1998 Musculosketal Disorders in Newspapers and Commercial Printing PDF en

FINDING SOLUTIONS
Research at the
Workers’ Compensation Board
1150-20 C 1998
(98FS-33)
A STUDY OF MUSCULOSKELETAL DISORDERS IN

NEWSPAPERS AND COMMERCIAL PRINTING
Ms. Judy Village, C.P.E., M.Sc.

© 2001 Workers’ Compensation Board of British Columbia.
All rights reserved. The Workers’ Compensation Board of B.C. encourages the copying,
reproduction, and distribution of this document to promote health and safety in the workplace,
provided that the Workers’ Compensation Board of B.C. is acknowledged. However, no part of
this publication may be copied, reproduced, or distributed for profit or other commercial
enterprise or may be incorporated into any other publication without written permission of the
Workers’ Compensation Board of B.C.
Additional copies of this publication may be obtained by contacting:
Workers’ Compensation Board of British Columbia

Publications & Videos Department
6711 Elmbridge Way
Richmond, BC V7C 4N1
Phone (604) 276-3068 / Fax (604) 279-7406

Toll-free within BC – 1-800-661-2112
1150-20 C1998
(98FS-33)
A STUDY OF MUSCULOSKELETAL DISORDERS IN NEWSPAPERS AND

COMMERCIAL PRINTING
Issue: Reducing musculoskeletal injuries in newspaper and commercial

printing workers
Agency: Communications, Energy and Paperworkers Union of Canada,

Local 2000
Representative: Harold Funk
Funding: $53,000.00
Context: Workers in all three sectors of newspaper and commercial printing

operations, (office workers, bindery workers and press workers), suffer relatively high
incidences of musculoskeletal pain and injury. Health and safety committees lacked
resources and training for no programs existed that dealt with musculoskeletal injuries
specific to this industry.
Objective: Reduce musculoskeletal injury claims and symptoms in the newspaper and
commercial printing sector in BC by providing health and safety committees with a
practical, field-test program specific to their needs and in compliance with the
ergonomics regulations.
Design: In order to develop the program, analyses of the physical and psychosocial
risk factors for each of the three work categories were undertaken. Ergonomic
assessments were performed and a worker questionnaire was administered to identify
risk factors and possible solutions. An ergonomic manual was developed with input
again from employers and WCB. The manuals were introduced to Health and Safety
committees at one-day training sessions. Follow-up was conducted to determine what
parts of the ergonomic program were implemented at the different sites and the ease of
use of the manual. Worker questionnaires were distributed again to determine impact
of the ergonomics program on reduction of injuries and risk factors. A final manual was
developed based on feedback, and made available to other newspaper and commercial
printing companies throughout the province.
Setting: Four newspaper and commercial printing operations in British Columbia:

Mitchell Press Ltd., NOW Newspapers (Burnaby, New Westminster and Coquitlam),
The Abbotsford News, and the Pacific Press Ltd.
Subjects: 61 bindery, office and press workers from Mitchell Press Ltd.; 64 office
workers from the NOW Newspapers; 140 bindery, office and press workers from The
Abbotsford News; and 50 office workers from Pacific Press Ltd.
Main Outcome Measures: Identification of risk factors and potential solutions for
musculoskeletal injuries for all three sectors of the industry. Evaluation of the impact of
the training program in terms of reduced pain or psychosocial risk factors from pre–to-
post questionnaire.
Results: 27 tasks with potential risk factors were identified and solutions
recommended for the three work sectors. 61% of workers responded to the first
questionnaire. Mitchell Press declined participation in the second questionnaire, and
response rates for the remaining workers was 40.8%.
Workers with musculoskeletal pain reported significantly greater psychosocial demand,

less support and empowerment, less job satisfaction and an unbalanced effort-reward
system in their jobs. Bindery workers reported less pain than press or office workers
did.
“An Ergonomic Program in the Newspaper and Commercial Industry” was developed.
Health and Safety committees at the participating companies reported the program was
useful, however no significant differences in pain or psychosocial demand were
reported following the introduction of the program by the committees.
Conclusion: The project met its objectives. The lack of significant impact of the newly
developed program on pain or psychosocial factors experienced by workers could be
explained by the short (eight month) implementation period, the low response rates to
both questionnaires and/or the different sample of workers for the second questionnaire.
(Finding Solutions - 98FS-33)
Final Report
Prepared for:

Prevention Division
P.O. Box 5350 Stn Terminal
Vancouver, BC V6B 5L5
Prepared by:
Judy Village
Judy Village & Associates
2220 Badger Road
North Vancouver, BC V7G 1T1
June, 2001
ACKNOWLEDGEMENTS
We would like to acknowledge the following for various contributions to this project

Finding Solutions Program for funding this project
Communications, Energy and Paperworkers Union of Canada (CEP) Local 2000

especially Mr. Harold Funk and Ms. Gaylin Chavarie
for initiating, supporting and assisting with the project
The Abbotsford News

NOW Newspapers Ltd.
Mitchell Press
and Pacific Newspaper Group Inc., a CanWest Company
for participation in the project
and
Ms. Judy Village, Certified Professional Ergonomist

Judy Village & Associates
for conducting the research and drafting the binder, training materials and reports
JV/gmc
ppwc local 5
final report
A Study of Musculoskeletal Disorders in Newspapers and Commercial Printing Final Report

A STUDY OF MUSCULOSKELETAL DISORDERS IN NEWSPAPERS
AND COMMERCIAL PRINTING (Finding Solutions - 98FS-33)
Final Report Summary
Four newspaper and commercial printing operations participated in a 2.5-year study of muscu-
loskeletal disorders. Questionnaires were distributed and completed by 190 workers including
questions about pain and discomfort, psychosocial factors (such as support, control, psycho-
logical demands and job satisfaction), and work aspects that contribute to injuries. Pain recur-
ring at least three times or lasting longer than five days in the previous year was experienced by
55.8% of workers. Of those in pain, 77.8% sought treatment, yet only 55% reported the pain in the
workplace.
Statistical analyses revealed that workers with pain reported significantly greater psychological
demands, less management support and empowerment, less job satisfaction and an unbalanced
effort-reward scale. Those in pain were more likely female, older, with greater than 10 years of
work experience, and they spent more time sitting continuously, using the telephone, using a
keyboard, using a mouse and worked with deadlines, quotas or other pressures. Those in pain
spent less time standing. Results compare closely to those of office workers at the Toronto Star
newspaper in Ontario.
Bindery workers reported significantly less pain (38.5%) than press (65.9) or office workers
(64.8%). This was surprising given the repetitive and physical nature of their jobs. Bindery work-
ers compared with office and press workers had significantly less skill discretion, decision
authority, empowerment and greater physical exertion. However, they had greater job security
and significantly less psychological demands. The lower psychological demands appears pro-
tective given the higher physical nature of their job.
Office workers are at risk of injury due to the repetitive nature of their tasks, lack of breaks, work
organization issues such as scheduling and system problems, deadlines, computer and tele-
phone technology problems that cause frustration and pressure, problems with communication
and coordination of workload and office furniture and equipment issues. Bindery workers are at
risk of injury due to the repetitive and physical nature of their work, equipment problems and
inadequacies, and organization of work. Press workers have some heavy and awkward physical
demands although they are infrequent and intermittent, there is considerable autonomy, but
stress from deadlines and dealing with customers.
Ergonomic assessments were conducted at each workplace and used to develop “An Ergonomics
Program in the Newspaper and Commercial Printing Industry” binder with sample ergonomic
problems and solutions. Binders also contain information about the ergonomics regulations,
risk identification checklists, ergonomic guidelines and four training programs (standard lesson
plans and 60 overheads). The binders were distributed to health and safety committee members
of the four operations in full-day training sessions and the operations spent eight months imple-
menting ergonomic education, assessments, and work changes.
A Study of Musculoskeletal Disorders in Newspapers and Commercial Printing Final Report Page 1
Follow-up focus groups and questionnaires (n=127) revealed the materials were useful for health
and safety committees and were used, copied, posted and distributed to workers. There were no
significant differences in pain or in psychosocial factors from pre-to-post questionnaire (follow-
ing eight months to implement the ergonomics program). This could be explained by a low
response rate to both questionnaires and a different sample of the workforce in the second ques-
tionnaire (i.e. missing Mitchell Press, and more office workers responding). It may also be
explained by insufficient intervention at some locations (i.e. limited numbers of workstation
assessments). Lack of change could also be due to insufficient time both to implement and to
affect change in pain or psychosocial scores (eight months). Upon specific evaluation of training
or ergonomic changes however, 40-60% of workers reported that their jobs were better, less tir-
ing, had less physical effort, they were less sore and their job was more interesting, These
responses indicate positive benefits from the ergonomics program materials and training.
The program binders were printed and distributed to approximately 38 newspaper and commer-
cial printing operations in B.C. and a series of training binders and overheads are available on
disc or by loan from the CEP (local 2000) office. Results of the questionnaire survey were pub-
lished and presented at the Association of Canadian Ergonomists Annual Conference in
Montreal (October 2001). It is anticipated that the WCB will publish some of the program materi-
als on their website to further disseminate the information.
Table of Contents
1.0 INTRODUCTION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . page 5

1.1 Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . page 5
1.2 Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . page 5
1.3 Review of Selected Literature . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . page 6
2.0 METHODS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
page 8
2.1 Selection of Newspaper and Commercial Printing
Operations for Study . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . page 8
2.2 Ergonomic Assessments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .page 8
2.3 Questionnaire Development . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . page 8
2.4 Development of “An Ergonomics Manual for the Newspaper
and Commercial Printing Industry” . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . page 10
2.5 Training Health and Safety Committee Members . . . . . . . . . . . . . . . . . . . page 10
2.6 Implementation of an Ergonomics Program at Each Organization . . page 11
2.7 Evaluation of the Ergonomics Program Manual and its
Implementation at each Workplace . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . page 11
2.8 Completion of Ergonomics Program Manual and Training
Programs and Distribution . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . page 12
3.0 RESULTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . page 13

3.1 Project Timeline . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . page 13
3.2 Ergonomic Assessments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . page 13
3.3 Questionnaire Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . page 16
3.3.1 Descriptive Questionnaire Results Pre and Post Intervention . . page 16
3.3.2 Pre-Intervention Questionnaire Results:
Variables Associated with Pain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . page 23
3.3.3 Logistic Regression Modelling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . page 25
3.3.4 Comparison with Toronto Star Questionnaire Results . . . . . . . page 25
3.3.5 Open-Ended Questionnaire Comments . . . . . . . . . . . . . . . . . . . . . . page 28
3.4 Development of Ergonomics Program Manual . . . . . . . . . . . . . . . . . . . . . page 33
3.5 Implementation of an Ergonomics Program at the Companies . . . . . . page 34
3.6 Results of Questionnaires Following Implementation of
Ergonomics Programs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . page 37
3.7 Dissemination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . page 38
4.0 CONCLUSIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .page 39
APPENDICES
Appendix A: Pre Questionnaire . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .page 41
Appendix B: Agenda for Training Programs for Health and

Safety Committees . . . . . . . . . . . . . . . . . . . . . . . . . . . . .page 50
Appendix C: Post Questionnaire . . . . . . . . . . . . . . . . . . . . . . . . . . . . .page 51
Appendix D: List of Newspaper and Commercial Print Operations . . . . .page 60

Receiving Ergonomics Binder
Appendix E: Paper Published in Proceedings of Association of

Canadian Ergonomics (ACE/SELF) Annual Conference,
Montreal, October, 2001 . . . . . . . . . . . . . . . . . . . . . . . . .page 61
(Finding Solutions - 98FS-33)
Final Report
1.0 INTRODUCTION
1.1 Objectives
The overall objective of this project is to reduce the musculoskeletal injury claims and
symptoms in the newspaper and commercial printing sector in B.C. by providing health
and safety committees with a practical, comprehensive, field-tested program specific to
their needs and in compliance with the ergonomics regulations.
The project objectives were to be achieved by the following:
• analyzing the physical and psychosocial risk factors for each of the three work cate-
gories in the newspaper and commercial printing industry (office, press and bindery)
as well as symptoms of pain and injury reporting
• developing a comprehensive ergonomics program for each of the three work cate-
gories based on the best scientific information and in compliance with the new
ergonomics regulations
• implementing the comprehensive ergonomics program in a minimum of four loca-

tions representative of each job category and both newspaper and commercial print
operations with the assistance of employers and the CEP
• evaluating the effectiveness of the program at four locations by comparing signs and
symptoms of injury (before and after), ability to identify musculoskeletal injury risks,
training sessions provided, and effectiveness of ergonomic risk controls implement-
ed
• evaluating and modifying the ergonomics program, as needed, and distributing the
final program binder and training material to employers for use by health and safety
committees at 38 newspaper and commercial print workplaces in B.C.
1.2 Background
The Communications, Energy and Paperworkers Union of Canada (CEP Local 2000) repre-
sents approximately 2200 workers in British Columbia in 38 newspaper and commercial
printing operations from the Lower Mainland to Prince Rupert. Workers in this industry
generally are one of three types of work: office workers who work predominately with com-
puters (eg. reporters, editors, compositors, sales); bindery workers who assemble, cut and
package materials; and press workers who feed paper into presses, change inks, and mon-
itor production. All three groups suffer from relatively high incidences of musculoskeletal
pain and injury.
Pain and injury for newspaper and commercial print workers have increased over the past
few years. The CEP believe there are several reasons for this. The first reason is drastic
reorganization in many operations. The second reason is changes in technology, especial-
ly computer technology. The technology in some cases reduces physical load, but in con-
junction there have been reductions in the workforce and an increase in production
speed. Reorganization has altered traditional jobs and teamwork and segregated some
jobs into discrete units of work. The third reason is the popularity of the morning news-
papers. This has led to a reduced window for the work to be done. This increases workload
and pressure due to deadlines for every job in the organization.
The presence of health and safety committees in the newspaper and commercial printing
industry is only recent in many operations, and absent still in a few others. Members of
health and safety committees, in general lack training and resources, especially in dealing
with musculoskeletal injuries. No programs currently exist to our knowledge that are spe-
cific to the types of work and risk factors in this industrial sector.
1.3 Review of Selected Literature

While there is extensive documentation about the physical risk factors in office work, few
studies have been conducted specific to the newspaper and commercial printing industry.
In those that have been conducted, only office staff are usually assessed. There is an
absence of information about other work (press and bindery) in this industry. In a study
with the Los Angeles Times, Bernard et al. (1994) reported that prolonged use of comput-
ers in the workplace increased the risk of work-related musculoskeletal disorders
(WMSDs). He also reported that time spent working under deadlines and job pressure
increased risk of WMSDs. He reported that computers have increased ease of information
retrieval and processing, yet have also likely increased the burden of WMSDs among
employees (Bernard et al., 1994).
In three newspaper companies in Iowa City, an active surveillance program was developed for
management and control of cumulative trauma disorders (Rosecrance et al., 1994). Symptom
and job factor questionnaires, anatomical surveys and clinical detection tests were used with
1,150 employees. Results of the study indicated that musculoskeletal symptoms in the back,
neck and hands accounted for the majority of reported missed work. Production workers had
a higher prevalence of symptoms than office workers. The prevalence of probable carpal tun-
nel syndrome among the newspaper workers in this study was 1.5%.
A large study was conducted with the Toronto Star Newspaper Group in Toronto, Ontario
(Beaton et al., 2000, Polyani et al., 1997). As part of the study, a questionnaire survey was
returned from 1,007 workers (84% response rate). Questions asked about worker charac-
teristics, physical stressors (time sitting, using a mouse, etc.), work postures (using dia-
grams), task demands such as deadlines, work stress, job satisfaction, worker empower-
ment, workplace support and symptoms of musculoskeletal pain. Beaton et al. (2000)
reported that 59.7% of the workers reported pain in the previous year in the upper limbs.
A lower percentage (20%) of the workforce met the NIOSH definition of musculoskeletal
pain, which is moderate, severe or unbearable pain or discomfort either once per month or
for longer than a week over the past year (Polyani et al., 1997). Despite these numbers, less
than 1% of the sample had a lost time workers’ compensation claim for their upper-limb
disorder. Only 15% of the workers reported losing any time from work and overall 29% had
sought health care for their problem. The most common areas of the body affected were
the neck, shoulder, and elbow. Among departments, the advertising department had the
highest proportion of cases (25%), while the finance department had the lowest (15.6%).
From statistical modelling, the primary variables associated with WMSD cases was gen-
der (being female), more time spent keyboarding, screen in non-optimal positions, dead-
lines, high psychological demands, lack of social support and low skill discretion.
Psychosocial aspects of work have been emerging as one of the biggest problems for VDT
users in the 1990’s and there is some literature documenting psychosocial aspects of VDT
work in office environments (Moon, 1996; Smith, 1997). Usually computerized jobs are
more sedentary, require more cognitive processing and mental attention and require less
physical energy expenditure than other jobs. Yet, the production demands are often high,
with constant work pressure and little decision-making possibilities (Smith, 1997). In the
VDT literature, work design aspects related to job stress and ill-health include lack of
employee skill use, monotonous tasks, high job demands and work pressure, lack of con-
trol over the job, poor supervisor relations, fear of job loss and unreliable technology
(Smith, 1997). This is similar to factors defined in blue collar jobs.
2.0 METHODS
2.1 Selection of Newspaper and Commercial Printing Operations for Study

The original proposal included commitments from four operations:
1. Mitchell Press Ltd., Vancouver (bindery, office and press workers)

2. NOW Newspapers Ltd. The Royal City Record, New Westminster (office workers)
3. NOW Newspapers Ltd., Coquitlam Now, Coquitlam (office workers)
4. Hacker Press Ltd., Abbotsford (bindery, office and press workers)
Early in the project, it was decided that recruitment of another operation would help
increase the sample size, especially for press and bindery workers. Contact was made
with Mr. Phil Faulkner of Pacific Press and it was agreed that the bindery and press at the
Kennedy Heights location with 160 workers would be included. Also, the Burnaby NOW
Newspaper was added since the three offices are small and have one health and safety
committee among the three.
Unfortunately, when the questionnaire was distributed to the Kennedy Heights site, the
local union members refused to participate. Discussions began again about who to
include as the fourth operation. It was agreed that two departments within the offices of
Pacific Press would be chosen based on their higher rates of injury and the psychosocial
aspects of their job. Both departments had workers taking calls and simultaneously using
the computer, with no variety and few breaks in their tasks.
The project therefore involved the four operations, as follows:

1. Mitchell Press Ltd., Vancouver (61 bindery, office and press workers)
2. NOW Newspapers, Burnaby, New Westminster and Coquitlam
(64 total, office workers)
3. The Abbotsford News (140 bindery, office and press workers)
4. Pacific Press Ltd., Vancouver (50 office workers from two departments)
Meetings and tours of each facility were held early in the project to solicit commitment
and explain the work plan and timelines.
2.2 Ergonomic Assessments

Ergonomic assessments were performed at each of the six locations. This involved observ-
ing typical work activities, documenting tasks and amount of time in each task, videotap-
ing the job, taking measurements, and conducting informal interviews with workers,
supervisors and health and safety committee representatives. Multiple visits were made
to some of the locations for taking photographs and further clarifying the risk factors in
the job and possible solutions.
2.3 Questionnaire Development

The literature was reviewed with respect to standardized scales for measuring muscu-
loskeletal pain and discomfort, physical workload risk factors, psychosocial risk factors
and work organization. Of special importance were articles about the Job Content
Questionnaire (JCQ) by Karasek et al. (1998), the Nordic Questionnaire for musculoskele-
tal symptoms (Kuorinka, et al., 1987) and articles that had used various questionnaire
tools for evaluating musculoskeletal pain and symptoms (Holstrom et al., 1992;
Toomingas, et al., 1997; Hales, et al., 1996). Contact was established with the Worksite
Upper Extremity Group at the Institute for Work and Health in Toronto who conducted the
study for the Toronto Star. The researchers shared their questionnaires used in the
Toronto study, as well as the outcome data and results. They were instrumental in answer-
ing questions about design and analysis of questionnaire data.
The draft questionnaire was reviewed by the statistician for this project, Dr. Jonathan
Berkowitz, and by the CEP. It was then sent to each employer for their review. The ques-
tionnaire, especially the psychosocial questions created a concern for employers, which
led to extensive discussions, meetings and sharing of scientific literature to justify the
need to explore psychosocial risk factors. After a lengthy delay in the timeline of the pro-
ject, all employers except The Abbotsford News agreed to the original questionnaire. The
Abbotsford News would only proceed with the questionnaire if most of the psychosocial
questions were removed.
The final questionnaire contained questions about job, department, age, gender and years at
their particular job. A series of questions were asked about risk exposures, such as time per
day on the telephone, sitting at a desk, in a vehicle, standing, keyboarding, using a mouse,
lifting and handling. They were also asked about missing work breaks and how many times
they leave their workstation. Questions were asked about deadlines, quotas and other work
pressures, as well as job satisfaction, permission to leave the workplace, management
encouragement to report physical problems and to alter a job for return to work.
A series of questions asked about pain and discomfort in the previous year for each part
of the body, including length of episode, number of episodes, intensity of pain, days of work
lost, modified duty, interference with daily activities, health care use, and reporting in the
workplace. Nineteen questions were asked based on the Karasek job content question-
naire and others developed by the Institute for Work and Health. Combinations of these
questions were used to discern skill discretion, decision authority, psychological
demands, job insecurity, physical exertion, social support, empowerment and manage-
ment support. A series of questions (17) based on the effort-reward imbalance scale were
used to determine a ratio of effort to reward. The last page contained a series of open-
ended questions asking about the most physically demanding part of the job, the most
mentally demanding task and the task most in need of change. The questionnaire is
shown in Appendix A.
Questionnaires were administered on site by the ergonomist at one of the NOW

Newspaper locations (Burnaby). At all other workplaces, the health and safety committee
or manager distributed and collected questionnaires and returned them sealed to the
ergonomist. Questionnaires were coded and input to a computer by Dr. Berkowitz.
Descriptive statistics were run for the entire sample. This was followed by analysis by job
type and by company. The job types were too different and there were inconsistent names,
so this analysis did not proceed further.
Pain cases were defined a variety of ways to compare the methods. Any pain in the previ-
ous year was contrasted with the Hunting definition (those experiencing pain > 3 times in
the previous year or having pain lasting > 5 days), the Nordic definition (pain in the previ-
ous seven days), and the NIOSH definition (pain of moderate or higher intensity either
occurring monthly in the last year or lasting longer than seven days). Prevalence of expo-
sures and pain outcomes were compared for the entire sample testing differences with
either chi square or one-way ANOVA. Similar statistics were used to evaluate pain out-
comes with exposure for each work type (bindery, press and office). Completeness of data
and results of the bi-variate analysis guided choice of variables for inclusion in logistical
regression models to determine the predictors of caseness. A backward stepwise tech-
nique was used to eliminate redundant variables, retaining those at p<0.1. Since one oper-
ation did not complete the psychosocial questions, the sample size for these questions
was reduced and separate models were run with and without psychosocial variables.
Open-ended questions were input to the computer and grouped according to similar top-
ics. Results from open ended questions were summarized. Results of the questionnaires
were presented to all employers and worker representatives at a formal one day session
organized by the CEP. Ample opportunity was provided to discuss the results and the
remaining steps in the project.
2.4 Development of “An Ergonomics Manual for the Newspaper and Commercial
Printing Industry”
A draft table of contents for the manual was circulated to all employers and the CEP and
the proposed contents were agreed to. Results from the ergonomic assessments, the ques-
tionnaire analysis and discussions with health and safety committee members were used
to develop the content of the ergonomics manual. The final section included standard les-
son plans and copies of overheads for four distinct training programs.
As sections of the manual were drafted, they were reviewed by the CEP and edits incorpo-
rated. When the final draft was completed, it was copied and bound and presented to each
employer and worker representative at the six locations of the four organizations. It was
requested that edits and suggestions be made as quickly as possible so the manual could
be modified and a date for training health and safety committee members in use of the
manual could be arranged. There was considerable discussion about the need for suffi-
cient time to thoroughly review and edit the manual. The employers suggested the editing
task would take them four months. A final date for edits was agreed to.
When the final editing date approached, two of the employers requested that edits and com-
ments be shared through a series of in-person meetings. During the process it was revealed
that two of the original seven sections were uncomfortable for employers. This included the
section describing psychosocial risk factors and their relationship to musculoskeletal
injury, and the section on development of a return-to-work program. The employers were
unwilling to move forward unless these two sections were removed from the manual. It was
eventually agreed that these sections would be sent to employers for information only, but
would not form part of a manual for use by health and safety committee members.
2.5 Training Health and Safety Committee Members

When the edits to the manual were completed, one-day training sessions were arranged
for health and safety committee members. The purpose of the training was to provide
background information for committee members about the ergonomics regulations, caus-
es and types of musculoskeletal injuries, risk factors in the newspaper and commercial
printing industry and common solutions to risks in their industry. The training also intro-
duced participants to the four training programs in the ergonomics program manual and
the overheads for these programs. Some time at the end of the day was allotted for partic-
ipants from each company to discuss a plan for how they would implement an ergonomics
program at their work site.
The agenda for the training program is found in Appendix B. One training program was
conducted for The Abbotsford News and the NOW Newspaper groups combined. A second
training program was arranged on site at Mitchell Press and a third program was arranged
on site at Pacific Press.
2.6 Implementation of an Ergonomics Program at Each Organization

The expectation from the training program was that health and safety committee mem-
bers would develop a plan for implementing some or all parts of an ergonomics program at
their work site, including education, identification of risk factors, assessment of risk fac-
tors and development of risk control options. Regular follow-ups were conducted by tele-
phone with each of the six sites (four companies) to document what was planned, what had
been achieved and whether any assistance was required.
2.7 Evaluation of the Ergonomics Program Manual and its Implementation at each
Workplace
There are two components to evaluation in this project. The first is to evaluate the pro-
gram manual and training materials in “An Ergonomics Program for the Newspaper and
Commercial Printing Industry”. This involves evaluation of whether the information was
useful, informative, presented in a way it can be readily found and used, and easily under-
stood. Evaluation of the training programs is important for content, length, detail, under-
standability and ease of use by trainers. This evaluation was performed by having focus
groups with health and safety committee members following an 8-month implementation
period after the training. In focus groups, participants were asked about what specific
ergonomics initiative had occurred in the eight months (training, identification of risks,
implementation of risk control, etc.). They were asked which parts of the program manual
were used (eg. checklists, training program, assessment tools, etc.). They were asked ques-
tions about how easy it is to find information, understand information and share informa-
tion from the program. They were also asked for any suggestions for change, addition or
deletion.
In conjunction with evaluation of the manual by health and safety committees, a meeting
was held at the Workers’ Compensation Board with the education department, ergono-
mists, and industry representatives. At this meeting, the program manual was shown and
there was general discussion about content. The ergonomist (Mr. Bawan Saravanabawan)
agreed to review the manual to ensure the material covering the ergonomics regulations
was accurate and consistent with information being circulated by the WCB. The education
department expressed considerable interest in posting pages from the manual that high-
lighted using pictures a typical task with problems (risk factors) and pictures of solutions.
It was agreed that once completed the manual would be made available to the WCB elec-
tronically so they could proceed with dissemination of this type of information. However,
the WCB did not agree to produce the manual through the education department, but
instead advised us to proceed to copy and disseminate the manual as proposed in the
Finding Solutions Grant.
The second component of the evaluation is to evaluate whether ergonomic activities initi-
ated as a result of the ergonomics program manual were effective in the workplace for
reducing signs and symptoms of injury, improving psychosocial factors or increasing
awareness of ergonomic risks. For this evaluation, the questionnaire used prior to the pro-
gram manual development was re-issued to all four operations. Identical questions about
pain, symptoms, injuries and psychosocial factors were asked for comparison pre-to-post.
The final page, rather than asking about concerns, asked a series of questions about any
changes made in their workplace or training conducted. A copy of this questionnaire is
found in Appendix C. Workers were asked whether they were aware of ergonomic changes,
whether they took part in education, whether changes made their job better, reduced
physical effort, made the job more interesting, makes them less tired or less sore. Open-
ended questions asked about the most important positive and negative change and the
effect.
During the follow-up, one company (Mitchell Press) had decided not to initiate any
ergonomics activities. Following the training in September, Mitchell Press seemed well
aware of the ergonomics requirements and had a plan on paper for how they would go
about implementing the program. They agreed at this time to having meetings with super-
visors and managers to discuss the signs and symptoms and risk factor material, then to
have supervisors do crew talks with workers. In follow-up telephone calls in January and
February, 2001, the Assistant to the President, Mr. Dan Castilloux stated that a meeting
was held with the occupational health and safety committee and many members had dif-
ficulty with the idea of providing signs and symptoms training. There was concern about
the training causing an over-reporting of injuries. Mr. Castilloux expressed frustration
with the ergonomics regulations, and the WCB enforcement of regulations in general. He
stated that he feels they already are leaders in the industry in terms of modifying equip-
ment and processes where there are injuries and they don’t want to feel forced to comply
with the ergonomics program. They feel they already implement the basic ergonomic
requirements without using our program manual and following the training programs.
Mitchell Press, therefore did not participate in evaluation of either the ergonomics pro-
gram manual or its implementation on site.
At the remaining companies, questionnaires were distributed in May and were returned
through the months of May and June. Statistical analysis involved descriptive statistics,
using the Hunting definition of pain (pain recurring three or more times in previous year
or lasting at least five days), and pre-to-post comparison. On psychosocial factors, one
company (The Abbotsford News) again declined, leaving final numbers small. Also ana-
lyzed is evaluation of questions about the outcomes of the ergonomic intervention or
training. Again, open-ended questions were evaluated by grouping common responses
and discussing these by grouping. This was also analyzed by company since each imple-
mented slightly different components of the program.
2.8 Completion of Ergonomics Program Manual and Training Programs and

Distribution
Based on feedback about the program manual, edits were made to the ergonomics pro-
gram manual and training programs. A final manual was printed in addition to the two sec-
tions previously removed from the manual. It was decided that rather than providing each
individual newspaper or commercial printing operation with a manual, as some opera-
tions would involve fewer than 15 workers, a number of training binders with overheads
would be available for loan from the CEP head office. In addition, the powerpoint training
program would be available to those requesting it in electronic format. This way they
could modify or customize the material for in-house use.
A list of newspaper and commercial printing operations was compiled (Appendix D). It
does not include operations that are very small and are linked by ownership to another
operation. It was assumed that smaller operations would borrow or share materials with-
in their company.
3.0 RESULTS
3.1 Project Timeline

A project timeline showing each milestone and delay is found on the next two pages. The
blue timelines represent progress in the overall project with activities being conducted by
the ergonomist, or employers, or both. The red timelines represent delays or concerns
expressed by the employers at various stages of the project. Unless otherwise indicated,
the term “employers” is meant to represent all organizations involved in this project.
3.2 Ergonomic Assessments

Based on results of the ergonomic assessments a list of tasks with potential risk factors was
identified for each type of work: office, bindery and press. The list of tasks is as follows:
Office
• simultaneous computer and telephone work
• tasks involving combined data input and writing
• computer work with bifocals
• keyboard and mouse on desktop surfaces
• keyboard trays or drawers too narrow for a mouse
• extensive mouse work (eg. creative services, composing room)
• paste-up
• office tasks involving lifting and carrying (paper, water containers)
• sharing a computer workstation
• glare on computer monitor
• prolonged continuous sitting
• working with light tables and viewing boards
• tasks involving repetitive reaching (such as mail sorting into slots)
Bindery
• inserter - lifting stacks of flyers from pallets, sorting and inserting into machine
• stacker - jogging paper and stacking on pallets or in boxes
• bindery feeder - unbinds strap from stacks with clipper and loads machine for binding
• bindery outfeed - loading boxes with stacks and palletizing
• cutters - lifting, jogging and cutting sheets, then stacking
• hand binding - binding and stacking products into boxes
Press
• moving rolls of paper
• handling shafts in paper rolls
• cleaning the blanket (wash-up of rollers)
• removing rollers to clean
• changing the ink in presses
• flyboy - stacking sheets or papers off press onto pallet
• making bundles - pressing product between wooden plates and palletizing the bundles
• loading paper to sheet feed press
For each task, pictures were taken of the potential risk factors in the task, such as repeti-
tive reaching, heavy lifting, awkward hand-arm motions, etc. In addition, discussions were
conducted with employers and workers about solutions to the risks in each task. Solutions
where they existed were photographed and documented. Other potential solutions were
also documented. Each task is displayed on a single page in the manual with pictures of
before and after, and explanation of the task, risk factors and possible solutions.
3.3 Questionnaire Results
3.3.1 Descriptive Questionnaire Results Pre and Post Intervention
Distribution by Organization
Company Number Responses # Workers Response Response

Pre Post Rate Pre (%) Rate Post (%)
NOW 39 20 64 60.9 31
Mitchell Press 38 0 61 62 0
The Abbotsford News 90 75 140 64 53.6
Pacific Press 23 32 50 46 64
Total 190 127 311 61 40.8*
*excluding Mitchell Press in post analysis
As seen from the table above, the overall response rate to the first questionnaire was 61%. Despite
numerous attempts at some organizations, it was difficult to increase this response rate. Almost
half the sample came from The Abbotsford News, the remainder were spread across the other
organizations. In the post questionnaire, Mitchell Press declined to participate reducing the over-
all number of workers from 311 to 250. There were 127 post-questionnaires returned for an over-
all response rate of 40.8%. An increased response was achieved for Pacific Press, however there
was a slightly lower response from The Abbotsford News (53.6 vs. 64%). The NOW Newspapers had
half the response rate (31% vs. 60.9%). It should be noted that 14 more questionnaires were later
received from the NOW Newspapers, however it was well past the deadline and the statistical
analysis had already been completed. With the absence of Mitchell Press, the sample includes a
higher percent of office workers than the first questionnaire, as will be discussed later.
Gender
Gender Number Pre Post Percent Pre Post

Male 88 36 49.2 30.5
Female 91 82 50.8 69.5
Age Ranges
Age Range Number Pre Post Percent Pre Post
under 30 28 22 15.9 19.5
30-39 47 32 26.7 28.3
40-49 48 36 27.3 31.9
50-59 45 26 25.6 23.0
60 or over 8 4 4.5 3.5
Years on Current Job
Range of Years Number Pre Post Percent Pre Post

Under 3 months 5 2 2.6 1.6
3-12 months 12 14 6.3 11.2
1-5 years 44 33 23.3 26.4
5-10 years 51 30 27.0 24.0
over 10 years 77 46 40.7 36.8
Gender is fairly evenly distributed within the first sample. On the post questionnaires, the
increased percentage of females is a reflection of less workers from bindery and press and a high-
er percentage of office workers. The age ranges in the pre questionnaire are well split with approx-
imately one-quarter in the 30-39 year range, another quarter in 40-49 year range and a third quar-
ter in the 50-59 year range. A small proportion were over 60 years. Experience on the current job
was highest for over 10 years in both samples, reflecting a very stable workforce.
Hours at Various Job Activities
Activity Average hours/day Pre Average hours/day Post

on telephone 1.7 1.92
sitting at desk 3.4 4.45
in a vehicle 0.4 0.41
standing in one spot 2.6 1.87
keyboarding 2.5 3.31
using a mouse 1.3 1.62
lifting/handling 2.9 2.16
It must be kept in mind that the numbers above reflect a combination of three work types - office,
bindery and press. Approximately half the sample in the pre-questionnaire were office workers
and the remaining half split fairly evenly between bindery and press. In the post questionnaire,
73% were office workers and only 20.2% bindery and 6.5% press. The average hours per day in var-
ious activities in the post assessment therefore reflects more office-type of work. A look at activ-
ities for each work type is more meaningful. This data is further along.
Time Sitting for Continuous Period
Amount of Time Number Pre Post Percent Pre Post

under 30 minutes 74 37 40.9 29.6
30 min to 1 hour 32 36 17.7 28.8
1 to 2 hours 41 31 22.7 24.8
over 2 hours 34 21 18.8 16.8
Likewise, this data presents all three work types combined and data for each work type is pre-
sented later.
Frequency of Skipping or Missing Breaks
Frequency Number Pre Post Percent Pre Post

almost always (>3x/week) 75 41 40.1 33.6
frequency (1x/week) 24 21 12.8 17.2
sometimes (1x/month) 18 15 9.6 12.3
rarely (1x/2-3 months) 30 17 16.0 13.9
almost never (1x/6 months) 40 28 21.4 23.0
As will be seen later, there are some differences in frequency of skipping or missing breaks when
the responses are compared by work type. For the whole sample, between 33.6 and 41% almost
always report missing work breaks, and from 23 to 28% report almost never missing work breaks.
Number of Times Per Day Getting Up from Workstation

Never (0) 14 20 9.6 18.5
Rarely (1-2x/day) 16 3 11.0 2.8
3 to 5 times per day 36 21 24.7 19.4
6 to 10 times per day 37 29 25.3 26.8
11 to 20 times per day 27 20 18.5 18.5
more than 20 times per day 16 15 11.0 13.9
The number of times workers report getting up from their workstation remained fairly stable
between pre and post-questionnaire. Approximately one fifth of workers report never getting up
from their workstation. There was a wide range in remaining responses.
Working with Deadlines, Quotas and other Pressures
Feature Number Pre Post Percent Pre Post

deadlines 159 104 83.7 81.9
sales/service quotas 35 19 18.4 15.0
other pressures 83 34 43.7 26.8
no deadlines/quotas/pressures 21 13 11.1 10.2
A very high percentage of the workforce (83.7% pre and 81.9% post) report working with dead-
lines. Only 11.1% pre and 10.2% post reported no deadlines, quotas or other work pressures. An
explanation for the difference in percent with “other pressures” in the post questionnaire is like-
ly due to small numbers of press workers responding.
Frequency of Deadlines/Quotas/Pressures

daily 132 91 82.5 87.5
weekly 56 47 35.0 45.2
short-term (>1 wk, <1 mo.) 44 31 27.5 29.8
long term (>1 mo.) 30 18 18.8 17.3
seasonal 29 19 18.1 18.3
The frequency of deadlines, quotas and other pressures was fairly consistent in both pre and
post questionnaires, with the majority of the workforce reporting daily deadlines (82.5% pre and
87.5% post). Since respondents were able to answer more than one category, we see that there are
often multiple types of deadlines occurring for these workers.
Psychosocial Questions (Karasek scale)

Note: n=99 responses in pre and n=52 responses in post
Number and Percent who “agree” or “strongly agree”
Question Percent Pre Percent Post
My job requires that I learn new things 71.8 72.0
My job requires a high level of skill 79.8 74.5
My job allows me the freedom to decide how I work 62.7 68.0
My job requires doing things over and over 83.7 88.0
My job is very hectic 66.6 66.7
I am free from conflicting demands others make 22.4 17.7
My job security is good 54.5 47.0
My job requires a lot of physical effort 33.3 11.8
I have a lot of say about what happens on my job 38.4 33.4
I am exposed to co-worker hostility or conflict 45.5 45.1
My supervisor is helpful in getting the job done 53.5 64.7
My co-workers are helpful in getting the job done 70.7 66.6
Generally responses to the psychosocial questions were similar pre and post intervention. The
difference in percentage reporting physical effort in their job (33.3% pre and 11.8% post) reflects
the larger percentage of office workers in the post questionnaire. In general, a large percentage
of the workforce feel they have jobs where they learn new things, have a high level of skill and
they are allowed the freedom to decide how to work. A large percentage also report their job
requires doing things over and over and about two-thirds feel it is very hectic. Conflicting
demands from others were not a major concern, but job security for about half the workforce is a
concern. Physical effort was reported by about one-third in the first sample, and 11.8% in the sec-
ond. Less than 40% of the workers reported they have a lot of say about what happens on the job
and 45% report co-worker hostility or conflict. Supervisors were reported to be helpful by 53.5
and 64.7% of workers in pre and post questionnaire and co-workers were helpful for 70.7% and
66.6% of the workforce pre and post, respectively.
How Frequently do Workers take part in Decision Making?

Frequency Percent Pre Percent Post
Often 13.1 12.2
Sometimes 51.5 49.0
Rarely 22.2 22.4
Never/almost never 13.1 16.3
About half the workers felt they can take part in decision making “sometimes” and another 12-
13% reported “often. This stayed consistent on pre and post-questionnaires.
Employees Ideas and Opinions are Listened to by Management
Response Percent Pre Percent Post

strongly agree 5.1 4.0
agree 23.2 30.0
neither agree nor disagree 32.3 30.0
disagree 28.3 18.0
strongly disagree 11.1 18.0
Although workers generally report they take part in decision making, a smaller percent report
that their ideas are listened to by management, with “agree” or “strongly agree” combined repre-
senting 28.3% pre intervention and 34% post intervention.
Health and Safety is considered equally with Productivity/Quality by Management

often 21.4 16.7
sometimes 37.8 47.9
rarely 28.6 25.0
never/almost never 12.2 10.4
When asked whether health and safety is considered equally with productivity and quality by man-
agement, responses were split with about 59.2% reporting “sometimes or often” pre intervention
(64.6% post questionnaire) and 40.8% reporting “rarely or never” (35.4% post questionnaire).
Management encourages employees to promptly report work-related physical symptoms

Note: n=99 responses in pre and n=52 in post

agree 31.5 38.5
disagree 14.7 11.5
More than a quarter of the workforce neither agreed nor disagreed about management encour-
agement to report work-related physical symptoms. About half (54.3% pre and 55.7% post) agreed
there was encouragement and 19.6% and 15.6% disagreed (pre and post questionnaire, respec-
tively).
Need Permission to leave the Workplace

Never 47.3 51.6
Sometimes 28.8 27.4
Always 23.9 21.0
This question indicates the amount of control workers have in their job according to whether
they need permission to leave the workplace. The numbers pre and post intervention were very
similar with about half stating they never need permission and the remaining half split between
sometimes and always.
Management would make changes to my job or hours to help me return-to-work

agree 39.2 47.5
disagree 8.6 7.4
This question is meant to indicate management commitment and support in return-to-work pro-
grams. Most workers (58.6 and 62.3%, respectively) felt management would change their job or
hours to assist with return-to-work. A large percentage of workers were non-committal about
whether they would have support (26.3 to 27.9%).
Job Satisfaction
Level Percent Pre Percent Post

Very satisfied 31.7 34.4
Somewhat satisfied 52.2 53.3
Not too satisfied 10.2 10.7
Not at all satisfied 5.9 1.6
Approximately one-third of the workers reported being “very” satisfied with their work and
another half reported being “somewhat” satisfied.
Symptoms of Pain or Discomfort
Any pain/discomfort related to work in last year?
Response Number Pre Post Percent Pre Post

yes 112 75 58.9 59.5
no 78 51 41.1 40.5
“Any” pain or discomfort related to work in the last year is reported by 58.9 and 59.5% of the
workers pre and post-intervention respectively. The occurrence of pain did not change signifi-
cantly following the interventions conducted by the companies involved.
Part of Body with pain/discomfort in last year
Part of Body Percent Pre Percent Post

neck 32.1 38.6
shoulder 30.0 36.2
elbow 18.4 23.6
hand/wrist 37.9 36.2
upper back 14.7 18.9
lower back 27.4 29.9
thigh/leg 13.2 11.8
ankle/foot 11.6 7.1
Pain is most commonly reported in newspaper and commercial print workers in the hand/wrist,
neck, shoulder and lower back. While there were slight differences from pre to post intervention
for some parts of the body, this is not surprising given the different work types represented in the
two surveys.
Pain/Discomfort by Various Case Definitions
Case Definition and Part of Body Percent Pre Percent Post

Any pain/discomfort in last year 58.9 59.1
Hunting (>3x in year or >5 days duration) all parts 55.8 56.7
Hunting (>3x in year or >5 days duration) upper limbs 50.0 50.4
Hunting (>3x in year or >5 days duration) back 28.4 34.6
NIOSH (12x in year or >7 days and moderate intensity) all parts 40.0 37.8
NIOSH (12x in year or >7 days and moderate intensity) upper limbs 34.2 30.7
NIOSH (12x in year or >7 days and moderate intensity) back 18.4 18.9
Nordic-week (pain/discomfort in last 7 days) all parts 46.8 45.7
Nordic-week (pain/discomfort in last 7 days) upper limbs 40.0 41.7
Nordic-week (pain/discomfort in last 7 days) back 22.1 24.4
Nordic-interfere (interfering with ability to do job) all parts 23.7 18.1
Nordic-interfere (interfering with ability to do job) upper limbs 16.3 13.4
Nordic-interfere (interfering with ability to do job) back 7.9 8.7
A variety of “case” definitions were used with the same sample to define musculoskeletal pain.
While 58.9 and 59.1% of workers reported any pain in the previous year (pre and post question-
naires), this was only slightly reduced using the “Hunting” definition of pain recurring at least
three times in the year or lasting longer than five days. Incidences using the Hunting definition
were 55.8% pre and 56.7% post. Most workers reporting pain were therefore reporting a recurring
or fairly long-lasting pain. More of this pain was in the upper limbs than the back. The NIOSH def-
inition for pain is recurrences of at least 12-times in the year (monthly) or lasting greater than
seven days, as well as at least “moderate” in intensity. The percent of the workforce with the
NIOSH definition were 40.0% pre and 37.8% post questionnaire. This reflects a higher severity
pain since it recurs monthly or lasts a longer period of time and is rated as more severe. The
Nordic-week definition is commonly used, however it defines pain only in the last seven days.
Slightly less than half the sample (46.8% pre and 45.7% post) reported pain in the previous seven
days. This is a very high percentage for current symptoms. Once again, pain was more common
in the upper limbs than the back. The Nordic-interfere question asks about the pain interfering
with ability to do the job. A smaller percentage of workers (23.7% pre and 18.1% post) reported
that their pain interfered with their job.
Of those with Pain/Discomfort
Response Number Pre Post Percent Pre Post

those with prior injury/accident 35 25 32.1 35.7
those who sought medical treatment 84 59 77.8 76.1
those who reported injury to workplace 60 41 55.0 57.7
Of those workers who reported pain or discomfort in the previous year, about one-third have had
prior injuries or accidents. While roughly three-quarters of these workers sought medical treat-
ment for the pain, 55% pre and 57.7% post reported the injury in the workplace. Non-reporting of
pain is therefore occurring for 42.3 to 45% of the workforce.
Days Lost and Light Duty
Numbers of Days Percent Pre Percent Post

Days lost from work (0) 69.4 69.0
Days lost from work (1-10) 23.1 25.0
Days lost from work (>10) 7.4 5.6
Days of light duty (0) 89.8 85.9
Days of light duty (1-10) 7.4 7.0
Days of light duty (>10) 2.8 7.0
Of those in pain, 69% in both pre and post questionnaires did not lose any time from work due to
the pain. Of those that lost time, most were less than 10 days. Likewise, between 85 and 90% did
not receive any light duty.
3.3.2 Pre-Intervention Questionnaire Results: Variables Associated with Pain

Data from the first questionnaire were analyzed using chi square or ANOVA tests to look for vari-
ables associated with pain according to the Hunting definition (pain recurs at least three times in
the year of lasts longer than five days). This definition was used since it represents a more signifi-
cant musculoskeletal “case” than a positive response to “any pain”. It was chosen instead of NIOSH
as it would include a higher percentage of the workforce and this is important when looking for dif-
ferences pre and post to indicate change. The table below summarizes the variables found signifi-
cantly associated with pain at the p<0.05 level (primary) and p<0.25 level (secondary).
Summary of Variables Associated with Pain (Hunting)
Variable p-value meaning p<0.05 (primary) p<0.25 (sec’ary)

psychological demands 0.026 cases had higher •
management support 0.19 cases had less •
empowerment 0.05 cases had less •
job satisfaction 0.13 cases had less •
effort-reward imbalance 0.014 cases not in balance •
gender 0.12 cases more likely female •
time on the job 0.045 more than 10 years increased risk •
time sitting continuously 0.0014 more than 1-2 hours increases
risk - mean case=4 vs non-case=2.5 •
work with deadlines 0.036 “yes” more likely cases •
work with quotas 0.019 “yes” more likely cases •
having any deadline/
quota or pressure vs not 0.083 “yes” more likely a case •
deadlines & quotas 0.058 “yes” more likely a case • (marg)
daily deadline/quota 0.02 “yes” more likely a case •
weekly deadline/quota 0.11 “yes” more likely a case •
short-term deadline/quota 0.059 “yes” more likely a case • (marg)
long-term deadline/quota 0.19 “yes” more likely a case •
mean age 0.019 cases older (43 vs 39) •
mean hrs on telephone 0.108 cases longer (1.95 vs 1.39) •
mean hrs keyboarding 0.002 cases longer (3 vs 1.5) •
mean hrs using mouse 0.001 cases longer (1.7 vs 0.75) •
mean hrs standing 0.065 non-cases stood more (protective) (3 vs 2 hr) • (marg)
Evaluating the psychosocial factors and effort-reward imbalance scale involved a smaller sample
size (99 responses) as one company would not include these questions in their questionnaire.
Those reporting pain (according to Hunting definition) also reported significantly greater psycho-
logical demands, significantly less management support and empowerment, less job satisfaction
and effort-reward scales that were not in balance. This can be interpreted to mean that the efforts
in the job do not outweigh the rewards. Note that the vast majority of workers responding to these
questions (88 of 95) were considered “in balance”. Only seven were “not” in balance.
Those with pain or discomfort were more likely to be female and to have greater than 10 years on
the job. Cases with pain spent more time sitting continuously with an average of 4.0 hours for
cases and 2.5 hours for non-cases. Sitting continuously for more than 1-2 hours per day
increased risk of injury. Working with deadlines, quotas or having a deadline/quota or other pres-
sure were all associated with musculoskeletal injury “cases”. All frequencies of deadlines (daily,
weekly, short term and long term) were highly significant with those reporting pain.
Those with pain were found to be significantly older (43 years vs. 39 years for non-cases), howev-
er this can also be reflected in more years of experience. Those in pain spent significantly more
hours per day on the telephone (1.95 hours compared with 1.39 hours), using a keyboard (3 hours
compared with 1.5 hours), and using a mouse (1.7 hours compared with 0.75 hours). Interestingly,
non-cases were found to stand significantly more (3 hours compared with 2 per day) indicating
that the ability to stand for some portion of the day is protective.
There were also significant differences between the percent of the workforce reporting pain at
the different companies as shown in the table below. It is interesting to note that the two compa-
nies with significantly less pain also have binderies and press operations, in addition to office
workers. Differences between companies could somewhat reflect differences in work types.
Pain/Discomfort significantly different between companies
Company Number with Pain Percent of Total

NOW Newspapers 30 76.9
Mitchell Press 23 60.5*
The Abbotsford News 41 45.6*
Pacific Press 18 78.3
*2 companies significantly lower than others
Comparison by Work Type
When occupations were classified as either “office”, “bindery”, or “press”, there were significant
differences in the percent of the workers reporting pain (Hunting definition) between types of
work, with the bindery workers reporting significantly less pain as shown in the table below.
Job Number with Pain/Discomfort Percent

office 68 64.8
bindery 17 38.6*
press 27 65.9
*the bindery workers had significantly less pain/discomfort
Results of the comparison between jobs is somewhat surprising due to the physical and repeti-
tive nature of bindery work. From ergonomic assessments, and evaluation of risk factors, one
might conclude that bindery workers are at the highest risk of injury. Evaluating the psychoso-
cial factors provides more information, as shown in the table below. Those variables found to be
significantly different between occupations are listed and the meaning is interpreted alongside
the p-values.
Conclusions of Differences Between Occupations

(office, bindery, press)
Variable p-value Meaning

skill discretion 0.0005 bindery had least and press the most
decision authority 0.0225 office and press had most and bindery least
psychological demands 0.0001 bindery had least (press/office similar)
job insecurity 0.0056 office had least security (bindery/press similar)
physical exertion 0.0001 bindery had most and office least
empowerment 0.0001 bindery had least and office/press similar
Comparison between work types showed that bindery workers had the least skill discretion,
decision authority and empowerment compared with office or press workers. This is reflected in
the machine paced, repetitive nature of their work. They also had the most physical exertion.
However, they had more job security than office workers and significantly less psychological
demands than office or press workers. It appears that reduced psychological demands were pro-
tective given increased physical exertion. The psychological demands are a combination of two
questions. The first asks workers to respond to whether they feel their job is very hectic. The sec-
ond asks workers whether they have conflicting demands from others in their job.
Office workers had significantly more decision authority and empowerment, with less physical
exertion. However, they had the least job security and higher psychological demands. Press
workers had the most skill discretion of all work types, and similar levels of empowerment, job
security and psychological demands to office workers. This is interesting since their rate of mus-
culoskeletal pain is similar to office workers. The heavy but infrequent physical nature of press
workers jobs was not reflected in answers, likely since it is not repetitive and they have consid-
erable autonomy and control over their work.
3.3.3 Logistic Regression Modeling

Variables found to be significantly related to the Hunting definition of musculoskeletal pain
using Chi square or ANOVA tests were included in a stepwise logistic regression model to deter-
mine the final variables found to be independently correlated with pain. In the first model, psy-
chosocial questions were not included so the entire sample of questionnaires could be used.
Variables that remained in the final model were job category (bindery had less pain than office
and press), company (companies with bindery and press had less pain), time on the job (increased
risk beyond 10 years), more time sitting continuously, having work quotas, and more mean hours
keyboarding per day. When a model was run including the psychosocial questions (n=97), vari-
ables remaining in the model were psychological demands (more was associated with pain), and
an unbalanced effort-reward ratio. Empowerment and job satisfaction did not remain in the final
model.
3.3.4 Comparison with Toronto Star Questionnaire Results

Results from the questionnaire were compared with results from a similar questionnaire dis-
tributed to slightly over 1000 office workers at the Toronto Star Newspaper (84% response rate).
In the Toronto Star study, musculoskeletal pain was limited to the upper limb only. Comparisons
by work type and B.C. vs. Ontario are shown in the table below. An asteriks indicates a statistical
difference between the three work types in B.C.
Prevalence of pain caseness (>3 times/year or >than 5 days) and associated variables by
BC work types (p<0.05 for differences) and region for office workers
British Columbia Ontario

Outcome Variables Press Bindery Office Office
Pain any body part 65.9 34.1 61.0* n/a
Pain upper limbs 51.2 31.8 57.1* 54.6
Pain upper/lower back 36.6 13.6 31.4* n/a
Neck 29.3 6.8 43.8* 37.7
Shoulder 29.3 15.9 36.2* 32.5
Elbow 12.2 11.4 23.8 22.3
Hand/wrist 36.6 27.3 42.9 37.8
Upper back 7.3 4.5 21.9* n/a
Lower back 34.1 22.7 26.7 n/a
Thigh/leg 26.8 9.1 9.5* n/a
Ankle/foot 12.2 13.6 10.5 n/a
Seeking health care 74.1 93.8 75.4 45.9
Reporting in workplace 51.9 87.5 48.5* 34.9
Pain in the upper limbs was very similar for office workers at the Toronto Star compared with
office workers in B.C. (54.6% in Ontario and 57.1% B.C.). The percent reporting pain in various
parts of the upper limbs was also similar among the two groups of office workers. Interestingly
there is a much higher percentage of workers in B.C. who reported seeking health care for the
pain (75.4% of office workers), compared with 45.9% in Ontario. B.C. newspaper and commercial
print workers were also more likely to report the pain in the workplace (48.5% compared to 34.9%
in Ontario).
The table below compares exposure variables between work types in B.C. and contrasts respons-
es from the Toronto Star study for office workers in Ontario. The asterisk again indicates where
there are significant differences between B.C. work types for a variable.
Exposures by work types in British Columbia (*p<0.05 for differences) and for Ontario
office work
Exposure Variables British Columbia Ontario

Continuous - Mean (standard deviation) Press Bindery Office Office
Hours on telephone per day 0.1 (0.26) 0.0 (0.1) 3.0 (2.6)* 2.6 (2.0)
Hours sitting at a desk per day 1.3 (2.5) 0.05 ().3) 5.7 (2.3)* 5.3 (1.8)
Hours in a vehicle per day 0.1 (0.37) 0.25 (1.1) 0.6 (1.1)* 2.3 (1.4)
Hours standing in one spot per day 3.3 (3.2) 6.8 (2.9) 0.5 (0.99)* n/a
Hours keyboarding per day 0.5 (1.1) 0.2 (1.2) 4.2 (2.9)* 3.4 (2.1)
Hours using a mouse per day 1.1 (2.2) 0.0 (0.15) 1.98 (2.7)* 2.2 (2.0)
Hours lifting/handling items per day 3.65 (3.6) 7.4 (2.4) 0.7 (1.6)* n/a
Times away from a workstation per day 9.0 (17.7) 3.9 (3.3) 13.7 (11.7)* 10.6 (9.4)
Skill discretion 4.3 (1.6) 6.9 (2.5) 5.0 (1.99)* 10.35 (2.16)
Decision authority 3.3 (1.6) 4.7 (1.97) 3.1 (1.8)* 6.79 (1.88)
Psychological demands 5.1 (1.3) 3.8 (1.6) 5.8 (1.4)* 7.27 (1.58)
Job insecurity 1.3 (0.7) 1.0 (0.7) 1.9 (1.15)* 2.82 (1.02)
Physical exertion 2.1 (1.2) 3.3 (0.65) 1.6 (1.16)* 2.35 (0.95)
Social support 5.2 (1.7) 5.7 (2.2) 5.1 (2.1) 10.77 (2.11)
Empowerment 5.2 (3.1) 2.1 (2.5) 5.5 (2.9)* n/a
Management support 6.3 (2.3) 5.9 (2.6) 6.2 (2.5) n/a

Categorical – Percent Press Bindery Office Office
Sitting more than 2 hours 7.5 0 29.5* 24.4
Frequency of skipped breaks (>1/week) 79.6 13.6 60.6* 62.3
Work with deadlines/quotas/pressures 90.2 68.2 97.1* 92.2
Job satisfaction: not too/not at all 17.1 15.9 15.8 11.2
Need permission to leave workplace: sometimes/always 59.0 81.8 37.7* 25.2
Workers take part in decision making: rarely/never 34.6 58.4 31.2 32.1
Ideas listened to by management: disagree/strongly 38.4 50.0 37.7 20.2
Health/safety equal to productivity: rarely/ never 38.4 50.0 40.0 19.6
Encouraged to report symptoms: disagree/strongly 24.8 21.4 32.3* 12.4
Management change job to help RTW: disagree/strongly 9.8 11.9 6.8* 7.7
Effort/Reward (binary): imbalanced 0 18.2 11.3 n/a
Responses to the questionnaire were similar for office workers in Ontario and B.C. with a few
exceptions. B.C. office workers reported considerably less skill discretion, decision authority
and social support than Ontario office workers. This could reflect a more fractious labour cli-
mate in B.C. More office workers in B.C. reported needing permission to leave the workplace,
fewer felt their ideas are listened to by management and fewer felt that health and safety is con-
sidered equal to productivity by management. Almost one third (32.3%) of B.C. office workers
reported that they are not encouraged to report symptoms, compared with 12.4% in Ontario.
3.3.5 Open-Ended Questionnaire Comments
Information from open-ended questionnaire comments has been summarized according to job
category, keeping the company confidential.
Office Workers
Questionnaire comments regarding office work can generally be categorized into issues around
the repetitious nature of tasks such as keyboarding and mousing, features of the work organi-
zation including scheduling, deadlines and other pressures, computer/telephone equipment or
technology problems, lifting/handling and other physical demands of work, communication and
co-ordination of work and furniture or equipment problems or features.
Repetitious Nature of Tasks/Lack of Breaks
• several workers mentioned that computer work involves sitting in the same position for too
long and that the tasks are repetitive - they suggested the need for more varied tasks
• one worker expressed that “mousing involves constant, unsupported, repetitive movements
of the same small tense muscles”
• long hours staring at computer causes eyestrain - need to try more frequent short breaks or
changes in tasks
• several workers suggested there needs to be more opportunity to get up and stretch and
move and to take more frequent breaks
• repetitious tasks mentioned include booking ads, doing ad changes and paginating (intense
computer mouse work)
• as well as more breaks, several workers mentioned that tasks such as paginating should be
performed for fewer hours
• with pagination, one worker suggested the need to figure out a way to share some of the
workload better due to intense use of the limbs in one spot
Work Organization
• a couple workers expressed great satisfaction with their job
• one worker summarized the job by saying it is a “boring, repetitive job, but independence,
flexible hours and good supervisors are positive factors”
• a couple workers expressed concern about job security
• one worker stated the overtime and pressure to work overtime is self-induced largely
because of peer pressure to produce as much as younger reporters
• several workers mentioned the difficulty of staying creative while under time pressures,
some suggestions were more quick breaks, management support and education
• some workers expressed concern about the hours of work, managing conflict, trying to
please supervisors and taking criticism
• one suggestion was to cut down travel time or schedule at low peak hours and use couriers more
• several workers mentioned the need for fair distribution of work
• several workers mentioned the difficulty of doing customer service due to attitudes, they
suggested the need for more staff and more training, one worker suggested dedicated phone
people who are not doing other work
• one worker suggested system changes or reassignment to allow a worker to complete the
retail ad system so they are not feeling like they are only doing half the job
• workers mentioned work volume and stress
• one worker mentioned the need for more contact with the client
• one work organization suggestion was to assign all types of jobs to all people instead of cre-
ating specialists who do not understand the whole picture
Deadlines
• although pressures and erratic workloads were recognized as an intrinsic part of the work
(reporting), several workers mentioned that meeting deadlines is mentally demanding, places
pressure in short time periods, that all deadlines can’t be met, and it’s hard to stay organized
• there was frustration regarding the need for others to meet their deadlines (eg. sales) and
take responsibility for their tasks, one person mentioned that “people tend not to worry
about things further along the production chain after their job is done”, another mentioned
that “management needs to be stricter with other departments”
• several workers suggested streamlining paperwork and deadlines and restructuring for a
better work flow
• in data entry it was suggested that a better flow of orders is needed so they are not coming
all at once
• several workers mentioned that the solution is more help around deadlines (eg. “producing
vast quantities of stories under pressure - need other reporters assigned” and “many phone
calls in quick succession - no time to organize story before being presented with another and
another - another reporter at peak times would help”)
• others stated the solution is more time (eg. doing page layout using a mouse)
Computer/Telephone Technology Problems
• hardware/software problems (due to age of system) causes stress
• many workers mentioned the frustration and stress due to computer hardware and software
technology problems (eg. “computers crashing at alarming rate -6-7 times a day”, “computer
can’t multi-task so I can’t perform in less time”, “need better billing system with less errors”,
need more streamlined accounting system”, “phone system needs upgrading”)
• sometimes the frustration was incompatibilities with clients (eg. “emailed ads on different
platforms”)
• in some cases the need was for more computers (eg. “insertion orders a problem - too many
errors, we need computers”, or sharing computers is a problem)
• workers suggested more education and updates (eg. “computing demanding as things often
don’t work - need to keep people updated on changes and problems”, “extremely frustrating
when things don’t work properly - need better communication of problems and fixes - more
and better training”, “new procedures and software mentally demanding - no standards or
published info”)
Communication/Co-ordination of Workload
• numerous workers mentioned the need for work to flow more smoothly to minimize last
minute projects and changes and the need for improved communication between depart-
ments and managers to accomplish this and to reduce redundant work (eg. “proofing ads - no
one takes responsibility - need more cooperation”, “better communication and training
needed re special features and selling”)
• to facilitate better communication and cooperation between departments, several workers

suggested meetings, such as monthly department head meetings or group meetings
• one worker suggested management and employees need to work together and a more posi-
tive environment is needed
Lifting/Handling and Other Physical Demands
• workers mentioned a variety of tasks considered heavy, such as putting in a new box of film,
loading paper into a printer, moving boxes of files and stacks of newspapers, changing water
bottles at the cooler, and disposing of old newspapers
• one suggestion was for someone accustomed to doing heavy lifting to perform these tasks
• inadequate storage was also mentioned as a problem
• pasting up pages was also mentioned as physically demanding due to bending over for long
periods of time at make-up tables
• one worker suggested trolleys for lifting and carrying items
Furniture/Equipment/Office Environment
• a number of people mentioned the need for better equipment and more support at the desk
(proper height, better ergonomic equipment, adjustable screen, bigger screen, adjustable
desks and keyboards, and better headsets)
• office environment issues mentioned were printer noise, air quality, glare and better lighting
• noise and distraction was mentioned by several workers, especially due to open office
designs
• one person mentioned the interruptions and having to get up often to use fax and suggested
they need closer office equipment
• some workers mentioned cramped space
• for repetitive mouse-work, one person suggested a better/faster mouse or different type
Bindery
Questionnaire comments generally fall into categories of physical demands of work, equipment
problems and work organization as follows.
Physical Demands of Work

• workers in the bindery mentioned a number of tasks they considered very physical and
offered solutions - examples include:
- skid-wrapping - purchase automatic wrapping machine
- some bundles too large and heavy - need smaller bundles
- need greater awareness of size and weight of flyers
and papers before summaries are prepared
- need more hydraulic lifters and other lifting devices
- when inserting 2-3 pockets at a time - need to even out flyers during week and
and jogging papers that are heavy set a limit to the very heavy ones
- heavy flyers in one pocket only
- higher jogging desks
- stacking bundles - need to be reduce height for lifting
- heavy, glossy ones slide everywhere - need to
work with company putting out flyer for input on
a solution - need to work together and set limits
- loading pallets (heavy lifting and bending) - have them raised to waist level and lowered as
each layer is complete
- need to change people around
• workers feel the physical demands of being bent over and leaning forward (loading feeders),
the heavy lifting (with bundles and flyers) and the repetitive handling (when jogging)
• general suggestions also included using a relief person to trade off on jobs so everyone can
work at a comfortable pace and more automatic lifting devices throughout
Equipment Problems
• a number of workers mentioned frustrations and extra physical demands due to equipment
breakdowns, such as the stacker (“always jamming up and making job harder - flying papers
- constant motion, high speed - need better stacker”, wrapping pallets “plastic wrap is weak”,
“cutting needs changing - not proper equipment”)
• some workers mentioned the need for constant maintenance on the machine due to break-
downs
• one worker mentioned that blue boxes needs changing - takes too long - better to run flyers
in the paper
• suggestions for the stacker include better flyer quality control, better monitoring, and hav-
ing loaders trained one-on-one
• a worker mentioned the waste bins could easily fall and hurt someone and that the solution
is either a week-end janitor or a better system for removal of paper waste
• moving skids was considered a problem due to rough floors
Organization of Work
• a couple workers mentioned there were many things to keep track of and figuring amounts
for stacking bundles is mentally demanding - training was suggested and having this done by
supervisors so more time would be given for doing pallets
• shift scheduling and fatigue was a concern with too many back to back shifts, long hours,
and not enough hours between shifts
• rotation of jobs was suggested by several workers (“would like to work in different areas of
shop to break monotony and have better training”, “need floater to relieve periodically to
switch around between feeding pockets and end delivery boxing, cages”)
• other concerns included deadlines (“need better handling in production department”) and
lack of input
Press
Comments were generally made about the physical demands of work and the work environment,
dealing with customers and the organization of work, as follows:
Physical Demands of Job and Work Environment

• several jobs were mentioned for their physical demands, including repiling (“heavy, a 2 man
job”), ink distribution (“hard on wrist - putting in 150 to 275 kg in 8-hr shift” - ink pumps were
suggested), second man on the mitts (“very physical with little support from other depart-
ments”), cleaning machine (“difficult to do from just one side - need to take off front panels”),
rolltenders job (“lots of lifting and moving of heavy objects”), flyboy job (“new machine would
eliminate unnecessary physical labour”), flying papers and roll shafts are continuous,
demanding and heavy, and plate burning (“repetitious and strains wrists - need automated
plate burners”),
• some workers mentioned more general physical concerns, such as standing for long dura-
tions, no breaks or place to sit down and suggested bar stools and footrests, more press
ready skids and an extra man when needed
• one worker mentioned that the constant lifting is demanding and said more high-lifters and
other lifting devices were needed
• another worker said paper handling needs changing and adequate equipment is needed
• one environmental concern was for cooler temperatures in the pressroom in summer and
better air circulation
Dealing with Customers
• a few comments were made about dealing with customers who are unclear of the printing
process and what they want
• it was suggested that sales staff need to play a larger role and that there be customer proof-
ing rooms that are clean and quiet
Work Organization
• concern was mentioned about workload not flowing smoothly due to constant last minute
projects and changes - it was suggested that improved communication between depart-
ments and managers to reduce redundant work would help
• roll tending was also considered mentally demanding since if material breaks (web) dead-
lines fall behind - it was suggested that operating instructions be posted clearly on machin-
ery to eliminate minor problems
• a suggestion was made for training seminars about how workers and management could
work together more effectively
3.4 Development of Ergonomics Program Manual

The first draft of the program manual contained seven sections as follows:
1. An Introduction to Ergonomics - this explained what ergonomics is, why organizations

should consider ergonomics, typical musculoskeletal injuries in the industry (based on
questionnaire findings), the WCB Ergonomics Requirements and a process for developing an
ergonomic program, including commitment from Senior Management, Allocation of
Resources from Senior Management, Accountability from Senior Management to
Supervisors, Foremen and Workers, Active Participation by Workers, Involvement from
other Key Individuals, Training, and Prompt Follow-up on Risk Control Measures.
2. Typical Ergonomic Problems and Solutions in the Newspaper and Commercial Printing
Industry - this section was divided into three parts: the office environment, bindery, and
press. In each section, a full page was used to illustrate a typical task in one of the work envi-
ronments, such as handling shafts of paper in the press. The task is described and a photo
shown. The risk factors are listed. This is followed by a list of possible solutions to minimize
risk in the task. In most cases photos are shown of one or more of the solutions. This section
is meant to provide ideas about how to develop solutions.
3. Risk Identification Tools - this section contains a series of checklists that can be used to help
identify where signs, symptoms or risk factors may be occurring. One checklist specifically
asks about signs and symptoms, the second is for identifying risk of musculoskeletal injury
in office work, the third is for identifying risk of upper limb MSIs from repetitive work and the
fourth is for identifying risk of back overexertion injuries.
4. Ergonomic Guidelines and Standards - this large section includes technical information and
risk assessment methods for topics such as working heights, working reaches, work sur-
faces, office accessories, guidelines for lifting tasks, guidelines for pushing and pulling
tasks, guidelines for visual angle and viewing distance and guidelines for an office chair.
5. Psychosocial Factors Related to Injuries in the Newspaper and Commercial Printing Industry
- this section explained in general terms the findings from the questionnaire survey about
psychosocial factors related to pain and discomfort among workers. It explains the important
psychosocial factors then for each makes recommendations for ways of improving the fac-
tors of deadlines and quotas, job satisfaction and effort-reward balance, management support
and psychological demands.
6. Return-to-Work Programs - this section discussed return-to-work programs, the components
of a program, opening channels of communication, provision of modified work, developing
rehabilitation plans and evaluating the program. Material from some of the participating
companies was used in development of this section.
7. Ergonomics Training Programs - overhead transparency copies were included for four dis-
tinct training programs: “WCB Ergonomics Requirements”, “Minimizing Musculoskeletal
Injuries to Office Workers”, “Minimizing Risk of Upper Limb Musculoskeletal Injuries” and
“Minimizing Risk of Back Overexertion Injuries”. In addition a standard lesson plan showed
each overhead and explained to the presenter what topics should be discussed and ways to
present the information.
As mentioned earlier, two groups of employers had substantial difficulty with two sections of the
manual: discussion of psychosocial factors related to pain and injury, and the return-to-work sec-
tion. They were philosophically opposed to including these issues in an ergonomics manual
since they see this as labour-relations functions. After much discussion, it was agreed that the
sections would be removed from the manual designed for health and safety committees.
However, the sections would still be produced and made available to employers in the newspaper
and commercial printing industry.
During focus groups with health and safety committees at each workplace, questions were asked
about manual content and presentation. Suggestions for change were solicited. There were only
a few minor editorial changes based on this feedback. Based on the meeting with the WCB, there
were some minor revisions to the section discussing the ergonomics regulations and their imple-
mentation. To make the publication consistent with other ergonomics publications produced by
the WCB, a flow chart and some description of the ergonomic program process was included in
the program manual.
A copy of the final manual “An Ergonomics Program for the Newspaper and Commercial Printing
Industry” is provided with this report. In addition, a binder with the overheads for the four train-
ing programs and the standard lesson plan is also included.
3.5 Implementation of an Ergonomics Program at the Companies

With the exception of Mitchell Press, the other companies implemented to various extents por-
tions of the ergonomics program manual and training. In general, the ergonomics manual was
found to be extremely useful as a resource for health and safety committee members. It was used
in various ways, such as to look up guidelines, to copy and distribute specific information, to post
pictures of “problems” and “solutions” and to develop training programs. The overheads in small-
er companies were not used as they do not have overhead projectors or a large training room.
Instead, the standard lesson package was copied as a hand-out and less formal training discus-
sions were conducted. At the larger company, the overheads were used in a training room.
Specific activities of each company and feedback is provided below.
NOW Newspapers
Although there is one overall health and safety committee for the three sites of NOW Newspapers,
Burnaby and New Westminster worked together through the health and safety committee, while
Coquitlam seemed to do its own program. It must be remembered that each of these sites is a small
office with between 19 and 24 workers. At the Burnaby NOW, the health and safety committee met
in New Westminster with all department heads. They discussed the project and the ergonomics pro-
gram manual. They made department heads aware of the ergonomics requirements and the various
tools available in the ergonomics program manual. The occupational health and safety committee
have done some assessments of a limited number of workstations where problems or concerns
existed and recommendations and adjustments were made. They had planned to have a meeting
with all workers and make the program more formal, however to date this has not yet occurred. At
this stage, only individual high risk situations have been assessed and controlled. They have used
the program manual mostly as a reference for specific information during assessments. Some
material from the manual has been copied and handed out. Also, checklists have been copied and
provided to workers. It was reported by health and safety committee members that workers have
not been very positive about the information because they feel the management will not make nec-
essary changes. Requests for new equipment have previously not materialized.
At New Westminster, meetings were conducted with all workers and department managers. The
ergonomics requirements were discussed, including recognizing early signs and symptoms and
reporting. The program manual was shown to workers and made available as a resource. Portions
of the manual referring to workstation set-up and the overheads pertaining to this in the training
program were used during the training session. Approximately 20 workers participated in the
training (almost all the workers). Health and safety committee members discussed prevention of
musculoskeletal injuries, proper workstation arrangement and posture and the importance of
taking breaks and varying tasks. Two workers with specific concerns were provided information
about reaches and visual angles and viewing distances. The health and safety committee report-
ed that the ergonomics manual was very useful and the training material was especially helpful.
They photocopied photos from the manual and posted them on bulletin boards to make people
more aware of posture. Three workers requested head-sets and these were purchased. They
reported that workers had discussions about micro pauses and the importance of breaks.
Workers were also made more aware of the first aid book and the importance of reporting symp-
toms. As a result, there has been an increase in symptom reporting in New Westminster.
In Coquitlam, the Editorial and Production department who use computers most extensively met
with department heads for a meeting/training session. During this session, the ergonomics
requirements were mentioned, information was provided about optimal posture and good work-
station arrangement. Overheads and material from the program manual was used in the training.
Workers found the training useful and interesting. They are planning to conduct reminder train-
ing. No workstations were formally assessed, however the manager does visually observe and
remind workers about the importance of breaks and good posture.
The Abbotsford News (Hacker Press)

The health and safety committee discussed the various components of the ergonomics program
and decided to conduct ergonomic assessments as a first priority. They felt this would help them
determine how much training is necessary, compared with how much purchase of equipment
would be a priority. At least two members from the health and safety committee were assigned
various jobs and departments for ergonomic assessment. During the assessment, information
from the ergonomics manual was referenced. They observed the job, had informal discussions
with workers about concerns and discussed possible solutions. In the office, they made adjust-
ments to chairs and workstation layout and more formally discussed posture. Workers were
shown one-on-one how to make improvements to their workstation.
To date in the office, assessments have been completed for all workstations. In general, they have
found that 70% of the problems in the office can be rectified with employee awareness. They
assisted workers to perform housekeeping to clear away clutter from workstations. For example,
workers stored boxes under desks limiting leg room. They have determined which monitors need
to be raised and where possible have done this. They are investigating articulating keyboard
trays and footrests and have put this into the budget.
Assessments were carried out in the press room. Concerns over being in tight, cramped loca-
tions and postures when working on the machines were discussed at length. Health and safety
committee members increased the awareness of injuries and the importance of good posture.
They reinforced with workers that they should spend as little time in these postures as possible.
At crew meetings, the weight of rolls was discussed and they have purchased a new stacker for
the press to minimize some of the lifting and handling for the flyboys. They are also investigating
different types of core shafts available in reduced weights for the pressmen. Training has been
ongoing using some of the material and overheads provided in the training package. They con-
tinue also to train new employees. Training has included discussion of proper lifting procedures
and techniques. They have also installed new floor matting.
In the bindery, special attention was given to inserters who perform repetitive lifting and han-
dling tasks. They especially looked at heights and reaches for different sizes of workers and how
that affects posture. They referenced the manual for guidelines and discussed various solutions.
A portable ramp was constructed to go in front of the pockets for shorter workers. The trial was
unsuccessful though as workers felt the ramp was too cumbersome. At crew meetings with
bindery workers, managers reinforced proper lifting and bending techniques. They also assessed
floor mats and have replaced some and are discussing exercises that could be done on the job in
this area. Modifications were made to the tying machine to raise the legs. They have also put in a
step to reduce reaching. They are doing more job rotation in the bindery to help reduce the repet-
itive demands. The Health and Safety representative from the bindery stated that the training
and assessments have made them more aware and encouraged them to look at their jobs to see
what can be improved and how to make the job easier.
In general, Abbotsford has reported that the ergonomics manual has been very helpful. They
have incorporated part of the manual into their occupational health and safety manual. This
internal manual is given to all workers. They stated that the feedback from workers about the
manual is that it is appreciated, the information is clear and the layouts and guidelines are use-
ful. The overheads were provided to Abbotsford, at their request, on disc so they could modify
some for their purposes. They used the overheads in their training, especially for workstation
design principles. Some of the checklists, especially for the office environment have also been
used. The guidelines for chairs, monitor heights, etc. have also been extensively referenced.
The Abbotsford News’ occupational health and safety committee have made ergonomics their instruc-
tional focus this year. They expect to proceed with training in the next six months. Their plan is for a
meeting and training session with supervisors and managers of each department. It will then be
expected that supervisors will do crew talks about signs and symptoms and risk factors in their jobs.
Mitchell Press
As stated earlier, Mitchell Press declined to implement an ergonomics program or use the pro-
gram manual and training materials in a formal way.
Pacific Press
A series of training sessions were arranged for the two participating departments in the fall of
2000. Ian McCoan (CEP rep on the health and safety committee) conducted the training with the
assistance of Mr. Phil Faulkner (Health and Safety Director). Groups were kept small (6 to 8 at a
time). Overheads and material from the ergonomics manual was used. In addition, Mr. McCoan
made some additional overheads. Training covered the requirements of the ergonomics regula-
tions, signs and symptoms and reporting, workstation design and arrangement and some orga-
nizational and procedural issues regarding work flow. Workers discussed why they do not come
forward to their supervisor when they are experiencing pain. They expressed concern they
would be constantly watched, they reported that the onset is often quite subtle and you don’t
know when it starts, they don’t want to stand out or be re-assigned to other duties and they have
guilty feelings or feelings of self-denial that there may be a problem.
Considerable follow-up assessments were requested as a result of the training. Mr. McCoan and
Mr. Faulkner performed assessments at between 12 to 15 different workstations, as well as some
common shared workstations. Where necessary, changes or adjustments were made and addi-
tional accessories obtained. Some decisions were made about altering work flow and how work
is organized to reduce pressures. There were also decisions made about reducing volume of work
for injured workers during their return-to-work period. There are no other immediate plans for
further assessment in these areas.
3.6 Results of Questionnaires Following Implementation of Ergonomics Programs
A series of questions asked respondents whether their job had changed in the previous six
months and whether they participated in ergonomic education or changes. Responses are tabu-
lated and summarized below.
Question Percent Percent Percent

Responding Responding Responding
“Not at all” “Somewhat” “Completely”
Has the way you work changed
in the past six months 78.3% 21.7% 0%
I’m aware of ergonomic changes 38.6% 40.6% 20.8%
I took part in ergonomic education 50% 29.3% 20.6%
I was involved in the changes 58.8% 35% 6.2%
As much as possible was done 39.8% 47.1% 13.3%
The changes have made my job better 37% 50.7% 12.3%
My job requires less physical effort 47.9% 38.3% 13.7%
My job is now more interesting 55.1% 43.4% 1.4%
My job makes me less tired 56.8% 41.9% 1.4%
My job makes me less sore 55.8% 39% 5.2%
The response to the first question about whether work has changed in the past six months
appears to have been misinterpreted by workers completing the questionnaire. Only 21.7% stat-
ed that work changed somewhat. Open-ended questions asking how work has changed indicate
many workers responding with statements such as: “more pressure”, “more work in a shorter
period”, “more stress”, “I changed jobs”, “possible merger”, and “trying to be more aware”. They
appear to not be linking this question directly to ergonomic interventions. Later questions were
more specific and responses were more in line with activities present in the various companies.
A good percentage of workers were aware of ergonomic changes in their workplace (20.8% com-
pletely and 40.6% somewhat). A good percentage also took part in ergonomics education (20.6%
completely and 29.3% somewhat).
Few workers were completely involved with ergonomic changes (6.2%), however 35% were some-
what involved. A majority of workers felt that as much as possible was done in the ergonomic
changes (13.3% agreed completely and 47.1% somewhat). The changes made a positive impact on
a good percentage of the workforce. Combining the “completely agree” and “somewhat agree” cat-
egories, 63% responded that the changes made their job better, 52% that their job requires less
physical effort, 44.8% that their job is more interesting, 43.3% that their job makes them less
tired, and 44.2% that their job makes them less sore. Although there were few differences in the
percent of workers in pain from the first to second questionnaire, the differences may be masked
because the sample responding to the questionnaire was quite different. Other possible reasons
for not seeing pre-to-post changes in pain and symptoms is that either the intervention in some
cases was not sufficient, or the time period (eight months) for follow-up was insufficient. These
specific questions about the education and changes are more indicative, for those responding, of
how ergonomic education and changes affected them.
Open ended questions were grouped according to the company. At the NOW Newspapers, the com-
ments mostly pertained to lack of adequate furniture and equipment. Workers responded that
there was more work and pressure in the workplace than previously. At Pacific Press there were a
number of very positive comments about changes to their workstation set-ups, such as new key-
board trays, more space, chair adjusted, new desk, better chair, positioning of keyboard and desk,
etc. Several workers also commented about adjustments to work postures or how the desk is orga-
nized. One worker commented that they are more aware of their posture and it is nice to know that
people care so much. Another commented that getting approval to stretch made a big difference.
Workers liked knowing there is someone to consult. One worker stated there is more variety in the
job, another that there is now less telephone time. Some workers responded that they have less
back problems. One worker stated that “our ergonomics committee certainly goes the distance to
ensure we are able to do our jobs without too much damage to our bodies”.
At The Abbotsford News, there were comments about desk adjustments, proper hand-arm
angles, adjustments to chairs, additional footrests, floor mats, new shrink wrap and new strap-
ping machine and a higher tying machine. A few workers discussed the increased awareness of
posture and the way tasks are performed. A small number of workers noted negative changes
such as more speed, and increased physical work.
3.7 Dissemination
The final binder (90 pages) “An Ergonomics Program for the Newspaper and Commercial Printing
Industry” was printed and distributed to approximately 38 newspaper and printing operations in
B.C. Five sets of training overheads and standard lesson plans were produced and reside in the
CEP (local 2000) office for loan and a disc with overheads may be obtained from the CEP. A paper
was published and presented at the Association of Canadian Ergonomics Annual Conference in
Montreal (October 2001). This paper is found in Appendix E. It is also anticipated, based on meet-
ings with the education department at the WCB, that information from the program binder will be
published on the WCB website for further dissemination.
4.0 CONCLUSIONS
1. The project met the objectives as outlined in section 1.1. Specifically, the physical and psychoso-
cial risk factors for each of the three work categories in the newspaper and commercial printing
industry (office, press and bindery) were analyzed as well as symptoms of pain and injury report-
ing. A comprehensive ergonomics program was developed for each of the three work categories
based on the best scientific information and in compliance with the new ergonomics regulations.
The program was implemented in three operations and the effectiveness evaluated afterwards.
The final ergonomics program binder and training materials were then modified and distributed
to approximately 38 newspaper and commercial print workplaces in B.C.
2. With respect to the psychosocial work environment in the newspaper and commercial print-
ing industry, a large percentage of workers (between 60 and 80%) report that their job allows
them to learn new things, has a high degree of skill and they are allowed the freedom to
decide how to work. There is also an atmosphere of helpfulness from supervisors and co-
workers. However, a similar percentage of workers report that their job requires they do
things over and over and their job is very hectic. Job security is a concern, less than 40% of
workers feel they have say in what happens on the job and 45% report co-worker hostility or
conflict. Deadlines and pressures are experienced by 83.7% of the workforce.
3. When asked about pain or discomfort in the past year, 58.9% reported positively. Pain was
most common in the hand/wrist, neck, shoulder and lower back. Pain recurring at least three
times or lasting longer than five days was experienced by 55.8% of workers. Pain recurring
monthly or lasting longer than seven days and experienced as moderate or worse in severi-
ty was reported for 40% of workers. And, 46.8% reported experiencing pain in the last seven
days. Of those in pain, 77.8% sought treatment, yet only 55% reported the pain in the work-
place.
4. Statistical analyses revealed that workers with pain (recurring three times in the year or
lasting longer than five days) reported significantly greater psychological demands, less
management support and empowerment, less job satisfaction and an unbalanced effort-
reward scale. Those in pain were more likely female, older, with greater than 10 years of work
experience, and they spent more time sitting continuously, using the telephone, using a key-
board, using a mouse and worked with deadlines, quotas or other pressures. Those in pain
spent less time standing. Results compare closely to those of office workers at the Toronto
Star newspaper in Ontario.
5. Bindery workers reported significantly less pain (38.5%) than press (65.9) or office workers
(64.8%). This was surprising given the repetitive and physical nature of their jobs. Bindery
workers compared with office and press workers had significantly less skill discretion, deci-
sion authority, empowerment and greater physical exertion. However, they had greater job
security and significantly less psychological demands. The lower psychological demands
appears protective given the higher physical nature of their job.
6. Office workers are at risk of injury due to the repetitive nature of their tasks, lack of breaks,
work organization issues such as scheduling and system problems, deadlines, computer
and telephone technology problems that cause frustration and pressure, problems with
communication and coordination of workload and office furniture and equipment issues.
Bindery workers are at risk of injury due to the repetitive and physical nature of their work,
equipment problems and inadequacies, and organization of work. Press workers have some
heavy and awkward physical demands although they are infrequent and intermittent, there
is considerable autonomy, but stress from deadlines and dealing with customers.
7. “An Ergonomics Program for the Newspaper and Commercial Printing Industry” binder (90
pages) was produced in conjunction with standard lesson plans and overheads (60) for four
training programs. Training sessions were conducted for health and safety committees and
the program was implemented to some extent in three of the four companies (five locations).
The materials were felt to be very useful, practical and thorough. One company included the
material in their health and safety manual that is provided to each worker.
8. There were no significant differences in pain or in psychosocial factors from pre-to-post

questionnaire (following eight months to implement the ergonomics program). This could be
explained by a low response rate to both questionnaires and a different sample of the work-
force in the second questionnaire (i.e. missing Mitchell Press, and more office workers
responding). It may also be explained by insufficient intervention at some locations (i.e. lim-
ited numbers of workstation assessments). Lack of change could also be due to insufficient
time both to implement and to affect change in pain or psychosocial scores (eight months).
Upon specific evaluation of training or ergonomic changes however, approximately 60% of
workers reported taking part in education or were aware of ergonomic changes made as a
result of the program. Education and changes made a positive impact, with 40-60% of work-
ers reporting that they made their job better, reduced the physical effort, made the job more
interesting, and they are less tired and less sore. These responses indicate positive benefits
from the ergonomics program materials and training.
9. The final program binder was printed and distributed to approximately 38 newspaper and
commercial printing operations in British Columbia. Five sets of training binders with the 60
overheads and standard lesson plans are available at the CEP (local 2000) office for loan. The
overheads may also be obtained from the CEP on disc. Results of the questionnaire survey
were published and presented at the Association of Canadian Ergonomists Annual
Conference in Montreal (October 2001). It is anticipated that the WCB will publish some of the
program materials on their website to further disseminate the information.
Appendix A
Pre Questionnaire
A Study of Musculoskeletal Disorders in Newspaper and Commercial Printing
Questionnaire
Section A
We would like to begin by asking a few questions about yourself and your job.
• Job ___________________________________________ Department _________________________
• Age _____________ Sex ________
• Time on THIS job: ■ Less than 3 months
■ 3 mo. To 1 year
■ Greater than 1 year to 5 years
■ Greater than 5 years to 10 years
■ Greater than 10 years
• On an average day at work, approximately how much time do you spend on each of the following
activities? (write in time spent, indicate NA if not applicable)
1. On the telephone (for any reason)? _________hours
2. Sitting at a desk? _________hours
3. In a vehicle (not including to and from work) _________hours
4. Standing (in one spot) _________hours
5. Keyboarding? _________hours
6. Using a mouse? _________hours
7. Lifting and handling items _________hours
• At work, how long do you usually sit for a continuous period of time? (circle number)
1. Less than 1/2 hour
2. 1/2 hour to 1 hour
3. Between 1 hour and 2 hours
4. More than 2 hours
• How often do you skip or miss work breaks (excluding lunch)? (circle number)
1. Almost always (3 or more times per week)
2. Frequently (once a week)
3. Sometimes (once a month)
4. Rarely (once every 2-3 months)
5. Almost never (once every 6 months)
• In a typical day, how many times does your job take you (excluding lunch and breaks) away from
your workstation for 1/2 minute to 10 minutes (please specify a number) ____________________
• Do you work with any of the following? (circle all numbers that apply)
1. Deadlines
2. Sales or service quotas
3. Other pressures (please specify) _______________________
4. No (if no, skip next question)
• If you work with deadlines/quotas, what were they (circle all numbers that apply)
1. Daily
2. Weekly
3. Short-term projects (more than 1 week but less than 1 month)
4. Long-term projects (1 month or more)
5. Seasonal
Section B
In this section we want to ask you about your job. For each statement, please check the box with the one
answer that best describes your situation.
1. My job requires that I learn new things.

■ Strongly ■ Agree ■ Neither agree ■ Disagree ■ Strongly
agree nor disagree disagree
2. My job requires a high level of skill
3. My job allows me freedom to decide how I do my work.
4. My job requires that I do things over and over.
5. My job is very hectic.
6. I am free from conflicting demands that others make.
7. My job security is good.
8. My job requires a lot of physical effort.
9. I have a lot of say about what happens on my job.
10. I am exposed to hostility or conflict from the people with whom I work.
11. My supervisor is helpful in getting the job done.
12. The people with whom I work are helpful in getting the job done.
13. How satisfied are you with your job?
■ Very Satisfied ■ Somewhat satisfied ■ Not too satisfied ■ Not at all Satisfied
14. Do you need permission or do you have to find someone to take your place if you leave your work-
place for five or ten minutes? (check box)
■ Never ■ Sometimes ■ Always
15. How frequently do workers take part in decision making in the workplace?
■ Often ■ Sometimes ■ Rarely ■ Never/Almost never
16. I feel employees ideas/opinions are listened to by management.
17. Health and safety is considered equally with productivity and quality goals in management think-
ing.
18. Management encourages employees to promptly report physical symptoms arising from job tasks.
19. If I were recovering from an injury, management would make changes to my job or to my working
hours to help me return to work.
20. Have you had any pain or discomfort (aching, tingling) during the last year?
■ No (if No, skip to pages 7 & 8) ■ Yes
Section C
Please complete the column for each area that bothers you in your neck and upper limbs
Neck Shoulder Elbow/Forearm Hand/Wrist
Which side
bothers you? ■ L ■ R ■ Both ■ L ■ R ■ Both ■ L ■ R ■ Both ■ L ■ R ■ Both
What year did you
first notice the ____________ ____________ ____________ ____________
problem?
How long was ■ Less than 1 hr ■ Less than 1 hr ■ Less than 1 hr ■ Less than 1 hr
each episode? ■ 1 hr to 1 day ■ 1 hr to 1 day ■ 1 hr to 1 day ■ 1 hr to 1 day
■ more than ■ more than ■ more than ■ more than
1 day to 1 week 1 day to 1 week 1 day to 1 week 1 day to 1 week
■ more than 1 ■ more than 1 ■ more than 1 ■ more than 1
week to 1 month week to 1 month week to 1 month week to 1 month
month to 5 mo. month to 5 mo. month to 5 mo. month to 5 mo.
■ more than 6 mo ■ more than 6 mo ■ more than 6 mo ■ more than 6 mo
How many separate ■ Constant ■ Constant ■ Constant ■ Constant
times have you had ■ Daily ■ Daily ■ Daily ■ Daily
the problem in the ■ Once a week ■ Once a week ■ Once a week ■ Once a week
last year? ■ Once a month ■ Once a month ■ Once a month ■ Once a month
■ Every 2-3 mo ■ Every 2-3 mo ■ Every 2-3 mo ■ Every 2-3 mo
What do you think ____________ ____________ ____________ ____________
caused the problem? ____________ ____________ ____________ ____________
Which job or task ____________ ____________ ____________ ____________
most aggravates ____________ ____________ ____________ ____________
the problem?
Continued Neck Shoulder Elbow/Forearm Hand/Wrist
Have you had any ■ Yes ■ No ■ Yes ■ No ■ Yes ■ No ■ Yes ■ No
pain or discomfort
at any time in the
past 7 days?
According to a scale 1 = No discomfort 1 = No discomfort 1 = No discomfort 1 = No discomfort
from 1-5, how would 2 = Mild 2 = Mild 2 = Mild 2 = Mild
you rate your 3 = Moderate 3 = Moderate 3 = Moderate 3 = Moderate
problem over the 4 = Severe 4 = Severe 4 = Severe 4 = Severe
last 7 days? 5 = Unbearable 5 = Unbearable 5 = Unbearable 5 = Unbearable
(circle number)
from 1-5, in the 2 = Mild 2 = Mild 2 = Mild 2 = Mild
past year, how bad 3 = Moderate 3 = Moderate 3 = Moderate 3 = Moderate
was your worst pain 4 = Severe 4 = Severe 4 = Severe 4 = Severe
or discomfort? 5 = Unbearable 5 = Unbearable 5 = Unbearable 5 = Unbearable
(circle number)
from 1-5, in the past 2 = Mild 2 = Mild 2 = Mild 2 = Mild
year, on average, 3 = Moderate 3 = Moderate 3 = Moderate 3 = Moderate
how intense was 4 = Severe 4 = Severe 4 = Severe 4 = Severe
your pain or 5 = Unbearable 5 = Unbearable 5 = Unbearable 5 = Unbearable
discomfort?
(circle number)
Is the problem ■ Yes ■ No ■ Yes ■ No ■ Yes ■ No ■ Yes ■ No
interfering with your
ability to do your job?
How many days of __________ days __________ days __________ days __________ days
work did you lose in
the last year due to
this problem?
(write in number)
light or modified
duties did you have
in the last year due
to this problem?
(write in number)
In the past year, 1 = Never 1 = Never 1 = Never 1 = Never
how much has your 2 = Sometimes 2 = Sometimes 2 = Sometimes 2 = Sometimes
pain/discomfort 3 = Half the time 3 = Half the time 3 = Half the time 3 = Half the time
interfered with your 4 = Most of time 4 = Most of time 4 = Most of time 4 = Most of time
daily activities? 5 = Always 5 = Always 5 = Always 5 = Always
(circle number)
recreational, social 5 = Always 5 = Always 5 = Always 5 = Always
or family activities?
(circle number)
Did your problem ■ Yes ■ No ■ Yes ■ No ■ Yes ■ No ■ Yes ■ No
lead you to seek care
from a health care
professional (doctor,
therapist)?
Did you report your ■ Yes ■ No ■ Yes ■ No ■ Yes ■ No ■ Yes ■ No
pain or discomfort to
your workplace?
Prior to your current ■ Yes ■ No ■ Yes ■ No ■ Yes ■ No ■ Yes ■ No
problem, did you ever
have an accident or
sudden injury to this area?
What do you think _______________ _______________ _______________ _______________
would improve your _______________ _______________ _______________ _______________
symptoms? _______________ _______________ _______________ _______________
Please complete the column for each area that bothers you in your back and lower body
Upper Back Lower Back Thigh/knee/leg Ankle/Foot
Which side
What year did you
first notice the ____________ ____________ ____________ ____________
problem?
What do you think ____________ ____________ ____________ ____________
Which job or task ____________ ____________ ____________ ____________
most aggravates ____________ ____________ ____________ ____________
the problem?
pain or discomfort
at any time in the
past 7 days?
Continued Upper Back Lower Back Thigh/knee/leg Ankle/Foot
(circle number)
(circle number)
discomfort?
(circle number)
this problem?
(write in number)
light or modified
duties did you have
to this problem?
(write in number)
(circle number)
(circle number)
from a health care
therapist)?
your workplace?
have an accident or
What do you think _______________ _______________ _______________ _______________
symptoms? _______________ _______________ _______________ _______________
Section D
In this section, we want to ask you about how supportive you find your workplace. Please check the box
that best describes how strongly you agree with the statements.
1. I have constant time pressure due ■ AGREE ■ I am very distressed

to a heavy workload (check box) ■ DISAGREE ■ I am distressed
■ I am somewhat distressed
■ I am not at all distressed
2. I have many interruptions and ■ AGREE ■ I am very distressed
disturbances in my job. (check box) ■ DISAGREE ■ I am distressed
3. I have a lot of responsibility ■ AGREE ■ I am very distressed
in my job. (check box) ■ DISAGREE ■ I am distressed
4. I am often pressured to work overtime. ■ AGREE ■ I am very distressed
(check box) ■ DISAGREE ■ I am distressed
5. My job is physically demanding. (check box) ■ AGREE ■ I am very distressed
■ DISAGREE ■ I am distressed
6. Over the past few years, my job has ■ AGREE ■ I am very distressed
become more and more demanding. ■ DISAGREE ■ I am distressed
(check box) ■ I am somewhat distressed
7. I receive the respect I deserve from ■ AGREE ■ I am very distressed
my superiors. (check box) ■ DISAGREE ■ I am distressed
my colleagues. (check box) ■ DISAGREE ■ I am distressed
9. I experience adequate support in ■ AGREE ■ I am very distressed

difficult situations. (check box) ■ DISAGREE ■ I am distressed
10. I am treated unfairly at work. (check box) ■ AGREE ■ I am very distressed

11. I have experienced or I expect to ■ AGREE ■ I am very distressed

experience an undesirable change ■ DISAGREE ■ I am distressed
in my work situation. (check box) ■ I am somewhat distressed
12. My job promotion prospects are poor. ■ AGREE ■ I am very distressed

13. My job security is poor. (check box) ■ AGREE ■ I am very distressed

14. My current occupational position ■ AGREE ■ I am very distressed

adequately reflects my education ■ DISAGREE ■ I am distressed
and training. (check box) ■ I am somewhat distressed
15. Considering all my efforts and ■ AGREE ■ I am very distressed

achievements, I receive the respect ■ DISAGREE ■ I am distressed
and prestige I deserve at work. ■ I am somewhat distressed
(check box) ■ I am not at all distressed

achievements, my work prospects ■ DISAGREE ■ I am distressed
are adequate. (check box). ■ I am somewhat distressed

achievements, my salary/income ■ DISAGREE ■ I am distressed
is adequate. (check box) ■ I am somewhat distressed
And Finally,
• Which task that you perform do you think is most in need of changing? ________________________
• Why? ________________________________________________________________________________________
• What would you suggest could be done?
_____________________________________________________________________________________________
_____________________________________________________________________________________________
• Which task do you find most physically demanding? __________________________________________
• Why? ________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
• Which task do you find most mentally demanding? ___________________________________________
• Why? ________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
• Other Comments?
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
Thank-you for your cooperation and participation
Appendix B
Agenda for Training Programs for Health and Safety Committees
An Ergonomics Program for the

Newspaper and Commercial Printing Industry
Training Program Agenda
Agenda Item Time
Introduction of Instructor and Participants 9:00-9:30

Overview of Agenda and Objectives
Definitions of common musculoskeletal injuries (MSIs) 9:30-10:30

Risk factors for MSIs (physical and psychosocial)
Break 10:30-10:45
WCB Ergonomics Requirements using Training Program 1 10:45-11:30
Identifying risk factors using examples from the 11:30-12:00

newspaper and commercial printing industries
Lunch 12:00-1:00
Introduction and orientation to “An Ergonomics Program 1:00-2:15

for the Newspaper and Commercial Printing Industry”
program binder and how to use it
Discussion about “identified problem” and
“possible solutions” (section 2 of binder)
Overview of Training Program 2:
“Minimizing MSIs to Office Workers”
Break 2:15-2:30
Overview of Training Program 3: 2:30-3:15

“Minimizing Risk of Upper Limb MSIs”
Overview of Training Program 4:
“Minimizing Risk of Overexertion Injuries to the Back”
Discussion about Process for Implementation 3:15-4:00

at individual workplaces
Timelines and What to Expect
Appendix C
Post Questionnaire
A Study of Musculoskeletal Disorders in Newspaper and Commercial Printing
Questionnaire
Section A
We would like to begin by asking a few questions about yourself and your job.
• Job ___________________________________________ Department _________________________
• Age _____________ Sex ________
• Time on THIS job: ■ Less than 3 months
■ 3 mo. To 1 year
■ Greater than 1 year to 5 years
■ Greater than 5 years to 10 years
■ Greater than 10 years
• On an average day at work, approximately how much time do you spend on each of the following
activities? (write in time spent, indicate NA if not applicable)
1. On the telephone (for any reason)? _________hours
2. Sitting at a desk? _________hours
3. In a vehicle (not including to and from work) _________hours
4. Standing (in one spot) _________hours
5. Keyboarding? _________hours
6. Using a mouse? _________hours
7. Lifting and handling items _________hours
• At work, how long do you usually sit for a continuous period of time? (circle number)
1. Less than 1/2 hour
2. 1/2 hour to 1 hour
3. Between 1 hour and 2 hours
4. More than 2 hours
• How often do you skip or miss work breaks (excluding lunch)? (circle number)
1. Almost always (3 or more times per week)
2. Frequently (once a week)
3. Sometimes (once a month)
4. Rarely (once every 2-3 months)
5. Almost never (once every 6 months)
• In a typical day, how many times does your job take you (excluding lunch and breaks) away from
your workstation for 1/2 minute to 10 minutes (please specify a number) ____________________
• Do you work with any of the following? (circle all numbers that apply)
1. Deadlines
2. Sales or service quotas
3. Other pressures (please specify) _______________________
4. No (if no, skip next question)
• If you work with deadlines/quotas, what were they (circle all numbers that apply)
1. Daily
2. Weekly
3. Short-term projects (more than 1 week but less than 1 month)
4. Long-term projects (1 month or more)
5. Seasonal
Section B
In this section we want to ask you about your job. For each statement, please check the box with the one
answer that best describes your situation.
1. My job requires that I learn new things.

2. My job requires a high level of skill
3. My job allows me freedom to decide how I do my work.
4. My job requires that I do things over and over.
5. My job is very hectic.
6. I am free from conflicting demands that others make.
7. My job security is good.
8. My job requires a lot of physical effort.
9. I have a lot of say about what happens on my job.
10. I am exposed to hostility or conflict from the people with whom I work.
11. My supervisor is helpful in getting the job done.
12. The people with whom I work are helpful in getting the job done.
13. How satisfied are you with your job?
■ Very Satisfied ■ Somewhat satisfied ■ Not too satisfied ■ Not at all Satisfied
14. Do you need permission or do you have to find someone to take your place if you leave your work-
place for five or ten minutes? (check box)
■ Never ■ Sometimes ■ Always
15. How frequently do workers take part in decision making in the workplace?
16. I feel employees ideas/opinions are listened to by management.
17. Health and safety is considered equally with productivity and quality goals in management think-
ing.
18. Management encourages employees to promptly report physical symptoms arising from job tasks.
19. If I were recovering from an injury, management would make changes to my job or to my working
hours to help me return to work.
20. Have you had any pain or discomfort (aching, tingling) during the last year?
■ No (if No, skip to pages 7 & 8) ■ Yes
Section C
Please complete the column for each area that bothers you in your neck and upper limbs
Neck Shoulder Elbow/Forearm Hand/Wrist
Which side
What year did you
first notice the ____________ ____________ ____________ ____________
problem?
What do you think ____________ ____________ ____________ ____________
Which job or task ____________ ____________ ____________ ____________

most aggravates ____________ ____________ ____________ ____________
the problem?
Continued Neck Shoulder Elbow/Forearm Hand/Wrist

pain or discomfort
at any time in the
past 7 days?
(circle number)
(circle number)
discomfort?
(circle number)
this problem?
(write in number)
light or modified
duties did you have
to this problem?
(write in number)
(circle number)
(circle number)
from a health care
therapist)?
your workplace?
have an accident or
What do you think _______________ _______________ _______________ _______________
symptoms? _______________ _______________ _______________ _______________
Please complete the column for each area that bothers you in your back and lower body
Upper Back Lower Back Thigh/knee/leg Ankle/Foot
Which side
What year did you
first notice the ____________ ____________ ____________ ____________
problem?
day to 1 week day to 1 week day to 1 week day to 1 week
What do you think ____________ ____________ ____________ ____________
Which job or task ____________ ____________ ____________ ____________

most aggravates ____________ ____________ ____________ ____________
the problem?
pain or discomfort
at any time in the
past 7 days?
(circle number)
(circle number)
discomfort?
(circle number)
this problem?
(write in number)
light or modified
duties did you have
to this problem?
(write in number)
(circle number)
(circle number)
from a health care
therapist)?
your workplace?
have an accident or
What do you think _______________ _______________ _______________ _______________
symptoms? _______________ _______________ _______________ _______________
Section D
In this section, we want to ask you about how supportive you find your workplace. Please check the box
that best describes how strongly you agree with the statements.
1. I have constant time pressure due ■ AGREE ■ I am very distressed

to a heavy workload (check box) ■ DISAGREE ■ I am distressed
2. I have many interruptions and ■ AGREE ■ I am very distressed
disturbances in my job. (check box) ■ DISAGREE ■ I am distressed
3. I have a lot of responsibility ■ AGREE ■ I am very distressed
in my job. (check box) ■ DISAGREE ■ I am distressed
4. I am often pressured to work overtime. ■ AGREE ■ I am very distressed
5. My job is physically demanding. (check box) ■ AGREE ■ I am very distressed
6. Over the past few years, my job has ■ AGREE ■ I am very distressed
become more and more demanding. ■ DISAGREE ■ I am distressed
(check box) ■ I am somewhat distressed
my superiors. (check box) ■ DISAGREE ■ I am distressed
my colleagues. (check box) ■ DISAGREE ■ I am distressed
9. I experience adequate support in ■ AGREE ■ I am very distressed

difficult situations. (check box) ■ DISAGREE ■ I am distressed
10. I am treated unfairly at work. (check box) ■ AGREE ■ I am very distressed

11. I have experienced or I expect to ■ AGREE ■ I am very distressed

experience an undesirable change ■ DISAGREE ■ I am distressed
in my work situation. (check box) ■ I am somewhat distressed
12. My job promotion prospects are poor. ■ AGREE ■ I am very distressed

13. My job security is poor. (check box) ■ AGREE ■ I am very distressed

14. My current occupational position ■ AGREE ■ I am very distressed

adequately reflects my education ■ DISAGREE ■ I am distressed
and training. (check box) ■ I am somewhat distressed

achievements, I receive the respect ■ DISAGREE ■ I am distressed
and prestige I deserve at work. ■ I am somewhat distressed
(check box) ■ I am not at all distressed

achievements, my work prospects ■ DISAGREE ■ I am distressed
are adequate. (check box). ■ I am somewhat distressed

achievements, my salary/income ■ DISAGREE ■ I am distressed
is adequate. (check box) ■ I am somewhat distressed
And Finally,
In the past six months, you may have received some ergonomic education or modifications to
your workstation and work tasks. We are interested in how you feel about these.
Has the way you do your work changed in the past six months? (please circle)
1. Not at all 2. Somewhat 3. Yes, very much so
Briefly describe the changes that have occurred in your job? ___________________________
_______________________________________________________________________________________
Please circle the appropriate number:

• I’m aware of the ergonomic changes: not at all completely
1 2 3 4 5 NA
• I took part in ergonomic education: not at all completely
1 2 3 4 5 NA
• I was involved in the changes: not at all completely
1 2 3 4 5 NA
• As much as possible was done: not at all completely
1 2 3 4 5 NA
• The changes make my job better: disagree agree
1 2 3 4 5 NA
• My job requires less physical effort: disagree agree
1 2 3 4 5 NA
• My job is now more interesting: disagree agree
1 2 3 4 5 NA
• My job now makes me less tired: disagree agree
1 2 3 4 5 NA
• My job now makes me less sore: disagree agree
1 2 3 4 5 NA
The most important positive change for me was: ____________________________________________
If there were any negative changes, please describe: ________________________________________
___________________________________________________________________________________________
The biggest effect it has on me is: __________________________________________________________
___________________________________________________________________________________________
Thank-you for your cooperation and participation
Appendix D
List of Newspaper and Commercial Print Operations Receiving Ergonomics Binder
Company Name City Type

Broadway Printers Vancouver Printer
Burnaby News Burnaby Newspaper
Burnaby NOW Burnaby Newspaper
Campbell River Courier Islander Campbell River Newspaper
Castlegar Citizen Castlegar Newspaper
Chilliwack Progress Chilliwack Newspaper
College Printers Vancouver Printer
Coquitlam NOW Coquitlam Newspaper
Cowichan News Leader Duncan Newspaper
Cranbrook Daily Townsman Cranbrook Newspaper
Glenwood Label & Print New Westminster Labels/Box
Hacker Press (Abbotsford News) Abbotsford Newspaper
Hope Standard Hope Newspaper
Kamloops Daily News Kamloops Newspaper
Kamloops This Week Kamloops Newspaper
Kelowna Daily Courier Kelowna Newspaper
Korea Times Burnaby Newspaper
Langley Times Langley Newspaper
Maple Ridge News Maple Ridge Newspaper
Mission City Record Mission Newspaper
Mitchell Press Vancouver Printer
Nanaimo Daily News Nanaimo Newspaper
Nelson Daily News Nelson Newspaper
Pacific Newspaper Group Vancouver Newspaper
Peace Arch News White Rock Newspaper
Penticton Daily Herald Penticton Newspaper
Prince Rupert Daily News Prince Rupert Newspaper
Queen’s Printers Victoria Printer
The Royal City Record New Westminster Newspaper
Richmond Review Richmond Newspaper
Salmon Arm Observer Salmon Arm Newspaper
Surrey News-Leader Surrey Newspaper
Surrey NOW Surrey Newspaper
Times Colonist Victoria Newspaper
Trail Daily Times Trail Newspaper
Tri-City News Port Coquitlam Newspaper
West Ender Vancouver Newspaper
Xtra! West Publications Vancouver Newspaper
Appendix E
Paper Published in Proceedings of

Association of Canadian Ergonomics
(ACE/SELF)
Annual Conference, Montreal, October, 2001
MUSCULOSKELETAL DISORDERS AND PSYCHOSOCIAL FACTORS AMONG NEWSPAPER AND
COMMERCIAL PRINT WORKERS
VILLAGE JUDY
Judy Village & Associates/UBC School of Occupational and Environmental Health
2220 Badger Road, North Vancouver, BC V7G 1T1 village@interchange.ubc.ca
COLE DONALD C.
Institute for Work and Health/UofT Department of Public Health Sciences, Toronto, Ontario
Results of a survey of physical and psychosocial factors associated with musculoskeletal disorders are compared
between three work types in six newspaper and printing operations in B.C. (n=190) and office workers are compared
to data from a major Ontario newspaper. In B.C., pain recurring >3 times/year or lasting >5 days was reported for
56%. Among office workers, upper limb symptoms were similar between B.C. (57%) and Ontario (54.6%). In B.C.
higher levels of symptoms among office workers than other work types appears associated with static and repetitive
work combined with high pressures from deadlines and psychological demands. Bindery workers had the lowest
prevalence of pain (34%) despite highest physical demands. They had less skill discretion, decision authority, and
empowerment, but the greatest job security and least psychological demands and deadlines/pressures. Compared
with Ontario, B.C. office workers had less skill discretion, decision authority and social support, perhaps reflecting
a more fractious labour climate.
Key words: work-related musculoskeletal disorders, psychosocial factors, newspaper/printing
TROUBLES MUSCULO-SQUELETTIQUES ET FACTEURS PSYCHOSOCIAUX PARMI LES

OUVRIERS DE JOURNALS ET D’EMPREINTE DE PRESSE COMMERCIAUX
Les résultats d’une enquête sur les facteurs physique et psychosociaux associés aux troubles musculo-squelettiques
sont ici comparés pour 3 types d’emploi dans 6 journals et imprimeries dans la C.-B. (N=190) et les employés d’un
journal majeur en Ontario. Dans la C.-B., une douleur qui reparaît > 3 fois/année ou qui dure > 5 jours a été rapporté
par 56%. Parmi les employés de bureaux, les symptômes de membre supérieurs étaient similaires entre la C.-B.
(57%) et Ontario (54.6%). Dans la C.-B. les niveaux élevés de symptômes parmis les employés de bureaux comparés
aux autres types d’emploi apparaît associé au travail statique et répétitif ainsi qu’avec la tension associée avec les
dates limite et demandes psychologiques. Les ouvriers dans les ateliers de reliure ont eu la prévalence la plus basse
de douleur (34%) malgré les plus hautes demandes physiques. Ils ont moins de discrétion d’habileté, d’autorité, et de
prise en charge, cependant ils ont une plus grande sécurité d’emploi et moins de demandes concernant les dates lim-
ite et tensions psychologiques. Comparé aux employés en Ontario, dans la C.-B. les employés de bureaux ont moins
de discrétion d’habileté, d’autorité de décision et de soutien social, peut-être reflètant un climat rechigné.
Les mots principaux: troubles musculo-squelettiques, facteurs de psychosociaux,

journals/imprimeries
INTRODUCTION
In 1998 a 2-year study was funded by the Workers’ Compensation Board of British Columbia (B.C.) to determine
ergonomic and psychosocial risk factors for musculoskeletal disorders (MSD) in the newspaper and commercial print-
ing industry, to develop ergonomics programs, and to evaluate these post-implementation. The Communications,
Energy and Paperworkers Union (CEP Local 2000) represents 2,200 workers in B.C. in 35 operations in three work
types: offices who predominately use computers (reporters, editors, compositors); bindery who assemble, cut and
package; and press workers who feed paper, inks and run presses.
The objective of this paper is to present results of a questionnaire survey of physical and psychosocial risk factors
associated with MSD symptoms and compare these results with those from a similar survey conducted at a major
metropolitan Ontario newspaper.
LITERATURE REVIEW
Several studies have been conducted on MSDs in the newspaper sector (1,2,3,4). A 1996 survey of over 1000 office
employees in Ontario found that 20% reported moderate or worse upper limb pain recurring at least monthly or last-
ing greater than one week over the previous year (1). Most commonly affected was the neck, followed by shoulder,
wrist/hand and elbow, consistently across case definitions constructed with different frequency, duration and severity
of pain/discomfort (2). Bernard and colleagues (3) have argued that while computers in the newspaper industry have
increased ease of information retrieval and processing, they have also likely increased WMSDs among workers. Only
one study compared work types finding a higher prevalence of symptoms in production workers vs. office workers (4).
Variables independently associated with WMSD of the upper limb in the Ontario study included female gender, work-
ing with frequent deadlines, high psychological demands, low skill discretion, low social support, more time spent key-
boarding and having the computer screen in a non-optimal position (1). Conceptually, researchers are arguing for
examination of both biomechanical and psychosocial factors associated with MSD in the workplace (5).
METHODS
Six newspaper and printing operations agreed to participate in B.C., including: three small local newspapers (offices
only); selected departments of a metropolitan newspaper (offices only); and a large area newspaper and commercial
printing operation (both with office, bindery and press workers).
The B.C. questionnaire built on the one used in Ontario (1). Questions were asked about: time spent each day on the
telephone, in a vehicle, standing, and lifting; sitting continuously, missing work breaks and deadlines/quotas. Job sat-
isfaction and psychosocial variables were based on Karasek (6), Siegrist and Peters (7) and questions about empow-
erment and work culture from Ontario (1). Questions on symptoms during the past year and week were from a vari-
ety of sources (2, 8,9). Questionnaires were pilot tested by labour and employer representatives and administered by
CEP representatives during work.
Job Content Questionnaire scales were computed and effort-reward imbalance calculated (7,8). Pain cases were
defined using Hunting (2), as those experiencing pain > 3 times in the previous year or having pain lasting > 5 days.
BC and Ontario prevalences were compared. Prevalence of exposures and pain outcomes were compared across
BC work types, testing differences with either chi square or one-way ANOVA. Completeness of data and results of the
bi-variate analysis guided choice of variables for inclusion in logistical regression models to determine the predictors
of caseness. A backward stepwise technique was used to eliminate redundant variables, retaining those at p<0.1.
RESULTS AND DISCUSSION

Of 311 B.C. employees, 190 completed the questionnaire (61% response versus 84%, Ontario). Results of demo-
graphic data showed significant gender differences between work types -7.7% of B.C. press workers being women
compared to 52.6% in bindery and 66.7% in the office (p<0.001) (Ontario, 44.4% women). There were also significant
differences in experience with 61% of press workers having more than 10 years compared with 39.5% of bindery and
33.3% of B.C. office workers (p=0.0002), (Ontario,34.6%). Age was not statistically different between B.C work types
or regions (B.C., 42.5 years; Ontario, 43.5).
Table 1 presents descriptive results of exposures by work type and region. Note that ‘n’s’ vary only slightly across vari-
ables, except JCQ and ERI scales (refused at one company ‘n’=98). Bindery workers reported significantly more
hours standing and lifting/handling and the most physical exertion. They also needed permission to leave the work-
place more often than other work types. Bindery workers had lower skill discretion, decision authority, empowerment
but the greatest job security and least psychological demands. They have fewer deadlines and pressures and rarely
missed taking breaks. On open-ended questions, bindery workers had concerns over fatigue due to long hours and
multiple shifts. Press workers had significantly more skill discretion and empowerment than bindery workers. Their
main concern was equipment breakdowns and changes causing psychological stress.
Office workers in B.C. spent significantly more hours on the telephone, sitting at a desk, in a vehicle, keyboarding,
and using a mouse than bindery or press. They reported more deadlines and psychological demands and the least
job security but significantly less physical exertion and more decision authority, empowerment and flexibility in leav-
ing their workstation. Comparing B.C. and Ontario office workers, B.C. workers spent less time in a vehicle and slight-
ly more time keyboarding. They had substantially lower skill discretion, decision authority and social support, perhaps
reflecting a more fractious labour climate in B.C. newspapers. In open-ended questions, B.C. office workers shared
frustrations about staying creative under time pressures, stress due to hardware and software problems, the need for
better communication between departments and more management support.
Fifty-six percent of B.C. respondents were Hunting cases, most commonly hand/wrist (38%), neck (32%), shoulder
(30%) and low back (27%) (Table 2). Of these, 78% sought medical treatment, and 51% reported the pain at the work-
place. Significant differences in pain occurred across B.C. work types for most body areas. Bindery workers had the
lowest prevalences, despite higher physical demands. Perhaps the lower psychological demands and fewer pres-
sures and deadlines were protective. However, they were significantly more likely to report their symptoms at work,
perhaps reflecting difficulties in returning to work.
Prevalence of neck and upper limb case-ness was similar among Ontario (54.6%) and B.C. (57.1% overall) office
workers.The generally higher levels of pain in the office appear to be associated with a combination of static and rep-
etitious work activities (keying and mouse work) combined with high pressures from deadlines, psychological
demands and computer/telephone technology problems (based on above exposure and open-ended comments).
When compared with bindery and press workers, office workers felt they were not encouraged to report symptoms.
Interestingly, both prevalence of reporting symptoms to the workplace and seeking health care were higher among all
work types in B.C. compared to Ontario office workers, perhaps reflecting differences in either the timing of the sur-
vey (1999 versus 1996) with the secular change in recognition of MSD, more openness to seeking care among BC
workers or a different labour-management climate in Ontario .
Table 1. Exposures by work types in British Columbia (*p<0.05 for differences) and for Ontario office work
Exposure Variables British Columbia Ontario
Continuous - Mean (standard deviation) Press Bindery Office Office
Hours on telephone per day 0.1 (0.26) 0.0 (0.1) 3.0 (2.6)* 2.6 (2.0)
Hours sitting at a desk per day 1.3 (2.5) 0.05 ().3) 5.7 (2.3)* 5.3 (1.8)
Hours in a vehicle per day 0.1 (0.37) 0.25 (1.1) 0.6 (1.1)* 2.3 (1.4)
Hours standing in one spot per day 3.3 (3.2) 6.8 (2.9) 0.5 (0.99)* n/a
Hours keyboarding per day 0.5 (1.1) 0.2 (1.2) 4.2 (2.9)* 3.4 (2.1)
Hours using a mouse per day 1.1 (2.2) 0.0 (0.15) 1.98 (2.7)* 2.2 (2.0)
Hours lifting/handling items per day 3.65 (3.6) 7.4 (2.4) 0.7 (1.6)* n/a
Times away from a workstation per day 9.0 (17.7) 3.9 (3.3) 13.7 (11.7)* 10.6 (9.4)
Skill discretion 4.3 (1.6) 6.9 (2.5) 5.0 (1.99)* 10.35 (2.16)
Decision authority 3.3 (1.6) 4.7 (1.97) 3.1 (1.8)* 6.79 (1.88)
Psychological demands 5.1 (1.3) 3.8 (1.6) 5.8 (1.4)* 7.27 (1.58)
Job insecurity 1.3 (0.7) 1.0 (0.7) 1.9 (1.15)* 2.82 (1.02)
Physical exertion 2.1 (1.2) 3.3 (0.65) 1.6 (1.16)* 2.35 (0.95)
Social support 5.2 (1.7) 5.7 (2.2) 5.1 (2.1) 10.77 (2.11)
Empowerment 5.2 (3.1) 2.1 (2.5) 5.5 (2.9)* n/a
Management support 6.3 (2.3) 5.9 (2.6) 6.2 (2.5) n/a

Categorical – Percent Press Bindery Office Office
Sitting more than 2 hours 7.5 0 29.5* 24.4
Frequency of skipped breaks (>1/week) 79.6 13.6 60.6* 62.3
Work with deadlines/quotas/pressures 90.2 68.2 97.1* 92.2
Job satisfaction: not too/not at all 17.1 15.9 15.8 11.2
Need permission to leave workplace: sometimes/always 59.0 81.8 37.7* 25.2
Workers take part in decision making: rarely/never 34.6 58.4 31.2 32.1
Ideas listened to by management: disagree/strongly 38.4 50.0 37.7 20.2
Health/safety equal to productivity: rarely/ never 38.4 50.0 40.0 19.6
Encouraged to report symptoms: disagree/strongly 24.8 21.4 32.3* 12.4
Management change job to help RTW: disagree/strongly 9.8 11.9 6.8* 7.7
Effort/Reward (binary): imbalanced 0 18.2 11.3 n/a
Regression modelling revealed independent associations with case-ness for work type (press & office > bindery),
more years on current job, more time sitting continuously, and working with quotas. The model was able to correctly
classify 69% of the variance, which is an improvement over the baseline of 56%.
CONCLUSION
Newspaper and print workers have unique pressures, deadlines and psychological demands. Among B.C. newspa-
per workers, time related variables and psychosocial work demands appeared to be more important than heavy phys-
ical demands, as best exemplified by the contrasts between bindery and other workers. The bindery is not charac-
teristically under the same magnitude of production pressure from deadlines and equipment breakdowns as the press
or office. Yet measures of physical demand variables by questionnaire are traditionally less accurate than direct mea-
sures, not possible in this study. Further, time variables often reflect duration or intensity of both physical and psy-
chosocial exposures. CEP believes that some reasons for pain among office workers include increased computer
technology, reorganization and fewer workers, and the popularity of morning newspapers increasing pressures and
deadlines due to a reduced window for work to be done. Relevant work design responses include minimizing monot-
onous tasks, high job demands, work pressure and fear of job loss while increasing reliability of technology, use of
employee skills, job control and improving supervisory relationships (10)
Table 2. Prevalence of pain caseness (>3 times/year or >than 5 days) and associated variables by BC work
types (p<0.05 for differences) and region for office workers

Outcome Variables Press Bindery Office Office
Pain any body part 65.9 34.1 61.0* n/a
Pain upper limbs 51.2 31.8 57.1* 54.6
Pain upper/lower back 36.6 13.6 31.4* n/a
Neck 29.3 6.8 43.8* 37.7
Shoulder 29.3 15.9 36.2* 32.5
Elbow 12.2 11.4 23.8 22.3
Hand/wrist 36.6 27.3 42.9 37.8
Upper back 7.3 4.5 21.9* n/a
Lower back 34.1 22.7 26.7 n/a
Thigh/leg 26.8 9.1 9.5* n/a
Ankle/foot 12.2 13.6 10.5 n/a
Seeking health care 74.1 93.8 75.4 45.9
Reporting in workplace 51.9 87.5 48.5* 34.9
ACKNOWLEDGEMENTS
The Workers’ Compensation Board of B.C., CEP (Local 2000), Dr. J. Berkowitz, The Toronto Star/Southern Ontario
Newspaper Guild RSI Committee and participants in Phase 1. The IWH and associates Worksite Upper Extremity
Research Group.
REFERENCES
(1)Polanyi, M.F., Cole, D.C., Beaton, D.E., Chung, J., Wells, R., Abdolell, M., Beech-Hawley, L., Ferrier, S.E., Mondloch, M.V., Shields, S.A., Smith,
J.M., Shannon, H.S. (1997). Upper limb work-related musculoskeletal disorders among newspaper employees: cross-sectional survey results.
American Journal of Industrial Medicine, vol. 32, pp. 620-628
(2)Beaton, D.E., Cole, D.C., Manno, M., Bombardier, C., Hogg-Johnson, S., Shannon, H.S. (2000). Describing the burden of upper-extremity mus-
culoskeletal disorders in newspaper workers: what difference do case definitions make? Journal of Occupational Rehabilitation, vol. 10, no. 1, pp.
39-53.
(3) Bernard, B.S., Fine, S., Petersen, M., Hales, T. (1994) Job task and psychosocial risk factors for work-related musculoskeletal disorders among
newspaper employees. Scand. J. Work Environ. Health, vol. 20, pp. 417-426.
(4) Rosecrance, J.C., Cook, T.M., Zimmermann, C.L. (1994, May). Active surveillance for the control of cumulative trauma disorders: a working
model in the newspaper industry. J. Orthop Sports Phys. Ther., vol. 19, no. 5, pp. 267-276.
(5) Smith, M.J. and Carayon, P. (1996) Work organization, stress and CTDs, in Moon and S. Sauter (eds), Beyond Biomechanics: Psychosocial
Aspects of Cumulative Trauma Disorders (Taylor & Francis, London), pp. 23-42.
(6)Karasek, R., Brisson, C., Kawakami, N., Houtmann, I., Bongers, P., Amick, B. (1998). The job content questionnaire (JCQ): an instrument for
internationally comparative assessments of psychosocial job characteristics. J. of Occupational Health Psychology, vol. 3, no. 4, pp. 322-355.
(7) Siegrist, J., Peter, R. (1996, July) Measuring effort-reward imbalance at work: Guidelines. University of Dusseldorf.
(8) Hagberg, M. Silverstein, B., Wells, R., Smith, M.J., Hendrick, H.W., Carayon, P., Perusse, M., Kuorinka, I., Forcier, L. (eds) (1995). Work-relat-
ed musculoskeletal disorders: A reference book for prevention. (Taylor & Francis, London).
(9) Kuorinka, I., Jonsson, B., Kilbom, A., Vinterberg, H., Biering-Sorensen, F., Andersson, G., Jorgensen, K. (1987). Standardised Nordic ques-
tionnaires for the analysis of musculoskeletal symptoms. App. Ergo, vol 18, no. 3, pp. 233-237.
(10) Smith, M.J. and Sainfort, P.C. (1989). A balance theory of job design for stress reduction. Int. J. Industrial Ergonomics, vol. 4, pp. 67-79.

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FINDING SOLUTIONS

A STUDY OF MUSCULOSKELETAL DISORDERS IN

Ms. Judy Village, C.P.E., M.Sc.

Additional copies of this publication may be obtained by contacting:

Workers’ Compensation Board of British Columbia

Phone (604) 276-3068 / Fax (604) 279-7406

A STUDY OF MUSCULOSKELETAL DISORDERS IN NEWSPAPERS AND

Issue: Reducing musculoskeletal injuries in newspaper and commercial

Agency: Communications, Energy and Paperworkers Union of Canada,

Representative: Harold Funk

Context: Workers in all three sectors of newspaper and commercial printing

Setting: Four newspaper and commercial printing operations in British Columbia:

Workers with musculoskeletal pain reported significantly greater psychosocial demand,

Workers’ Compensation Board of British Columbia

Workers’ Compensation Board of British Columbia

Communications, Energy and Paperworkers Union of Canada (CEP) Local 2000

The Abbotsford News

Ms. Judy Village, Certified Professional Ergonomist

A Study of Musculoskeletal Disorders in Newspapers and Commercial Printing Final Report

Final Report Summary

1.0 INTRODUCTION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . page 5

3.0 RESULTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . page 13

4.0 CONCLUSIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .page 39

Appendix A: Pre Questionnaire . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .page 41

Appendix B: Agenda for Training Programs for Health and

Appendix C: Post Questionnaire . . . . . . . . . . . . . . . . . . . . . . . . . . . . .page 51

Appendix D: List of Newspaper and Commercial Print Operations . . . . .page 60

Appendix E: Paper Published in Proceedings of Association of

The project objectives were to be achieved by the following:

• implementing the comprehensive ergonomics program in a minimum of four loca-

1.3 Review of Selected Literature

2.1 Selection of Newspaper and Commercial Printing Operations for Study

1. Mitchell Press Ltd., Vancouver (bindery, office and press workers)

The project therefore involved the four operations, as follows:

2.2 Ergonomic Assessments

2.3 Questionnaire Development

Questionnaires were administered on site by the ergonomist at one of the NOW

2.5 Training Health and Safety Committee Members

2.6 Implementation of an Ergonomics Program at Each Organization

2.8 Completion of Ergonomics Program Manual and Training Programs and

3.1 Project Timeline

3.2 Ergonomic Assessments

3.3 Questionnaire Results

3.3.1 Descriptive Questionnaire Results Pre and Post Intervention

Company Number Responses # Workers Response Response

Gender Number Pre Post Percent Pre Post

Range of Years Number Pre Post Percent Pre Post

Hours at Various Job Activities

Activity Average hours/day Pre Average hours/day Post

Time Sitting for Continuous Period

Amount of Time Number Pre Post Percent Pre Post

Frequency Number Pre Post Percent Pre Post

Number of Times Per Day Getting Up from Workstation

Frequency Number Pre Post Percent Pre Post

Working with Deadlines, Quotas and other Pressures

Feature Number Pre Post Percent Pre Post

Frequency Number Pre Post Percent Pre Post

Psychosocial Questions (Karasek scale)

How Frequently do Workers take part in Decision Making?

Response Percent Pre Percent Post

Health and Safety is considered equally with Productivity/Quality by Management

Response Percent Pre Percent Post