Simple Schedule Changes Could Improve Shift Worker Health

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Simple work schedule adjustments might promote health and help shift workers strike a better balance between work and personal life, according to a new review of evidence.

Every workplace has its own definition of shift work, but it generally includes nighttime employees as well as anyone who works outside the traditional 7 a.m. to 6 p.m. workday.

Previous research has established that shift workers are vulnerable to certain health and social problems including substance abuse, sleep disturbances, absenteeism, injuries and accidents.

Many shift workers have frequently changing schedules. Instead of a permanent night shift, for instance, some workers clock in -- or log on -- at night for several days and then rotate to afternoons for several days. According to the review, forward-rotating shifts that follow the logical order of the day seem to be less damaging to health and easier on the body.

"A forward rotation would be a shift in the morning, then the afternoon and then maybe a night shift later. That is less harmful to people's health than starting at night," said lead review author Clare Bambra, a lecturer in the Department of Geography at Durham University in England.

The systematic review, which examines the influence of company and organizational-level changes on the health and well-being of shift workers, appears in the May issue of the American Journal of Preventive Medicine.

The findings cull data from 26 -- mostly small -- studies of shift workers around the world, including traffic controllers, autoworkers, police officers, nurses and chemical plant employees.

The review also found that rotating workers through shift changes more quickly -- perhaps every three or four days versus every seven days -- is better for health and work-life balance.

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As many countries move toward 24-hour societies, shift work is becoming more common in the professional and service sectors. Still, shift work is still most prevalent in lower- paying industries.

"Shift work tends to affect people of lower socioeconomic groups more often, so it could be a factor in the health disparities that we see between groups," Bambra said.

Bambra's team also found that giving employees more control over their schedules resulted in some health improvement and better work-life balance.

"For these three interventions where most of the evidence was found on work-life balance, it's a less clear benefit for health," Bambra said. "I think employers may want to know these changes didn't have big costs associated with them and they were not particularly disruptive."

Alec Davidson, who studies circadian rhythms in animals, said the study of health promotion among shift workers is in very early stages. Most organizations have yet to establish, much less adopt, best practices.

"I don't think there are standards in place. If anything, I think there is a huge amount of resistance," he said.

"You'd think there would be motivation to fix these things. Substance abuse, sickness and health -- as well as the happiness of the workforce -- are bottom-line issues for companies if they could overcome these problems," said Davidson, an assistant professor with the Neuroscience Institute at Morehouse School of Medicine in Atlanta.

The review finding on the less harmful effects of forward-rotating shifts mirrors Davidson's laboratory research, but he wants to see human studies with much longer follow-up to understand bigger and longer-lasting health outcomes.

"Anything in moderation our bodies tend to tolerate, but abuse over the long term -- we just don't know," Davidson said.

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