Glorian Sorensen’s research while affiliated with Dana-Farber Cancer Institute and other places

Objective : Vicarious trauma (VT) is “secondhand” trauma healthcare workers experience when interacting with trauma survivors. The prospective relationship between workers’ VT symptoms and physical health has not been studied. Methods : Survey data from 775 hospital workers were linked to health insurance expenditures to identify stress-related conditions known as disorders of gut-brain interaction (DGBI) occurrence within one-year follow-up. VT symptoms (modeled continuously and categorically) and conditional odds of developing DGBI were assessed with multilevel logistic regression. Results : Conditional odds of DGBI increased 4% for every one-point increase in VT symptom score (95% CI: 0.98-1.11, p = 0.17). Participants with high versus low VT symptoms had 3.40-times the conditional odds of DGBI (95% CI: 1.44-8.06, p = 0.01). Conclusion : Workers with high versus low VT symptoms had significantly higher odds of developing DGBIs, indicating that VT may adversely impact workers’ physical health.

This study sought to investigate whether association between customer verbal abuse and depressive symptoms differed by workload. We conducted a cross-sectional survey of 795 cosmetic sales workers at department store in South Korea. Experience of customer verbal abuse over the past one month was measured by using a yes/no question. Depressive symptoms during the preceding week were assessed by using 20 items from the Center for Epidemiologic Studies-Depression scale. Workload during the past week was measured by asking the number of customers a worker dealt with on average in a day and classified into two categories: 1) Low (15 people or less), and 2) High (more than 15 people). Cosmetics sales workers’ experience of customer verbal abuse was associated with a higher prevalence of depressive symptoms (PR: 1.37, 95% CI: 1.15–1.63). After being stratified by workload, customer verbal abuse showed a statistically significant association with depressive symptoms among high workload groups (PR: 1.46, 95% CI: 1.19–1.79), whereas the association was not statistically significant among low workload group (PR: 1.23, 95% CI: 0.91–1.65). Our findings suggest that experience of customer verbal abuse could have a negative influence on depressive symptoms among high-workload cosmetics sales workers in South Korea.

Objective The cross-sectional study evaluates if the pre-pandemic work environments in nursing homes predict COVID-19 cases among residents and staff, accounting for other factors. Method Leveraging data from a survey of California and Ohio nursing homes (n = 340), we examined if Workplace Integrated Safety and Health domains - Leadership, Participation, and Comprehensive and Collaborative strategies predicted cumulative COVID-19 cases among nursing home residents and staff. Results In Ohio, a 1-unit increase in Leadership score was associated with 2 fewer staff cases and 4 fewer resident cases. A 1-unit increase in Comprehensive and Collaborative Strategies score in California showed an average marginal effect of approximately 1 less staff case and 2 fewer resident cases. Conclusion These findings suggest that leadership commitment and inter-department collaboration to prioritize worker safety, may have protected against COVID-19 cases in nursing homes.

A randomised control trial was conducted among school teachers in Bihar, India for upscaling a tested, evidence-based tobacco intervention using train-the-trainer model. Six blocks in three districts were selected and randomised into intervention and control blocks. Cluster coordinators in intervention blocks were given training in the details of intervention. Cluster coordinators routinely train headmasters and they were asked to include intervention training in their routine. Except for the training material, no additional resources were provided to cluster coordinators and headmasters. Headmasters implemented the intervention along with the teachers in the school. Post-intervention random sample of 70 schools out of 219 schools from intervention blocks and 70 schools out of 224 schools in control blocks were surveyed. The survey was self-administered among 429 school teachers in intervention schools and 331 among control schools. For all 140 headmasters, the survey was interviewer administered. Almost all headmasters in intervention schools had attended the training and had involved teachers in the intervention program. Odds ratios for carrying out the recommended activities in intervention schools compared to control schools were very high and significant. In addition, intervention schools also conducted activities such as including intervention messages in classroom teaching and conveying them to parents, activities that were not directly recommended in intervention program. Thus, this train-the-trainer model demonstrated that it is possible to upscale the intervention programs successfully with the resources within the system.

Objectives: To assess whether a measure of leadership support for worker safety, health, and well-being predicts staff turnover in nursing homes after controlling for other factors. Design: This paper uses administrative payroll data to measure facility-level turnover and uses a survey measure of nursing home leadership commitment to workers. In addition, we use data from Medicare to measure various nursing home characteristics. Setting and participants: Nursing homes with at least 30 beds serving adults in California, Ohio, and Massachusetts were invited to participate in the survey. The analysis sample included 495 nursing homes. Methods: We used a multivariable ordinary least squares model with turnover rate as the dependent variable. We used an indicator for nursing homes who scored above the median on the measure of leadership that supports worker safety, health, and well-being. Control variables include bed count (deciles), ownership (corporate/noncorporate × for-profit/not-for-profit), percent of residents on Medicaid, state, being in a nonmetropolitan county, and total nurse staffing per patient day in the 2 quarters before the survey. Results: The unadjusted turnover rate was lower for those nursing homes that scored higher on leadership commitment to worker safety, health, and well-being. After controlling for additional variables, greater leadership commitment was still associated with lower turnover but with some attenuation. Conclusions and implications: We find that nursing homes with leadership that communicated and demonstrated commitment to worker safety, health, and well-being had relatively fewer nurses leave during the study period, with turnover rates approximately 10% lower than homes without. These findings suggest that leadership may be a valuable tool for reducing staff turnover.

Background Tobacco-Free Teachers, Tobacco-Free Society (TFT-TFS) is an evidence-based intervention that promotes tobacco use cessation among teachers and tobacco control policies among schools in India. This study tested an implementation model to build Bihar Department of Education (DOE) capacity to support and deliver TFT-TFS within schools, leveraging DOE training infrastructure. Method We used a training-of-trainers (TOT) “cascade” implementation strategy to embed the TFT-TFS program into the Bihar DOE infrastructure. We trained 46 Cluster Coordinators to train and support Headmasters to implement TFT-TFS in their schools over one academic year. We selected three school districts, representing approximately 46 clusters and 219 schools. We used the RE-AIM framework to assess program adoption (Headmaster participation in at least one of six TFT-TFS trainings), implementation (of four core program components), and reach (teachers' participation in three or more group discussions). Using a non-inferiority design, we hypothesized that program adoption, implementation, and reach would not be inferior to the high standards demonstrated when TFT-TFS was originally tested in the Bihar School Teachers Study. We used self-reported checklists to measure outcomes and SPSS Version 25 to analyze data. Results For adoption, 94% of Headmasters attended the first training, although participation declined by the sixth training. Among the 112 schools out of 219 with complete Headmaster checklist data, all met our minimum criteria for implementing TFT-TFS. Over 99% of schools posted a school tobacco control policy and distributed quit booklets. However, only 69% of schools met our criteria for program reach. Conclusions This study outlines the processes for taking a tobacco control intervention to scale and implementing it through the Bihar DOE infrastructure. These findings provide a foundation for other Indian states and low- and middle-income countries to implement tobacco control and other health programs for schoolteachers. Trial registration NCT05346991. Plain Language Summary Each year in India, more than 1.2 million people die from tobacco-related causes, and India has the world's highest oral cancer burden. The world needs more evidence on how to bring cost-effective tobacco control interventions to scale, especially in low- and middle-income countries (LMICs). To address this gap, from 2017 to 2021, we examined the process of scaling up Tobacco-Free Teachers, Tobacco-Free Society (TFT-TFS), an evidence-based intervention promoting tobacco use cessation among teachers and tobacco control policies in schools. Our study tested an implementation model aimed at building the Bihar State Department of Education (DOE) capacity to support and deliver TFT-TFS. We used a training-of-trainers model to embed TFT-TFS into Bihar DOE infrastructure, training 46 Cluster Coordinators to in turn train and support Headmasters to implement TFT-TFS over one academic year. We hypothesized that program adoption, implementation, and reach would not be inferior to the high standards demonstrated when we originally tested TFT-TFS through the Bihar School Teachers Study (2013–2017). For adoption, 94% of Headmasters attended the first training, although participation declined by the sixth training. Of 112 schools (out of 219 with complete Headmaster checklist data), all met our minimum criteria for implementing TFT-TFS. Over 99% of schools posted a school tobacco control policy and distributed quit booklets. However, only 69% of schools met our criteria for program reach. Study findings offer other Indian states and LMICs lessons to implement tobacco control and other health programs for schoolteachers within educational systems.

Introduction: Thriving from Work is defined as the state of positive mental, physical, and social functioning in which workers' experiences of their work and working conditions enable them to thrive in their overall lives, contributing to their ability to achieve their full potential at work, at home, and in the community. The purpose of this study was to develop a psychometrically-sound questionnaire measuring the positive contribution that work can have on one's well-being both at, and outside of, their work. Methods: We used both a qualitative and quantitative approach of item reduction, domain mapping dimensionality testing, development of "long-" and "short-" versions of the questionnaire, reliability, and construct and criterion validity testing. This was established in two independent online samples of US based workers (n = 1550, n = 500). Results: We developed a bi-factor model 30-item long-form and a uni-factorial 8-item short-version. The long-form measures both the latent construct of Thriving from Work and six domains (psychological/emotional; work-life integration; social; experience of work; basic needs; health). Both long- and short- forms were found to have high empirical reliability (0.93 and 0.87 respectively). The short-form captures 94% of variance of the long-form. Construct and criterion validity were supported. Test-retest reliability was high. Conclusions: The Thriving from Work Questionnaire appears to be a valid and reliable measure of work-related well-being in United States workers. Further testing is needed to refine and test the instrument in specific industries, unique worker populations, and across geographic regions.

Increased lethality and availability of addictive substances has strained US addiction treatment services, further exacerbating workforce shortages in these settings. The emotional and physical health toll of providing treatment may contribute to shortages. This community-initiated qualitative study aimed to identify conditions that affect provider health and turnover in residential addiction treatment from a Total Worker Health® perspective. Providers (direct service, supervisors, leaders) working in nonprofit residential treatment facilities in Massachusetts were recruited by role and geography to participate in interviews and focus groups. NVivo12 facilitated coding and analysis. 25% of transcripts were double coded to assess interrater reliability and coding consistency (mean Kappa = 0.82). Providers (N = 49) participated in 33 interviews and 4 focus groups. Many participants reported personal addiction histories. Analysis revealed how socio-contextual factors originating outside of residential facilities were dominant influences on “downstream” working conditions, worker health, staff turnover, and by extension, client care. Four primary socio-contextual themes surfaced:1) Changes in type and potency of substances and client need not reliably accompanied by shifts in treatment practices; 2) challenges balancing state requirements and state-provided resources; 3) influence of structural discrimination and addiction stigma on pay and professional advancement; and 4) geographic location of facilities shape work and quality of life. Results were used to develop a conceptual model for residential addiction treatment to illustrate pathways by which ecological factors interact to affect provider health and turnover. Findings indicate that protecting health and wellbeing of providers—many of whom are in addiction recovery themselves— is integral to improving addiction treatment. From this workforce's perspective, recent changes in socio-contextual factors have intensified already challenging working conditions (job demands, pay, advancement), negatively impacting worker health, turnover, and client care. Any interventions to improve treatment outcomes or working conditions in nonprofit addiction facilities must consider larger socio-contextual factors influencing these organizations.