title: Individual-level and plant-level predictors of acute, traumatic occupational injuries in a manufacturing cohort.
abstract: OBJECTIVE
  Workplace and contextual factors that may affect risk for worker injury are not well described. This study used results from an employee job satisfaction survey to construct aggregate indicators of the work environment and estimate the relative contribution of those factors to injury rates in a manufacturing cohort.
  
  
  METHODS
  Principal components analysis was used to construct four plant-level factors from responses to a 32 question survey of the entire workforce, administered in 2006. Multilevel Poisson regression was used to evaluate the relationship between injury rate, individual-level and plant-level risk factors, unionisation and plant type.
  
  
  RESULTS
  Plant-level 'work stress' (incident rate ratio (IRR)=0.50, 95% CI 0.28 to 0.90) was significant in the multilevel model, indicating the rate of injury for an average individual in that plant was halved (conditional on plant) when job stress decreased by a tertile. 'Overall satisfaction', 'work environment' and 'perception of supervisor' showed the same trend but were not significant. Unionisation was protective (IRR=0.40, 95% CI 0.17 to 0.95) as was any plant type compared with smelter.
  
  
  CONCLUSIONS
  We demonstrated utility of data from a human resources survey to construct indicators of the work environment. Our research suggests that aspects of the work environment, particularly work stress and unionisation, may have a significant effect on risk for occupational injury, emphasising the need for further multilevel studies. Our work would suggest monitoring of employee perceptions of job stress and the possible inclusion of stress management as a component of risk reduction programmes.
authors.affiliation: Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA.
authors.forename: Kerry
authors.initials: K
authors.lastname: Souza
authors.affiliation: Department of Occupational & Environmental Medicine, Yale School of Medicine, New Haven, Connecticut, USA.
authors.forename: Linda F
authors.initials: LF
authors.lastname: Cantley
authors.affiliation: Department of Occupational & Environmental Medicine, Yale School of Medicine, New Haven, Connecticut, USA.
authors.forename: Martin D
authors.initials: MD
authors.lastname: Slade
authors.affiliation: Department of Environmental Health Sciences, Berkeley School of Public Health, Berkeley, California, USA.
authors.forename: Ellen A
authors.initials: EA
authors.lastname: Eisen
authors.affiliation: Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA Departments of Environmental Health, Harvard School of Public Health, Boston, Massachusetts, USA.
authors.forename: David
authors.initials: D
authors.lastname: Christiani
authors.affiliation: Division of General Medical Disciplines, Stanford School of Medicine, Stanford, California, USA.
authors.forename: Mark R
authors.initials: MR
authors.lastname: Cullen
mesh_terms: D000062:Accidents, Occupational / Q000523:psychology*; D000328:Adult; D003625:Data Collection; D005260:Female; D006801:Humans; D007221:Industry; D007588:Job Satisfaction; D007750:Labor Unions; D008297:Male; D008875:Middle Aged; D016273:Occupational Exposure; D016272:Occupational Health; D060051:Occupational Injuries / Q000209:etiology* / Q000523:psychology; D009790:Occupations; D025341:Principal Component Analysis; D012044:Regression Analysis; D012307:Risk Factors; D013315:Stress, Psychological / Q000150:complications*; D011795:Surveys and Questionnaires; D014937:Work / Q000523:psychology; D017132:Workplace
keywords: injuries; occupational injuries; unions; work environment; work stress
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