Frequent Exertion and Frequent Standing at Work, by Industry and Occupation Group — United States, 2015

Taylor M. Shockey, MPH1; Sara E. Luckhaupt, MD1; Matthew R. Groenewold, PhD1; Ming-Lun Lu, PhD2

Summary

What is already known about this topic?

Occupational ergonomic hazards are risk factors for negative health outcomes such as musculoskeletal disorders. Previous research has found that employees in the agricultural and construction sectors experience high rates of musculoskeletal disorders and other injuries because of the physical nature of the work and has also found that workers in the construction and agricultural sectors have high prevalence rates of exertion including bending, lifting, pushing, and pulling.

What is added by this report?

Analysis of data from the National Health Interview Survey to examine two ergonomic hazards among currently employed adults who work at least 20 hours per week in 20 major industry groups and 22 major occupation groups found a 41.7% prevalence of frequent exertion (repeated lifting, pushing, pulling, or bending) at work and a 66.6% prevalence of frequent standing at work. A wide range in prevalence for these ergonomic hazards was observed among the industry and occupation groups.

What are the implications for public health practice?

Large differences in prevalence of frequent exertion at work and frequent standing at work exist among the major industry and occupation groups. Identification of workers with the highest prevalences of exposure to these two ergonomic hazards can inform the targeting of interventions.

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Repeated exposure to occupational ergonomic hazards, such as frequent exertion (repetitive bending or twisting) and frequent standing, can lead to injuries, most commonly musculoskeletal disorders (1). Work-related musculoskeletal disorders have been estimated to cost the United States approximately $2.6 billion in annual direct and indirect costs (2). A recent literature review provided evidence that prolonged standing at work also leads to adverse health outcomes, such as back pain, physical fatigue, and muscle pain (3). To determine which industry and occupation groups currently have the highest prevalence rates of frequent exertion at work and frequent standing at work, CDC analyzed data from the 2015 National Health Interview Survey (NHIS) Occupational Health Supplement (OHS) regarding currently employed adults in the United States. By industry, the highest prevalence of both frequent exertion and frequent standing at work was among those in the agriculture, forestry, fishing, and hunting industry group (70.9%); by occupation, the highest prevalence was among those in the construction and extraction occupation group (76.9%). Large differences among industry and occupation groups were found with regard to these ergonomic hazards, suggesting a need for targeted interventions designed to reduce workplace exposure.

NHIS is an annual, in-person, household interview survey of noninstitutionalized, U.S. civilian residents that has been continuously conducted since 1957 with the main purpose of monitoring the health of the U.S. population through assessment of a range of health topics and demographic characteristics.* The NHIS questionnaire contains a set of core questions with Household, Family, Sample Adult, and Sample Child components, which have remained relatively unchanged from 1997 through 2017. In addition, NHIS has sets of questions, known as Supplements, which vary each year depending on new public health data needs. In 2015, CDC’s National Institute for Occupational Safety and Health (NIOSH) sponsored an OHS to collect information on work-related health conditions as well as psychological and physical occupational exposures. The OHS questions were included in the Sample Adult questionnaire, which had a final, unconditional response rate of 55.2%.†

To determine industry and occupation, currently employed adult respondents were asked, in reference to the job they were working at during the week before the interview, “What kind of business or industry was this?” and “What kind of work were you doing?” Open-ended responses were recorded as text and subsequently coded by the U.S. Census Bureau into 4-digit codes derived from the 2012 North American Industrial Classification System (NAICS) industry groups and 2010 Standard Occupational Classification (SOC) occupation groups. To improve reliability of the statistical estimates, the detailed 4-digit industry and occupation groups were collapsed into 2-digit industry groups and occupation groups (based on the NAICS and SOC major groups§). As part of the OHS, currently employed adults were asked two questions related to the ergonomics of their current job: “How often does your job involve repeated lifting, pushing, pulling, or bending?” and “How often does your job involve standing or walking around?” Responses to these questions were dichotomized into Often/Always and Never/Seldom/Sometimes, to indicate frequent or infrequent exertion or standing, respectively. Responses to these two ergonomics questions were also used to create one dichotomous variable capturing respondents that reported both frequent exertion at work and frequent standing at work.

Among the 36,672 adult NHIS respondents, 19,456 were currently employed and considered for analyses. After excluding 1,615 respondents who worked <20 hours per week, 187 respondents who did not provide adequate information on their hours worked in the previous week, and 190 respondents in military-specific occupations, the final analytic sample included 17,464 respondents (89.8% of the currently employed adult respondents). Sample adults who worked more than 20 hours per week were more likely to be aged <65 years, men, and hold a college degree or higher; however, there was no difference in the distribution of frequent exertion and frequent standing by number of hours worked. Unadjusted prevalence of frequent exertion at work, frequent standing at work, and both frequent exertion and frequent standing at work were calculated by the 20 major industry groups and the 22 major occupation groups. The unadjusted prevalence estimates were obtained using statistical software. All analyses were weighted, and standard errors were adjusted to account for the survey design.

Overall, 39.5% of currently employed adults who work at least 20 hours per week reported both frequent exertion and frequent standing at work (Table 1). The prevalences of frequent exertion at work or frequent standing at work, or both frequent exertion at work and frequent standing at work were highest among men, persons aged 18–29 years, Hispanics, and adults with less than a high school diploma (Table 1).

Among the 20 major industry groups, the groups with the highest prevalence of both frequent exertion and frequent standing at work were agriculture, forestry, fishing, and hunting (70.9%); construction (67.2%); and accommodation and food services (57.7%) (Table 2). These same three industry groups also had the highest prevalence rates of frequent exertion at work and frequent standing at work considered separately. The finance and insurance industry group had the lowest prevalence rates of all three exposures (Table 2). Among the 22 major occupation groups, the groups with the highest prevalence of both frequent exertion and frequent standing at work were construction and extraction (76.9%); farming, fishing, and forestry (75.5%); and building and grounds cleaning and maintenance (74.0%) (Table 3). These same three occupation groups also had the highest prevalence rates for frequent exertion at work. The food preparation and serving related occupation group (97.2%) had the highest prevalence of frequent standing at work. The computer and mathematical occupation group had the lowest prevalence rate of the combined exposures of frequent exertion and frequent standing at work (4.6%) (Table 3).

Discussion

This is the first CDC report to evaluate exposure to frequent exertion and frequent standing at work among U.S. employed adults in all industries and occupations. The prevalence of exposure to both of these ergonomic hazards was higher among agricultural and construction workers than among workers in all other industries. A previous study using the U.S. Department of Labor’s Occupational Information Network database found that of 10 detailed occupation categories evaluated with regard to self-reported bending or twisting at work, half were construction-related, which is consistent with the findings from this study (4). In addition, previous research using NHIS data that evaluated musculoskeletal disorders among agricultural workers found that low back pain was the most prevalent musculoskeletal disorder. That study also found that agricultural workers had a significantly higher prevalence of upper extremity pain compared with all other industries (5). Research has shown that agricultural and construction work are physically demanding, as these industries often require manual material handling, repetitive exertions, awkward body postures, and use of machinery that causes whole body vibration (4–7).

Approximately two thirds of all workers reported frequent standing at work. The industry and occupation groups that reported high prevalence rates of frequent exertion (e.g., farming, construction, and food services) also tended to report high prevalence rates of frequent standing, possibly because bending, pushing, pulling, and lifting commonly co-occur with standing. Several industry and occupation groups, such as education and protective services, reported a high prevalence of frequent standing at work with a low prevalence of frequent exertion at work compared with other industry and occupation groups.

Recent studies have emphasized health risks associated with excessive sitting during the workday (8); however, excessive standing on the job also has been linked to adverse health outcomes (9). A systematic review of peer-reviewed articles on musculoskeletal symptoms and occupational standing as the main exposure variable found that occupational standing is associated with low back pain; however, associations with lower and upper extremity symptoms were inconclusive (9). More research is needed to understand how to balance time spent sitting and standing while at work.

The findings in this report are subject to at least four limitations. First, because NHIS data are cross-sectional, it is not possible to make causal inferences. Second, because NHIS data are self-reported, they are subject to recall or social desirability bias. Third, the intermediate exposure categories (Often, Sometimes, and Seldom) rely on subjective assessment of frequency. Finally, collapsing the detailed industry and occupation groups into the major industry and occupation groups might have aggregated employees with different working conditions.

Healthy People 2020 has an objective to “reduce rate of injury and illness cases involving days away from work due to overexertion and repetitive motion,” by at least 10%.¶ NIOSH has developed educational resources on a variety of ergonomic issues.** For example, NIOSH provides a demonstration guide on ergonomic principles including how to maintain neutral postures when working, how to select the appropriate hand tools, and how to prevent fatigue failure of the vertebrae. In addition, NIOSH offers ergonomic guidelines for manual material handling, a primer for creating a workplace ergonomic programs, and ergonomic interventions by specific industry, including agriculture and construction.†† Because ergonomic hazards are risk factors for work-related musculoskeletal disorders, continued research is necessary to develop a better understanding of these hazards and to create interventions aimed at reducing them (2,8–10).

Conflict of Interest

No conflicts of interest were reported.

Corresponding author: Taylor M. Shockey, tshockey@cdc.gov, 513-841-4239.

1Division of Surveillance, Hazard Evaluations, and Field Studies, National Institute for Occupational Safety and Health, CDC; 2Division of Applied Research and Technology, National Institute for Occupational Safety and Health, CDC.

• https://www.cdc.gov/nchs/nhis/about_nhis.htm.

† ftp://ftp.cdc.gov/pub/Health_Statistics/NCHS/Dataset_Documentation/NHIS/2015/srvydesc.pdf.

§ https://www.census.gov/cgi-bin/sssd/naics/naicsrch?chart=2012 and https://www.bls.gov/soc/major_groups.htm.

¶ https://www.healthypeople.gov/2020/topics-objectives/topic/occupational-safety-and-health/objectives.

** https://www.cdc.gov/niosh/topics/ergonomics/default.html.

†† https://www.cdc.gov/niosh/docs/2001-111/ and https://www.cdc.gov/niosh/docs/2007-122/.

References

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• The survey sample consisted of 17,464 U.S. workers aged ≥18 years who worked at least 20 hours per week.
  † Education level only shown for persons aged ≥25 years.

• The survey sample consisted of 17,464 U.S. workers aged ≥18 years who worked at least 20 hours per week.
  † The Management of Companies and Enterprises industry group was removed from the results because the cell size was <10 and did not meet the National Center for Health Statistics’ standards of reliability.

• The survey sample consisted of 17,464 U.S. workers aged ≥18 years who worked at least 20 hours per week.
  † Estimate has a relative standard error >30% and <50% and should be used with caution because it does not meet the National Center for Health Statistics’ standards of reliability.
  § Estimate had a cell size <10 and was removed from the results because it did not meet the National Center for Health Statistics’ standards of reliability.

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