Swedish Workplaces Research Articles

Hexavalent chromium still a concern in Sweden – Evidence from a cross-sectional study within the SafeChrom project

ObjectivesHexavalent chromium (Cr(VI)) is classified as a human carcinogen. Occupational Cr(VI) exposure can occur during different work processes, but the current exposure to Cr(VI) at Swedish workplaces is unknown. MethodsThis cross-sectional study (SafeChrom) recruited non-smoking men and women from 14 companies with potential Cr(VI) exposure (n = 113) and controls from 6 companies without Cr(VI) exposure (n = 72). Inhalable Cr(VI) was measured by personal air sampling (outside of respiratory protection) in exposed workers. Total Cr was measured in urine (pre- and post-shift, density-adjusted) and red blood cells (RBC) (reflecting Cr(VI)) in exposed workers and controls. The Bayesian tool Expostats was used to assess risk and evaluate occupational exposure limit (OEL) compliance. ResultsThe exposed workers performed processing of metal products, steel production, welding, plating, and various chemical processes. The geometric mean concentration of inhalable Cr(VI) in exposed workers was 0.15 μg/m3 (95% confidence interval: 0.11–0.21). Eight of the 113 exposed workers (7%) exceeded the Swedish OEL of 5 μg/m3, and the Bayesian analysis estimated the share of OEL exceedances up to 19.6% for stainless steel welders. Median post-shift urinary (0.60 μg/L, 5th-95th percentile 0.10–3.20) and RBC concentrations (0.73 μg/L, 0.51–2.33) of Cr were significantly higher in the exposed group compared with the controls (urinary 0.10 μg/L, 0.06–0.56 and RBC 0.53 μg/L, 0.42–0.72). Inhalable Cr(VI) correlated with urinary Cr (rS = 0.64) and RBC-Cr (rS = 0.53). Workers within steel production showed the highest concentrations of inhalable, urinary and RBC Cr. Workers with inferred non-acceptable local exhaustion ventilation showed significantly higher inhalable Cr(VI), urinary and RBC Cr concentrations compared with those with inferred acceptable ventilation. Furthermore, workers with inferred correct use of respiratory protection were exposed to significantly higher concentrations of Cr(VI) in air and had higher levels of Cr in urine and RBC than those assessed with incorrect or no use. Based on the Swedish job-exposure-matrix, approximately 17 900 workers were estimated to be occupationally exposed to Cr(VI) today. ConclusionsOur study demonstrates that some workers in Sweden are exposed to high levels of the non-threshold carcinogen Cr(VI). Employers and workers seem aware of Cr(VI) exposure, but more efficient exposure control strategies are required. National strategies aligned with the European strategies are needed in order to eliminate this cause of occupational cancer.

Gender-based harassment in Swedish workplaces and alcohol-related morbidity and mortality: A prospective cohort study.

The study investigated experiences of different types of work-related gender-based harassment (GBH), specifically sexual and gender harassment, as risk factors for alcohol-related morbidity and mortality (ARMM). Information about experiences of (i) sexual harassment (SH-I) and (ii) gender harassment (GH-I) from inside the organization and (iii) sexual harassment from a person external to the organization (SH-E) were obtained from the Swedish Work Environment Survey 1995-2013, a biannual cross-sectional survey, administered to a representative sample of the Swedish working population. The survey responses from 86 033 individuals were connected to multiple registers containing information about alcohol-related diagnoses, treatment, or cause of death. Cox proportional hazard models were fitted to assess hazard ratios (HR) of incident ARMM during a mean follow-up of eight (SH-I and GH-I) and ten (SH-E) years. A higher prospective risk estimate of ARMM was found among participants who reported experiences of SH-E [HR 2.01, 95% confidence interval (CI) 1.61-2.52], GH-I (HR 1.33, CI 1.03-1.70), or SH-I (HR 2.37, CI 1.42-3.00). Additional analyses, distinguishing one-time from reoccurring harassment experiences, indicated a dose-response relationship for all three harassment types. Gender did not modify the associations. Under the assumption of causality, 9.3% (95% CI 5.4-13.1) of the risk of ARMM among Swedish women and 2.1% (95% CI 0.6-3.6) among Swedish men would be attributable to any of the three types of GBH included in this study. Experiences of GBH in the work context may be a highly relevant factor in the etiology of ARMM.

The economic cost of fatal workplace accidents in Sweden - A methodology for long-term decision analysis.

The few studies attempting to estimate costs of fatal accidents at workplaces suffer from poor or obscure applied methodologies. As the costs are often limited for the exposed company/industry in the short run, economic decisions about investments to improve the safety and security of workplaces are moreover not made at the societal level nor within an appropriate time frame. In a social economic decision, the total potential productivity lost over time due to a fatal accident is considered regardless of who pays what compensation to the families involved. This study introduces a methodology appropriate for making long-term economic decisions at the societal level to prevent accidents in Swedish workplaces. The introduced methodology, which is based on the human capital approach, is used to assess potential productivity losses associated with the accidents. The empirical findings show that, over the period 2008-2019, Swedish society could have gained more than 8.5 billion Swedish crowns by preventing accidents at Swedish workplaces. The objective achieved as the economic cost of fatal workplace accidents assessed from a long-term societal perspective. Effective preventive measures in the workplace make thus an incredible contribution to society in the form of increased national income, sustainable welfare and economic development.

Gambling among employees in Swedish workplaces: A cross-sectional study

Gambling among employees in Swedish workplaces: A cross-sectional study

Increasing prevalence of illicit drug use among employees at Swedish workplaces over a 25-year period.

BackgroundReports indicate that the proportion of adults using drugs of abuse has been increasing in recent years in Europe. Although there are various indicators of increased drug use in Sweden over time, few studies could demonstrate an increase in the proportion of adults using drugs. To investigate changes in drug use prevalence over time, drug testing at the workplace has been used for a 25-year period.MethodsThe urine samples of employees sent by occupational health services from all over Sweden during a 25-year period were analyzed. The analyzing capacity increased over time (from 3411 in 1994 to 60 315 samples analyzed in 2019), and the majority of the samples was analyzed for the following drugs: cannabis (tetrahydrocannabinol), amphetamine, opiates, cocaine, and benzodiazepines.ResultsThere was an overall increase in the proportion of samples that tested positive for illicit drugs over a 25-year period. This increase seemed to take place step-wise, with phases of linear increases and plateaus that over time became shorter. About 1.3% of samples tested positive for drugs in 1994, whereas 5.6% tested positive in 2019. Since 2007, the rate of positive samples has increased for cannabis and decreased for benzodiazepines. Although the rate of samples tested positive for opiates had remained relatively stable over the last 20 years, this rate had increased for amphetamine and cocaine between 2013 and 2019.ConclusionThe results indicate that the use of illicit drugs among employees at Swedish workplaces has increased during a 25-year period.

Perceived barriers in the dissemination of an organisational alcohol policy as part of implementing an alcohol prevention programme among managers

PurposeAn alcohol prevention programme, consisting of the implementation of an organisational alcohol policy and skills development training for managers, was delivered in Swedish workplaces. Previous findings revealed challenges in policy implementation because of the lack of dissemination amongst managers. This study aims to describe perceived dissemination barriers of the organisational alcohol policy by managers.Design/methodology/approachA cross-sectional survey (n = 193 managers) was performed to identify common dissemination barriers in the workplace and complementary case illustrations derived from semi-structured interviews (n = 18 managers) were used to understand the dissemination barriers of the organisational alcohol policy. Frequency distributions were presented to describe common perceived barriers.FindingsSixty-five per cent of managers reported that their workplace had not changed their approach to addressing alcohol-related issues compared to their usual practice before programme delivery. Various organisational factors, such as deprioritisation of programme dissemination, lack of communication and inadequate strategies were some of the common barriers perceived by managers. Moreover, managers reported uncertainties regarding any changes concerning the workplace’s approach for addressing alcohol-related issues. Increased efforts in disseminating the organisational alcohol policy can reduce uncertainties among managers.Practical implicationsA thorough process evaluation to understand processes in programme delivery and implementation is necessary to ensure the uptake of the intervention.Originality/valueThis study highlighted the complexity of disseminating an alcohol policy in a dynamic setting, such as the workplace, and provided the importance of addressing organisational obstacles.

Intersectional Discrimination: Gaining Entry to Swedish Workplaces

Intersectional Discrimination: Gaining Entry to Swedish Workplaces

Sexual and gender harassment in Swedish workplaces: A prospective cohort study on implications for long-term sickness absence.

Objectives:This prospective cohort study aimed to investigate gender harassment and sexual harassment as risk factors for prospective long-term sickness absence (LTSA, ≥21 days). Furthermore, support from colleagues was investigated as a moderating factor of this association.Methods:Information on gender harassment, sexual harassment and support by colleagues were derived from the biannual Swedish Work Environment Survey 1999–2013, a representative sample of the Swedish working population (N=64 297). Information on LTSA as well as demographic and workplace variables were added from register data. Relative rates of LTSA the year following the exposure were determined using modified Poisson regression.Results:Monthly to daily exposure to gender harassment was a risk factor for prospective LTSA among women [rate ratio (RR) 1.04, 95% confidence interval (CI) 1.02–1.05] and men (RR 1.07, 95% CI 1.04–1.10). Monthly to daily exposure to sexual harassment was also a risk factor for LTSA among women (RR 1.05, 95% CI 1.01–1.10) and men (RR 1.07, 95% CI 1.02–1.13). Exposure to sexual or gender harassment once in the last 12 months was not associated with LTSA. There was no support for an interaction between either of the exposures and support from colleagues in relation to LTSA.Conclusions:Sexual harassment and gender harassment appear to contribute to a small excess risk for LTSA among women and men. For both kinds of offensive behaviors, the pervasiveness appears to be important for the outcome. The role of support by colleagues was inconclusive and needs further investigation.

‘We don't talk about age’: a study of human resources retirement narratives

AbstractAt the societal and policy level, delaying retirement is generally agreed upon to solve the problem of the increasing proportion of older workers in Sweden, as in many other countries. At the same time, two co-existing narratives that create legitimacy for earlyversusdelayed retirement were found in our study, among both societal- and organisational-level actors. Older workers are viewed as either representatives of productive ageing and a solution to labour shortage problems, or as a barrier to recruiting younger, more promising employees with new skills. Through inductive qualitative analysis, this study shows in what way human resources departments are taking part in the institutional work of maintaining retirement-timing narratives in Swedish workplaces. The existing general organisational narrative of ‘the business case’ is used to mute discussion about delaying the retirement age, except for a select few. Their maintenance of this narrative is supported by the way in which the societal-level narratives target the individual, often backgrounding the role of employers.

Effectiveness of Combining Organizational Alcohol Policy and Skills Training for Managers to Reduce Hazardous Alcohol Consumption in Swedish Workplaces: Study Protocol for a Cluster Randomized Study.

BackgroundHigh alcohol consumption poses risks to individual health and society. Previous alcohol interventions have mainly focused on high-risk consumers or young adults in school-based settings. Since the majority of the adult population is in the workforce, the workplace can be considered a favorable arena for implementing interventions.ObjectiveThis protocol describes a project aimed at increasing knowledge of the effectiveness of combining the implementation of an organizational alcohol policy with skills training for managers as a workplace alcohol prevention program, by evaluating the intervention and exploring managers’ perceptions of the intervention.MethodsOrganizations with at least 100 employees were invited to take part in the project. A total of 11 organizations (744 managers and 11,761 employees) were included in the project. Data are collected through self-administered online surveys at baseline, 12 months, and 24 months. The primary outcome is managers’ inclination to initiate an early alcohol intervention (eg, by initiating a dialogue) when concern regarding employees’ hazardous alcohol consumption arises. The secondary outcomes of interest are managers’ and employees’ organizational alcohol policy knowledge and changes in alcohol consumption, as measured using the Alcohol Use Disorder Identification Test (AUDIT) score. A linear mixed-model framework will be used to model variability on different levels. Primary analysis will follow an intention-to-treat approach. Additionally, managers’ responses from semistructured interviews will be analyzed using thematic analysis to explore managers’ experiences regarding the prevention program.ResultsThis study is ongoing. The overall study start was on January 2018, and the study is planned to end in December 2020. Baseline and 12-month follow-up measurements have been collected.ConclusionsThis project is designed to evaluate the effectiveness of an alcohol prevention program regarding higher inclination to initiate early alcohol interventions after policy implementation and skills training among managers, compared to the usual practices in the workplace. The results from this study can contribute to increased knowledge about alcohol interventions and future prevention programs in the workplace.Trial RegistrationISRCTN17250048; http://www.isrctn.com/ISRCTN17250048International Registered Report Identifier (IRRID)DERR1-10.2196/17145

A scoping survey of attitudes towards occupational exposure limits and REACH derived no effect levels for workers among chemical risk managers at Swedish workplaces.

Setting and implementing occupational exposure limits (OELs) is one of the measures taken to protect workers from adverse effects of hazardous chemicals. The EU Regulation on Registration, Evaluation, Authorisation and Restriction of Chemicals (REACH) introduced an additional kind of exposure guidance values for workers; namely, the derived no effect level (DNEL) for workers' inhalation exposure (worker DNEL). About 500 substances have a Swedish OEL, while roughly 5000 substances have a worker DNEL derived by REACH registrants. This work aims to investigate how the Swedish OELs and worker DNELs are perceived at Swedish workplaces, and whether worker DNELs are considered a possible alternative to OELs when the latter are lacking. An online questionnaire was designed and sent to Swedish companies identified through the European Chemicals Agency's database of registered substances (N = 126) and the Swedish Chemicals Agency's registry of companies that import or manufacture notifiable chemical products (N = 227). The response rates were 52% and 38%, respectively. The respondents stated that they were using the Swedish OELs and most of them considered these to be a suitable risk management tool. As about one-third of the respondents expressed that they had some experience in using substances without the Swedish OELs, there are certain data gaps that worker DNELs may fill. One-third of the respondents familiar with worker DNELs stated that they would consider using worker DNELs for substances without the Swedish OELs. However, nearly half of the respondents reported to be unfamiliar with worker DNELs. Poor familiarity with DNELs may pose an obstacle to properly recognizing DNELs' potential as well as the possible limitations of individual DNELs. There is a need for education about DNELs, as well as for tools facilitating the evaluation of DNELs and OELs from other sources in cases where the applicable Swedish OEL is lacking. Int J Occup Med Environ Health. 2020;33(5):611-20.

Occupational status and organizations: Variation in occupational hierarchies across Swedish workplaces

A foundational claim in social stratification research is that occupational hierarchies are largely invariant across societies, a phenomenon known as the Treiman constant. However, recent research in social stratification has focused on the role of local social spaces in generating inequalities, casting doubt on the validity of the idea of a universally invariant occupational hierarchy. In this paper, we focus on organizations as a local space in which occupational hierarchies may vary. We ask three questions: (1) do occupational hierarchies vary across workplaces, (2) why do occupational hierarchies vary across workplaces, and (3) what can explain why some occupations move up or down the occupational hierarchy in specific workplace contexts? Using novel administrative data from Sweden we measure and model the correlation between a workplace’s occupational hierarchy and the national occupational hierarchy, finding substantial variation across workplaces in the matching of a given workplace’s hierarchy to the national hierarchy. We then develop a set of contextual and relational variables at the organizational level to potentially explain this variation, as well as to explain which occupations move up or down the workplace hierarchy. This paper points toward an important and novel empirical finding – variation across workplaces in occupational hierarchies – both confirming the power of the Treiman constant while opening up avenues to explore deviations from it. It also reveals the need to develop theories than can explain this workplace-level variation.

Place, kinship, and employment

AbstractThis study explores the magnitude and composition of kinship ties at Swedish workplaces. By analysing official register data and illustrating findings from interviews with HR personnel at different workplaces, the following questions are discussed: How much kinship concentration is there today on the labour market in a modern Western society such as Sweden? How is the kin‐based selection of workplace members structured by place? The study is based on an analysis of individually connected register information on all workplaces in Sweden in 2012. The number of individual links between relatives and couples at an average workplace amounts to 14% of the number of employees as derived from 310, 000 couples and pairs of relatives among 4.3 million workers. So, even today in Sweden, kinship is a common phenomenon observable for most workers at most workplaces. Of all such connected pairs of kin at workplaces, more than a third contain counterparts living in the same household. A non‐linear individual‐level regression reveals that population density in the vicinity of the workplace is substantially related to kin density. Large agglomerations seem to coexist with low kin density workplaces. Although some level of kin membership is unavoidable especially at workplaces in sparsely populated places, removing this part still reveals that kinship above an unavoidable level seems to exist. The study contributes to the discussion of kinship in workplaces by examining the magnitude and composition of kinship ties in the whole work force and complementing findings with interviews.

It's not all about moral reasoning: Understanding the content of Moral Case Deliberation.

Moral Case Deliberation is one form of clinical ethics support described as a facilitator-led collective moral reasoning by healthcare professionals on a concrete moral question connected to their practice. Evaluation research is needed, but, as human interaction is difficult to standardise, there is a need to capture the content beyond moral reasoning. This allows for a better understanding of Moral Case Deliberation, which may contribute to further development of valid outcome criteria and stimulate the normative discussion of what Moral Case Deliberation should contain. To explore and compare the content beyond moral reasoning in the dialogue in Moral Case Deliberation at Swedish workplaces. A mixed-methods approach was applied for analysing audio-recordings of 70 periodic Moral Case Deliberation meetings at 10 Swedish workplaces. Moral Case Deliberation facilitators and various healthcare professions participated, with registered nurses comprising the majority. Ethical considerations: No objection to the study was made by an Ethical Review Board. After oral and written information was provided, consent to be recorded was assumed by virtue of participation. Other than 'moral reasoning' (median (md): 45% of the spoken time), the Moral Case Deliberations consisted of 'reflections on the psychosocial work environment' to a varying extent (md: 29%). Additional content comprised 'assumptions about the patient's psychosocial situation' (md: 6%), 'facts about the patient's situation' (md: 5%), 'concrete problem-solving' (md: 6%) and 'process' (md: 3%). The findings suggest that a restorative function of staff's wellbeing in Moral Case Deliberation is needed, as this might contribute to good patient care. This supports outcome criteria of improved emotional support, which may include relief of moral distress. However, facilitators need a strategy for how to proceed from the participants' own emotional needs and to develop the use of their emotional knowing to focus on the ethically difficult patient situation.

‘Not a Problem Until it Becomes a Problem’: A Qualitative Study of Values and Risks of In-house Family Ties in Swedish Workplaces

In-house family ties at workplaces occur in most contexts, and are associated with both advantages and disadvantages. On the basis of 40 interviews with human resource managers at Swedish workplaces, the values and risks of in-house family ties and their importance within the workplace are analyzed jointly, thus allowing for a holistic perspective. The interviews reveal values and risks on a strategic level, for day-to-day operations, for the social work environment, and on the level of individuals. Crucially, even when in-house family ties are perceived as uncomplicated, there is a latent risk that problems might arise. The interpretation of the role of in-house family ties is also strongly related to whether they are paired with asymmetrical (vertical) power relations. It also depends heavily on the chosen perspective—that of the organization, the social work environment, the individual, or the broader society—and the perceived advantages tend to come with corresponding inverted disadvantages.

What healthcare teams find ethically difficult.

Ethically difficult situations are frequently encountered by healthcare professionals. Moral case deliberation is one form of clinical ethics support, which has the goal to support staff to manage ethical difficulties. However, little is known which difficult situations healthcare teams need to discuss. To explore which kinds of ethically difficult situations interprofessional healthcare teams raise during moral case deliberation. A series of 70 moral case deliberation sessions were audio-recorded in 10 Swedish workplaces. A descriptive, qualitative approach was applied, using thematic content analysis. Ethical considerations: An advisory statement specifying no objections to the study was provided from an Ethical Review Board, and consent to be recorded was assumed by virtue of participation in the moral case deliberation. Three themes emerged: powerlessness over managing difficult interactions with patients and next-of-kin, unease over unsafe and unequal care, and uncertainty over who should have power over care decisions. The powerlessness comprised feelings of insufficiency, difficulties to respond or manage patient's/next-of-kin's emotional needs or emotional outbursts and discouragement over motivating patients not taking responsibility for themselves. They could be uncertain over the patient's autonomy, who should have power over life and death, disclosing the truth or how much power next-of-kin should have. The findings suggest that the nature of the ethically difficult situations brought to moral case deliberations contained more relational-oriented ethics than principle-based ethics, were permeated by emotions and the uncertainties were pervaded by power aspects between stakeholders. MCD can be useful in understanding the connection between ethical issues and emotions from a team perspective.

Sickness absence in workplaces: Does it reflect a healthy hire effect?

Sickness absence in workplaces may reflect working conditions. It may also reflect a "healthy hire effect," i.e., that workplaces recruit individuals with experience of sickness absence differently. The purpose of the study was to determine if a history of sickness absence among recruits is associated with the average level of sickness absence in workplaces. In a register-based follow-up study, Swedish workplaces with at least 5 employees in 2006 were selected (approximately 127 000 workplaces with 3.9 million employees). The workplaces were categorized according to the average workplace sickness absence in 2006 and the recruits were categorized according to the individual sickness absence in 2005. The workplaces with a high average level of sickness absence were more likely than those with a low level to hire employees with high sickness absence in the year preceding employment: men - odds ratio (OR) = 7.2, 95% confidence interval (CI): 6.6-7.8, women - OR = 7.5, 95% CI: 6.9-8.1. The results show that there is a greater likelihood of employing individuals with high levels of sickness absence in the workplaces with many days of the average sickness absence than in the workplaces with few days of the average sickness absence. The results suggest that sickness absence in workplaces may reflect a healthy hire effect.

‘You need help as usual, do you?’: Joking and swearing for collegiality in a Swedish workplace

AbstractThis paper draws on the KINSA project (The Communicative Situation of Immigrants at Swedish Workplaces), which aimed to identify communicative factors that have a positive impact on the integration of second language speakers in the workplace and in their immediate work team. The focus here is on humour and swearing as strategies for doing collegiality and for building and maintaining good relations between co-workers. The article presents data from five second language speakers, permanently employed industrial or office workers in a major Swedish company. Theoretically and methodologically, the paper has its basis in discourse analysis, interactional sociolinguistics and the ethnography of communication. By means of fieldwork, a large body of empirical data was collected, comprising detailed field notes, audio and video recordings of naturally occurring talk, and texts processed and produced by participants. The analysis of the data shows that metalinguistic and metacultural awareness and performance of relational communicative acts among the participants appear to have helped to facilitate and consolidate integration in the workplace and the immediate work team. To foster good relations at work, the five participants make strategic use of jokes, compliments, narratives, swearing and greetings. In this article the use of jokes and swearing is highlighted. It closes by making a case for future research in the area of integration in the workplace through relational communication, especially among second language speakers.

Covert Chemicals, Tangible Trust: Risk Management of Chemicals in the Workplace

In Sweden, as in other industrialised nations, occupational exposure limits are considered to be an important tool for chemical risk management, although many other factors also play a role in occupational safety and health management. The aim of this study was to investigate the role of occupational exposure limits in relation to information about, and the risk perception of, chemicals. An interview study was performed at four Swedish process industry workplaces in order to investigate these issues. For each workplace, the range of informants covered at least one person who spent most of their working time in the production process; one person in a managerial position; one person in the site health, safety and environment department; the main safety ombudsman; and the site manager. The results show that informants' understanding of occupational exposure limits and their use is quite poor, although they do understand that there is epistemic uncertainty in determining the toxicological effects of hazardous substances. The risk perception and safety behaviour of the informants were not affected by the occupational exposure limits, nor did occupational exposure limits have any role as sources of information. Nevertheless, almost all the informants expressed the view that occupational exposure limits are trusted and needed; safety engineers and main safety ombudsmen, generally, also added that occupational exposure limits are useful. What was found to be most important factor for the informants' perception of risk and safety was trust in specific people, often established through long-term relationships.

Risk Perception and Its Foundation among Swedish Individuals Occupationally Exposed to Air Pollutants and Chemicals: A Comparison of 1975 and 2011

Although work environment conditions have improved much in the last decades, occupational exposures to chemicals and air pollutants still cause adverse health effects. The risk perception of occupational exposures to hazardous substances and the motivations for it have been investigated through a questionnaire study. These results have also been compared to previous studies performed by the largest trade union confederation in Sweden in 1975. In the current survey, 30% of the respondents believe to be at risk, 48% not, and 22% state to be unsure. The proportion of persons experiencing to be at risk due to exposures to chemicals or air pollution at work is unexpectedly similar to that of 1975. The explanations offered for the risk perception were in many cases vague and of a subjective nature, but again results are similar to those of 1975. References to more solid justifications such as performed exposure measurements or medical health checks are scarce, with the latter case being as scarce today as in 1975. There are only a few indications that a more systematic management of work environment issues has developed at Swedish workplaces; for instance, managers were more commonly stated as a source of information in 2011 than in 1975.