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Purpose: Workplace support needs for women and men living with mental health conditions are not well understood. This study examined workplace accommodation and support needs among women and men with and without mental health or cognitive conditions and individual and workplace factors associated with having unmet needs. Methods: A cross-sectional survey of 3068 Canadian workers collected information on disability, gender, gendered occupations, job conditions, work contexts, and workplace accommodations. Multivariable logistic regression analyses examined gender- and disability-based differences in unmet needs for workplace flexibility, work modifications, and health benefits, and the association of work context (i.e., work schedule, job sector) and job conditions (i.e., precarious work) on the likelihood of unmet accommodation needs. The additive (i.e., super- or sub-additive) and multiplicative effects of disability, gender, and occupational gender distribution on the probability of unmet accommodation needs were also assessed. Results: The most common unmet workplace accommodation was work modifications reported by 35.9% of respondents with mental/cognitive disability and workplace flexibility reported by 19.6% of individuals without a mental/cognitive disability. Women, employees in female dominant occupations, and participants with mental/cognitive disabilities were more likely to report unmet needs compared with men, employees in non-female dominant occupations, and participants without disabilities but these findings were largely explained by differences in job conditions and work contexts. No interacting effects on the likelihood of reporting unmet needs for workplace accommodations were observed. Conclusions: To support employee mental health, attention is needed to address work contexts and job conditions, especially for people working with mental/cognitive disabilities, women, and workers in female-dominated occupations where unmet accommodation needs are greatest. [ABSTRACT FROM AUTHOR]

This study examined the impact of the 1998 Canadian ice storm on the physical and psychological health of older adults (age greater than 55 years) living with a chronic physical illness, namely osteoarthritis and/or osteoporosis. Although disasters are relatively rare, they are a useful means of examining the impact of a single stressor on a group of individuals. Specifically, we took advantage of a natural experiment to compare the responses of a group of 59 ice storm victims to those of 55 matched controls living outside the ice storm area. Data on disability, pain, self-reported health, helplessness, depression, and independence were assessed prior to the ice storm and approximately 17 months later. Older adults who reported greater helplessness and lost independence prior to the storm reported significantly greater ice storm stress and rumination and were more likely to report that the storm affected their condition. In addition, participants exposed to the ice storm reported significant changes in disability and pain nearly a year and a half later, compared to matched controls. These results suggest that older adults with chronic physical illness may be particularly vulnerable when faced with additional stressful events. (Contains 3 tables and 2 figures.) [Abstract provided in both French and English.]

Purpose This study aimed to understand age differences in wage-replacement duration by focusing on variations in the relationship across different periods of follow-up time. Methods We used administrative claims data provided by six workers' compensation systems in Canada. Included were time-loss claims for workers aged 15–80 years with a work-related injury/illness during the 2011 to 2015 period (N = 751,679 claims). Data were coded for comparability across cohorts. Survival analysis examined age-related differences in the hazard of transitioning off (versus remaining on) disability benefits, allowing for relaxed proportionality constraints on the hazard rates over time. Differences were examined on the absolute (hazard difference) and relative (hazard ratios [HR]) scales. Results Older age groups had a lower likelihood of transitioning off wage-replacement benefits compared to younger age groups in the overall models (e.g., 55–64 vs. 15–24 years: HR 0.62). However, absolute and relative differences in age-specific hazard rates varied as a function of follow-up time. The greatest age-related differences were observed at earlier event times and were attenuated towards a null difference across later follow-up event times. Conclusions Our study provides new insight into the workplace injury/illness claim and recovery processes and suggests that older age is not always strongly associated with worse disability duration outcomes. The use of data from multiple jurisdictions lends external validity to our findings and demonstrates the utility of using cross-jurisdictional data extracts. Future work should examine the social and contextual determinants that operate during various recovery phases, and how these factors interact with age. [ABSTRACT FROM AUTHOR]

Purpose: To understand the similarities and differences in the employment participation of people living with arthritis across the life course. Method: Focus groups and interviews were conducted with young (ages 18-34 years, n = 7), middle-aged (ages 35-54 years, n = 13) and older adults (>55 years, n = 25) with arthritis. Participants were asked about the impact of arthritis on employment, experiences with health-related changes, career progression and social role involvement. A modified grounded theory approach was used to inductively analyze the data. Results: Young adults indicated the school-to-work transition as being influential in their employment and described the need to direct their time and energy toward finding work that accommodated health and met career aspirations. Middle-aged adults described how the transition from good health to an arthritis diagnosis disrupted involvement in diverse social roles. However, they often downplayed the impact of arthritis on employment. Older adults described the work-to-retirement transition and their decline in physical functioning as contributing to changing involvement in the labor market. Conclusion: Transitions related to health, career progression and social role involvement shaped employment experiences, and represent opportunities for future research and practice that is tailored to life course issues. Implications for rehabilitation: Little is known about the work experiences of young- and middle-aged adults with arthritis and how they compare to their older counterparts. Life course theory offers an important framework for research and practice by providing a perspective to enhance our understanding of how employment participation differs across phases of life. Salient and diverse changes related to health, career and social role involvement were identified at each life phase and shaped employment. Rehabilitation practitioners should pay special attention to a client’s age, life phase and work history as a strategy to enhance the delivery of interventions that promote work participation. [ABSTRACT FROM AUTHOR]

Background: The use of complementary and alternative medicine (CAM) is growing. However the factors contributing to changes over time and to birth cohort differences in CAM use are not well understood. Setting: We used data from 10186 participants, who were aged 20–69 years at the first cycle of data collection in the longitudinal component of the Canadian National Population Health Survey (1994/95-2010/11). We examined chiropractic and other practitioner-based CAM use with a focus on five birth cohorts: pre-World War II (born 1925–1934); World War II (born 1935–1944); older baby boomers (born 1945–1954); younger baby boomers (born 1955–1964); and Gen Xers (born 1965–1974). The survey collected data every two years on predisposing (e.g., sex, education), enabling (e.g., income), behavior-related factors (e.g., obesity), need (e.g., chronic conditions), and use of conventional care (primary care and specialists). Results: The findings suggest that, at corresponding ages, more recent cohorts reported greater CAM (OR = 25.9, 95% CI: 20.0; 33.6 for Gen Xers vs. pre-World War) and chiropractic use than their predecessors (OR = 2.2, 95% CI: 1.7; 2.8 for Gen Xers vs. pre-World War). There was also a secular trend of increasing CAM use, but not chiropractic use, over time (period effect) across all ages. Factors associated with cohort differences were different for CAM and chiropractic use. Cohort differences in CAM use were partially related to a period effect of increasing CAM use over time across all ages while cohort differences in chiropractic use were related to the higher prevalence of chronic conditions among recent cohorts. The use of conventional care was positively related to greater CAM use (OR = 1.8, 95% CI: 1.6; 2.0) and chiropractic use (OR = 1.2, 95% CI: 1.1; 1.4) but did not contribute to changes over time or to cohort differences in CAM and chiropractic use. Conclusion: The higher CAM use over time and in recent cohorts could reflect how recent generations are approaching their healthcare needs by expanding conventional care to include CAM therapies and practice for treatment and health promotion. The findings also underscore the importance of doctors discussing CAM use with their patients. [ABSTRACT FROM AUTHOR]

Objective: Examine feasibility of conducting a randomized controlled trial of the Timing it Right Stroke Family Support Program (TIRSFSP) and collect pilot data. Design: Multi-site mixed method randomized controlled trial. Setting: Acute and community care in three Canadian cities. Subjects: Caregivers were family members or friends providing care to individuals who experienced their first stroke. Intervention: The TIRSFSP offered in two formats, self-directed by the caregiver or stroke support person-directed over time, were compared to standard care. Main measures: Caregivers completed baseline and follow-up measures 1, 3 and 6 months post-stroke including Centre for Epidemiological Studies Depression, Positive Affect, Social Support, and Mastery Scales. We completed in-depth qualitative interviews with caregivers and maintained intervention records describing support provided to each caregiver. Results: Thirty-one caregivers received standard care (n=10), self-directed (n=10), or stroke support person-directed (n=11) interventions. We retained 77% of the sample through 6-months. Key areas of support derived from intervention records (n=11) related to caregiver wellbeing, caregiving strategies, patient wellbeing, community re-integration, and service delivery. Compared to standard care, caregivers receiving the stroke support person-directed intervention reported improvements in perceived support (estimate 3.1, P=.04) and mastery (estimate .35, P=.06). Qualitative caregiver interviews (n=19) reflected the complex interaction between caregiver needs, preferences and available options when reporting on level of satisfaction. Conclusions: Preliminary findings suggest the research design is feasible, caregivers’ needs are complex, and the support intervention may enhance caregivers’ perceived support and mastery. The intervention will be tested further in a large scale trial. [ABSTRACT FROM AUTHOR]

Objective: To examine work absenteeism, job disruptions, and perceived productivity loss and factors associated with each outcome in young adults living with systemic lupus erythematosus (SLE) and juvenile arthritis (JA).Methods: One hundred forty-three young adults, ages 18-30 years with SLE (54.5%) and JA (45.5%), completed an online survey of work experiences. Demographic, health (e.g., fatigue, disease activity), psychosocial (e.g., independence, social support), and work context (e.g., career satisfaction, job control, self-disclosure) information was collected. Participants were asked about absenteeism, job disruptions, and perceived productivity loss in the last 6 months. Log Poisson regression analyses examined factors associated with work outcomes.Results: A majority of participants (59%) were employed and reported a well-managed health condition. Employed respondents were satisfied with their career progress and indicated moderate job control. More than 40% of participants reported absenteeism, job disruptions, and productivity loss. Greater job control and self-disclosure, and less social support, were related to a higher likelihood of absenteeism. More disease activity was related to a greater likelihood of reporting job disruptions. Lower fatigue and higher job control were associated with a reduced likelihood of a productivity loss.Conclusion: Young adult respondents with rheumatic disease experienced challenges with employment, including absenteeism, job disruptions, and productivity loss. While related to greater absenteeism, job control could play a role in a young person's ability to manage their health condition and sustain productive employment. Greater attention should also be paid to understanding health factors and social support in early work experiences. [ABSTRACT FROM AUTHOR]

Objectives The aim of this study was to examine the risk of work injury associated with changes in shift schedules and identify whether work injury risks differ between men and women. Methods Longitudinal panels from the Survey of Labor and Income Dynamics were used to describe work schedule patterns over a 6-year period among a representative sample of Canadian workers (N=19 131). Cox regression was used to estimate the risk of work injury among workers who (i) switched from regular day to nonstandard shifts, (ii) switched from nonstandard to day shifts and (iii) remained in nonstandard shifts, compared with (iv) those who worked regular day shifts only. Gender differences were examined in separate stratified analyses. Adjustments were made for potential respondent and occupational confounders. Results Increased injury risk was observed among those who: switched from day to nonstandard shifts [hazard ratio (HR) 2.60, 95% confidence interval (95% CI) 1.79-3.77], switched from nonstandard to days (HR 2.36, 95% CI 1.62-3.49), and worked nonstandard shifts only (HR 1.44, 95% CI 1.23-1.70). For women, work injury risk was higher among those who switched shifts (days to nonstandard HR 3.10, 95% CI 1.76-5.46; nonstandard to days HR 2.31, 95% CI 1.36-3.91), or worked nonstandard shifts only (HR 1.85, 95% CI 1.44-2.37) compared to day schedules. However, for men the risk of injury was elevated only among those who switched shifts (days to nonstandard HR 2.18, 95% CI 1.35-3.51; nonstandard to days HR 2.38, 95% CI 1.41-3.95). The only significant difference between men and women were among nonstandard shift workers. Conclusion Our results suggest that changing shift types may increase work injury risk among men and women, and that the risk remains increased among women who work nonstandard shifts for a prolonged period of time. This highlights the need for awareness and implementation of health and safety programs when workers initially change shift schedules and on a regular basis to maintain worker health. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic created new difficulties for people living with brain injury, their families, and caregivers while amplifying the challenges of community-based associations that support them. We aimed to understand the effects of the pandemic on clients who live with brain injury, as well as on the provision of community brain injury services/programs in Canada., Methods: Online cross-sectional survey conducted in January 2022. Representatives of brain injury associations across Canada completed the 31 open- and closed-ended questions about meeting clients' needs, addressing public health guidelines, and sustaining the association. Data were analyzed using descriptive statistics (close-ended questions) and qualitative content analysis (open-ended questions)., Results: Of the 45 key representatives from associations in Pacific/Western (40%), Central (56%), and Atlantic Canada (4%), the majority were paid executive directors (67%). Participants reported that the most frequent psychosocial challenges experienced by their clients during the pandemic were social isolation (98%), loneliness (96%), and anxiety (93%). To alleviate these challenges, associations implemented wellness checks and psychosocial support. Most respondents (91%) affirmed that clients faced multiple technological barriers, such as a lack of technological knowledge and financial resources for devices and/or internet. In the open-ended questions, twenty-nine (64%) associations reported providing clients with devices, technology training, and assistance. Regarding public health measures, thirty (67%) respondents reported that clients had challenges understanding and/or following public health guidelines. Forty-two associations (93%) provided tailored information to help clients understand and comply with public health measures. Although associations (67%) received pandemic-related funding from the Canadian government they still struggled with the association's sustainability. Thirty-four (76%) lost funding or financial resources that prevented them from delivering programs or required the use of reserve funds to continue to do so. Only 56% reported receiving sufficient funding to address additional COVID-19-related expenses., Conclusion: Although the pandemic added further challenges to the sustainability of brain injury associations across Canada, they quickly adapted services/programs to respond to the increasing and varied needs of clients, while complying with protective measures. To ensure community associations' survival it is essential to aptly recognize the vital role played by these associations within the brain injury care continuum., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Salazar, Bottari, Lecours, McDonald, Gignac, Swaine, Schmidt, Lemsky, Brosda and Engel.)

Background: People with disabilities often report restrictions to employment participation. Recent theorising emphasises the need for broadened conceptualisations of participation, incorporating subjective participation experiences., Objective: To examine relationships between subjective, experiential aspects of employment participation and work-specific outcomes in adults with and without physical disabilities., Methods: Using a cross-sectional study design, 1624 working Canadian adults with and without physical disabilities completed (a) the recently-developed Measure of Experiential Aspects of Participation (MeEAP) to assess six experiential aspects of employment participation: autonomy, belongingness, challenge, engagement, mastery and meaning and (b) work-outcome measures of perceived work stress, productivity loss, health-related job disruptions and absenteeism. Forced entry multivariable regression analyses were conducted., Results: Among respondents with and without disabilities, greater autonomy and mastery were associated with less work stress (ps < .03); greater belongingness was associated with less productivity loss (p < .0001). Greater engagement was associated with fewer job disruptions (p = .02) but only for respondents with physical and non-physical disability. This sub-group scored lower on all experiential aspects of participation than workers with no disability or physicaldisability only (ps < .05)., Conclusions: Results provide some support for the hypothesis that people with more positive employment participation experiences also report better work outcomes. The concept and measurement of experiential aspects of participation have value for advancing understanding of factors related to employment outcomes in workers with disabilities. Research is needed to determine how positive participation experiences manifest in workplace settings, and antecedents and consequences of positive and negative employment participation experiences., Competing Interests: Disclosures This research was part of the Canadian Disability Participation Project funded by a Social Sciences and Humanities Research Council of Canada Partnership Grant #895-2013-021. Funding also was received through a Healthy and Productive Work (HPW) partnership grant from the Social Sciences and Humanities Research Council (SSHRC) and the Canadian Institutes of Health Research#890-2016-3002. KMG holds the Reichwald Family UBC Southern Medical Program Chair in Preventive Medicine. AJ receives partial salary support from a Stars Early Career Salary Award from the Arthritis Society (Canada), #20-0014., (Copyright © 2023 Elsevier Inc. All rights reserved.)

The COVID-19 pandemic has increased challenges for people living with brain injury and community associations to support this vulnerable population. This study aimed to gain an in-depth understanding of the challenges faced by brain injury survivors during the first year of the pandemic and how community brain injury associations adapted their services to respond to these needs. Findings from seven focus-group with 31 representatives of Canadian brain injury associations revealed 4 main themes: (1) Addressing evolving client needs; (2) Keeping clients safe; (3) Challenges and opportunities navigating the digital world; and (4) Sustaining brain injury associations in the face of uncertainties and disruptions. To comply with public health measures, associations reported pivoting their service delivery online, despite recognizing the difficulties this could create for many brain injury survivors in accessing and using technology. Our findings also highlight concrete directions for not-profit organizations providing instrumental help with activities, acting as a liaison and interpreter of public health guidelines, and in connecting with clients using technology while handling potential cognitive and technological challenges. Addressing these issues has the potential to protect people living with brain injury and community associations from external threats, like pandemics, in the future., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objective: Young adults with rheumatic disease face challenges communicating health needs, accessing workplace support, and sustaining productivity. Our objective was to examine whether disclosure modifies the relationship between workplace support and presenteeism., Methods: An online survey was administered to Canadian young adults with rheumatic disease and asked about presenteeism (0 = health had no effect on work; 10 = health completely prevented working), workplace support need, availability, and use and whether health details were disclosed to an immediate supervisor. A multivariable robust linear regression model was conducted and stratified by those who did and did not disclose the details of their health to their supervisor., Results: A total of 306 participants completed the survey with a mean ± SD presenteeism score of 4.89 ± 2.65. More than 70% disclosed health details to their supervisor; those who disclosed reported greater presenteeism (mean ± SD 5.2 ± 2.5) when compared to those who did not disclose (mean ± SD 4.2 ± 2.61). Greater disease severity was associated with disclosure. Half of the participants reported unmet workplace support needs (53%), 32% reported that their workplace support needs were met, and 15% reported exceeded workplace support needs. The relationship between presenteeism and workplace support needs was modified by disclosure. For participants who disclosed, workplace support needs that were unmet (β = 1.59 [95% confidence interval (95% CI) 0.75, 2.43]) and that were met (β = 1.25 [95% CI 0.39, 2.11]) were associated with greater presenteeism when compared to those with exceeded workplace support needs., Conclusion: To address presenteeism, strategies should be developed for young adults with rheumatic disease to foster access to available workplace supports and to navigate disclosure decisions., (© 2021 The Authors. Arthritis Care & Research published by Wiley Periodicals LLC on behalf of American College of Rheumatology.)

Objective: The focus on disability in osteoarthritis (OA) has largely been on the ability to perform specific activities, which neglects the greater implications for social participation. We investigated the association between OA and social participation, considering activity limitations and instrumental supports as intervening variables in the association., Methods: Data were from 21,214 respondents, ages 45-85 years, from cycle 1 of the Canadian Longitudinal Study on Aging. The questionnaire elicited information regarding self-reported doctor-diagnosed OA, difficulty with 14 activities, perceived availability and receipt of instrumental supports, and 17 social participation activities. Structural equation modeling was used. The primary outcome was social participation, and the primary predictor was OA. The intervening variables included activity limitations, received instrumental supports, and perceived instrumental supports. Latent variables were developed for intervening and social participation variables. The covariates included age, sex, body mass index, income, education, smoking, and comorbidity count., Results: The mean age of the respondents was 63 years, 51% were female, and 26.5% reported having OA. Two distinct social participation indicators were identified, including social participation-diversity and social participation-intensity. When intervening variables were not considered, minimal/no association was found between OA and social participation. When intervening variables were considered, unique pathways linking OA and social participation were found. The overall negative association between activity limitations and social participation was partially direct and partially buffered by both receipt of and perceived availability of instrumental supports. In the absence of activity limitations, OA was associated with greater social participation., Conclusion: Enhanced social participation in people with OA who do not have activity limitations may reflect proactive steps taken by those with mild OA to maintain activity and social engagement. For those with activity limitations, findings highlight the need for interventions to mitigate limitations and draw particular attention to the importance of both provision and awareness of available instrumental supports in maintaining social participation., (© 2020, American College of Rheumatology.)

Background: Individuals with physical or mental health disabilities may be particularly vulnerable to the impact of COVID-19 on their health and employment., Objectives: We examined COVID-19-related concerns for health, finances, and organizational support among workers with no disability, a physical, mental health, or both physical and mental health disability, and factors associated with COVID-19 perceptions., Methods: An online, cross-sectional survey was administered to a sample of Canadians in the first wave of the COVID-19 pandemic. Questions asked about COVID-19 perceptions, demographics (gender, age, education), work context (e.g., sector, contract work) and employment conditions (e.g., job stress, control, accommodation needs). Descriptive, multivariable, and nested regression analyses examined factors associated with COVID-19 perceptions., Results: A total of 3066 participants completed the survey. Workers with both a physical and mental health disability reported significantly greater health and financial concerns and less organizational support than those with no disability. Workers with a physical disability reported more health concerns and those with a mental health disability reported more financial concerns and less organizational support. Respondents with disabilities also reported significant differences in employment conditions (e.g., more contract work, stress, unmet accommodation needs) than those with no disability. Employment conditions were consistently significant predictors of COVID-19 perceptions and attenuated the significance of disability type in analyses., Conclusions: Concerns about the impact of COVID-19 on one's health, finances, and organizational support reflected existing disability inequities in employment conditions and highlight the importance of creating more inclusive employment opportunities for people living with physical and mental health disabilities., (Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.)

Objective: The COVID-19 pandemic has had considerable economic repercussions for young workers. The current study was undertaken to examine the impact of the pandemic on the employment of young adults with rheumatic disease and on perceptions of work and health., Methods: Surveys were administered to young adults with rheumatic disease prior to and following the onset of the COVID-19 pandemic. Surveys asked about employment status and collected information on sociodemographic, disease/health, and work-context factors. Items also asked about the perceived impact of the COVID-19 pandemic on work and health. A generalized estimating equation model was fitted to examine the effect of the pandemic on employment., Results: In total, 133 young adults completed the pre-COVID-19 pandemic survey (mean age 28.9 years, 82% women). When compared to the pre-COVID-19 pandemic period, employment decreased from 86% to 71% following the pandemic, but no other changes were identified in sociodemographic, disease/health, or work-context factors. The time period following the COVID-19 pandemic was associated with a 72% lower odds of employment compared to the pre-pandemic period (odds ratio 0.28 [95% confidence interval 0.11-0.71]). Those with a postsecondary education or who reported more mental job demands were more likely to be employed following the onset of the pandemic. Also, a majority of participants reported that the pandemic affected health care (83%), treatment access (54%), working conditions (92%), and occupational health and safety (74%)., Conclusion: The onset of the COVID-19 pandemic had socioeconomic implications for young people with rheumatic disease. To support economic recovery for individuals with rheumatic disease, strategies to promote employment should be designed that account for the young adult life phase and occupational characteristics., (© 2021 The Authors. Arthritis Care & Research published by Wiley Periodicals LLC on behalf of American College of Rheumatology.)

Objectives: Prevailing job stress models encourage a multidimensional view of the psychosocial work environment and highlight the role that multiple co-occurring stressors play in the aetiology of mental health problems. In this study, we develop a latent typology of psychosocial work environment profiles to describe how a comprehensive array of job stressors are clustered in the Canadian labour market. We also examine the association between these latent psychosocial work environment profiles and several indicators of mental health., Methods: Data were collected from 6408 workers who completed the Canadian National Psychosocial Work Environment Survey. Psychosocial work exposures were measured using standard items from the Copenhagen Psychosocial Questionnaire. We employed latent profile analyses to identify groups of individuals with similar psychosocial work environment profiles. We used log-linear regression models to examine the association between latent psychosocial work environment profiles and burnout, stress, and cognitive strain., Results: Four distinct groups with highly divergent psychosocial work environment profiles were identified. Adjusting for a range of demographic and socioeconomic factors, latent psychosocial work environment profiles were strongly related to mental health. Individuals who reported exposure to a comprehensive array of psychosocial job stressors (11% prevalence) reported the highest probability of burnout (PR: 7.51, 95% confidence interval [CI]: 5.56-10.15), stress (PR: 8.98, 95% CI: 6.20-13.0), and cognitive strain (PR: 7.29, 95% CI: 5.02-10.60)., Conclusions: Findings suggest that psychosocial work stressors are tightly clustered in the Canadian labour market, and that the clustering of work stressors is strongly associated with adverse mental health outcomes. Future scholarship may benefit from adopting a more comprehensive approach to the assessment of psychosocial job quality as a determinant of health and well-being., (© The Author(s) 2021. Published by Oxford University Press on behalf of the British Occupational Hygiene Society.)

In Canada, public safety personnel, including correctional officers, experience high rates of mental health problems. Correctional officers' occupational stress has been characterized as insidious and chronic due to multiple and unpredictable occupational risk factors such as violence, unsupportive colleagues and management, poor prison conditions, and shift work. Given the increased risk of adverse mental health outcomes associated with operational stressors, organizational programs have been developed to provide correctional officers with support to promote mental well-being and to provide mental health interventions that incorporate recovery and reduction in relapse risk. This paper uses two theories, the Job Demand Control Support (JDCS) Model and Social Ecological Model (SEM), to explore why workplace social support programs may not been successful in terms of uptake or effectiveness among correctional officers in Canada. We suggest that structural policy changes implemented in the past 15 years have had unintentional impacts on working conditions that increase correctional officer workload and decrease tangible resources to deal with an increasingly complex prison population. Notably, we believe interpersonal support programs may only have limited success if implemented without addressing the multilevel factors creating conditions of job strain.

Introduction: Individual attributes including disability and sex/gender have the potential to intersect and determine the likelihood of unmet workplace support needs. Our study compares unmet workplace support needs between workers with and without a disability, and according to disability type and sex/gender differences., Methods: Workers with (n = 901) and without (n = 895) a disability were surveyed to examine their need and use of workplace supports including job accommodations, work modifications and health benefits. A multivariable logistic model was conducted to examine the relationship between disability status, disability type and sex/gender and unmet workplace support needs. The model included interaction terms between sex/gender × physical disability, sex/gender × nonphysical disability, and sex/gender × physical and nonphysical disability., Results: Among participants with a disability, 24% had a physical disability, 20% had a nonphysical disability (e.g., cognitive, mental/emotional or sensory disability) and 56% had both physical and nonphysical disability. Over half of the respondents were women (56%). Results from the multivariable model showed that nondisabled women were more likely to report unmet workplace support needs when compared to nondisabled men (odds ratio [OR] = 1.54, 95% confidence interval [CI], 1.13-2.10). Findings also showed an intersection between the number and type of disability and sex/gender; women with both a physical and nonphysical disability had the greatest likelihood of reporting unmet workplace support needs when compared to nondisabled men (OR = 2.73; 95% CI, 1.83-4.08)., Conclusions: Being a woman and having one or more disabilities can determine unmet workplace support needs. Strategies to address workplace support needs should consider the intersection between disability and sex/gender differences., (© 2020 The Authors. American Journal of Industrial Medicine published by Wiley Periodicals LLC.)

Background: Precarious work is an increasingly common characteristic of industrialized labor markets that can widen health inequities, especially among disadvantaged workforce segments. Study objectives are to compare precarious employment in workers with and without disabilities, and to examine the modifying effect of disability in the relationships between age, job tenure and precarious work., Methods: Employed Canadians with (n = 901) and without disabilities (n = 901) were surveyed on exposure to precarious working conditions. Information on age and job tenure were collected from respondents along with sociodemographic, health and work context details. Multivariable logistic models examined the association between disability and precarious work. Also, multigroup probit models examined precarious work for young (18-35 yrs), middle-aged (36-50 yrs) and older adults (> 50 yrs) and job tenure and was stratified by participants with and without disabilities., Results: Almost equal proportions of young, middle-aged and older participants were recruited. Mean job tenure of participants was 9.5 years (SD = 9.0). Close to one-third of participants reported working precariously. At the multivariable level, a disability was not associated with working precariously. However, multigroup modelling indicated that disability was a significant effect-modifier. Older adults with a disability had a 1.88 times greater odds of reporting precarious work when compared to young adults (OR = 1.88, 95%CI 1.19, 2.98). When reporting a disability, longer job tenure was related to a 0.95 times lower odds of precarious work (OR = 0.95 95%CI 0.93, 0.98). The relationship between age and job tenure was not significant for those not reporting a disability., Discussion: Precarious work has the potential to affect workers with and without disabilities. For those with a disability, being an older adult and/or a new worker can contribute to a greater likelihood of being employed precariously. Policies and programs can be recommended to address precarious working conditions and related health inequities for people with disabilities based on life and career phase.

Objectives: There is a paucity of longitudinal population-based studies examining whether changes in work factors are associated with concurrent changes in leisure time physical activity (LTPA). This study examines this issue using 12 years of longitudinal survey data., Methods: Data were drawn from the Canadian National Population Health Survey. The initial analytical sample in 1994 of 6407 working individuals was followed every 2 years from 2000 to 2010. Seven work factors were measured as independent variables: skill discretion, decision authority, psychological demands, physical exertion, number of jobs, hours at work and shift schedule. LTPA was categorised as inactive, moderately active or active based on metabolic equivalent task values. Fixed-effects multinomial logistic models were used to examine associations between work factors and LTPA controlling for time-invariant effects and adjusted for covariates., Results: Workers with lower skill discretion (OR=0.96; 95% CI 0.92 to 0.99), higher psychological demands (OR=0.95; 95% CI 0.92 to 0.99), higher physical exertion (OR=0.93; 95% CI 0.88 to 0.99) and longer work hours (OR=0.97; 95% CI 0.95 to 098) were associated with a lower odds of transitioning from inactive to active and moderately active. There was no evidence of effect modification by age or sex., Conclusion: Results suggest that as participants' skill discretion decreased, and their physical and psychological demands, and work hours increased, their likelihood of becoming more active and moderately active also decreased, supporting the value of targeting improvements in these work factors for physical activity interventions., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.)

Access to workplace showers and change rooms (WS/CR) has been found to be associated with active commuting (AC). Yet it is unclear whether this extends to older workers. We examined the association between WS/CR and AC (walking, cycling) comparing older and younger workers. Data came from 53,294 respondents to the 2007-2008 Canadian Community Health Survey. Associations between WS/CR and walking and cycling were analyzed for main effects and by age and sex using logistic regression. Compared with younger ages, workers 50 to 75 years old were more likely to cycle to work if WS/CR were available (odds ratio [OR] = 1.71, 95% confidence interval [CI] = [1.13, 2.58]), though the overall and sex-related associations between WS/CR and AC were nonsignificant. WS/CR may be a promising strategy to promote AC particularly among older workers. With large numbers of middle- and older-aged adults working longer, the implications of AC for sustaining good health may be considerable.

ABSTRACTWe know little about the retirement plans of adults with chronic diseases. This research recruited Canadian workers 50-67 years of age from a national panel of 80,000 individuals (arthritis, n = 631; diabetes, n = 286; both arthritis and diabetes, n = 111; no chronic disabling conditions, n = 538). A cross-sectional survey asked participants about their expected age of retirement, future work plans, whether they were retiring sooner than planned, and bridged retirement. Chi-square analyses, analyses of variance, and regression analyses examined expectations and factors associated with them. Despite health difficulties, workers with arthritis and diabetes had retirement plans similar to those of healthy controls and consistent with normative expectations of working to a traditional retirement age. However, more respondents with arthritis or diabetes reported bridged retirement than healthy controls. Contrary to predictions, health factors accounted for less of the variance in retirement expectations than other factors. These findings point to the complexity surrounding retirement expectations and highlight person-job fit rather than disease factors alone.

Objectives: Chronic conditions and multimorbidity are increasing worldwide. Yet, understanding longitudinal changes in multimorbidity over the lifecourse is limited. We compared the age-trajectory of multimorbidity by birth cohort and examined effects of socio-demographic (e.g., sex, income) and behavioral risk (e.g., obesity) factors in multimorbidity., Methods: Using data from the Canadian Longitudinal National Population Health Survey (1994-2010), we examined 10,186 participants born 1925-1974 grouped in 5 birth cohorts. Data on the number of chronic conditions (up to 17), income, education, and behavioral risk factors were collected biannually. We used multilevel logistic growth modeling techniques for analyses of multimorbidity defined as the presence of 2+ chronic conditions versus 1 or none., Results: We found significant cohort differences in the age-trajectory of multimorbidity: at corresponding ages, each succeeding recent cohort had higher odds of reporting multimorbidity than their predecessors. Access to healthcare did not fully explain these differences. Women, having lower income, being obese, smoking, and a sedentary lifestyle had increased odds of reporting multimorbidity. Obese individuals, particularly Gen Xers and younger boomers, reported multimorbidity at an earlier age than those of normal weight. We observed divergent trajectories of greater multimorbidity for lower than higher income individuals. Furthermore, after accounting for age and risk factors there was an apparent increase in reporting multimorbidity over time (period effect) across all ages., Discussion: Our findings indicate that multimorbidity is not only becoming the norm, but is emerging earlier in the lifecourse and particularly for low income and obese individuals from more recent cohorts. The findings point to the importance of planning interventions and policies to deal with more recent birth cohorts entering into older age with worse health than their predecessors.

Background: With the aging of populations in many countries, workers are expected to remain employed longer but may struggle with the onset of common, chronic conditions like arthritis. To date, few studies have examined workplace policies and practices that could help accommodate individuals with arthritis, and fewer still have used a sex and gender-based approach to explore similarities and differences between women and men., Objectives: This study compared the health and work contexts of workers aged ≥50 years to better understand similarities and differences between women and men in accommodation availability, need, use, and unmet needs., Methods: A cross-sectional survey of men and women with osteoarthritis (OA), inflammatory arthritis (IA), or both OA and IA was administered online or by telephone and assessed demographics (e.g. age, education), health (e.g. pain, fatigue, workplace activity limitations), work context factors (e.g. job sector, full/part-time work, job control), and workplace accommodations (e.g. health benefits, flexible hours, special equipment/adaptations, modified duties). Sex and gender-based analyses examined similarities and differences between men and women and included descriptive statistics, multivariable multinomial analyses, and nested regression analyses., Results: There was a 58.9% response rate and final sample of 463 participants (women, n = 266; men, n = 197; OA = 59.0%; IA/both IA and OA = 23.7%; unsure = 17.3%). Women and men were significantly different in a number of health (e.g. fatigue, health variability, workplace activity limitations) and work context factors (e.g. job sector, part-time work, job stress). However, in other respects, they were similar (e.g. pain, job involving physical demands, size of organization, shift work, union membership, job control). There were no differences between men and women in the availability or use of workplace accommodations. However, women reported significantly more accommodation needs and had greater unmet needs. Multivariable multinomial analyses found male/female as a binary variable did not explain differences in accommodation need, use, and unmet need. Nested analyses highlighted that differences in health variables explained male/female differences in accommodation need, while work context differences explained male/female differences in whether needs were met., Conclusions: The findings highlight that women and men draw on a range of existing accommodation policies and practices to help manage their arthritis and that most have their accommodation needs met. Decomposing the context within which men and women with arthritis work suggests that women may face health and work context challenges that differ from men and that are related to greater accommodation needs and unmet need. This highlights potential vulnerabilities in the work of women that need to be addressed.

Objective: This study compares health and occupational outcomes following a work-related injury for nonstandard and day-shift workers., Methods: National Population Health Survey data were used to explore outcomes 2 years post-work injury. Retrospective-matched cohort analyses examined main effects and interactions of shift schedule and work injury with changes in health, shift schedule, and labor force status. Models were adjusted for respondent characteristics, baseline health status, and occupational strength requirements., Results: Injured nonstandard shift workers reported lower health utility index scores, compared with uninjured and injured daytime workers and uninjured nonstandard-shift workers. No significant interactions between shift and injury were found with schedule change and leaving the labor force., Conclusions: Injured nonstandard-shift workers are as likely to remain employed as other groups, but may be vulnerable in terms of diminished health.

Objective: To examine the availability, need, and use of workplace policies for workers with osteoarthritis (OA) and inflammatory arthritis (IA) and their association with employment outcomes., Methods: Participants (n = 219) were employed, ages ≥25 years, and diagnosed with OA or IA. They were recruited through community advertising and rheumatology clinics in 2 Canadian provinces. Respondents completed a 35-45-minute telephone interview assessing demographics (age, sex), health (diagnosis, pain, activity limitations), work context (job control), employment outcomes (workplace activity limitations, absenteeism, productivity losses, reduced hours), benefits (extended health, short-term leaves), and accommodations (flexible hours, modified schedules, special equipment/adaptations, work-at-home arrangements). Regression analyses examined differences in benefit/accommodation need and use., Results: Many participants reported that arthritis impacted their work. But with the exception of extended health benefits, ∼50-65% of participants reported not needing each individual benefit/accommodation, although only 7.3% of respondents reported needing no benefits or accommodations at all. Greater job control and education were associated with greater perceived need and use of benefits/accommodations. Need was also associated with greater activity limitations, and disclosure of arthritis was related to use of benefits/accommodations. Participants needing but not using workplace policies often had significantly poorer employment outcomes compared to those using benefits/accommodations., Conclusion: Findings are relevant to workers with arthritis and to employers. Results suggest that individuals with arthritis are unlikely to be a drain on workplace resources. Many individuals do not use benefits/accommodations until needed, and among those using them, there were generally positive relationships with diverse employment outcomes., (© 2015, American College of Rheumatology.)

Unlabelled: POLICY POINTS: Despite beliefs that baby boomers are healthier than previous generations, we found no evidence that the health of baby boomers is substantially different from that of the previous or succeeding cohorts. The effects of increased education, higher income, and lower smoking rates on improving self-rated health were nearly counterbalanced by the adverse effect of increasing body mass index (BMI). Assumptions that baby boomers will require less health care as they age because of better education, more prosperity, and less propensity to smoke may not be realized because of increases in obesity., Context: Baby boomers are commonly believed to be healthier than the previous generation. Using self-rated health (SRH) as an indicator of health status, this study examines the effects of age, period, and birth cohort on the trajectory of health across 4 generations: World War II (born between 1935 and 1944), older baby boomers (born between 1945 and 1954), younger baby boomers (born between 1955 and 1964), and Generation X (born between 1965 and 1974)., Methods: We analyzed Canada's longitudinal National Population Health Survey 1994-2010 (n = 8,570 at baseline), using multilevel growth models to estimate the age trajectory of SRH by cohort, accounting for period and incorporating the influence of changes in education, household income, smoking status, and body mass index (BMI) on SRH over time., Findings: SRH worsened with increasing age in all cohorts. Cohort differences in SRH were modest (p = 0.034), but there was a significant period effect (p = 0.002). We found marked cohort effects for increasing education, income, and BMI, and decreasing smoking from the youngest to the oldest cohorts, which were much reduced (education and smoking) or removed (income and BMI) once period was taken into account. At the population level, multivariable analysis showed the benefits of increasing education and income and declines in smoking on the trajectory of improving SRH were almost counterbalanced by the effects of increasing BMI (obesity)., Conclusions: We found no evidence to support the expectation that baby boomers will age more or less healthily than previous cohorts did. We also found that increasing BMI has likely undermined improvements in health that might have otherwise occurred, with possible implications for the need for health care. Period effects had a more profound effect than birth cohort effects. This suggests that interventions to improve health, such as reducing obesity, can be targeted to the entire, or a major portion of the, population and need not single out particular birth cohorts., (© 2015 Milbank Memorial Fund.)

Background: The purpose of this study is to examine the risk of a work-injury absence and the likelihood of receiving compensation among partnered and lone mothers and fathers., Methods: This study utilized data from an annual survey of Canadian residents. Logistic regression models examined the association between family status and the receipt of workers' compensation, and absences due to work-related injury or illnesses of 7 or more days., Results: Being a lone mother was significantly associated with the risk of work-injury absence. Gender differences were observed for workers' compensation: mothers were half as likely as fathers to receive workers' compensation benefits, which may be attributed to differences in work experiences between men and women., Conclusions: Findings may help in understanding whether some parental situations are more vulnerable than others and may contribute to identifying policies that could help workers sustain employment or return to work following an injury., (© 2014 Wiley Periodicals, Inc.)

Objective: To examine the employment status characteristics of people with arthritis disability, with a focus on gender differences and who remains in the workforce., Methods: Analyses were based on cross-sectional, self-reported data of the Canadian Participation and Activity Limitation Survey, administered in 2001-2002 (n = 28,908). Labor force status was categorized into employed, unemployed, and not in the labor force. Prevalence estimates were derived from descriptive analyses, and logistic regression determined the factors associated with being out of the labor force. Chi-square and sex-stratified analyses examined gender differences., Results: An estimated 2.3% of the working-age population (ages 25-64 years) reported arthritis disability, and >50% were out of the labor force. Being female, single, older, and having less education and more severe pain and disability were associated with being out of the labor force. Employed women with arthritis disability required more accommodations in the workplace and reported more activity limitations than men. Perceived discrimination was more likely to be reported by employed men, and men reported more changes to their work than women., Conclusion: This study underscores the importance of looking more closely at differences in the employment experiences of women and men. Specifically, the results suggest that arthritis may marginalize women and men in different ways. Women may be more likely to leave employment, whereas men may be more likely to remain working and report negative workplace experiences.

Objective: To determine the prevalence, accrual over time, and risk factors of work disability in patients with systemic lupus erythematosus (SLE)., Methods: We studied 432 patients from an inception cohort. Work disability was measured from a single self-report question. Data were prospectively collected and included sociodemographic information, clinical lupus features including activity (Systemic Lupus Erythematosus Disease Activity Index 2000 update [SLEDAI-2K]), damage (Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index), and organ involvement, as well as health status (Short Form 36 [SF-36]), comorbidity, and medication use. Student's t-test and Wilcoxon's rank sum test were used to compare continuous variables and chi-square tests were used for dichotomous variables. Descriptive survival curves of time to work disability were presented. Bivariate and multivariate logistic regressions were used to describe the relationships between clinically relevant factors and work disability., Results: Of 432 patients, 88% were women and 73% were white. Within the first year of diagnosis, 47% of patients were employed, 7% had a disability, and 7% were on sick leave. Overall, work disability was found in 98 (23%) patients. Risk factors for work disability found in the multivariate regression analysis were younger age at diagnosis, less education, fibromyalgia, hypertension, higher first-visit SLEDAI-2K score, and lower first-visit SF-36 score., Conclusion: Work disability is frequent in patients with SLE, with a cumulative prevalence of 23%. Work disability was associated with a complex array of health factors, including comorbidity, physical and mental health limitations, and clinical features of lupus, that warrant increased attention in future research.

Background: The ability to locate those sampled has important implications for response rates and thus the success of survey research. The purpose of this study was to examine predictors of locating women requiring tracing using publicly available methods (primarily Internet searches), and to determine the additional benefit of vital statistics linkages., Methods: Random samples of women aged 65-89 years residing in two regions of Ontario, Canada were selected from a list of those who completed a questionnaire between 1995 and 1997 (n = 1,500). A random sample of 507 of these women had been searched on the Internet as part of a feasibility pilot in 2001. All 1,500 women sampled were mailed a newsletter and information letter prior to recruitment by telephone in 2003 and 2004. Those with returned mail or incorrect telephone number(s) required tracing. Predictors of locating women were examined using logistic regression., Results: Tracing was required for 372 (25%) of the women sampled, and of these, 181 (49%) were located. Predictors of locating women were: younger age, residing in less densely populated areas, having had a web-search completed in 2001, and listed name identified on the Internet prior to recruitment in 2003. Although vital statistics linkages to death records subsequently identified 41 subjects, these data were incomplete., Conclusion: Prospective studies may benefit from using Internet resources at recruitment to determine the listed names for telephone numbers thereby facilitating follow-up tracing and improving response rates. Although vital statistics linkages may help to identify deceased individuals, these may be best suited for post hoc response rate adjustment.

Objective: To develop a measure of job strain related to differing aspects of working with arthritis and to examine the demographic, illness, work context, and psychosocial variables associated with it., Methods: Study participants were 292 employed individuals with osteoarthritis or inflammatory arthritis. Participants were from wave 3 of a 4-wave longitudinal study examining coping and adaptation efforts used to remain employed. Participants completed an interview-administered structured questionnaire, including a Chronic Illness Job Strain Scale (CIJSS) and questions on demographic (e.g., age, sex), illness and disability (e.g., disease type, pain, activity limitations), work context (e.g., job type, job control), and psychosocial variables (e.g., arthritis-work spillover, coworker/managerial support, job perceptions). Principal component analysis and multiple linear regression were used to analyze the data., Results: A single factor solution emerged for the CIJSS. The scale had an internal reliability of 0.95. Greater job strain was reported for future uncertainty, balancing multiple roles, and difficulties accepting the disease than for current workplace conditions. Participants with inflammatory arthritis, more frequent severe pain, greater workplace activity limitations, fewer hours of work, less coworker support, and greater arthritis-work spillover reported greater job strain., Conclusion: The findings underscore the diverse areas that contribute to perceptions of job strain and suggest that existing models of job strain do not adequately capture the stress experienced by individuals working with chronic illnesses or the factors associated with job strain. Measures similar to the CIJSS can enhance the tools researchers and clinicians have available to examine the impact of arthritis in individuals' lives.

Purpose: This study extends understanding of the relationship between disability and independence in older adults with COPD., Methods: An interviewer-administered questionnaire was used to examine disability, adaptation, perceptions of independence, and self-efficacy in a sample of 50 community-dwelling older adults. Odds ratios were used to investigate relationships between variables., Results: Participants used a wide range of behavioural strategies to adapt to their disability including: limiting activities, optimizing performance (e.g. taking rests), compensating for lost function (e.g. using equipment), and obtaining help from others. The relative use of these adaptations varied across five domains of activity: personal care, in-home mobility, household activities, community mobility, and valued activities. Most participants felt very or extremely independent in all domains. In personal care, those who reported greater disability (O.R. = 0.26), more frequent attempts to optimize performance (O.R. = 0.57), or greater reliance on help from others (O.R. = 0.79) were significantly (p < 0.05) less likely to feel very or extremely independent., Conclusions: The relationship between disability and perceptions of independence depends on the nature of the activity and is influenced by factors that are amenable to study and intervention. In particular, the vast array of behavioural strategies available to older adults with COPD enables them to feel highly independent despite disability.