Blue collar workers work longer and in worse health than their white collar bosses, study finds

ScienceDaily (July 21, 2011) — While more Americans are working past age 65 by choice, a growing segment of the population must continue to work well into their sixties out of financial necessity. Research conducted by the Columbia University's Mailman School of Public Health and the University of Miami Miller School of Medicine looked at aging, social class and labor force participation rates to illustrate the challenges that lower income workers face in the global marketplace.See Also:Health & MedicineWorkplace HealthArthritisJoint PainScience & SocietyIndustrial RelationsDisaster PlanPublic HealthReferenceArthritisCOX-2 inhibitorOily fishRheumatoid arthritis

The study used the burden of arthritis to examine these connections because 49 million U.S. adults have arthritis, and 21 million suffer activity limitations as a result. The condition is also relatively disabling and painful but not fatal. The researchers found that blue collar workers are much more likely to work past 65 than white collar workers and are much more likely to suffer from conditions like arthritis, reducing their quality of life and work productivity.

The study findings are reported online in the American Journal of Public Health.

The investigators calculated estimates and compared age-and occupational specific data for workers with and without arthritis, merging data from the U.S. National Health Interview Survey (NHIS), Medical Expenditure Panel Survey (MEPS) and National Death Index. They studied 17,967 individuals for the analysis out of 38,473 MEPS participants.

"Arthritis serves as a powerful lens for looking at these convergent phenomena," said Alberto J. Caban-Martinez, DO, PhD, MPH, Department of Epidemiology and Public Health at the University of Miami Miller School of Medicine and first author. "We found that blue-collar workers with arthritis are in much worse health than are all other workers, suggesting that they are struggling to stay in the workforce despite their health condition."

At all ages, blue-collar workers in the workforce are in worse health than white-collar workers. By age 65, 19% of white-collar workers with arthritis remain in the workforce compared with 22% of blue-collar workers. But employed blue-collar workers have more severe disease than employed white-collar workers, and look forward to fewer years of healthy life -- approximately 11 for blue-collar workers and 14 for white-collar workers.

The investigators reported that lower-income workers of older age in the service and farming sectors-- two job types that are unlikely to come with pension plans--are more likely to have arthritis than not, with 58% of service workers and 67% of farm workers continuing to work despite struggling with the painful health condition. Sixteen percent of all blue collar workers are over 65 and 47% report they have arthritis. By contrast, 14% of white collar workers work beyond the age of 65, and 51% of these workers reporting arthritis. Overall, approximately 15% of all workers remain in the workforce at or past retirement age, and 44% have arthritis.

"The increasing age of the U.S. workforce presents new challenges for government, employers and working families," observes Peter Muennig, MD, MPH, associate professor of Health Policy and Management and senior author. "It is estimated that by the year 2030 approximately 67 million adults aged 18 years and older will have arthritis. Because the 'graying' workforce will be disproportionately represented by people from middle and lower occupational classes that also suffer from a higher prevalence of arthritis and a shorter life expectancy than wealthier Americans, Dr. Muennig points out that additional enhancements to federal programs such as better disability, health and unemployment insurance will be needed to maintain a higher quality of life for all workers, particularly for those with chronic conditions such as arthritis. "As the population ages in the face of expanding budget deficits, we face politically difficult choices if the U.S. is to prevent significant declines in its standard of living."

This study was funded by in part the National Institute of Arthritis and Musculoskeletal and Skin Diseases and the National Institute for Occupational Safety and Health.

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Misuse of pain medication is pathway to high-risk behaviors, study finds

ScienceDaily (July 24, 2011) — A new study by researchers at Drexel University's School of Public Health suggests that abuse of prescription painkillers may be an important gateway to the use of injected drugs such as heroin, among people with a history of using both types of drugs.See Also:Health & MedicinePharmacologyControlled SubstancesChildren's HealthMind & BrainOpiumAddictionChild PsychologyReferenceAnalgesicNarcoticDrug addictionOpioid drug

The study, published in the International Journal of Drug Policy, explores factors surrounding young injection drug users' initiation into the misuse of opioid drugs. Common factors identified in this group included a family history of drug misuse and receiving prescriptions for opioid drugs in the past. The results support a need for efforts to prevent misuse of prescription drugs, particularly during adolescence.

"Participants were commonly raised in household where misuse of prescription drugs, illegal drugs, or alcohol, was normalized," explains Dr. Stephen Lankenau, an associate professor in the School of Public Health and principal investigator of the study. "Access to prescription medications -- either from a participant's own source, a family member, or a friend -- was a key feature of initiation into prescription drug misuse."

In numerous cases, the desire to experiment with a prescription opioid drug (the common class of drugs that includes codeine and oxycodone), combined with financial incentives or pressures from friends to sell available quantities, resulted in escalated patterns of opioid misuse, according to the study.

Lankenau and colleagues also describe two key findings as evidence of an emerging dynamic among misuse of opioid drugs and the use of injection drugs. First, four of five IDUs misused an opioid before injecting heroin, in contrast to more conventional patterns of using opioids as a substitute drug after initiating heroin use.

Second, in nearly one out of four young IDUs in this study, a prescription opioid was the first type of drug they injected. Prescription opioids are rarely reported at initiation into injection drug use amongst young IDUs. All but two of these participants later transitioned into injecting heroin.

Opioid misuse is an important public health concern due to the increasing association of opioids with drug dependence and fatal overdose, and much research has focused on the factors affecting how and when people initially misuse opioids. However, descriptive data about initiation into prescription opioid misuse among young injection drug users are scarce.

To fill this gap, in this study researchers interviewed 50 young IDUs aged 16 and 25 years old in New York and Los Angeles, who had misused a prescription drug at least three times in the past three months, to study contextual factors leading to their use of opioid drugs. Participants were recruited in natural settings, such as parks, streets, and college campuses, during 2008 and 2009. A mixed-methods research design was utilized that collected both quantitative and qualitative data.

Additional findings and descriptors of the study population include:

Most were white, heterosexual males in their early 20s Many did not complete high school, were expelled from school, or held back a grade Nearly all were homeless at some point, most were currently homeless, and most regarded themselves as "travelers," (i.e., moving from city to city in search of work, housing, or adventure) Most had received a psychological diagnosis, such as depression, anxiety, or Attention Deficit Hyperactivity Disorder (ADHD), and many had a history of drug treatment Most generally regarded prescription opioids as readily accessible, valued commodities that could be traded or sold Nearly three-quarters had been prescribed an opioid in their lifetime, which occurred on average at 14.6 years old, often for common ailments such as dental procedures or sports injuries Most witnessed family members misuse one or more substances during childhood and adolescence, ranging from alcoholism to injecting heroin

The authors conclude that prevention efforts, especially during adolescence, are needed, and that parents and guardians need to carefully monitor and safeguard all prescription medications, particularly opioids, within the household. Although households where drug use is normalized or where broader social or psychological problems exist are more difficult to remedy with prevention efforts or policy changes, future research examining prescription opioid misuse among a range of adolescents and young adults to better understand the contextual and environmental factors of drug use may yield additional solutions.

The article was co-authored by Karol Silva (Drexel University); Michelle Teti (University of Missouri); Alex Harocopos (National Development and Research Institutes); and Jennifer Jackson Bloom and Meghan Treese (Children's Hospital Los Angeles).

Lankenau is also principal investigator of two studies evaluating the effectives of overdose prevention programs in Los Angeles and Philadelphia.

Lankenau is an associate professor in the Department of Community Health & Prevention at the Drexel University School of Public Health. He received his PhD and MA degrees in Sociology from the University of Maryland. He earned his BA in Sociology at the University of Vermont.

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Patients who used mail-order pharmacy for new statin prescriptions achieved better cholesterol control, study finds

ScienceDaily (July 21, 2011) — Kaiser Permanente Northern California patients who obtained new statin prescriptions via a mail-order pharmacy achieved better cholesterol control in the first 3-15 months following the initiation of therapy -- compared to those patients who only obtained their statin prescription from their local Kaiser Permanente Northern California pharmacy.See Also:Health & MedicinePharmacologyToday's HealthcareCholesterolDiseases and ConditionsWounds and HealingDiabetesReferencePharmacologyPediatricsCOX-2 inhibitorHypercholesterolemia

Greater adjusted rates of LDL-C control in mail-order pharmacy users were seen across all gender and race-ethnicity groups, according to the study that appears in the current online issue of the Journal of General Internal Medicine.

After adjustment for demographic, clinical, and socioeconomic characteristics, as well as for potential unmeasured differences between mail-order and in-person pharmacy users, 85 percent of patients who used the mail-order pharmacy achieved target cholesterol levels, compared to 74.2 percent of patients who only used the local Kaiser Permanente pharmacy.

Previous studies have shown that mail-order pharmacy use is associated with greater medication adherence. However, this is the first study to examine whether mail-order pharmacy use is related to improved cardiovascular risk factor outcomes, according to Julie Schmittdiel, PhD, an investigator with the Kaiser Permanente Division of Research in Oakland, Calif., and the lead author of the study.

"While the findings of this study should be confirmed in a randomized controlled trial, they provide new evidence that mail-order pharmacy use may be associated with improved care and outcomes for patients for risk factors with cardiovascular disease," Schmittdiel said.

"Though mail order may not be right for all patients, this study shows that it is one possible tool in the broader health care system-level toolbox that can help patients meet their medication needs."

At Kaiser Permanente, members have 24/7 access to online pharmacy and pharmacy refills at kp.org using My Health Manager, which can be mailed to them free of shipping charges or made available for pick-up at any Kaiser Permanente pharmacy.

In comparing the effectiveness of mail-order pharmacy vs. local pharmacy use on cholesterol control in new statin users, investigators tapped a study population of 100,298 Kaiser Permanente members who were statin users between Jan. 1, 2005, and Dec. 31, 2007. Statin use was obtained from automated pharmacy records and patients were considered to be new users if they had not recorded use of statin in records prior to the initial statin prescription date.

Greater adherence to these medications by mail-order pharmacy users may reflect improved access to medications, researchers explain. Mail order does not require travel to the local pharmacy, which may provide ease and convenience for patients refilling medications. To address possible selection biases -- for example, the possibility that patients who use mail-order pharmacy services are more motivated to take care of their health than patients who do not use such services -- researchers conducted additional analyses.to minimize such biases. All analyses, even those accounting for such potential differences, showed a positive, significant association between mail order pharmacy use and cholesterol control.

This study is part of an ongoing body of work analyzing the impact of mail-order pharmacy use on clinical outcomes, and seeks to further understand how health care systems can work with patients to optimize medication use without compromising patient choice or safety.

In a January 2010 study in the American Journal of Managed Care, researchers from UCLA and the Kaiser Permanente Division of Research found that patients with diabetes, high blood pressure or high cholesterol who ordered their medications by mail were more likely to take them as prescribed by their doctors than did patients who obtained them from the local pharmacy.

Additional authors on the Journal of General Internal Medicine study include Andrew J. Karter, PhD; Wendy Dyer, MS; Melissa Parker, MS; and Connie Uratsu, all with the Kaiser Permanente Division of Research. James Chan, PharmD, PhD, with the Kaiser Permanente Pharmacy Outcomes and Research Group, and O.Kenrik Duru, MD, MSHS, with the UCLA David Geffen School of Medicine, also are co-authors. Funding was provided by the Centers for Disease Control and Prevention (Division of Diabetes Translation) and the National Institute of Diabetes and Digestive Kidney Diseases.

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