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Leso V, Carugno M, Carrer P, Fusco F, Mendola M, Coppola M, Zaffina S, Di Prinzio RR, Iavicoli I. The Total Worker Health® (TWH) approach: a systematic review of its application in different occupational settings. BMC Public Health 2024; 24:2037. [PMID: 39080673 PMCID: PMC11287918 DOI: 10.1186/s12889-024-19500-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Accepted: 07/16/2024] [Indexed: 08/03/2024] Open
Abstract
BACKGROUND The National Institute for Occupational Safety and Health (NIOSH), in 2011, developed the "Total Worker Health®" (TWH) as a holistic approach to protect and promote the workers' safety, health, and well-being. After over ten years from the TWH development, the aim of the present systematic review is to provide a comprehensive overview of the worldwide TWH initiatives. METHODS PubMed, Scopus and ISI Web of Science were searched for TWH studies published up to the 31st of July 2023, and 43 investigations could be included. The review was registered on the International prospective register of systematic reviews PROSPERO with the reference number CRD42023416972. RESULTS Issues that emerged as relevant for the TWH operationalization were the awareness about the TWH approach and fundamentals, the leadership commitment, and a participatory engagement of the workforce: these aspects all contributed to acceptable and effective setting oriented TWH plans, specifically tailored on the peculiarities of the workplace, including small enterprises and multiemployer worksites. Evaluation and continual improvement were reported as fundamental for the successful implementation of TWH initiatives. Limited resources for safety and health initiatives, in terms of time, people, and funds, together with difficulties in the identification of safety and health priorities and a poor participatory culture were recognized as obstacles to the TWH application. Training resulted the core component of the TWH leadership and workforce preparedness, with beneficial results in terms of safety culture and adoption of preventive measures. CONCLUSIONS Although interesting aspects emerged from our review, future longitudinal investigations should confirm the effectiveness, easy integration, and long-term sustainability of TWH models in different workplaces, in order to effectively support safe and health-enhancing works able to improve innovation and productivity.
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Affiliation(s)
- Veruscka Leso
- Department of Public Health, Section of Occupational Medicine, University of Naples Federico II, Via S. Pansini 5, 80131, Naples, Italy
| | - Michele Carugno
- Department of Clinical Sciences and Community Health, University of Milan, Via San Barnaba 8, 20122, Milan, Italy
- Epidemiology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via San Barnaba 8, 20122, Milan, Italy
| | - Paolo Carrer
- Occupational Health Unit, Fatebenefratelli-Sacco University Hospital, Via G.B. Grassi 74, 20157, Milan, Italy
- Department of Biomedical and Clinical Sciences, University of Milan, Via G.B. Grassi 74, 20157, Milan, Italy
| | - Fabio Fusco
- Department of Public Health, Section of Occupational Medicine, University of Naples Federico II, Via S. Pansini 5, 80131, Naples, Italy
| | - Marco Mendola
- Occupational Health Unit, Fatebenefratelli-Sacco University Hospital, Via G.B. Grassi 74, 20157, Milan, Italy
| | - Mariagaia Coppola
- Department of Public Health, Section of Occupational Medicine, University of Naples Federico II, Via S. Pansini 5, 80131, Naples, Italy
| | - Salvatore Zaffina
- Occupational Medicine Unit, IRCCS Bambino Gesù Children's Hospital, Piazza S.Onofrio, 4, Rome, 00165, Italy
| | - Reparata Rosa Di Prinzio
- Occupational Medicine Unit, IRCCS Bambino Gesù Children's Hospital, Piazza S.Onofrio, 4, Rome, 00165, Italy
- Alta Scuola Di Economia E Management Dei Sistemi Sanitari (ALTEMS), Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, Rome, 00168, Italy
| | - Ivo Iavicoli
- Department of Public Health, Section of Occupational Medicine, University of Naples Federico II, Via S. Pansini 5, 80131, Naples, Italy.
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Schwatka NV, Dally M, Shore E, Tenney L, Brown CE, Scott JG, Dexter L, Newman LS. Small + Safe + Well: lessons learned from a Total Worker Health® randomized intervention to promote organizational change in small business. BMC Public Health 2022; 22:1039. [PMID: 35610627 PMCID: PMC9128251 DOI: 10.1186/s12889-022-13435-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 05/11/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Leadership commitment to worker safety and health is one of the most important factors when organizations develop and implement a Total Worker Health® approach. We aimed to assess the effectiveness of a Total Worker Health ("TWH") leadership development program that targeted owners and other senior-level leadership positions on changing organizational and worker outcomes from baseline to one-year later. METHODS The Small + Safe + Well study included small businesses from a variety of industries in the state of Colorado, USA that were participating in Health Links™. We designed a randomized waitlisted control comparison design (RCT) to evaluate the added benefit of a TWH leadership development program. An employer assessment tool was used to assess TWH policies and programs, and an employee health and safety survey was used to assess safety leadership and health leadership practices, safety climate and health climate, safety behaviors and health behaviors, and well-being. We used a linear mixed model framework with random effects for business and employee to assess the impact of intervention on the outcomes of interest. RESULTS Thirty-six businesses (37% retention) and 250 employees (9% retention) met the RCT study inclusion criteria and were included in the analysis. Businesses improved their TWH policies and programs score from baseline to one-year later, regardless of leadership intervention group assignment. Neither intervention group demonstrated improvements in employee-reported outcomes. CONCLUSIONS This study sought to address a gap in the literature regarding small business senior leadership development for TWH. Our study demonstrates many of the challenges of conducting studies focused on organizational change in workplaces, specifically in small businesses. When designing TWH intervention studies, researchers should consider how to best engage small business leaders in interventions and implementations early on, as well as methods that are well matched to measuring primary and secondary outcomes longitudinally. Future research is needed to test the feasibility and sustainability of TWH interventions in small business. TRIAL REGISTRATION The trial was retrospectively registered with ClinicalTrials.gov ( ID U19OH011227 ).
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Affiliation(s)
- Natalie V Schwatka
- Center for Health, Work & Environment, Colorado School of Public Health, Anschutz Medical Campus, University of Colorado, 13001 E. 17th Pl., 3rd Floor, Mail Stop B119 HSC, Aurora, CO, 80045, USA.
- Department of Environmental and Occupational Health, Colorado School of Public Health, Anschutz Medical Campus, University of Colorado, 13001 E. 17th Pl., 3rd Floor, Mail Stop B119 HSC, Aurora, CO, 80045, USA.
| | - Miranda Dally
- Center for Health, Work & Environment, Colorado School of Public Health, Anschutz Medical Campus, University of Colorado, 13001 E. 17th Pl., 3rd Floor, Mail Stop B119 HSC, Aurora, CO, 80045, USA
- Department of Environmental and Occupational Health, Colorado School of Public Health, Anschutz Medical Campus, University of Colorado, 13001 E. 17th Pl., 3rd Floor, Mail Stop B119 HSC, Aurora, CO, 80045, USA
| | - Erin Shore
- Center for Health, Work & Environment, Colorado School of Public Health, Anschutz Medical Campus, University of Colorado, 13001 E. 17th Pl., 3rd Floor, Mail Stop B119 HSC, Aurora, CO, 80045, USA
- Present Address: University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Liliana Tenney
- Center for Health, Work & Environment, Colorado School of Public Health, Anschutz Medical Campus, University of Colorado, 13001 E. 17th Pl., 3rd Floor, Mail Stop B119 HSC, Aurora, CO, 80045, USA
- Department of Environmental and Occupational Health, Colorado School of Public Health, Anschutz Medical Campus, University of Colorado, 13001 E. 17th Pl., 3rd Floor, Mail Stop B119 HSC, Aurora, CO, 80045, USA
| | - Carol E Brown
- Center for Health, Work & Environment, Colorado School of Public Health, Anschutz Medical Campus, University of Colorado, 13001 E. 17th Pl., 3rd Floor, Mail Stop B119 HSC, Aurora, CO, 80045, USA
| | - Joshua G Scott
- Center for Health, Work & Environment, Colorado School of Public Health, Anschutz Medical Campus, University of Colorado, 13001 E. 17th Pl., 3rd Floor, Mail Stop B119 HSC, Aurora, CO, 80045, USA
- Present Address: 2U, Inc., Lanham, MD, USA
| | - Lynn Dexter
- Center for Health, Work & Environment, Colorado School of Public Health, Anschutz Medical Campus, University of Colorado, 13001 E. 17th Pl., 3rd Floor, Mail Stop B119 HSC, Aurora, CO, 80045, USA
| | - Lee S Newman
- Center for Health, Work & Environment, Colorado School of Public Health, Anschutz Medical Campus, University of Colorado, 13001 E. 17th Pl., 3rd Floor, Mail Stop B119 HSC, Aurora, CO, 80045, USA
- Department of Environmental and Occupational Health, Colorado School of Public Health, Anschutz Medical Campus, University of Colorado, 13001 E. 17th Pl., 3rd Floor, Mail Stop B119 HSC, Aurora, CO, 80045, USA
- Department of Epidemiology, Colorado School of Public Health, and Department of Medicine, School of Medicine, Anschutz Medical Campus, University of Colorado, 13001 E. 17th Pl., 3rd Floor, Mail Stop B119 HSC, Aurora, CO, 80045, USA
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Siegel A, Hoge AC, Ehmann AT, Martus P, Rieger MA. Attitudes of Company Executives toward a Comprehensive Workplace Health Management-Results of an Exploratory Cross-Sectional Study in Germany. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111475. [PMID: 34769990 PMCID: PMC8583484 DOI: 10.3390/ijerph182111475] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 10/26/2021] [Indexed: 11/16/2022]
Abstract
Workplace health management (WHM) in Germany aims at maintaining and increasing the health and well-being of employees. Little is known about company executives’ attitudes toward WHM. To gain more insight, we conducted a large-scale survey in companies in the German county of Reutlingen in 2017. We sent a standardized questionnaire to 906 companies, containing inter alia 26 self-constructed declarative statements depicting company executives’ opinions on various WHM aspects; 222 questionnaires could be evaluated. By exploratory factor analysis we assigned the 26 items to six factors reflecting different attitudes toward WHM. Factor values were standardized to a scale from 0 to 10. The attitude ‘positive view of general health services in the company’, for example, achieved by far the lowest mean agreement (3.3 points). For the attitude ‘general skepticism toward WHM’, agreement and disagreement were balanced (5.0 points). Using multiple regression analyses, we searched for variables that could partially explain respondents’ agreement with attitudes. In conclusion, a general WHM skepticism was widespread, but not dominant. The idea that general health services should be offered in companies was predominantly rejected. Older respondents and respondents from smaller companies and craft enterprises were more skeptical than average about WHM and its possible extensions.
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Affiliation(s)
- Achim Siegel
- Institute of Occupational and Social Medicine and Health Services Research, University Hospital Tübingen, Wilhelmstr. 27, 72074 Tübingen, Germany; (A.C.H.); (A.T.E.); (M.A.R.)
- Correspondence: ; Tel.: +49-7071-29-86812
| | - Aileen C. Hoge
- Institute of Occupational and Social Medicine and Health Services Research, University Hospital Tübingen, Wilhelmstr. 27, 72074 Tübingen, Germany; (A.C.H.); (A.T.E.); (M.A.R.)
| | - Anna T. Ehmann
- Institute of Occupational and Social Medicine and Health Services Research, University Hospital Tübingen, Wilhelmstr. 27, 72074 Tübingen, Germany; (A.C.H.); (A.T.E.); (M.A.R.)
| | - Peter Martus
- Institute for Clinical Epidemiology and Applied Biometry, University Hospital Tübingen, Silcherstr. 5, 72076 Tübingen, Germany;
| | - Monika A. Rieger
- Institute of Occupational and Social Medicine and Health Services Research, University Hospital Tübingen, Wilhelmstr. 27, 72074 Tübingen, Germany; (A.C.H.); (A.T.E.); (M.A.R.)
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Education and Training to Build Capacity in Total Worker Health®: Proposed Competencies for an Emerging Field. J Occup Environ Med 2021; 62:e384-e391. [PMID: 32404840 PMCID: PMC7409771 DOI: 10.1097/jom.0000000000001906] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Objective: Establishment of core competencies for education and training of professionals entering the emerging field of Total Worker Health®. Methods: Compilation and distillation of information obtained over a 5-year period from Total Worker Health symposia, workshops, and academic offerings, plus contributions from key stakeholders regarding education and training needs. Results: A proposed set of Total Worker Health competencies aligns under six broad domains: Subject Matter Expertize; Advocacy and Engagement; Program Planning, Implementation and Evaluation; Communications and Dissemination; Leadership and Management; and Partnership Building and Coordination. Conclusions: Proposed set of core competencies will help standardize education and training for professionals being trained in Total Worker Health. It serves as an invitation for further input from stakeholders in academia, business, labor, and government.
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Tenney L, Dexter L, Shapiro DC, Dally M, Brown CE, Schwatka NV, Huebschmann AG, McMillen J, Newman LS. Impact of Advising on Total Worker Health Implementation. J Occup Environ Med 2021; 63:657-664. [PMID: 33950039 PMCID: PMC8729231 DOI: 10.1097/jom.0000000000002212] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Little is understood about the mechanisms for improving the adoption and implementation of Total Worker Health® (TWH) in workplace settings. The primary objective of this study was to identify whether the delivery of TWH advising is associated with subsequent changes in TWH in small-to-medium sized businesses. METHODS We conducted a longitudinal study of a TWH intervention in 200 organizations completing Health Links Healthy Workplace Assessments™ between October 2016 and December 2019. Organizations were offered consultation via telephonic and live web-based advising sessions. RESULTS Organizations exhibited non-significant albeit positive change in assessment scores from baseline to assessment 2. Businesses receiving advising showed significant score improvements from assessment 2 to 3, versus those without advising. CONCLUSIONS TWH consultation may enhance adoption of organizational behaviors that promote worker health, safety, and well-being over time.
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Affiliation(s)
- Liliana Tenney
- Center for Health, Work & Environment, Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, 13001 E. 17 Pl., W-3111, Mail Stop B119 HSC, Aurora, CO 80045
- Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, 13001 E. 17 Pl., 3 Floor, Mail Stop B119 HSC, Aurora, CO 80045
| | - Lynn Dexter
- Center for Health, Work & Environment, Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, 13001 E. 17 Pl., W-3111, Mail Stop B119 HSC, Aurora, CO 80045
| | - David C. Shapiro
- Center for Health, Work & Environment, Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, 13001 E. 17 Pl., W-3111, Mail Stop B119 HSC, Aurora, CO 80045
| | - Miranda Dally
- Center for Health, Work & Environment, Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, 13001 E. 17 Pl., W-3111, Mail Stop B119 HSC, Aurora, CO 80045
- Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, 13001 E. 17 Pl., 3 Floor, Mail Stop B119 HSC, Aurora, CO 80045
| | - Carol E. Brown
- Center for Health, Work & Environment, Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, 13001 E. 17 Pl., W-3111, Mail Stop B119 HSC, Aurora, CO 80045
| | - Natalie V. Schwatka
- Center for Health, Work & Environment, Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, 13001 E. 17 Pl., W-3111, Mail Stop B119 HSC, Aurora, CO 80045
- Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, 13001 E. 17 Pl., 3 Floor, Mail Stop B119 HSC, Aurora, CO 80045
| | - Amy G. Huebschmann
- University of Colorado School of Medicine, Adult & Child Consortium for Outcomes Research and Delivery Science (ACCORDS) Dissemination and Implementation program, Division of General Internal Medicine and Center for Women’s Health Research, Anschutz Medical Campus, 12631 E. 17th Ave., Mailstop B180, Aurora, CO 80045
| | | | - Lee S. Newman
- Center for Health, Work & Environment, Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, 13001 E. 17 Pl., W-3111, Mail Stop B119 HSC, Aurora, CO 80045
- Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, 13001 E. 17 Pl., 3 Floor, Mail Stop B119 HSC, Aurora, CO 80045
- Department of Epidemiology, Colorado School of Public Health, and Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, School of Medicine, University of Colorado, Anschutz Medical Campus, 13001 E. 17 Pl., 3 Floor, Mail Stop B119 HSC, Aurora, CO 80045
- Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, 13001 E. 17 Place, Mailstop B119, Aurora, CO, 80045
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Schwatka NV, Brown CE, Tenney L, Scott JG, Shore E, Dally M, Newman LS. Evaluation of a Total Worker Health ® leadership program for small business leaders. OCCUPATIONAL HEALTH SCIENCE 2021; 5:163-188. [PMID: 37366387 PMCID: PMC10291283 DOI: 10.1007/s41542-021-00086-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 03/11/2021] [Accepted: 03/15/2021] [Indexed: 06/28/2023]
Abstract
Leaders play a critical role in the development and execution of Total Worker Health (TWH). Small businesses, in particular, can benefit from strong leadership support for TWH as the burden of work-related injury, illness and fatality, as well as poor health and well-being is high in this population. In the present study, we conducted a program evaluation of a TWH leadership development program for small business leaders using the RE-AIM framework. The goal of the program was to help change leaders' behaviors around health, safety and well-being practices following the theory of transformational leadership. Two leaders from each business participated in pre-training activities on their own, a 6-hour in-person training, and three months of access to virtual training transfer activities, including coaching and goal tracking. Our results suggest that the TWH leadership development program is effective at improving leaders' self-reported TWH leadership practices and that the in-person training was implemented successfully. However, leaders did not report improvements in their personal health and in fact reported increased levels of work stress after the program. We also observed some challenges when implementing our training transfer strategies. Our study suggests that leaders may benefit from attending TWH leadership trainings alongside other colleagues in their organization to facilitate a shared vision and goals for TWH in their organization. As a next step, it will be important to determine the program's effectiveness in changing business TWH policies and practices, employee perceptions of TWH and leadership, and employee health and safety outcomes.
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Affiliation(s)
- Natalie V. Schwatka
- Center for Health, Work & Environment, Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, 13001 E. 17 Pl., 3 Floor, Mail Stop B119 HSC, Aurora, CO 80045
- Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, 13001 E. 17 Pl., 3 Floor, Mail Stop B119 HSC, Aurora, CO 80045
| | - Carol E. Brown
- Center for Health, Work & Environment, Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, 13001 E. 17 Pl., 3 Floor, Mail Stop B119 HSC, Aurora, CO 80045
| | - Liliana Tenney
- Center for Health, Work & Environment, Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, 13001 E. 17 Pl., 3 Floor, Mail Stop B119 HSC, Aurora, CO 80045
- Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, 13001 E. 17 Pl., 3 Floor, Mail Stop B119 HSC, Aurora, CO 80045
| | - Joshua G. Scott
- Center for Health, Work & Environment, Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, 13001 E. 17 Pl., 3 Floor, Mail Stop B119 HSC, Aurora, CO 80045
- Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, 13001 E. 17 Pl., 3 Floor, Mail Stop B119 HSC, Aurora, CO 80045
| | - Erin Shore
- Center for Health, Work & Environment, Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, 13001 E. 17 Pl., 3 Floor, Mail Stop B119 HSC, Aurora, CO 80045
| | - Miranda Dally
- Center for Health, Work & Environment, Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, 13001 E. 17 Pl., 3 Floor, Mail Stop B119 HSC, Aurora, CO 80045
- Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, 13001 E. 17 Pl., 3 Floor, Mail Stop B119 HSC, Aurora, CO 80045
| | - Lee S. Newman
- Center for Health, Work & Environment, Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, 13001 E. 17 Pl., 3 Floor, Mail Stop B119 HSC, Aurora, CO 80045
- Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, 13001 E. 17 Pl., 3 Floor, Mail Stop B119 HSC, Aurora, CO 80045
- Department of Epidemiology, Colorado School of Public Health and Department of Medicine, School of Medicine, University of Colorado, Anschutz Medical Campus, 13001 E. 17 Pl., 3 Floor, Mail Stop B119 HSC, Aurora, CO 80045
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Brown CE, Schwatka N, Dexter L, Dally M, Shore E, Tenney L, Newman LS. The Importance of Small Business Safety and Health Climates During COVID-19. J Occup Environ Med 2021; 63:81-88. [PMID: 33177474 PMCID: PMC7864611 DOI: 10.1097/jom.0000000000002080] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This study examines employee perceptions of safety and health climates for well-being during the COVID-19 pandemic in a sample of small businesses. METHODS We evaluated changes to employees' work and home life resulting from COVID-19 and perceptions of safety and health climates. Cross-sectional relationships were assessed using multivariable linear regression models for a sample of 491 employees from 30 small businesses in Colorado in May 2020. RESULTS Employee perceptions of safety and health climates were significantly related to their self-reported well-being during the first wave of COVID-19, even when there were changes to childcare, the ability to work, and limited social contacts. CONCLUSION Safety and health climates may influence employee well-being even when other disruptions occur, suggesting that during emergencies, small businesses with strong climates may be better prepared to maintain employee well-being.
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Affiliation(s)
- Carol E Brown
- Center for Health, Work & Environment, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado (Dr Brown, Dr Schwatka, Ms Dexter, Ms Dally, Ms Shore, Dr Tenney, Dr Newman); Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado (Dr Schwatka, Dally, Tenney, Newman); Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (Shore); Department of Epidemiology, Colorado School of Public Health and Department of Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado (Dr Newman), Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado (Dr Newman)
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Linnan LA, Vaughn AE, Smith FT, Westgate P, Hales D, Arandia G, Neshteruk C, Willis E, Ward DS. Results of caring and reaching for health (CARE): a cluster-randomized controlled trial assessing a worksite wellness intervention for child care staff. Int J Behav Nutr Phys Act 2020; 17:64. [PMID: 32414381 PMCID: PMC7227251 DOI: 10.1186/s12966-020-00968-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 05/04/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Child care workers are among the lowest paid US workers and experience a wide array of health concerns. The physical and mental demands of their job and the lack of employer-provided health-insurance increase health risks. The Caring and Reaching for Health (CARE) study evaluated a 6-month Healthy Lifestyles intervention targeting child care workers' physical activity (primary outcome), other health behaviors, and their workplace health environment. METHODS Eligible child care centers, defined as being in operation for at least 2 years and employing at least four staff, were enrolled into CARE's cluster-randomized trial. Centers and their child care staff were randomly assigned to either the Healthy Lifestyles (HL) intervention arm or the Healthy Finances (HF) attention control arm using a block randomization approach. Intervention components were delivered through in-person workshops, center-level displays, informational magazines, director coaching, electronic messaging, and an interactive website. Outcome measures were collected during center visits at baseline and immediately post-intervention by trained data collectors blinded to center arm assignment. Workers' physical activity was assessed with accelerometers, worn for 7 days. Secondary outcome measures included biometric assessments of health and fitness, web-based surveys about health behaviors, and an environmental audit of workplace supports for health. Multi-level linear mixed models assessed worker- and center-level changes in these outcomes. RESULTS Participants included 553 child care workers representing 56 centers (HL = 250 staff/28 centers, HF = 303 staff/28 centers). At 6 months, moderate-to-vigorous physical activity declined slightly in both arms (- 1.3 min/day, 95% CI: - 3.0, 0.3 in HL; - 1.9 min/day, 95% CI: - 3.3, - 0.5 in HF), but there was no significant group by time interaction. Several secondary outcomes for other health behaviors and workplace health environment showed improvements in favor of the intervention arm, yet differences did not remain statistically significant after adjustment for multiple comparisons. CONCLUSIONS While the Healthy Lifestyles intervention did not improve health behaviors or the workplace health environment, results confirmed the pressing need to focus on the health of child care workers. Future interventions should focus on prevalent health issues (e.g., weight, stress), include both high-tech and high-touch intervention strategies, and address work conditions or other social determinants of health (e.g. wages) as a means of improving the health of these essential workers. TRIAL REGISTRATION Care2BWell: Worksite Wellness for Child Care (NCT02381938).
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Affiliation(s)
- Laura A Linnan
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, CB 7440, Chapel Hill, North Carolina, 27599-7440, USA.
| | - Amber E Vaughn
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Falon T Smith
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Philip Westgate
- Department of Biostatistics, College of Public Heath, University of Kentucky, Lexington, Kentucky, USA
| | - Derek Hales
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Gabriela Arandia
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, CB 7440, Chapel Hill, North Carolina, 27599-7440, USA
| | - Cody Neshteruk
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Erik Willis
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Dianne S Ward
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Schwatka NV, Dally M, Tenney L, Shore E, Brown CE, Newman LS. Total Worker Health Leadership and Business Strategies Are Related to Safety and Health Climates in Small Business. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E2142. [PMID: 32213806 PMCID: PMC7143812 DOI: 10.3390/ijerph17062142] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 03/19/2020] [Accepted: 03/20/2020] [Indexed: 11/17/2022]
Abstract
The purpose of this study was to investigate the relationship between Total Worker Health® (TWH) business strategies and employee perceptions of leadership commitment and safety and health climates. Using data from 53 small enterprises and 1271 of their workers collected as part of the Small + Safe + Well (SSWell) Study, we confirm the primacy of the relationship between leadership commitment to safety and workplace safety climate. After accounting for leadership commitment to safety, business-reported policies and practices that promote the health, safety, and well-being of workers (i.e., TWH strategies) were no longer related to safety climate. In contrast, the relationship between TWH strategies and health climate were significantly associated with the level of small business leadership commitment to worksite wellness. Relatedly, our results demonstrate that leadership is a common correlate to both safety climate and health climate. Future research should investigate integrated TWH leadership development strategies as a means of simultaneously improving safety and health climates.
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Affiliation(s)
- Natalie V. Schwatka
- Center for Health, Work & Environment and Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, 13001 E. 17th Pl., 3rd Floor, Mail Stop B119 HSC, Aurora, CO 80045, USA; (M.D.); (L.T.); (E.S.); (C.E.B.); (L.S.N.)
| | - Miranda Dally
- Center for Health, Work & Environment and Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, 13001 E. 17th Pl., 3rd Floor, Mail Stop B119 HSC, Aurora, CO 80045, USA; (M.D.); (L.T.); (E.S.); (C.E.B.); (L.S.N.)
| | - Liliana Tenney
- Center for Health, Work & Environment and Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, 13001 E. 17th Pl., 3rd Floor, Mail Stop B119 HSC, Aurora, CO 80045, USA; (M.D.); (L.T.); (E.S.); (C.E.B.); (L.S.N.)
| | - Erin Shore
- Center for Health, Work & Environment and Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, 13001 E. 17th Pl., 3rd Floor, Mail Stop B119 HSC, Aurora, CO 80045, USA; (M.D.); (L.T.); (E.S.); (C.E.B.); (L.S.N.)
| | - Carol E. Brown
- Center for Health, Work & Environment and Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, 13001 E. 17th Pl., 3rd Floor, Mail Stop B119 HSC, Aurora, CO 80045, USA; (M.D.); (L.T.); (E.S.); (C.E.B.); (L.S.N.)
| | - Lee S. Newman
- Center for Health, Work & Environment and Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, 13001 E. 17th Pl., 3rd Floor, Mail Stop B119 HSC, Aurora, CO 80045, USA; (M.D.); (L.T.); (E.S.); (C.E.B.); (L.S.N.)
- Department of Epidemiology, Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, 13001 E. 17th Pl., 3rd Floor, Mail Stop B119 HSC, Aurora, CO 80045, USA
- Department of Medicine, School of Medicine, University of Colorado, Anschutz Medical Campus, 13001 E. 17th Pl., 3rd Floor, Mail Stop B119 HSC, Aurora, CO 80045, USA
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Shore E, Schwatka N, Dally M, Brown CE, Tenney L, Newman LS. Small Business Employees' Perceptions of Leadership Are Associated With Safety and Health Climates and Their Own Behaviors. J Occup Environ Med 2020; 62:156-162. [PMID: 31834140 PMCID: PMC7363040 DOI: 10.1097/jom.0000000000001789] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Leadership is an important factor in creating a safe and healthy work environment. Little is known about its influence in small organizations. This study assessed the relationship between leadership, climate, and employee behavior in organizations with less than 500 employees. METHODS We examined organizational factors and worker perceptions of leadership and safety/health behaviors in an analysis of 1271 employees in 53 Colorado small organizations. Cross-sectional relationships were assessed using multivariable linear regression models. RESULTS Perceived leadership commitment to safety was associated with safety climate (β = 0.67) and safety behaviors among employees (β = 0.45). Perceived leadership commitment to worksite wellness was associated with health climate (β = 0.66) and health behaviors (β = 0.42). CONCLUSIONS Leadership plays an important role in creating a positive work environment around safety and health.
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Affiliation(s)
- Erin Shore
- Center for Health, Work & Environment, Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, 13001 E. 17 Pl., 3 Floor, Mail Stop B119 HSC, Aurora, CO 80045
| | - Natalie Schwatka
- Center for Health, Work & Environment, Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, 13001 E. 17 Pl., 3 Floor, Mail Stop B119 HSC, Aurora, CO 80045
- Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, 13001 E. 17 Pl., 3 Floor, Mail Stop B119 HSC, Aurora, CO 80045
| | - Miranda Dally
- Center for Health, Work & Environment, Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, 13001 E. 17 Pl., 3 Floor, Mail Stop B119 HSC, Aurora, CO 80045
- Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, 13001 E. 17 Pl., 3 Floor, Mail Stop B119 HSC, Aurora, CO 80045
| | - Carol E. Brown
- Center for Health, Work & Environment, Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, 13001 E. 17 Pl., 3 Floor, Mail Stop B119 HSC, Aurora, CO 80045
| | - Liliana Tenney
- Center for Health, Work & Environment, Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, 13001 E. 17 Pl., 3 Floor, Mail Stop B119 HSC, Aurora, CO 80045
- Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, 13001 E. 17 Pl., 3 Floor, Mail Stop B119 HSC, Aurora, CO 80045
| | - Lee S. Newman
- Center for Health, Work & Environment, Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, 13001 E. 17 Pl., 3 Floor, Mail Stop B119 HSC, Aurora, CO 80045
- Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, 13001 E. 17 Pl., 3 Floor, Mail Stop B119 HSC, Aurora, CO 80045
- Department of Epidemiology, Colorado School of Public Health, and Department of Medicine, School of Medicine, University of Colorado, Anschutz Medical Campus, 13001 E. 17 Pl., 3 Floor, Mail Stop B119 HSC, Aurora, CO 80045
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Wijnen BFM, Lokkerbol J, Boot C, Havermans BM, van der Beek AJ, Smit F. Implementing interventions to reduce work-related stress among health-care workers: an investment appraisal from the employer's perspective. Int Arch Occup Environ Health 2019; 93:123-132. [PMID: 31451925 PMCID: PMC6989605 DOI: 10.1007/s00420-019-01471-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 08/19/2019] [Indexed: 11/30/2022]
Abstract
Purpose The Stress-Prevention@Work implementation strategy has been demonstrated to be successful in reducing stress in employees. Now, we assess the economic return-on-investment to see if it would make for a favourable business case for employers. Methods Data were collected from 303 health-care workers assigned to either a waitlisted control condition (142 employees in 15 teams) or to Stress-Prevention@Work (161 employees in 15 teams). Main outcome was productivity losses measured using the Trimbos and iMTA Cost questionnaire in Psychiatry. Measurements were taken at baseline, 6, and 12 months post-baseline. Results The per-employee costs of the strategy were €50. Net monetary benefits were the benefits (i.e., improved productivity) minus the costs (i.e., intervention costs) and were the main outcome of this investment appraisal. Per-employee net benefits amounted to €2981 on average, which was an almost 60-fold payout of the initial investment of €50. There was a 96.7% likelihood for the modest investment of €50 to be offset by cost savings within 1 year. Moreover, a net benefit of at least €1000 still has a likelihood of 88.2%. Conclusions In general, there was a high likelihood that Stress-Prevention@Work offers an appealing business case from the perspective of employers, but the employer should factor in the additional per-employee costs of the stress-reducing interventions. Still, if these additional costs were as high as €2981, then costs and benefits would break even. This study was registered in the Netherlands National Trial Register, trial code: NTR5527.
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Affiliation(s)
- Ben F M Wijnen
- Centre for Economic Evaluation, Trimbos-Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands. .,Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, P.O. Box 616, 6200, Maastricht, The Netherlands.
| | - Joran Lokkerbol
- Centre for Economic Evaluation, Trimbos-Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands.,Department of Public Mental Health, Trimbos-Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands.,Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Cecile Boot
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, VU University Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands.,TNO-VU University Medical Centre, Body@Work, Research Centre Physical Activity, Work and Health, Amsterdam, The Netherlands
| | - Bo M Havermans
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, VU University Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands.,TNO-VU University Medical Centre, Body@Work, Research Centre Physical Activity, Work and Health, Amsterdam, The Netherlands
| | - Allard J van der Beek
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, VU University Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands.,TNO-VU University Medical Centre, Body@Work, Research Centre Physical Activity, Work and Health, Amsterdam, The Netherlands
| | - Filip Smit
- Centre for Economic Evaluation, Trimbos-Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands.,Department of Public Mental Health, Trimbos-Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands.,Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, VU University Medical Centre, Amsterdam, The Netherlands
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Khan N, Kennedy A, Cotton J, Brumby S. A Pest to Mental Health? Exploring the Link between Exposure to Agrichemicals in Farmers and Mental Health. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E1327. [PMID: 31013861 PMCID: PMC6517992 DOI: 10.3390/ijerph16081327] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Revised: 03/08/2019] [Accepted: 04/09/2019] [Indexed: 01/20/2023]
Abstract
The current literature acknowledges that occupational exposures can adversely affect mental health. This review seeks to elucidate the current understanding of the effect of agrichemical exposure on mental health in the agricultural sector, including low-dose, chronic pesticide exposure. This scoping review adopted a snowballing and saturation approach. The review highlights inconsistencies in linking poor mental health and pesticide use. While some studies specifically showed that both high- and low-dose pesticide exposure were associated with poor mental health, consistent and rigorous research methods are lacking. The review also proposes terms to delineate exposure types described in the literature. The review outcomes direct efforts to protect the health, wellbeing and safety of farming communities across the globe.
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Affiliation(s)
- Nufail Khan
- School of Medicine, Deakin University, 75 Pigdons Road, Waurn Ponds, VIC 3216, Australia.
- National Centre for Farmer Health, Western District Health Service, Hamilton, VIC 3300, Australia.
| | - Alison Kennedy
- School of Medicine, Deakin University, 75 Pigdons Road, Waurn Ponds, VIC 3216, Australia.
- National Centre for Farmer Health, Western District Health Service, Hamilton, VIC 3300, Australia.
| | - Jacqueline Cotton
- School of Medicine, Deakin University, 75 Pigdons Road, Waurn Ponds, VIC 3216, Australia.
- National Centre for Farmer Health, Western District Health Service, Hamilton, VIC 3300, Australia.
| | - Susan Brumby
- School of Medicine, Deakin University, 75 Pigdons Road, Waurn Ponds, VIC 3216, Australia.
- National Centre for Farmer Health, Western District Health Service, Hamilton, VIC 3300, Australia.
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Hoge A, Ehmann AT, Rieger MA, Siegel A. Caring for Workers' Health: Do German Employers Follow a Comprehensive Approach Similar to the Total Worker Health Concept? Results of a Survey in an Economically Powerful Region in Germany. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16050726. [PMID: 30823428 PMCID: PMC6427417 DOI: 10.3390/ijerph16050726] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 02/22/2019] [Accepted: 02/26/2019] [Indexed: 11/16/2022]
Abstract
Similar to ‘Total Worker Health’ in the United States (USA), ‘Workplace Health Management’ in Germany is a holistic strategy to protect, promote, and manage employees’ health at the workplace. It consists of four subcategories. While the subcategories ‘occupational health and safety’ and ‘reintegration management’ contain measures prescribed by law, ‘workplace health promotion’ and ‘personnel development’ can be designed more individually by the companies. The present study focused on the current implementation of voluntary and legally required measures of the four subcategories, as well as companies’ satisfaction with the implementation. A total of N = 222/906 companies (small, medium, and big enterprises of one German county) answered a standardized questionnaire addressing the implementation of health-related measures, satisfaction with the implementation, and several company characteristics. In the subcategory ‘occupational health and safety’, 23.9% of the companies fulfilled all of the legally required measures, whereas in the category ‘reintegration management’, that rate amounted to 50.9%. There was a positive correlation between company size and the implementation grade, and as well between company size and the fulfilling of measures required by law. Companies tended to be more satisfied with higher implementation grades. Nevertheless, a surprisingly high proportion of the companies with poor implementation indicated satisfaction with the measures’ implementation.
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Affiliation(s)
- Aileen Hoge
- Institute of Occupational Medicine, Social Medicine and Health Services Research, University Hospital Tübingen, Wilhelmstraße 27, 72074 Tübingen, Germany.
| | - Anna T Ehmann
- Institute of Occupational Medicine, Social Medicine and Health Services Research, University Hospital Tübingen, Wilhelmstraße 27, 72074 Tübingen, Germany.
| | - Monika A Rieger
- Institute of Occupational Medicine, Social Medicine and Health Services Research, University Hospital Tübingen, Wilhelmstraße 27, 72074 Tübingen, Germany.
| | - Achim Siegel
- Institute of Occupational Medicine, Social Medicine and Health Services Research, University Hospital Tübingen, Wilhelmstraße 27, 72074 Tübingen, Germany.
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