Background:

Immigrant workers in the US face difficulties in accessing healthcare. The Latinx immigrant population lives at the intersection of many social determinants of health that affect health outcomes, such as immigration status, insurance status, and employment status. In New York City (NYC), nearly three-quarters of Latinx immigrants work in occupations that deem them “essential workers,” however, these same occupations can put them at higher risk for occupational injury as well as fail to provide health insurance or paid sick leave. Navigating how to address an occupational injury is further complicated by the complex health entities that exist in NYC. Despite some health care services available to workers regardless of immigration status, more information is needed to further understand the extent of the benefits, their role when occupational medicine needs arise, and the barriers workers experience to access those services.

Methods:

We used mixed methods consisting of focus groups of Latinx immigrant workers and semi-structured interviews with key stakeholders in the community as well as healthcare providers of the NYC public health system.

Results:

Our ongoing study has identified that Latinx immigrant workers have difficulty understanding the structure of the healthcare system, are unaware of occupational health services and the workers’ compensation system, feel discriminated against, and are unable to afford care. Further work is being conducted to understand the barriers that Latinx immigrant workers face in NYC and solutions to protect Latinx immigrant workers’ health.

Conclusion:

Latinx immigrant workers face many challenges to address their healthcare needs. Bridging existing preventive care and occupational health services can help reduce the challenges immigrant workers face.

Background While absenteeism has been widely studied in the field of occupational health, presenteeism—the act of attending work while ill—has not received as much attention despite its detrimental impact on the long-term health of workers. Likewise, while organizational culture is perceived to be crucial for promoting employee wellbeing and productivity, its specific effects are yet to be fully comprehended. Our objective was to assess the impact of people-oriented culture (POC) on presenteeism among cosmetics sales workers in Korean department stores.

Methods A nationwide cross-sectional survey of 571 cosmetics sales representatives was conducted in 2018 to measure POC and experiences of presenteeism over the past 12 months. POC was assessed using the 4-item measure from the Organizational Policies and Practices (OPP) questionnaire to determine the extent to which an organization values employee engagement. Experiences of presenteeism were measured through a self-reported questionnaire and three cutoffs (≥1day, ≥2days, and ≥6days) were used to define a case of presenteeism. Poisson regression models were used to analyze the data after adjusting for covariates.

Results Overall, 88.97% of cosmetics sales workers reported that they have experienced presenteeism in the past year. Employees working in low POC environments were 1.13 times more likely to experience presenteeism when ≥1day was used to define a case of presenteeism (95% CI 1.04-1.23), 1.55 times more likely with ≥2days cutoff (95% CI 1.26-1.89) and 2.22 times more likely with a ≥6days cutoff (95% CI 1.22-4.00) for presenteeism compared to those in high POC workplaces.

Conclusion This study demonstrates that low POC is associated with higher levels of presenteeism among cosmetics sales representatives. Such findings shed light on the importance of creating high POC organizations and emphasize the need to consider both presenteeism and absenteeism when addressing the impact of the workplace on employee health.

BACKGROUND: Early in the pandemic, the Rhode Island Department of Health (RIDOH) developed a publicly available, voluntary electronic business reporting survey to address the delay in workplace cluster detection and mitigation due to the large volume of cases and laboratory delays. We describe the association of community rates of infection with the number of survey submissions.

METHODS: A retrospective analysis comparing COVID-19 community case rates in Rhode Island to the volume of submissions on the business reporting survey was done to determine if there is an association between community transmission and employer outreach to RIDOH. Survey submissions were tracked and compared to overall community case rates (per 100,000) between June 25, 2020, and December 31, 2022.

RESULTS: Between June 2020 and December 2022, there were 2,308 total survey submissions, with an average of 15 submissions per day. The submission rate varied with the COVID-19 case rates from June 2020-March 2022, ranging from 0 to 79 submissions per week. After this period, submission rates remained high despite declining case rates. The number of submissions decreased over time.

CONCLUSIONS: Our data suggest that community cases of COVID-19 are associated with voluntary reporting of positive cases in businesses to RIDOH. Utilization of electronic reporting remained high, suggesting access to public health resources may be beneficial even during times of lower transmission. As COVID-19 becomes endemic, it is important that public health agencies can use mitigation resources efficiently. RIDOH’s business reporting survey allows workplaces concerned with facility transmission to seek engagement, facilitating resource allocation.

Background and introduction: There are roughly 2.5 million agricultural workers (AW) in the US that grow, tend, and harvest the food we eat and are an integral part of our food system, yet these workers experience health and social inequities rooted in structural racism. Agricultural exceptionalism, a form of structural racism, excludes AW from major federal worker and social protection laws. AW are exposed to occupational risks, are paid low wages, lack health insurance coverage, adequate housing, and sanitation. We identified and described how current labor and social determinants related state-level laws are important to AW’s health.

Methods: Through our agricultural community advisory board, we recruited key informants (from WA and all over the US) and AW (from WA). We explored how labor and social determinant related laws are experienced by AW at work and in their communities. Individuals 18+ who identify as agricultural workers or community leaders participated in the study. Interviews were conducted and transcribed in English or Spanish and coded by two researchers.

Results: We conducted seven key informant and 32 AW interviews. We explored the understanding of existing AW protections, how protections are enforced at their workplace, gain insight on what labor and social determinant-related laws, directly and indirectly, are important to AW. We learned that the workplace environment varies greatly in access to training, personal protection equipment, worker rights information, and access to water and a restroom, depending on the employer.

Conclusions: This study highlights 1.) how laws are linked to inequities agricultural workers experience and 2.) how we can use this information to advocate for changes that center agricultural workers.

Introduction: Silicosis is a preventable lung disease resulting from occupational inhalation of respirable crystalline silica (RCS) and is the most prevalent pneumoconiosis worldwide. Outbreaks of silicosis secondary to engineered stone countertop fabrication have been reported internationally since 2010 and, more recently, in the US. Fifty-two cases have been identified in California since 2019. We aim to describe a case of accelerated silicosis in the context of the largest US cohort of engineered stone-associated silicosis to date, focusing on socioeconomic characteristics and occupational history.

Case Description: To describe the course of disease, we present a 32-year-old Mexican-born, engineered stone fabricator who developed severe silicosis following 15 years of exposure to RCS. He worked as an independent contractor receiving cash payments from kitchen remodelers. For the first 10 years, he used no engineering dust mitigation or personal protective equipment, but for the last 5 years, he used water suppression and an N95 mask approximately 70% of the time. In 2019, he developed a progressive productive cough and was hospitalized due to severe COVID-19 infection in 2021. Chest imaging confirmed a diagnosis of progressive massive fibrosis (severe silicosis). Over nine months, his health deteriorated, and he underwent lung transplantation.

Discussion: This case report draws attention to an emerging outbreak of silicosis driven by engineered stone fabrication among a vulnerable immigrant population. The hope is this case prompts additional disease recognition and reporting, implementation of screening and prevention interventions, and ultimately elimination of the exposure aimed at protecting the health of stone fabricators.

Background: Workplace violence (WPV) is a critical public health issue. Each year, nearly 2 million American workers report they were victims of a WPV incident. One of the biggest challenges facing researchers when trying to understand the nature and causes of WPV is data availability. The Survey of Occupational Injuries and illness (SOII) provides estimates of non-fatal WPV incidents. However, this dataset contains limitations and as a result, a complete picture of WPV is currently not known. Moreover, workers’ compensation insurance claims and medical transaction data represent a superior and more complete source of data, but have not been utilized recently. There is a need to conduct epidemiologic surveillance research regarding workplace violence frequency and rates.

Methods: We will use data from 2013-2022 from the Workers’ Compensation Insurance Rating Bureau of California to produce estimates of non-fatal WPV injuries. We will examine injuries by claim and employer characteristics including, but not limited to, the part of body affected, cause of injury, primary medical diagnosis information (including if any psychological trauma occurred), worker age and sex, geographic location of the injury incident, industry sector, employer size, number of business locations, and history of similar injury claims. We will transform estimates into rates per 100,000 workers using employment data from the Bureau of Labor Statistics.

Results: Results from this research will provide estimates of WPV incidents stratified by several circumstances and characteristics. Results will provide stakeholders with a better understanding of medical claims related to WPV events within the state of California.

Discussion: Recent literature has predominantly focused on estimates of non-fatal WPV using data from SOII. While this dataset can provide national estimates, it lacks a nuanced understanding of WPV events. Medical claims data likely provides better incident/victim information which may lead to greater insight into prevention efforts.

Background and Objective: Community paramedics operate beyond traditional emergency response and transport roles to provide medical care in the community. In San Francisco, community paramedics serve clients experiencing homelessness, addiction, and mental health crises through multidisciplinary street response teams. This study explored community paramedics’ occupational exposures and risks, with a specific focus on moral injury - a mental health injury stemming from perceived transgression of deeply held moral values.

Methods: We conducted six focus groups with members of the San Francisco Fire Department Community Paramedicine (CP) Division from October 2022 - January 2023. Each group had 3 - 8 participants and lasted approximately 2 hours. Using a semi-structured guide, we asked CP members about their work and the challenges they face. Focus groups were audio recorded, transcribed, and thematically analyzed for semantic and latent themes.

Results: CP members report different stressors when working in community paramedicine than in traditional emergency medical services. CP members reported using a trauma-informed approach, aspiring to “move the needle” with each interaction while recognizing they may not resolve the underlying problem. In the context of limited resources to meet client needs (e.g. long-term treatment beds, access to shelter at night), clients who refuse care, and pressure from the calling party to remove clients when they are entitled to remain in the community, CP members are at risk of moral injury. We identified specific pathways where moral injury was occurring and some of the strategies CP members are employing to prevent moral injury and address its negative sequelae.

Conclusion: While moral injury has been described in veterans and healthcare workers, no prior research examined moral injury in emergency medical services or community paramedicine. We found moral injury is a salient health concern in this occupational group and provide suggestions for future research to assess and mitigate moral injury.

Background: Clinician burnout has become a major issue in the United States, contributing to increased mental health challenges and problems with quality of care, productivity, and retention. The objective of this study was to understand primary care providers’ experiences with burnout during the COVID-19 pandemic as well as their perspectives on the causes of burnout and strategies to improve provider well-being.

Methods: Qualitative research involving in-depth interviews with 27 primary care providers in a range of practice settings. Semi-structured interviews lasting between 60 and 75 minutes were conducted using Zoom video-conferencing software between July 2021 and February 2023. Open-ended questions offered providers an opportunity to reflect on their personal experiences with burnout and to discuss causes and potential solutions. Providers were given a $250 incentive upon completion of the interview.

Results: Providers shared their experiences with burnout and mental health challenges during the COVID-19 pandemic. Contributors to burnout include inefficiencies of electronic health record (EHR) systems, high levels of documentation, high volumes of patients, staffing shortages, and patient expectations for responding to emails and telephone calls. The majority of participants described the need to work after clinic hours to complete medical record documentation. Many providers discussed a need for health system leaders to recognize issues with burnout and to make sincere efforts to enhance work-life balance and create a culture of health and well-being for health professionals. Suggested strategies to address these issues include supportive leadership and accessible mental health services along with time away from work to access these services. Many participants also identified the need for additional administrative time to complete medical record documentation. At a systems-level, most providers discussed the need for reducing administrative burden associated with billing requirements and quality reporting.

Conclusions: These providers’ stories highlight the need for a systems approach to support the health and well-being of providers with interventions at the individual, organizational and systems level. Key strategies to reduce burnout include aligning payment models with the best approaches for delivering quality patient care, reducing administrative burden related to documentation and reporting requirements, and redesigning EHR systems with a human factors approach.