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1.  Examining Pre-migration Health Among Filipino Nurses 
The healthy immigrant hypothesis asserts that immigrants arrive in the receiving country healthier than same race/ethnic counterparts born there. Contemporary research, however, has not evaluated pre-migration health among migrants, nor has explicitly considered comparisons with non-migrants in the country of origin. Pre-migration health was examined among 621 Filipino nurses, including self-reported physical health, mental health, health behaviors, and social stress. Measures were compared by intention to migrate and also tested as predictors of actual migration using time-to-event analysis. Nurses intending to migrate had higher proportion of depression and reported higher general perceived stress compared to those not. Predictors of actual migration included age, mentally unhealthy days, social strain, and social support. Physical health and health behavior measures had no association with migration intention or actual migration. Findings suggest that, relative to those not intending to migrate, nurses intending to migrate have worse mental health status and social stress; and, do not have a physical health advantage. Future research must span the pre- to post-migration continuum to better understand the impact of moving from one country to another on health and well-being.
PMCID: PMC4427529  PMID: 25385090
Philippines; Nurses; Health; Migration; Mental health
2.  Job strain, occupational category, and hypertension prevalence: The Multi-Ethnic Study of Atherosclerosis 
To assess associations of occupational categories and job characteristics with prevalent hypertension.
We analyzed 2,517 Multi-Ethnic Study of Atherosclerosis (MESA) participants, working 20+ hours per week, in 2002–4.
Higher job decision latitude was associated with a lower prevalence of hypertension, prevalence ratio (PR)=0.78 (95% CI 0.66–0.91) for the top vs. bottom quartile of job decision latitude. However, associations differed by occupation: decision latitude was associated with a higher prevalence of hypertension in healthcare support occupations (interaction p=.02). Occupation modified associations of gender with hypertension: a higher prevalence of hypertension in women (vs men) was observed in healthcare support and in blue-collar occupations (interaction p=.03).
Lower job decision latitude is associated with hypertension prevalence in many occupations. Further research is needed to determine reasons for differential impact of decision latitude and gender on hypertension across occupations.
PMCID: PMC4636023  PMID: 26539765
job strain; occupation; blood pressure; hypertension
3.  Feasibility of Conducting a Longitudinal, Transnational Study of Filipino Migrants to the United States: A Dual-Cohort Design 
Most studies of immigrant health are cross-sectional and fail to collect information prior to migration, leading to potential bias and confounding. The present pilot study examines the feasibility of studying migrants prospectively, with baseline data collected before migration. The study followed two cohorts of Filipinos for one year, a migrant cohort (n=27) that emigrated to the U.S. and a second non-migrant cohort (n=26) in the Philippines. The one-year retention rate was 96% The migrant cohort arrived in the U.S. within 2 months of their baseline assessment. Migrants and non-migrants did not differ with regard to body mass index, waist circumference or waist to hip ratio at baseline or at follow-up. It is feasible to conduct a transnational, longitudinal study of two cohorts of Filipinos. This design provides important pre-migration information, is analogous to a natural experiment, can be upscaled, and allows for a rigorous examination of immigrant health.
PMCID: PMC4550438  PMID: 25913346
immigrant; prospective; Asian American; obesity; study design; transnational; comparative
4.  Job strain and changes in the body mass index among working women: A prospective study 
The relationship between job strain and weight gain has been unclear, especially for women. Using data from over 52 000 working women, we compare the association between change in job strain and change in BMI across different levels of baseline BMI.
We used data from participants in the Nurses’ Health Study II (n=52 656, mean age = 38.4), an ongoing prospective cohort study. Using linear regression, we modeled the change in BMI over 4 years as a function of the change in job strain, baseline BMI, and the interaction between the two. Change in job strain was characterized in four categories combining baseline and follow-up levels: consistently low strain [low at both points], decreased strain [high strain at baseline only], increased strain [high strain at follow-up only], and consistently high strain [high at both points]. Age, race/ethnicity, pregnancy history, job types, and health behaviors at baseline were controlled for in the model.
In adjusted models, women who reported high job strain at least once during the four-year period had a greater increase in BMI (ΔBMI=0.06–0.12, p<0.05) than those who never reported high job strain. The association between the change in job strain exposure and the change in BMI depended on the baseline BMI level (p=0.015 for the interaction): the greater the baseline BMI, the greater the BMI gain associated with consistently high job strain. The BMI gain associated with increased or decreased job strain was uniform across the range of baseline BMI.
Women with higher BMI may be more vulnerable to BMI gain when exposed to constant work stress. Future research focusing on mediating mechanisms between job strain and BMI change should explore the possibility of differential responses to job strain by initial BMI.
PMCID: PMC4564350  PMID: 25986779
5.  Anticipated Job Benefits, Career Aspiration, and Generalized Self-efficacy as Predictors for Migration Decision-Making 
This study aims to identify person-level factors, rather than economic situations, that influence migration decision-making and actual migration. Building on the theory of planned behavior, this study investigated potential migrants’ expectations and attitudes toward migration and career (i.e., anticipated job benefits of migration, career aspiration) as well as beliefs (i.e., generalized self-efficacy) as predictors of migration decision-making conceptualized in three phases: the pre-decisional, pre-actional, and actional phases. This was examined with cross-sectional pre-migration questionnaire data from 1163 potential migrants from Spain to Germany. We also examined whether the migration decision-making phases predicted actual migration with a subsample (n=249) which provided follow-up data within twelve months. For the cross-sectional sample, multinomial logistic regressions revealed that anticipated job benefits and career aspiration are predictive for all migration phases. Self-efficacy predicts the preactional (e.g., gathering information) and actional phases (e.g., making practical arrangements). Finally, for those with low self-efficacy, anticipated job benefits play a stronger role for taking action. For the longitudinal subsample, a logistic regression revealed that being in the preactional and actional phases at baseline is predictive of actual migration within twelve months. This study expands previous research on migration intentions and behaviors by focusing on expectations, values, and beliefs as person-level predictors for migration decision-making. With a longitudinal sample, it shows that international migration is a process that involves multiple phases.
PMCID: PMC4567544  PMID: 26379343
pre-migration period; beliefs; values; expectations; migration decision-making; international migration
6.  Associations of Work Hours, Job Strain, and Occupation with Endothelial Function: The Multi-Ethnic Study of Atherosclerosis (MESA) 
To investigate associations of work hours, job control, job demands, job strain, and occupational category with brachial artery flow-mediated dilation (FMD) in 1,499 MESA participants.
FMD was obtained using high-resolution ultrasound. Mean values of FMD were examined across categories of occupation, work hours, and the other exposures using regression analyses.
Occupational category was significantly associated with FMD overall, with blue-collar workers showing the lowest mean values: Management/professional=4.97±0.22%; sales/office=5.19±0.28%; services=4.73 ± 0.29%; and blue-collar workers=4.01±0.26% (adjusted P <0.001). There was evidence of effect modification by gender (interaction P=0.031): significant associations were observed among women (adjusted P =0.002) and nearly significant results among men (adjusted P=0.087). Other exposures were not significantly associated with FMD.
Differences in endothelial function may account for some of the variation in cardiovascular disease across occupational groups.
PMCID: PMC4225634  PMID: 25376409
Brachial artery flow-mediated dilation; endothelial function; work; occupation
7.  Occupational characteristics and the progression of carotid artery intima-media thickness and plaque over 9 years: the Multi-Ethnic Study of Atherosclerosis (MESA) 
The role of occupation in the development of cardiovascular disease (CVD) remains a topic of research because few studies have examined longitudinal associations, and because occupation can be an indicator of socioeconomic position (SEP) and a proxy for hazard exposure. This study examines associations of occupational category as an SEP marker and selected occupational exposures with progression of the subclinical carotid artery disease.
A community-based, multiethnic sample (n=3109, mean age=60.2) provided subclinical CVD measures at least twice at three data collection points (mean follow-up=9.4 years). After accounting for demographic characteristics, SEP, and traditional CVD risk factors, we modelled common carotid intima-media thickness, carotid plaque scores, and carotid plaque shadowing as a function of occupational category, physical hazard exposure, physical activity on the job, interpersonal stress, job control and job demands. These job characteristics were derived from the Occupational Resource Network (O*NET). Random coefficient models were used to account for repeated measures and time-varying covariates.
There were a few statistically significant associations at baseline. After all covariates were included in the model, men in management, office/sales, service and blue-collar jobs had 28–44% higher plaque scores than professionals at baseline (p=0.001). Physically hazardous jobs were positively associated with plaque scores among women (p=0.014). However, there were no significant longitudinal associations between any of the occupational characteristics and any of the subclinical CVD measures.
There was little evidence that the occupational characteristics examined in this study accelerated the progression of subclinical CVD.
PMCID: PMC4560665  PMID: 25217203
While the importance of worker notification has been widely recognized, little attention has been paid to social and psychological contexts in which worker notification occurs, especially after the exposure has ended. This study explores workers’ perspectives on exposure to polychlorinated biphenyls (PCBs), a toxic material whose manufacture in the United States ended in 1977. Four focus groups were conducted with former workers (n = 29) who were exposed to PCBs. Verbatim transcriptions were analyzed. Participants considered living in the PCB-contaminated community more dangerous than handling PCBs on the job. While they firmly believed that PCBs in the environment caused serious health problems, participants expressed doubts about the toxicity of PCBs in the workplace. Both beliefs undermined the value of worker notification about occupational exposure to PCBs. A long-term relationship between workers and researchers would provide opportunities to cultivate better understanding of the hazard and facilitate the process of worker notification.
PMCID: PMC4552038  PMID: 23896076
workers’ right to know; worker notification; focus groups; qualitative analysis; risk communication
9.  Occupational Risk Factors for COPD Phenotypes in the Multi-Ethnic Study of Atherosclerosis (MESA) Lung Study 
COPD  2014;11(4):368-380.
The contribution of occupational exposure to the risk of chronic obstructive pulmonary disease COPD in population-based studies is of interest. We compared the performance of self-reported exposure to a newly developed JEM in exposure-response evaluation.
We used cross-sectional data from Multi-Ethnic Study of Atherosclerosis (MESA), a population-based sample of 45–84 year olds free of clinical cardiovascular disease at baseline. MESA ascertained the most recent job and employment, and the MESA Lung Study measured spirometry, and occupational exposures for 3686 participants. Associations between health outcomes (spirometry defined airflow limitation and Medical Research Council-defined chronic bronchitis) and occupational exposure [self-reported occupational exposure to vapor-gas, dust, or fumes (VGDF), severity of exposure, and a job-exposure matrix (JEM)-derived score] were evaluated using logistic regression models adjusted for non-occupational risk factors.
The prevalence of airflow limitation was associated with self-reported exposure to vapor-gas (OR 2.6, 95%CI 1.1–2.3), severity of VGDF exposure (P-trend<0.01), and JEM dust exposure (OR 2.4, 95%CI 1.1–5.0), and with organic dust exposure in females; these associations were generally of greater magnitude among never smokers. The prevalence of chronic bronchitis and wheeze was associated with exposure to VGDF. The association between airflow limitation and the combined effect of smoking and VGDF exposure showed an increasing trend. Self-reported vapor-gas, dust, fumes, years and severity of exposure were associated with increased prevalence of chronic bronchitis and wheeze (P<0.001).
Airflow limitation was associated with self-reported VGDF exposure, its severity, and JEM-ascertained dust exposure in smokers and never-smokers in this multiethnic study.
PMCID: PMC4096066  PMID: 24568208
Spirometry; airflow obstruction; job exposure matrix; gas; dust; fumes
10.  Associations of Work Hours with Carotid Intima Media Thickness and Ankle-Brachial Index: The Multi-Ethnic Study of Atherosclerosis (MESA) 
Long working hours may be associated with cardiovascular disease (CVD). The objective was to investigate cross-sectional associations of work hours with carotid intima media thickness (CIMT) and ankle brachial index (ABI).
Participants were 1,694 women and 1,868 men from the Multi-Ethnic Study of Atherosclerosis. CIMT and ABI were measured using standard protocols. Information on work hours was obtained from questionnaires. Mean values of CIMT and ABI were examined across five categories of hours worked per week (≤20, 21-39, 40, 41-50, >50) using ANOVA/ANCOVA. P-values for trend were obtained from linear regression models.
Mean age of participants was 56.9±8.4 years; 52.4% were men. Distinct patterns of association between work hours and the subclinical CVD biomarkers were found for women and men, although this heterogeneity by gender was not statistically significant. Among women only, work hours were positively associated with common (but not internal) CIMT (p=0.073) after full risk factor adjustment. Compared to women working 40 hours, those working >50 hours were more likely to have an ABI <1 (vs. 1-1.4) (OR=1.85, 95% CI=1.01-3.38). In men, work hours and ABI were inversely associated (p=0.046). There was some evidence that the association between work hours and ABI was modified by occupational category (interaction p=0.061). Among persons classified as Management/Professionals, longer work hours was associated with lower ABI (p=0.015). No significant associations were observed among other occupational groups.
Working longer hours may be associated with subclinical CVD. These associations should be investigated using longitudinal studies.
PMCID: PMC4084707  PMID: 22767870
Atherosclerosis; carotid artery stenosis; ankle-brachial index; work
11.  Factorial invariance, scale reliability, and construct validity of the job control and job demands scales for immigrant workers: The Multi-Ethnic Study of Atherosclerosis (MESA) 
Immigrants have a different social context from those who stay in their home country or those who were born to the country that immigrants now live. Cultural theory of risk perception suggests that social context influences one’s interpretation of questionnaire items. We examined psychometric properties of job control and job demand scales with US- and foreign-born workers who preferred English, Spanish, or Chinese (n=3114, mean age=58.1). Across all groups, the job control scale had acceptable Cronbach’s alpha (0.78–0.83) and equivalent factor loadings (ΔCFI<0.01). Immigrants had low alpha (0.42–0.65) for the job demands scale regardless of language, education, or age of migration. Two job-demand items had different factor loadings across groups. Among immigrants, both scales had inconsistent associations with perceived job stress and self-rated health. For a better understanding of immigrants’ job stress, the concept of job demands should be expanded and immigrants’ expectations for job control explored. (149/150 limit)
PMCID: PMC4068014  PMID: 20582720
job stress; factor analysis; internal consistency; acculturation; health disparities
12.  Current employment status, occupational category, occupational hazard exposure, and job stress in relation to telomere length: The Multiethnic Study of Atherosclerosis (MESA) 
Telomere length has been proposed as a biomarker of cell senescence, which is associated with a wide array of adverse health outcomes. While work is a major determinant of health, few studies have investigated the association of telomere length with various dimensions of occupation. Accelerated cellular aging could be a common pathway linking occupational exposure to several health outcomes.
Leukocyte telomere length was assessed using quantitative polymerase chain reaction (Q-PCR) in a community-based sample of 981 individuals (age: 45–84 years old). Questionnaires were used to collect information on current employment status, current or main occupation before retirement, and job strain. The O*NET (Occupational Resource Network) database was linked to the questionnaire data to create 5 exposure measures: physical activity on the job, physical hazard exposure, interpersonal stressors, job control, and job demands. Linear regression was used to estimate associations of occupational characteristics with telomere lengths after adjustment for age, sex, race, socioeconomic position, and several behavioral risk factors.
There were no mean differences in telomere lengths across current employment status, occupational category, job strain categories or levels of most O*NET exposure measures. There was also no evidence that being in lower status occupational categories or being exposed to higher levels of adverse physical or psychosocial exposures accelerated the association between age and telomere shortening.
Cellular aging as reflected by shorter telomeres does not appear to be an important pathway linking occupation to various health outcomes.
PMCID: PMC4068015  PMID: 23686115
13.  Occupational gradients in smoking behavior and exposure to workplace environmental tobacco smoke: The Multi-Ethnic Study of Atherosclerosis (MESA) 
This study examines associations of occupation with smoking status, amount smoked among current- and former-smokers (number of cigarettes/day and lifetime cigarette consumption (pack-years)), and workplace exposure to environmental tobacco smoke (ETS) independent from income and education.
This is a cross-sectional analysis of data from a community sample (n=6355, age range: 45–84) using logistic and multinomial regression. All analyses were stratified by sex and adjusted for socio-demographic variables.
Male blue-collar and sales/office workers had higher odds of having consumed >20 pack-years of cigarettes than managers/professionals. For both male and female current- or former-smokers, exposure to workplace ETS was consistently and strongly associated with heavy smoking and greater pack-years.
Blue-collar workplaces are associated with intense smoking and ETS exposure. Smoking must be addressed at both the individual- and workplace-levels especially in blue-collar workplaces.
PMCID: PMC3275688  PMID: 22261926
14.  Associations of occupation, job control and job demands with intima-media thickness: The Multi-Ethnic Study of Atherosclerosis (MESA) 
Occupation has been linked to cardiovascular disease (CVD) incidence and mortality, but few studies have investigated occupation in relation to early atherosclerotic disease. This study examined associations between various occupational characteristics and carotid artery intima-media thickness (IMT) in a multi-ethnic sample.
The Multi-Ethnic Study of Atherosclerosis (MESA) recruited 6814 adults aged 45e84 years and free of clinical CVD (response rate 60%, 51% female). Questionnaire data were used to determine occupational group (managerial/professional, sales/office, service, blue-collar), psychosocial job characteristics (ie, job demands, job control) and other sociodemographic information.
Common carotid artery (CCA)-IMT was greater for blue-collar jobs than for management/professional jobs (mean difference=0.012 mm, p=0.049) after adjustment for age, sex, race, place of birth (US or foreign born) and CVD risk factors. Compared to management/professional jobs, internal carotid artery (ICA)-IMT was greater for sales/office, service and blue-collar jobs (mean difference=0.071 mm, p<0.001; 0.057 mm, p=0.009; and 0.110 mm, p<0.001, respectively) after adjustment for age, sex, race and place of birth. The difference between blue-collar jobs and management/professional jobs remained significant after additional adjustment for CVD risk factors, income and education (mean difference=0.048 mm, p=0.045). Higher levels of control at work were associated with thinner CCA-IMT (mean difference=‒0.009 mm, p=0.016, adjusted for age, sex, race and place of birth) but not with ICA-IMT. Job demands had no significant association with IMT.
Blue-collar jobs and low levels of job control were associated with the development of subclinical atherosclerosis.
PMCID: PMC3073024  PMID: 20935285
15.  Associations of Workplace Aggression With Work-Related Well-Being Among Nurses in the Philippines 
American journal of public health  2010;101(5):861-867.
We examined whether workplace aggression was associated with self-rated health and work-related injury and illness among nurses in the Philippines.
Our data came from a cross-sectional survey of nurses (n=687) in the Philippines. We assessed the associations of self-reported physical assault and verbal abuse with self-rated health, work-related injury and illness, and missed workdays with Poisson regression. Control variables included demographic and work characteristics (e.g., hours worked, work setting, shift).
Verbal abuse was associated with poor general health (prevalence ratio [PR]=1.94; 95% confidence interval [CI]=1.09, 3.45). Both physical assault and verbal abuse were associated with work-related injury (PR=1.48; 95% CI=1.00, 2.20; PR=1.72; 95% CI=1.34, 2.23, respectively) and work-related illness (PR=1.46; 95% CI=0.99, 2.15; PR=1.68; 95% CI=1.32, 2.14, respectively) after demographic and work characteristics were accounted for in the model. In addition, physical assault was associated with missed workdays (PR=1.56; 95% CI=1.02, 2.33).
Workplace aggression was associated with increased risks of poor general health and adverse work-related health outcomes among nurses in the Philippines.
PMCID: PMC3076410  PMID: 21088262
16.  Occupational Health and Safety Issues Among Nurses in the Philippines 
Nursing is a hazardous occupation in the United States, but little is known about workplace health and safety issues facing the nursing work force in the Philippines. In this article, work-related problems among a sample of nurses in the Philippines are described. Cross-sectional data were collected through a self-administered survey during the Philippine Nurses Association 2007 convention. Measures included four categories: work-related demographics, occupational injury/illness, reporting behavior, and safety concerns. Approximately 40% of nurses had experienced at least one injury or illness in the past year, and 80% had experienced back pain. Most who had an injury did not report it. The top ranking concerns were stress and overwork. Filipino nurses encounter considerable health and safety concerns that are similar to those encountered by nurses in other countries. Future research should examine the work organization factors that contribute to these concerns and strengthen policies to promote health and safety.
PMCID: PMC2797477  PMID: 19438081
17.  Workplace harassment, stress, and drinking behavior over time: Gender differences in a national sample 
Addictive behaviors  2008;33(7):964-967.
Research suggests that workplace harassment (WH) significantly predicts alcohol use and problem drinking behavior, but has generally failed to consider concurrent effects of other sources of stress. This two-wave study (n=1418) is the first to explore whether sexual harassment (SH) and generalized workplace harassment (GWH) predict increased drinking independently of the effects of job and life stress, and whether effects differ by gender, in a nationally representative sample. SH and GWH predicted increases in problem drinking one year later for men but not women, while life stress was associated with increased problem drinking for women but not men. This study confirms the importance of examining the associations between different types of stressors and drinking-related outcomes in gendered contexts.
PMCID: PMC2442899  PMID: 18384975
Stress; Harassment; Alcohol drinking patterns; Alcohol abuse; Human sex differences

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