Dana Madigan

Objectives: The goal of this study was to characterize the incidence of musculoskeletal conditions presenting to Illinois hospitals that are billed to workers’ compensation. Methods: Musculoskeletal conditions were defined as those with M codes in the International Classification of Diseases (ICD-10-CM) with and without concurrent acute injuries (S & T codes). Results: From 2017-2024, there were 319,775 hospital presentations for work-related musculoskeletal diagnoses, of which 229,295 (69.5%) did not have a concurrent acute traumatic injury. Of those without a concurrent acute injury, 29.8% (n=66,210) had a musculoskeletal pain diagnosis without a specific non-pain musculoskeletal diagnosis, 8.5% (N=18,799) had a diagnosis of non-specific lower back pain, and 61.8% (N=137,286) had a specific musculoskeletal diagnosis. Conclusions: Hospital data provide important information on work-related clinically significant conditions that may not be captured through other surveillance systems.

Housing is a social determinant of health, acting as both a driver and indicator of social inequity. For migrant and seasonal farmworkers, it is difficult to tease apart the interaction between the environmental and social factors related to their housing, in conjunction with extreme poverty, immigration, precarious employment, and linguistic, cultural, and educational factors. The relationship of housing with employment and the transient nature of farmworkers’ occupancy add to the complexity. To assess the strengths, weaknesses, and research gaps and to identify areas requiring further investigation, we performed a critical review of the scientific and gray literature on farmworker housing and health. We propose a framework to focus research and suggest housing policy interventions to improve the health and wellbeing of this essential workforce.

Background: Despite existing regulations mandating exposure control, training, and monitoring, many worksites continue to inadequately protect workers from lead exposure. The Environmental Protection Agency (EPA) requires facilities to report lead emissions to the Toxics Release Inventory (TRI), presenting a potential tool for identifying at‐risk worksites. Research has demonstrated that facilities responsible for high levels of environmental pollution often have poor occupational hygiene controls. Methods: We linked EPA's TRI, the Illinois Adult Blood Lead Registry and business employer data. Using generalized estimating equation (GEE) models, we evaluated the relationship between lead emissions and blood lead testing to estimate the number of potentially exposed workers at sites without medical surveillance of lead exposures between 2016 and 2023. Results: Of 477 Illinois facilities reporting lead emissions, 8.2% ( n = 39) were above‐threshold polluters. Only 3.98% ( n = 19) reported blood lead testing for 2 or more workers between 2016 and 2023. Average annual on‐site emissions were 86 pounds for below‐threshold polluters, 2601 pounds for facilities providing medical surveillance, and 16,917 pounds among above‐threshold polluters without medical surveillance. Among the 39 above‐threshold worksites without medical surveillance, the GEE model estimates that (range low‐to‐high) 7 to 684 workers annually had positive blood lead levels, and 10 to 256 workers had levels ≥ 25 μg/dL. The models indicate that the majority of estimated exposed workers would be employed at 15 worksites. Conclusions: Among facilities reporting above‐threshold lead releases, workers rarely received blood lead testing. EPA's TRI data can identify facilities where compliance with the OSHA lead standards is inadequate and can help prioritize worksites for outreach.

Background: There is a growing appreciation of the importance of health and well‐being and of the complex set of factors, within and outside the workplace, that interact to affect the well‐being of workers. Migrant and seasonal farmworkers experience particular challenges, and measurement of factors that influence their health and well‐being is important to the ethical sustainability of this critical workforce. Methods: To examine the applicability of the NIOSH Worker Well‐Being Framework to the health and well‐being of farmworkers, we conducted a literature review to (1) explore the ways in which the domains, subdomains, and constructs of the framework are described in studies of farmworkers, and (2) identify additional constructs that are not described or not in alignment with the framework. Results: Four reviewers used a thematic analysis approach to identify and summarize key areas of alignment and non‐alignment of 163 included articles. We found alignment with the five framework domains and their sub‐domains, though several are understudied or narrowly operationalized in studies of farmworkers. The vast majority of studies addressed contributors to poor health. We found five additional cross‐cutting or unaligned themes (legal status, discrimination, exploitation, fear of retaliation, fear of deportation). Conclusions: External and work‐related social factors are important to the well‐being of the farmworker workforce. Contextual determinants of employment precarity, hazardous occupational and nonoccupational exposures, and social safety nets should be considered in comprehensive assessments of worker well‐being. Other precarious and immigrant workforces may also require expansion of the NIOSH Worker Well‐Being Framework.

Agriculture is a dangerous industry, with evidence indicating a disproportionate burden among Hispanic/Latinx workers. There is a need to expand the utilization of different data systems to improve the surveillance of precarious workers within agriculture. This analysis describes inclusion criteria to identify farm-related injuries and illnesses in hospital data utilizing ICD-10 codes to better assess health equity issues involving Hispanic/Latinx workers and their associated costs. Discharge data of agriculture-related injuries and illnesses treated in Illinois hospitals and emergency departments from 2018 to 2021 were extracted using ICD-10 diagnosis and location of injury codes. Injury cause, nature, severity, and course of clinical care are stratified by ethnicity. Multivariable models were developed to assess differences in injury severity, level of care required, and cost of care. We identified 3,745 farm-related injuries and illnesses treated in Illinois hospitals between 2018 and 2021, of which 196 involved Hispanic/Latinx individuals. Hispanic/Latinx patients were substantially younger and disproportionately covered by workers' compensation insurance or uninsured. Compared to non-Hispanic/Latinx individuals, Hispanic/Latinx patients suffered injuries from different mechanisms, particularly involving animals and cutting/piercing instruments. While non-Hispanic/Latinx individuals demonstrated more severe injuries based on the descriptive statistics, after controlling for confounding (particularly age), we did not observe ethnic disparities in injury severity or level of care required. However, the cost of care was equivalent to or higher among Hispanic/Latinx persons. The case definition used for this analysis identified agriculture-related cases and provided insights on the course of clinical care by ethnicity. This strategy would likely yield valuable information in states with larger and more diverse agricultural workforces. More targeted research to appropriately scope the issue and inform interventions is needed to understand differential exposure and reduce agricultural workplace hazards and address the financial burden resulting from farm-related injuries.

Objective: Massage therapy involves pervasive ergonomic hazards with the majority of massage therapists (MTs) experiencing adverse musculoskeletal health issues. A variety of barriers and facilitators exist that can impact the efficacy of safety programs. Methods: A longitudinal study to characterize individual and organizational barriers and facilitators that influence the implementation of self-care techniques designed to reduce musculoskeletal health issues. Results: MTs who reported time as abarrier implemented 0.9 fewer selfcare items despite wanting to make these changes (P = 0.003) and 1.4 fewer self-care items when management was identified as a barrier (P < 0.001). Almost 20% of the MTs reported switching jobs which was associated with implementing 1.1 fewer self-care items (P = 0.002). Conclusions: Our findings show that organizational factors plays a critical role in workplace safety which can be used to improve working conditions faced by MTs.

Background: Employment is an important social determinant of health, and supporting individuals’ return to the workforce is likely to have robust impacts on their health and well-being. The aim of this study was to identify (a) the self-perceived employment needs and expectations of users of community employment services; (b) the assets, needs, and barriers to reemployment among users of community employment services; and (c) areas of priority for programmatic development, including implications for patient–worker needs assessment and care coordination in clinical settings. Methods: We conducted structured interviews with 71 adults recruited from three workforce development programs located in the Chicago metropolitan area serving vulnerable workers. Topics of discussion included job histories, financial and social assets, and the respondents’ motivation and expectations for their return to the workforce. We used descriptive statistics to analyze quantitative responses and performed content analysis for qualitative data. Findings: Users reported discrimination, legal barriers, family responsibilities, physical or mental health concerns, and needs related to transportation and housing as common challenges to reemployment. Concerns regarding navigating complex social support programs to meet individual and family needs, as well as uncertainty regarding what would qualify as sufficient employment in order to not be reliant on these programs in the future, were expressed. Conclusion/Application to practice: Health care providers have opportunities to identify those that may benefit from comprehensive referrals to reemployment programs and social services. Occupational health providers are also in a unique position to enhance workforce development programs through collaborations to better educate and support workers.

Objectives: To describe individuals coded as homeless in state-level data comprising of outpatient and inpatient cases over a multi-year period to provide public health surveillance data on the health care utilization and needs of this population. Research Design: In this cross-sectional study, outpatient and inpatient visits coded for homelessness were identified from the Illinois Hospital Discharge Database from January 1, 2011 through December 31, 2018. Demographic characteristics, primary diagnosis and comorbid conditions, and hospital course of treatment were described. Predictors of discharge to a health care facility versus routine discharge to home or self-care were evaluated using multivariable logistic regression. Results: There were 154,173 patient visits predominantly involving males, those aged 25–64 years, and non-Hispanic Whites and African Americans. The majority had comorbidities of depression, psychosis, and/or substance abuse (70.2%) and a routine discharge to home or self-care (81.9%). Discharge to home or self-care relative to another health care institution was associated with having charity coverage and being Black/African American. Conclusions: Those experiencing homelessness experience a high burden of health concerns. Hospital billing records can be used to prioritize the distribution of limited public health resources for health care programs and interventions among those experiencing homelessness.

Objective: This study uses a pre- and post-training program evaluation of chiropractic interns to (1) describe changes in their frequency of occupational history taking before and after a 1-hour training and (2) to document the attitudes and beliefs regarding occupational health and history taking. Methods: All chiropractic interns at 1 clinic location completed questionnaires assessing their attitudes and perceptions regarding documenting the occupational history of their patients each trimester they were enrolled in the study. Each intern enrolled in the study for 2 or more trimesters participated in a 1-hour-long training session on taking an occupational history. The supervising clinician independently evaluated charting behaviors of interns for the duration of the study. Results: The supervising clinician assessed 20 interns' level of documenting occupational history for 202 new patient or reexamination visits. A majority of interns (85% at baseline) were interested in occupational health, and 80% believed that occupational history taking was “very important.” Intern charting behaviors increased after training related to documentation of past occupation (62.9% from 32.4%) and relating the chief complaint to work (59.7% from 30.0%). Detailed occupational history taking remained low throughout the study but demonstrated a doubling in documentation after training (16.1% from 8.6%). Conclusion: Chiropractic interns and clinicians should be adequately trained in occupational health history documentation practices as they are likely to care for work-related injuries. Short training modules appear to be effective in demonstrating small changes in documentation related to occupational history taking.