Candidate: I am a social epidemiologist focused on understanding the role of the workplace in shaping short- and long-term disparities in population health. The overall training goal of this application is to augment my prior training in social and occupational epidemiology with training in economics and worksite interventions. This will allow me to achieve my long-term goal of becoming an independent scholar conducting worksite interventions aimed at improving psychosocial working conditions, with the dual purpose of improving worker health and demonstrating economic benefits to the employer. To work toward that long-term goal, I have set four short-term goals for the training period, each with a set of associated training activities: 1) develop proficiency in intervention design, deployment and evaluation through hands-on experience and mentorship from my mentor team;2) develop proficiency in health economics and organizational studies through a series of courses;3) develop a research portfolio with strengths in psychosocial occupational exposures and economic outcomes;4) develop and pilot a worksite intervention based on study findings and mentored training. Environment: I will have access to the intellectual capacity and facilities at the main campus of Harvard University in Cambridge, Massachusetts which encompasses a wide variety of strong academic departments and facilities in the humanities and sciences, and at the Boston campus of Harvard School of Public Health (HSPH), located in the Longwood Medical Area, one of the most concentrated areas of scientific research facilities in the United States. I will have full access to enrichment and professional development opportunities from several Departments and Centers across the University, including at the Center for Population and Development Studies;the Department of Social and Behavioral Sciences and the Department of Environmental Health at HSPH;the Dana-Farber Cancer Institute Center for Community-based Research;and the Harvard Catalyst, a research incubator and training program. Research: Decades of research have produced a large and growing body of evidence documenting health consequences of workplace psychosocial exposures, a category including harassment, bullying, abuse, discrimination, and work-family conflict. These exposures are especially prevalent in health care settings and have been found to predict multiple acute and chronic worker health outcomes, including injury, cardiovascular disease, sleep disruption, and poor mental health. Some studies have also linked these exposures with business outcomes such as turnover. However, there has been limited research that quantifies the actual economic impact of such exposures.
Our first aim i s to quantify the magnitude, direction, and significance of relationships between the psychosocial work environment and economic outcomes, overall and for individual stakeholders such as payers and health systems, in the acute care hospital setting.
Our second aim i s to determine the extent to which relationships between psychosocial work environments and economic outcomes, and the role of worker health in mediating the preceding associations, are consistent across acute-care and long-term care environments. Such comparisons will be important in future understanding of ways in which psychosocial interventions piloted in acute care hospitals can be adapted for long-term care settings and vice versa. The contribution of the proposed research is production of evidence documenting the potential economic consequences of adverse psychosocial occupational exposures. Through formative research to understand economic priorities of health care leaders, and then modeling of associations between psychosocial exposures and those metrics using rigorous economic methodology, we hope to quantify the potential competitive advantage that health care organizations may gain by improving the psychosocial work environment. This contribution is significant because improvement to psychosocial working conditions may not only benefit employers'outcomes of interest, but also may simultaneously benefit worker health. Thus, findings would represent an alignment of incentives for occupational health programs and for health care organizations. If the aims of our project are achieved and the economic implications of psychosocial exposures are better quantified, future psychosocial workplace intervention studies may be more likely to measure and report effects of interventions on economic endpoints. That inclusion, and subsequent dissemination of results, may further promote organizations'adoption of workplace health hazard reductions, increasing the impact of existing psychosocial workplace interventions. The study will also lay the groundwork for future intervention studies aimed at simultaneously improving worker health and employers'economic outcomes through improvement in the psychosocial work environment.

Public Health Relevance

This project seeks to quantify the economic impact of health care workers'exposure to psychosocial strains at work. We hypothesize that by determining the competitive advantage that health care organizations could gain by improving the psychosocial work environment, subsequent wider adoption of psychosocial interventions could benefit both workers'health and employers'economic outcomes of interest.

National Institute of Health (NIH)
National Institute for Occupational Safety and Health (NIOSH)
Research Scientist Development Award - Research & Training (K01)
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Safety and Occupational Health Study Section (SOH)
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Lioce, Maria
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Harvard University
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United States
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Sabbath, Erika L; Williams, Jessica A R; Boden, Leslie I et al. (2018) Mental Health Expenditures: Association With Workplace Incivility and Bullying Among Hospital Patient Care Workers. J Occup Environ Med 60:737-742
Sparer, Emily H; Boden, Leslie I; Sorensen, Glorian et al. (2018) The relationship between organizational policies and practices and work limitations among hospital patient care workers. Am J Ind Med :
Sabbath, Erika L; Shaw, Jessica; Stidsen, Andrea et al. (2018) Protecting Mental Health of Hospital Workers after Mass Casualty Events: A Social Work Imperative. Soc Work 63:272-275
Sabbath, Erika L; Sparer, Emily H; Boden, Leslie I et al. (2018) Preventive care utilization: Association with individual- and workgroup-level policy and practice perceptions. Prev Med 111:235-240
Sabbath, Erika L; Boden, Leslie I; Williams, Jessica Ar et al. (2017) Obscured by administrative data? Racial disparities in occupational injury. Scand J Work Environ Health 43:155-162
Sabbath, Erika L; Guevara, Ivan Mejía; Glymour, M Maria et al. (2015) Use of life course work-family profiles to predict mortality risk among US women. Am J Public Health 105:e96-e102