title: Asthma history, job type and job changes among US nurses.
abstract: OBJECTIVE
  Nurses are at increased risk of occupational asthma, an observation that may be related to disinfectants exposure. Whether asthma history influences job type or job changes among nurses is unknown. We investigated this issue in a large cohort of nurses.
  
  
  METHODS
  The Nurses' Health Study II is a prospective study of US female nurses enrolled in 1989 (ages 24-44 years). Job status and asthma were assessed in biennial (1989-2011) and asthma-specific questionnaires (1998, 2003). Associations between asthma history at baseline (diagnosis before 1989, n=5311) and job type at baseline were evaluated by multinomial logistic regression. The relations of asthma history and severity during follow-up to subsequent job changes were evaluated by Cox models.
  
  
  RESULTS
  The analytic cohort included 98 048 nurses. Compared with nurses in education/administration (likely low disinfectant exposure jobs), women with asthma history at baseline were less often employed in jobs with likely high disinfectant exposure, such as operating rooms (odds ratio 0.73 (95% CI 0.63 to 0.86)) and emergency room/inpatient units (0.89 (0.82 to 0.97)). During a 22-year follow-up, nurses with a baseline history of asthma were more likely to move to jobs with lower exposure to disinfectants (HR 1.13 (1.07 to 1.18)), especially among those with more severe asthma (HR for mild persistent: 1.13; moderate persistent 1.26; severe persistent: 1.50, compared with intermittent asthma, p trend: 0.004).
  
  
  CONCLUSIONS
  Asthma history was associated with baseline job type and subsequent job changes among nurses. This may partly reflect avoidance of tasks involving disinfectant use, and may introduce bias in cross-sectional studies on disinfectant exposure and asthma in nurses.
authors.affiliation: Channing Division of Network Medicine, Department of Medicine, Brigham & Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA Department of Emergency Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Orianne
authors.initials: O
authors.lastname: Dumas
authors.affiliation: INSERM, VIMA: Aging and chronic diseases. Epidemiological and public health approaches, U1168, F-94807, Villejuif, France UVSQ, UMR-S 1168, Université Versailles St-Quentin-en-Yvelines, Saint-Quentin-en-Yvelines, France.
authors.forename: Raphaëlle
authors.initials: R
authors.lastname: Varraso
authors.affiliation: Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands.
authors.forename: Jan Paul
authors.identifier: http://orcid.org/0000-0002-2941-6259
authors.initials: JP
authors.lastname: Zock
authors.affiliation: Division of Respiratory Disease Studies, National Institute for Occupational Safety and Health, Morgantown, USA.
authors.forename: Paul K
authors.initials: PK
authors.lastname: Henneberger
authors.affiliation: Channing Division of Network Medicine, Department of Medicine, Brigham & Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Frank E
authors.initials: FE
authors.lastname: Speizer
authors.affiliation: Channing Division of Network Medicine, Department of Medicine, Brigham & Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Aleta S
authors.initials: AS
authors.lastname: Wiley
authors.affiliation: INSERM, VIMA: Aging and chronic diseases. Epidemiological and public health approaches, U1168, F-94807, Villejuif, France UVSQ, UMR-S 1168, Université Versailles St-Quentin-en-Yvelines, Saint-Quentin-en-Yvelines, France.
authors.forename: Nicole
authors.initials: N
authors.lastname: Le Moual
authors.affiliation: Channing Division of Network Medicine, Department of Medicine, Brigham & Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA Department of Emergency Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Camargo
mesh_terms: D000328:Adult; D001249:Asthma / Q000191:economics / Q000209:etiology; D015982:Bias; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D004202:Disinfectants / Q000009:adverse effects*; D004651:Employment; D005260:Female; D006801:Humans; D016015:Logistic Models; D009726:Nurses; D009784:Occupational Diseases / Q000191:economics / Q000209:etiology; D016273:Occupational Exposure / Q000009:adverse effects*; D016017:Odds Ratio; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D014481:United States; D014937:Work; D055815:Young Adult
chemical_list: D004202:Disinfectants