions among blue-collar workers are needed to address growing class-based disparities. METHODS: We used a pre-post study design to test feasibility and effect size of a smoking cessation trial in a union apprenticeship training program for iron workers (n = 337). The 4-month intervention drew upon a health promotion-health protection model for smoking cessation among blue-collar workers. We conducted pairwise analyses to assess pre-post intervention differences in 7-day point prevalence smoking abstinence measured 1 month after intervention was completed. Additional secondary outcomes, including smoking frequency, intensity, intention and self-efficacy to quit, were also assessed. RESULTS: Baseline smoking prevalence was 41%. We observed a 19.4% post-intervention quit rate among baseline smokers. There were statistically significant positive changes pre- and post-intervention in intention to quit smoking, self-efficacy to quit, and a reduction in the number of days smoked. Participation in pro-active intervention components was associated with a three-fold (OR = 3.0, 1.15, 7.83) increase in the likelihood of quitting. Overall, participation in intervention components was low. CONCLUSIONS: Labor union apprenticeship programs represent a promising venue for smoking cessation interventions, particularly those that draw upon a health promotion-health protection model.
Adult↗
Estimation of net-costs for prevention of occupational low back pain: three case studies from the US.
BACKGROUND: Occupational low back pain (OLBP) is widespread in industrialized societies. We present a model to estimate the net economic costs of investments in ergonomic interventions at the company level to reduce work-related low back pain. METHODS: Costs of interventions are defined by incorporating not only the costs of investment of equipment and labor, but also by taking into account the avoided costs of lost work time, medical care costs, and productivity improvements. In the net-cost model, all costs are annualized and are calculated at the level of an individual organization. Three case studies have been performed based on data from three companies in the manufacturing sector of the United States using the above approach. RESULTS: The net-cost estimates for the three case studies consistently show that ergonomic interventions applied appropriately can result in substantial cost savings for the companies. CONCLUSIONS: Although generalizing on the basis of three case studies is not ideal, our analyses show that it might be in the economic interest of management to play a more active role to prevent back pain. Gathering useful retrospective cost data, even on interventions deemed effective by corporate innovators, proved to be extremely difficult. We conclude that it is essential to incorporate a protocol for collecting cost and effectiveness data in the standard operating procedures of ergonomists and companies introducing such innovation. We intend to validate the net-cost model for the monitoring and reporting of such data through prospective studies in a variety of industrial settings and in countries at various stages of economic development.
Cost-Benefit Analysis↗
The cost effectiveness of occupational health interventions: preventing occupational back pain.
BACKGROUND: Occupational back pain exacts a toll on society with concomitant economic losses; it is imperative to evaluate the cost-effectiveness of interventions to reduce the relevant ergonomic stressors at work. This study estimates and evaluates the average and incremental cost-effectiveness ratios (CERs) of specific interventions for the prevention of occupationally induced back pain for the World Health Organization (WHO) defined subregions of the world. METHODS: Four back-pain interventions were selected from the literature: training (T), engineering controls (EC), engineering controls and training (EC&T), and a comprehensive full ergonomics program (EP) for evaluation. A simulation model for a 100-year time horizon, developed by the WHO CHOICE initiative project was used to estimate the effectiveness of the interventions in healthy year equivalents. The intervention costs were adjusted for all WHO subregions. RESULTS: In all of the subregions, training was the most cost-effective with CERs varying from 74 dollars per healthy life years gained in the subregion comprising of Egypt, Iraq, Morocco, Yemen (EMROD) to approximately 567 dollars in the subregion covering Canada and the United States (AMROA). Training is considered to be very cost-effective and would be the first choice option where resources are scarce. However, the overall effectiveness of training is low. Although other interventions such as engineering controls and total ergonomic interventions are relatively more expensive, the addition to health outcome through these interventions is much higher. The difference in the CERs for training and other engineering controls and full ergonomic interventions is relatively small for most of the industrialized regions of the world. It is clear from the ranked CERs and incremental CERs over the different subregions that in most of the industrialized regions of the world additional resources, if they become available, should go straight to the full ergonomics program. CONCLUSIONS: The model results based on CERs show that worker training is a low cost, feasible first step toward reducing back pain/injury incidence. However, all of the average CERs for the different interventions, for each of the regions, fall well within their GDP per capita estimates [World Bank, 2001]. According to the WHO Commission on Macroeconomics and Health any intervention that costs less than three times GDP per capita for saving a healthy year equivalent should be considered worthwhile and good value for money [WHO, 2002]. Given this criterion, the engineering controls interventions as well as the full ergonomics program look very cost effective for all of the WHO subregions.
Back Pain↗
The cost effectiveness of occupational health interventions: prevention of silicosis.
BACKGROUND: The failure to recognize occupational health as an economic phenomenon limits the effectiveness of interventions ostensibly designed to prevent disease and injury. Hence, consideration of economic efficiency is essential in the evaluations of interventions to reduce hazardous working conditions. In this paper, we present an analysis of the cost effectiveness of alternative means of preventing silicosis. METHODS: To evaluate the cost effectiveness of specific interventions for the prevention of occupationally induced silicosis, we have used the simulation models based on the generalized cost-effectiveness analysis (GCEA) developed by the WHO-CHOICE initiative for two representative subregions namely AMROA (Canada, United States of America), and WPROB1 (China, Korea, Mongolia). RESULTS: In both of the two subregions, engineering controls are the most cost effective with ratios varying from 105.89 dollars per healthy year or disability adjusted life year saved in AMROA to approximately 109 dollars in WPROB1. In the two subregions, the incremental cost-effectiveness ratio of engineering controls (EC) looks most attractive. Although dust masks (DM) look attractive in terms of cost, the total efficacy is extremely limited. CONCLUSIONS: To the extent that this analysis can be generalized across other subregions, it suggests that engineering control programs would be cost effective in both developed and developing countries for reducing silica exposure to save lives. Note that this analysis understates health benefits since only silicosis and not all silica-related diseases are considered.
Adolescent↗
Net-cost model for workplace interventions.
PROBLEM: Few methods exist for comprehensively examining the costs and benefits of ergonomic interventions applicable to a variety of economic sectors and settings. METHODS: An instrument for data collection and data analysis at the facility level is presented. In this net-cost model intervention costs are defined by equipment and labor costs for the interventions as well as the avoided costs of lost work time, medical care, and productivity improvements. RESULTS: Net-cost estimates for three case studies show that ergonomic interventions applied appropriately can result in substantial cost savings for the companies. DISCUSSION: It would be prudent to incorporate a protocol for collecting cost and effectiveness data in the standard operating procedures of companies introducing ergonomic interventions. Validation of the net-cost model through prospective studies is necessary. IMPACT ON INDUSTRY: This model may be used to determine the net-cost of implemented or proposed ergonomic interventions in industrial facilities.
Ergonomics↗
Change in the world of occupational health: silica control, then and now.
To control silicosis, we need to understand how change happens in occupational health. Science alone does not drive policy, because we have known the causes of silicosis, and how to prevent it for decades, yet the disease persists. To control occupational disease, we need to enter the social realm of work. To investigate the determinants of a successful silicosis control program, we wrote a social history of the Vermont Granite Industry from 1938 to 1960, examining union journals, newspapers, industry journals, scientific literature and government documents, and interviewing key informants. The crucial factor of the successful program was a strong public health movement to control tuberculosis, rather than pressure to control the occupational disease. Using this lesson, to protect workers from silica exposure now, we chose to regulate silica under an environmental law, the Massachusetts Toxics Use Reduction Act. Science is but one small factor, necessary but insufficient, in policy change. We in occupational health need to hitch onto a stronger movement, currently the environmental movement. Where unions are too weak to demand safe technologies, we need to learn to speak the language of employers, because they may have little idea of the costs of interventions. We need to gather more economic information about the costs of interventions.
Dust↗
Smoke-free airlines and the role of organized labor: a case study.
Labor unions play an important role in debates about smoke-free worksites. We investigated the role of flight attendants and their unions in creating smoke-free air travel. We used case study methodology to search tobacco industry documents and labor union periodicals and to interview key informants (i.e., people identified as having first-hand information and experience in the campaign to make airlines smoke free). We then compared findings across these data sources. Tobacco industry strategies against the establishment of smoke-free worksites failed in the case of airlines, largely because of the efforts of flight attendants and their unions. Other factors contributed to the failure but likely would have been insufficient to derail industry efforts without strong stands by the flight attendants. This case illustrates the potential for successful partnerships between unions and tobacco control policy advocates when developing smoke-free worksite policies.
Air Pollution, Indoor↗
Editorial: in-house changes.
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Journal Article↗
Labor and the tobacco institute's labor management committee in new york state: the rise and fall of a political coalition.
In 1984 the Tobacco Institute and the Bakery, Confectionary and Tobacco Workers Union formed a Labor Management Committee. From the mid-1980s to the mid-1990s, this LMC worked to elicit labor support in New York by framing issues in terms that made them salient to unions: tobacco excise taxes as regressive taxation, workplace smoking restrictions as an intrusion into collective bargaining. By the late 1990s, however, most of labor in New York had shifted to support for anti-tobacco policies. The reasons for this shift include the growing size and influence of public-sector unions, and their generally favorable stances on tobacco control issues; the policy-making autonomy of the unions; the growing body of scientific knowledge concerning the dangers of tobacco use; and the rise in public awareness of such dangers. Nevertheless, for two decades, the LMC contributed to mutual suspicion between labor and tobacco control advocates that prevented collaboration between them.
Journal Article↗
Show me the money: cost-benefit analysis in the work environment.
During the last several decades, Cost-Benefit Analysis (CBA) has become a widely used technique in public policy-making. This review examines CBA from perspectives of both advocates and critics; it looks at its theory and practice, its purported advantages and shortcomings in application. It also proposes several ways in which the process can be made more accountable.
Journal Article↗
Reducing occupation-based disparities related to tobacco: roles for occupational health and organized labor.
BACKGROUND: Persistent and growing occupation-based disparities related to tobacco pose a serious public health challenge. Tobacco exacts a disproportionate toll on individuals employed in working class occupations, due to higher prevalence of smoking and exposure to secondhand smoke among these workers compared to others. METHODS: We provide an overview of recent advances that may help to reduce these disparities, including research findings on a successful social contextual intervention model that integrates smoking cessation and occupational health and safety, and a new national effort to link labor unions and tobacco control organizations around their shared interest in reducing tobacco's threat to workers' health. CONCLUSIONS: Implications of these efforts for future research and action are discussed.
Health Priorities↗
Wounding the messenger: the new economy makes occupational health indicators too good to be true.
The U.S. Bureau of Labor Statistics and workers' compensation insurers reported dramatic drops in rates of occupational injuries and illnesses during the 1990s. The authors argue that far-reaching changes in the 1980s and 1990s, including the rise of precarious employment, falling wages and opportunities, and the creation of a super-vulnerable population of immigrant workers, probably helped create this apparent trend by preventing employees from reporting some injuries and illnesses. Changes in the health care system, including loss of access to health care for growing numbers of workers and increased obstacles to the use of workers' compensation, compounded these effects by preventing the diagnosis and documentation of some occupational injuries and illnesses. Researchers should examine these forces more closely to better understand trends in occupational health.
Data Collection↗
'Doctors by Fax' or cleaner production: the problem of prevention in post-communist Hungary.
In 1989, approximately half of the medical visits in Hungary were to factory doctors. Two thousand physicians in the National Health Service were assigned to factories and all medical students served in factories as part of their training. There were certainly problems in the system, but workers preferred the factory doctors to other physicians based in communities or districts; and factory physicians knew about workplace hazards, knew what production processes looked like, and were mandated to deal with work environment problems as well as provide other kinds of patient care. With the reform of the National Health Service, the role of factory physician was eliminated, although companies could institute their own medical services (and sometimes employed the previous medical staff). Later legislation required companies to have access to occupational medical services, but critics have called the new system "Doctors by Fax." We discuss the adequacy of the new legislative requirements (including mandatory health and safety committees) and report on new issues in worker health and safety that have emerged post "reform." Finally, the possibility of linking the prevention of occupational disease and injury prevention to "cleaner production" in Hungary is discussed.
Journal Article↗
Linking work organization and policy: an invitation.
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Journal Article↗
New points of production: homework and shoemaking in Asia.
Globalization--and the manner in which it has been governed during the last decade--has harmed various public policy infrastructures of developing nations, but especially those in health, social, and environmental sectors. The poorest population suffers the most severe consequences, as production takes place in the "informal" economy and in homes. Work safety and health in the informal economy has not gained the attention it warrants and requires, considering that this "sector" constitutes the majority of the world's labor force. The purpose of this article is twofold: (i) to describe the working environment in home-based shoemaking--based on Indonesian and Philippines experience by Markkanen [1]; and (ii) to examine the research framework proposed by Levenstein and Tuminaro in The Political Economy of Occupational Disease [2] and further developed in Wooding and Levenstein, The Point of Production, 1999 [3]. The field investigation by Markkanen employed this approach to explore how hazardous working conditions and inadequate health protection are the product of complex, converging relationships among diverse "actors" or agents at international, national, community, and shoe industry levels.
Journal Article↗
Editorial policies on financial disclosure.
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Biomedical Research↗
Occupational health of Southeast Asian immigrants in a US city: a comparison of data sources.
OBJECTIVES: This study sought to characterize occupational injury and illness cases identified through 3 different sources of data on a population of immigrant workers. METHODS: Participants were Cambodian and Lao workers living in Lowell, Mass. A household survey allowed comparisons between characteristics of work-related cases documented in workers' compensation wage replacement records and hospital records and characteristics of self-reported cases. RESULTS: The household survey captured types of cases missing from existing data, particularly illnesses self-reported to be associated with chemical exposures. Injuries and illnesses affecting the study population appeared to be significantly underrepresented in workers' compensation wage replacement data. CONCLUSIONS: Community-based methods can supplement available occupational health data sources.
Accidents, Occupational↗