Structure and Control of Healthy Worker Effects in Studies of Pregnancy Outcomes

Details

• Personal Author:
  Grajewski, Barbara A. ; Howards PP ; Johnson CY ; Rocheleau CM
• Description:
  Much of the healthy worker effect literature focuses on studies of chronic disease and mortality; however, when studying pregnancy outcomes, these effects might differ because of the short, defined risk periods of most pregnancy outcomes. Three pregnancy-specific healthy worker effects have also been described, but the structure of these effects have not yet been investigated when occupational exposure, and not employment status, is the exposure of interest. We used directed acyclic graphs to examine healthy worker effects in studies of occupational exposures and pregnancy outcomes: healthy hire effect, healthy worker survivor effect, desperation/privilege effect (differential workforce re-entry after pregnancy), reproductively unhealthy worker effect (women with live births leave the workforce, women with non-live births do not), and insecure pregnancy effect (women with adverse pregnancy outcomes reduce exposures in subsequent pregnancies). Given our assumptions, healthy hire effect, desperation/privilege effect, reproductively unhealthy worker effect, and insecure pregnancy effect resulted from confounding that can be addressed if measured confounders, such as employment status, are available. Presence of healthy worker survivor effect, however, varied by study design. Different types of healthy worker effects can be present in studies of occupational exposures and pregnancy outcomes, and many of them are easily addressed analytically. [Description provided by NIOSH]
• Subjects:
  Epidemiology Mental Health Occupational Exposure Occupational Health Pregnancy Safety Urogenital System Women
• Keywords:
  Author Keywords: Bias Children Health Care Health Effects Health Standards Healthy Worker Effect Occupation Occupational Exposure Occupations Prenatal Exposure Psychological Effects Psychological Factors Reproductive Health Survival Rate Worker Health

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• ISSN:
  0002-9262
• Document Type:
  Text
• Funding:
  Cooperative Agreement
• Genre:
  Journal Article
• Place as Subject:
  Georgia ; Ohio ; OSHA Region 4 ; OSHA Region 5
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Division:
  DSHEFS - Division of Surveillance, Hazard Evaluations, and Field Studies
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Volume:
  188
• Issue:
  3
• NIOSHTIC Number:
  nn:20054194
• Citation:
  Am J Epidemiol 2019 Mar; 188(3):562-569
• Contact Point Address:
  Dr. Candice Johnson, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, 1090 Tusculum Ave, Mailstop R-15, Cincinnati, OH 45226
• Email:
  cyjohnson@cdc.gov
• Federal Fiscal Year:
  2019
• Performing Organization:
  Wisconsin Department of Health Services, Madison
• Peer Reviewed:
  True
• Start Date:
  20150701
• Source Full Name:
  American Journal of Epidemiology
• End Date:
  20260630
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:deb84bfd5eabdf7b493bef7d229a9d06bfebc7e58a51c4f214e36311620242a37ce9f8970643ec1fd4d07f92c02b08d2dcffc4ed92d1a9db99364ddf7da9fdb9
• Download URL:
  https://stacks.cdc.gov/view/cdc/216806/cdc_216806_DS1.pdf
• File Type:
  [PDF - 456.75 KB ]