Work, Health, And Worker Well-Being: Roles And Opportunities For Employers

Incorporating Lifestyle Medicine Into Occupational Medicine Practice: ACOEM Guidance Statement

ABSTRACT

Lifestyle medicine (LM) utilizes evidence-based therapeutic lifestyle changes to address lifestyle factors that impact health, performance, and injury risk and recovery. By integrating LM principles into clinical care, workplace policies, and programs, along with other evidence-based methods, occupational and environmental medicine clinicians and medical directors can enhance worker health and performance, manage chronic disease, and facilitate faster recovery from injury and illness. This guidance addresses approaches that can be used in the clinic and workplace to address tobacco, substance misuse, nutrition, physical activity, overweight/obesity, sleep, mental well-being, and social connectedness.

Effectiveness of workplace cancer screening interventions: a systematic review

INTRODUCTION

Cancer cases are rising globally, with a noticeable rise in younger adults. Screening and early detection are effective in decreasing mortality. Workplaces can play a role in promoting cancer screening uptake. This systematic review investigated the effectiveness of workplace breast, lung, colorectal, and cervical cancer screening interventions, and the factors impacting their effectiveness.

METHODOLOGY

Six databases (Embase, Medline, Web of Science, CINAHL, Cochrane Library, Scopus) were searched, and cancer screening promotion and cancer screening uptake was analysed using effect direction plots. Magnitude of effectiveness (i.e., change in knowledge or screening rate) was also evaluated.

RESULTS

In total, 13,426 articles were identified. After screening and applying the eligibility criteria, 21 articles were included in the analysis. A positive effect direction was seen for all workplace cancer screening promotion interventions. Magnitude of effectiveness for cancer screening promotion interventions resulted in a > 30% change in knowledge or screening uptake in 4/7 of breast cancer, in 3/4 of cervical cancer and 1/3 colorectal cancer screening promotion interventions. For workplace cancer screening uptake interventions, a positive effect direction was observed for the majority (18/22). Cancer screening uptake interventions showed a > 30% change in magnitude of screening rate in 4/7 breast cancer, 5/10 colorectal cancer and in 1/5 cervical cancer workplace interventions. No studies for lung cancer were eligible. Factors positively influencing effectiveness included an interest in health and previous healthcare use, while fear of cancer and embarrassment of screening negatively influenced effectiveness.

CONCLUSION

Workplace cancer screening promotion and uptake interventions can effectively improve cancer screening knowledge and increase uptake of screening tests.

The Power of Commitment: Creating an Award-Winning Culture of Health and Well-Being at DTE Energy

The evidence that a healthy and safe workforce provides a competitive business advantage is increasingly clear. However, how to obtain this may be unclear to many. This article presents a case study showcasing how one large employer worked toward improving its culture of health and well-being. Measuring progress using an established corporate health assessment tool, results improved 75% over a 5-year period. In addition, site scan culture checks showed annual improvement, exceeding best-in-class scores by the fifth year. Building a culture of health and well-being often requires a few years to implement fully and involves a commitment to plan, deploy, improve, and manage over time. Ultimately, by following approaches taken by best-in-class employers, this can be accomplished with some ease and without missteps along the way.

Real-world data of a digitally enabled, time-restricted eating weight management program in public sector workers living with overweight and obesity in the United Kingdom: A service evaluation of the Roczen program

Introduction

The health of the United Kingdom workforce is key; approximately 186 million days are lost to sickness each year. Obesity and type 2 diabetes (T2D) remain major global health challenges. The aim of this retrospective service evaluation was to assess the impact of a digitally enabled, time-restricted eating (TRE) intervention (Roczen Program, Reset Health Ltd) on weight and other health-related outcomes.

Methods

This service evaluation was conducted in people living with overweight/obesity, with 89% referred from public sector employers. Participants were placed on a TRE, low-carbohydrate, moderate protein plan delivered by clinicians and mentors with regular follow up, dietary guidance, goal setting, feedback, and social support.

Results

A total of 660 members enrolled and retention was 41% at 12 months. The majority were female (73.2%), 58.9% were of White ethnicity, with a mean (SD) age of 47.5 years (10.1), and a body mass index of 35.0 kg/m2 (5.7). Data were available for 82 members at 12-month. At 12-month, members mean actual and percentage weight loss was -9.0 kg (7.0; p < 0.001) and -9.2% (6.7, p < 0.001) respectively and waist circumference reduced by -10.3 cm (10.7 p < 0.001), with 45.1% of members achieving ≥10% weight loss. Glycated hemoglobin was significantly improved at 6 months in people living with T2D (-11 mmol/mol [5.7] p = 0.012). Binge eating score significantly reduced (-4.4 [7.0] p = 0.006), despite cognitive restraint increasing (0.37 [0.6] p = 0.006).

Conclusion

Our service evaluation showed that the Roczen program led to clinically meaningful improvements in body weight, health-related outcomes and eating behaviors that were sustained at 12-month.

Effective Vocational Rehabilitation Services for Transition-Aged Youth: Lessons From the Literature

Objective:The purpose of this study was to provide an overview of the current literature regarding the vocational rehabilitation services found effective in promoting employment among transition-age youth with disabilities as well as identifying factors affecting the effectiveness of those services.

Methods:This study utilized the Preferred Reporting Items for Systematic reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines to theoretically and methodologically ground the systematic review. Through a three-stage filtering process, 35 studies were identified that helped identify common and effective vocational rehabilitation services for transition-aged youth.

Findings:Three major themes were observed in the review of literature: validated vocational rehabilitation services, vocational rehabilitation counselor factors, and demographic variables.

Conclusions:Additional research is needed in the role of disability severity as a variable of successful service provision. Further identifying successful vocational services for varying levels of disability severity will provide vocational rehabilitation consumers with more individualized options and has the potential to increase positive case closure rates. Lastly, research indicated a need for continued training of VR counselors to ensure they are meeting the needs of their consumers.

Perceptions, feelings, and the routine of older adults during the isolation period caused by the COVID-19 pandemic: a qualitative study in four countries

OBJECTIVE

To evaluate the knowledge, routine, and perception of older adults from four countries about dealing with COVID-19 in the social isolation period.

METHODS

Qualitative study with semistructured interviews. Older persons (≥60 years old), who lived in the urban centers of four different countries (Brazil, United States, Italy, and Portugal), were asked about the changes experienced during the pandemic, new habits or restrictions during isolation, sources of social and emotional support, and their knowledge about COVID-19 pandemic. Data was transcribed, codified, and submitted to content analysis.

RESULTS

Twenty-five older persons (10 from Brazil, 5 from Italy, 5 from Portugal, and 5 from the United States) were interviewed. Participants reported feeling restricted in their daily life activities and emotional instability. Described adaptations in habits, coping strategies, and greater understanding of the diseased based on information available in the media. There was homogeneity in the statements of the elderly, showing that the pandemic affected them in a similar way, even though they lived in different cultures and contexts.

CONCLUSION

The social isolation caused by the COVID-19 pandemic changed the structure for the performance of many occupations, having an impact in the perception social participation and wellbeing of elders. This data can aid health professionals to outline strategies to deal with the impact of the social isolation in older persons.

Does the Number of Reasons for Seeking Care and Self-Rated Health Predict Sick Leave during the Following 12 Months? A Prospective, Longitudinal Study in Swedish Primary Health Care

BACKGROUND

Sick leave has major social and economic consequences for both individuals and society. Primary Health Care (PHC) meets people who seek care before they risk going on sick leave. This study examined the impact of self-perceived health on sick leave within 12 months for workers seeking care in PHC.

METHODS

The study had a prospective longitudinal design with 271 employed, non-sick-listed patients aged 18-64 years seeking care for physical and/or mental symptoms at PHC. In a logistic regression, an estimation of the odds ratio (OR) for belonging to the group workers with >14 days of sick-leave (W-SL) was made.

RESULTS

A high number of reasons when seeking care, with an OR of 1.33 (confidence interval 1.14 to 1.56), and lower self-rated health, with an OR of 1.45 (confidence interval 1.10 to 1.91), were determinants for sick leave at 12 months after adjusting for covariates and confounders. Mental symptoms constituted the main reason for seeking care, followed by musculoskeletal pain, and significant differences in proportions regarding most symptoms were shown between the groups with and without sick-leave >14 days.

CONCLUSION

Health care professionals in PHC need to be aware of the risk of future sick leave at comorbidity and low self-perceived health. Preventive rehabilitation interventions should be offered to improve health and prevent sick leave for this group.

The Effect of Health Promotion Educational Interventions on Self-care Behaviors of Nutrition and Physical Activity Among Universities Staff in Southeastern Iran

Background: A workplace has an important role in staff health. Besides, it is a suitable place for performing interventions to reduce the risk of suffering from health problems associated with physical inactivity and overweight, and to reduce risks of cardiovascular and non-communicable diseases. Objectives: This study aims to investigate the effects of health promotion educational interventions on self-care behaviors of nutrition and physical activity among the selected university staff in Zahedan during the COVID-19 pandemic. Methods: The present quasi-experimental research was conducted in 2020-2021 in Zahedan, southeastern Iran. The control and intervention groups included a random selectionof 110 and 144 non-academic staff members of Zahedan University of Medical Sciences (ZAUMS) as well as Sistan and Baluchestan University (SBU), respectively. At the beginning of the COVID-19 pandemic, an online researcher-made questionnaire (Porsline, https://survey.porsline.ir) (CVR: 92%; CVI: 90%; reliability: 85%) was uploaded, which had been already approved. Besides, educational booklets were provided to the intervention group via WhatsApp and Soroush messengers, through which the participants were allowed to ask their questions after every session. One month after the intervention, the online questionnaires were re-uploaded on Porsline and recompleted by the participants. The results were analyzed using SPSS V21.0. Results: The results indicated that the self-care behaviors of nutrition and physical activity increased significantly in terms of awareness, attitude, and performance among the intervention group participants after conducting the educational intervention (P-value < 0.05). Accordingly, the educational intervention resulted in an increase in the level of awareness, attitude, and performance of nutrition and physical activity among the university staff of the intervention group. Besides, the performance of physical activity was significantly affected not only by the intervention (P < 0.001) but also by work experience (P < 0.001). In addition, nutrition behavior was significantly better in female staff than male staff (P = 0.048), but there was no significant correlation between gender and the intervention (P = 0.266). Conclusions: The educational program executed in the present study was shown to be effective in promoting self-care behaviors of nutrition and physical activity among the university staff. Thus, health programmers and policymakers can have a significant role in promoting staff health by executing interventional educational programs. Accordingly, the efficiency of the whole system will improve by adopting these strategies and programs.

Pathways to Financial Success: An Empirical Examination of Perceived Financial Well-Being Based on Financial Coping Behaviors

The current study empirically tests a financial well-being (FWB) model built on financial socialization (FS) and early childhood consumer experience (ECCE). The current study was conducted based on primary data obtained through structured questionnaires. By using a convenient sampling technique, data were collected from 1,500 respondents from Pakistan. Results advocated that childhood experiences directly affect the FWB in adults. In addition, FS agents, such as parents, have direct and indirect effects on the FWB in adults. Findings revealed that financial coping behaviors mediate the relationship among FS agents, such as parents, students, and the FWB. Surprisingly, FS agent peers do not impact adult FWBs. The study concluded that FWB could be improved by socializing with parents and teachers and using childhood experiences. Considering the importance of the role of parents and teachers, they should discuss financial issues with children. Policymakers should work to provide some opportunities for children so that they can practice and gain experience.

Getting the Message Right: Evidence-Based Insights to Improve Organizational Return-to-Work Communication Practices

Purpose There is an absence of evidence-based guidance to support workplace stakeholders in the effective delivery of return-to-work (RTW) messages. Our study examines the specific RTW communication practices and their impact on the management of work disability. Methods Within two large and complex healthcare organizations, semi-structured interviews were conducted with workplace stakeholders (e.g., supervisors, union representatives, disability management professionals and workers' compensation representatives) and workers who had previously experienced sickness absence related to an occupational injury or illness. For workplace stakeholders interview questions asked about their roles and responsibilities in the RTW process, and specific communication strategies and messages that were used at different phases of the RTW process. For worker participants, interview questions explored RTW experiences and the impact of communication on work re-integration. An interpretative descriptive approach was used to inductively examine themes from interviews to create ways of understanding phenomena that yielded applied findings. Results Forty participants were interviewed including workplace stakeholders and workers. Participants frequently described effective RTW communication as messages that were delivered by a workplace stakeholder that included the content required by an injured worker to navigate the organizational disability management process and utilized specific strategies to address the perceived attitudes and perceptions held by an injured worker regarding work re-integration. Workplace stakeholders described five specific communication strategies including relaying messages of support, optimizing the timing of communication, careful word choice, framing messages, and tailoring communication to the injured worker.  Conclusion RTW communication is an active process that requires a strategic approach. Effective communication practices represent an important strategy for workplace stakeholders to address the barriers held by injured workers and foster early and sustained RTW.

Development of a Conceptual Framework for Occupational Safety and Health in Palestinian Manufacturing Industries

The annual increase in the number of occupational accidents and diseases in the Palestinian manufacturing industries confirms a serious problem that threatens the Occupational Safety and Health (OSH) in such industries, with negative consequences in the society and economy. As the Palestinian OSH data are insufficient, tightwad, and with discrepancies in published data by different agencies, this study aimed to investigate the OSH status in the Palestinian manufacturing industries and determine the Palestinian OSH trends rates based on international practice in the EU and USA. Also, to shed light on the OSH situation in the manufacturing sector and warrant the inspection and monitoring of industries by the respective officials. The OSH data of 175 industrial establishments and 199 industrial employees was collected by meetings, interviews, and structured questionnaires for the period 2009-2016. The US and EU OSHA (Occupational Safety and Health Administration) formulas were used to calculate the OSH rates. The analysis showed that 32.30% of the industrial employees suffered from occupational injuries. The average injury rate was 7566 per 100,000 workers, indicating a low OSH level in the Palestinian manufacturing industries. The leather industry was found as the most dangerous in terms of OSH, with an average safety performance factor (SPF) of 145.6 off days/accident. Pearson's chi-square test (χ2) revealed a correlation between occupational accidents and injuries and the employees' commitment and lost working days. An OSH framework was developed based on safety and sustainable development pillars to assure effective enforcement of the OSH law and prevent future occupational accidents and diseases.

Contributing factors to personal protective equipment shortages during the COVID-19 pandemic

This study investigates the forces that contributed to severe shortages in personal protective equipment in the US during the COVID-19 crisis. Problems from a dysfunctional costing model in hospital operating systems were magnified by a very large demand shock triggered by acute need in healthcare and panicked marketplace behavior that depleted domestic PPE inventories. The lack of effective action on the part of the federal government to maintain and distribute domestic inventories, as well as severe disruptions to the PPE global supply chain, amplified the problem. Analysis of trade data shows that the US is the world's largest importer of face masks, eye protection, and medical gloves, making it highly vulnerable to disruptions in exports of medical supplies. We conclude that market prices are not appropriate mechanisms for rationing inputs to health because health is a public good. Removing the profit motive for purchasing PPE in hospital costing models, strengthening government capacity to maintain and distribute stockpiles, developing and enforcing regulations, and pursuing strategic industrial policy to reduce US dependence on imported PPE will help to better protect healthcare workers with adequate supplies of PPE.

A combined health action process approach and mHealth intervention to reduce workplace sitting time in office-working adults: a secondary analysis examining health-related quality of life and work performance outcomes

OBJECTIVE

This secondary analysis study examined the effects of a 6-week theory-based planning and mHealth text message intervention targeting workplace sitting time on health-related quality of life and work performance in office workers.

DESIGN

Office-working adults (M_age=45.18 ± 11.33 years) were randomised into either a planning + text message intervention (n = 29) or control (n = 31) condition.

OUTCOME MEASURES

Workplace sitting time, time spent in specific non-sedentary behaviours (e.g. standing), health-related outcomes (i.e. emotional well-being, energy/fatigue, perceived role limitations), and work performance were assessed at baseline and week 6.

RESULTS

Significant group by time interaction effects, that favoured the intervention group, were found for perceived role limitations due to emotional health problems and emotional well-being. No significant interaction effects emerged for energy/fatigue, role limitations due to physical health problems or work performance. Significant correlations in the expected direction were found between sedentary/non-sedentary behaviours and health-related outcomes. No significant mediation effects were found to suggest the intervention affected health-related outcomes through reductions in sedentary behaviour.

CONCLUSION

Reducing workplace sitting improves emotional well-being and contributes to fewer perceived role limitations due to emotional health problems among office workers.

Financial Socialization, Childhood Experiences and Financial Well-Being: The Mediating Role of Locus of Control

The present study evaluates an empirical model of financial well-being (FWB) based on early childhood consumer experiences (ECCE) and financial socialization (FS). FWB is the overall satisfaction with one’s current financial situation, and that plays a vital role in the overall success and helps to overcome psychological health issues among adults. The results of the study suggested that ECCE has a significant direct effect on the FWB among adults. Moreover, FS agents such as peers harm the financial well-being of the adults. The results also revealed that financial locus of control (LOC) mediates the relationship between FS agents such as parents, teachers, and FWB. Surprisingly, FS agent peers and ECCE do not affect the FWB of adults when LOC works as a mediator. Possibly, when adults socialize more with parents and teachers, they often disregard the role of peers. Adults’ belief and confidence in their skills are vital in explaining the above relationships. Educationists and practitioners should focus on improving discussions with parents and teachers about the financial matters that result in improvements in financial well-being. The present study also provides theoretical and practical implications for adults, parents, and policymakers.

Utilization and Cost of an Employer-Sponsored Comprehensive Primary Care Delivery Model

IMPORTANCE

Primary care is increasingly delivered at or near workplaces, yet utilization and cost of employer-sponsored primary care services remain unknown.

OBJECTIVE

To compare the health care utilization and cost of an employer-sponsored on-site, near-site, and virtual comprehensive primary care service delivery model with those of traditional community-based primary care.

DESIGN, SETTING, AND PARTICIPANTS

This population-based cohort study of 23 518 commercially insured employees and dependents of an engineering and manufacturing firm headquartered in southern California was performed from January 1, 2016, to July 1, 2019. A subset of the population with most (≥50%) primary care visits through employer-sponsored on-site, near-site, or virtual care clinics was matched to a subset not having most such visits through the employer-sponsored clinics using propensity score matching (n = 1983 each). In sensitivity analyses, employees were matched to dependents at neighboring firms that lacked access to the employer-sponsored primary care delivery model (additional n = 1680).

EXPOSURES

Integrated primary care, mental health, and physical therapy delivered through on-site, near-site, and virtual clinics.

MAIN OUTCOMES AND MEASURES

Utilization (inpatient, outpatient, emergency department, pharmaceutical, radiology, and laboratory visits per 1000 member-months) and spending (2019 costs per member per month in US dollars) by service type.

RESULTS

A total of 23 518 individuals (mean [SD] age, 27 [15] years; 14 604 [62.1%] male) were included in the full population sample and had been enrolled in the employer-sponsored health plan for a mean of 29 months (interquartile range, 14-48 months). Of eligible members, 5292 (22.5%) used the employer-sponsored services, with 2305 (9.8%) using them for most of their primary care. The mean (SD) cost of employer-sponsored service delivery was $87 ($32) per member month. Among the matched populations (mean [SD] age, 31 [11] years; 3349 [84.5%] male) of primary users vs control individuals, total spending was 45% lower per member per month (95% CI, 35%-55%; cost difference, -$167 per member per month; 95% CI, -$204 to -$130; P < .001) among users after adjustment. The lower spending was associated with lower spending on non-primary care services, such as emergency department (-33%; 95% CI, -44% to -22%) and hospital visits (-16%; 95% CI, -22% to -10%), despite higher spending on primary care (109%; 95% CI, 102%-116%) and mental health (20%; 95% CI, 13%-27%).

CONCLUSIONS AND RELEVANCE

The findings suggest that individuals who used the models' services for most of their primary care had lower total spending despite higher primary care spending, which may be associated with self-selection of lower-risk persons to the employer-sponsored services and/or with the use of comprehensive primary care.

Diet, physical activity, and emotional health: what works, what doesn't, and why we need integrated solutions for total worker health

Background

Current research advocates lifestyle factors to manage workers’ health issues, such as obesity, metabolic syndrome, and type II diabetes mellitus, among other things (World Health Organization (WHO) Obesity: preventing and managing the global epidemic, 2000; World Health Organization (WHO) Obesity and overweight, 2016), though little is known about employees’ lifestyle factors in high-stress, high turnover environments, such as in the long term care (LTC) sector.

Methods

Drawing on qualitative single-case study in Ontario, Canada, this paper investigates an under-researched area consisting of the health practices of health care workers from high-stress, high turnover environments. In particular, it identifies LTC worker’s mechanisms for maintaining physical, emotional, and social wellbeing.

Results

The findings suggest that while particular mechanisms were prevalent, such as through diet and exercise, they were often conducted in group settings or tied to emotional health, suggesting important social and mental health contexts to these behaviors. Furthermore, there were financial barriers that prevented workers from participating in these activities and achieving health benefits, suggesting that structurally, social determinants of health (SDoH), such as income and income distribution, are contextually important.

Conclusions

Accordingly, given that workplace health promotion and protection must be addressed at the individual, organizational, and structural levels, this study advocates integrated, total worker health (TWH) initiatives that consider social determinants of health approaches, recognizing the wider socio-economic impacts of workers’ health and wellbeing.

Advanced Practice Provider Perspectives on Organizational Strategies for Work Stress Reduction

Unresolved work stress contributes to burnout, compassion fatigue, disengagement, and other work-contextualized factors. The impact of occupational stressors extends to the organization in a negative fashion as well. In 2017, advanced practice providers (APPs) from four health systems, including nurse practitioners, clinical nurse specialists, nurse midwives, nurse anesthetists, and physician assistants, participated in a quantitative online cross-sectional survey; 754 participants responded to a free-text question related to work stress and work–family balance. Suggested organizational strategies were ordered into 29 codes, 10 subthemes, and four main themes: “reduce job stressors,” “improve leadership and operations,” “promote APP well-being,” and “maintain the status quo.” Findings are consistent with other research related to occupational stress with many of the reported strategies considered as evidence-based. Targeted interventions for reducing job stress will need to include improved autonomy for APPs, role delineation, support for work–family balance, and better communication as part of management practices.

The Correlation of a Corporate Culture of Health Assessment Score and Health Care Cost Trend

Objective:

Employers that strive to create a corporate environment that fosters a culture of health often face challenges when trying to determine the impact of improvements on health care cost trends. This study aims to test the stability of the correlation between health care cost trend and corporate health assessment scores (CHAS) using a culture of health measurement tool.

Methods:

Correlation analysis of annual health care cost trend and CHAS on a small group of employers using a proprietary CHAS tool.

Results:

Higher CHAS scores are generally correlated with lower health care cost trend. For employers with several years of CHAS measurements, this correlation remains, although imperfectly.

Conclusion:

As culture of health scores improve, health care costs trends moderate. These findings provide further evidence of the inverse relationship between organizational CHAS performance and health care cost trend.

Low and Higher Wage Workers Report No Differences in Four Barriers to Primary Care Access

Lower wage workers, known to seek more care in the emergency department (ED), may encounter more barriers to timely outpatient primary care. This study aimed to identify differences in self-reported delays in care related to 4 modifiable barriers (phone availability, appointment wait time, in-clinic wait time, and limited service hours) across self-reported wage and to examine the relationship between these care delays and self-reported ED use. The authors examined data from the 2011-2015 National Health Interview Surveys for 58,298 self-identified full-time workers. Multivariable logistic models with geographical region and year fixed effects were used to test the association of wage group and barriers to care. In addition, the multiplicative and additive interaction effects upon self-reported ED use were tested. No association was observed between wage level and barrier to timely care. Lower wage workers (<$25,000 vs. >$75,000/yr.; OR 1.53, 95% CI 1.20-1.94, P = 0.001) and those reporting any of the 4 barriers to care (OR 1.99, 95% CI 1.71-1.94, P < 0.001) were more likely to report 2 or more ED visits in the past year. Multiplicative effects were not statistically significant. Additive interaction effects of wage and barriers were only significant among workers with wages $35,000-$44,999 annually (vs. >$75,000: relative excess risk coef. 1.23, 95% CI 0.07-2.38, P = 0.037) for 2 or more ED visits in past year. Although these modifiable barriers may explain the differences in repeat ED use for workers earning $35,000-$44,999 annually, these barriers do not explain disparities in ED use between highest and lowest wage workers.

Total Worker Health® 2014⁻2018: The Novel Approach to Worker Safety, Health, and Well-Being Evolves

Background: The objective of this article is to provide an overview of and update on the Office for Total Worker Health^® (TWH) program of the Centers for Disease Control and Prevention’s National Institute for Occupational Safety and Health (CDC/NIOSH). Methods: This article describes the evolution of the TWH program from 2014 to 2018 and future steps and directions. Results: The TWH framework is defined as policies, programs, and practices that integrate protection from work-related safety and health hazards with promotion of injury and illness prevention efforts to advance worker well-being. Conclusions: The CDC/NIOSH TWH program continues to evolve in order to respond to demands for research, practice, policy, and capacity building information and solutions to the safety, health, and well-being challenges that workers and their employers face.

Which work-related characteristics are most strongly associated with common mental disorders? A cross-sectional study

OBJECTIVES

Studies exploring work-related risk factors of common mental disorders (CMDs), such as major depressive disorder (MDD), generalised anxiety disorder (GAD) or alcohol abuse, have generally focused on a limited set of work characteristics. For the first time in a primary care setting, we examine simultaneously multiple work-related risk factors in relation to CMDs.

METHOD

We use data from a study of working individuals recruited among 2027 patients of 121 general practitioners (GPs) representative of the Nord-Pas-de-Calais region in the North of France (April-August 2014). CMDs (MDD; GAD; alcohol abuse) were assessed using the Mini-International Neuropsychiatric Interview. Six worked-related factors were examined (work intensity, emotional demands, autonomy, social relations at work, conflict in values and job insecurity). Several covariates were considered (patient, GP and contextual characteristics). To study the association between workplace risk factors and CMDs, we used multilevel Poisson regression models adjusted for covariates.

RESULTS

Among study participants, 389 (19.1%) met criteria for MDD, 522 (25.8%) for GAD and 196 (9.7%) for alcohol abuse. In multivariable analyses adjusted for covariates, MDD/GAD was significantly associated with work intensity (RR 1.16, 95% CI 1.06 to 1.27) (absolute risk=52.8%), emotional demands (RR 1.24, 95% CI 1.13 to 1.35) (absolute risk=54.9%) and social relations at work (RR 0.78, 95% CI 0.70 to 0.87) (absolute risk=15.0%); alcohol abuse was associated with social relations at work (RR 1.25, 95% CI 1.01 to 1.53) (absolute risk=7.6%) and autonomy (OR 0.82, 95% CI 0.67 to 0.99) (absolute risk=8.9%).

CONCLUSIONS

Several workplace factors are associated with CMDs among working individuals seen by a GP. These findings confirm the role of organisational characteristics of work as a correlate of psychological difficulties above and beyond other sources of risk.

Finding meaningful work in difficult circumstances: A study of prison healthcare workers

Prisons are rigidly structured institutions housing-in some cases-violent and unstable residents. To discover the positive job attributes and perceived challenges in this extreme practice environment, we employed exploratory qualitative content analysis on the written-in responses of 269 prison health workers in one state's Department of Corrections. Two researchers independently analyzed and coded the data. Using an iterative process, we categorized the responses into themes and critical underlying meanings. Positive job attributes included meaningful work, stability, variety of ailments treated, and feelings of support. Perceived challenges included ineffective leadership, constraints on the ability to effectively execute the role, perceived inequity, and organizational culture. The results of our study suggest that there are lessons to be learned from correctional health workers that could inform policy and management outside of the prison walls specifically as it pertains to motivating and engaging providers through meaningful work. Specifically, health organizations would improve the experience of their clinicians by offering a broader scope of practice experience, schedule stability, reducing bureaucratic redundancies, and-ultimately-restoring the sense of purpose within the work itself.

Access to Employee Wellness Programs and Use of Preventive Care Services Among U.S. Adults

INTRODUCTION

There is little research at the national level on access to employee wellness programs and the use of preventive care services. This study examined the use of seven preventive care services among U.S working adults with access to employee wellness programs.

METHODS

The study population comprised 17,699 working adults aged ≥18 years, obtained from the 2015 National Health Interview Survey. Multivariate logistic regression models examined the relationship between access to employee wellness programs and use of seven preventive care services: influenza vaccination, blood pressure check, diabetes check, cholesterol check, Pap smear test, mammogram, and colon cancer screening. Data analysis began in Fall 2016.

RESULTS

Overall, 46.6% of working adults reported having access to employee wellness programs in 2015. Working adults with access to employee wellness programs had higher odds of receiving influenza vaccination (OR=1.57, 95% CI=1.43, 1.72, p<0.001), blood pressure check (OR=2.46, 95% CI=2.17, 2.78, p<0.001), diabetes check (OR=1.30, 95% CI=1.12, 1.50, p<0.001), cholesterol check (OR=1.48, 95% CI=1.33, 1.67, p<0.001), and mammogram (OR=1.57, 95% CI=1.24, 1.98, p<0.001). However, there was no significant difference between access to employee wellness programs and the use of Pap smear test and colon cancer screening services.

CONCLUSIONS

Using a nationally representative sample of individuals, this study found a positive association between access to employee wellness programs and the use of preventive care services. The results support favorable policies to encourage implementing wellness programs in all worksites, especially those with <50 employees.