Total Worker Health® Video Series for Small Businesses
As part of the center’s education translation/small business outreach project, a series of short videos (~3-7 minutes) were developed to assist professionals in small Midwestern businesses identify and implement “best and promising practices” for improving worker health and wellbeing. Utilizing a peer-to-peer model, the videos focus on case studies from small business (<250 employees) that have adopted best practices and shown innovation, with the goal of persuading and instructing other small businesses on how to implement a total worker health program. Video content comes from site visits with workplaces that have been recognized for having exemplary health protection and/or health promotion programs. Interviews were coded using a combination of the NIOSH Essential Elements and supplemented with criteria used to assess best practices and worksite assessments to identify key themes for the site visits.
This project provides first-hand experience in developing, implementing, and evaluating case-study videos related to health promotion and health protection topics. It will further examine how a series of tutorial videos can facilitate the adoption of integrated workplace health promotion/health protection activities among small employers. Videos will be widely disseminated through the Healthier Workforce Learning Network and multiple communication channels including the HWCE website, monthly bulletin, social media channels, presentations and conferences.
What have Iowa employers implemented to protect workers’ health and safety?
Employers have lots of areas of need in order to effectively address employee total health management. The Institute of Medicine identified 12 key areas of total health management, such as wellness programs, absence management, disease and case management, health plan design, behavioral health, and occupational and environmental health. A study by the Healthier Workforce Center at the University of Iowa, funded by the National Institute of Occupational Safety and Health, examined the degree with which Iowa employers have implemented each of the 12 areas. Results published in the Journal of Occupational and Environmental Health in December 2014 suggest that employers are implementing less than 30% of each of 10 of the 12 components. The exception is that approximately half have implemented occupational safety and health, and nearly 90% have workers’ compensation insurance coverage.
Findings from Healthier Workforce Center Survey Shows Employment Status Matters in Iowa
In 2010, as part of the Real Iowans Research Initiative, the Healthier Workforce Center conducted a survey of 1271 Iowans to provide statewide employment sector estimates of health status, prevention behaviors, and productivity measures by employment status (self-employed, employed by an organization or currently unemployed, but seeking employment). Importantly, it also assessed whether measures of quality of life and prevention behaviors were linked with sickness absenteeism and presenteeism (self-rated job performance during the last four weeks). Results showed that higher quality of life measures and practicing more prevention behaviors are strongly associated with lower absenteeism and higher presenteeism scores. Findings were published in the Journal of Occupational and Environmental Medicine in July 2014, entitled Employment Status Matters—A Statewide Survey of Quality-of-Life, Prevention Behaviors, and Absenteeism and Presenteeism.
Participatory Ergonomics & Wellness Coaching Yield Health Improvements
Musculoskeletal pain (pain affecting the muscles, bones, or joints) is a very common complaint among workers and results in a large number of missed days from work and workers’ compensation claims. Nathan Fethke, professor of occupational and environmental health, received funding from the Healthier Workforce Center to develop and evaluate a workplace program to address this critical issue in a large window manufacturing company. His research combined wellness coaching for employee-identified issues (e.g., physical activity, stress reduction, weight loss) with a participatory ergonomic approach. Ergonomics is the science of designing and arranging equipment to fit the operator so that tasks can be completed more efficiently and safely. The ergonomic assessment was based on video footage of employees performing actual manufacturing tasks and was analyzed to reveal ergonomic issues that could be easily addressed by modifying the task, equipment, or physical position of the employee relative to the task. Participatory ergonomics makes full use of worker involvement in the assessment process, recognizing that the worker is the expert of his or her job. Employers then addressed those ergonomic problems by making changes to the equipment, work schedule, table height, etc. Both the wellness coaching and the ergonomic changes resulted in improvements in physical well-being. The wellness coaching also yielded significant improvements in self-reported overall health and fewer physical limitations. Findings from the study were published in the Journal of Occupational and Environmental Medicine.
Fethke NB, Merlino L, & Gerr F (2013). Effect of ergonomics training on agreement between expert and nonexpert ratings of the potential for musculoskeletal harm in manufacturing tasks. Journal of Occupational and Environmental Medicine. 55(Suppl. 12S):S82-S85.
Be Engaged: Help Integrate Protection/Promotion
Workplace wellness and safety are receiving increased attention. A recent study conducted by Linda Snetselaar, a professor of epidemiology, and colleagues tested a worksite intervention addressing wellness and ergonomics in six businesses. The study was funded through the Healthier Workforce Center at the University of Iowa. Many businesses fear that worksite wellness programs will not be adopted or sustained. Their study results showed that 90% of employees who started a group counseling program that included monthly group lunch sessions completed the program, and those who participated had lower absenteeism. This type of highly interactive and integrated short intervention can result in high levels of participation and may reduce absenteeism, a significant concern for many workplaces. Findings were published in Topics in Clinical Nutrition in January/March 2016, entitled A Participatory Integrated Health Promotion and Protection Worksite Intervention: A Cluster Randomized Controlled Trial.
Early Stage Breast Cancer and Return to Work
Early detection and treatment of breast cancer has led many women to be able to return to work, particularly those with early-stage cancer. While medical advances have been great, disparities for African American women remain. A pilot project funded by the Healthier Workforce Center of the Midwest to Christine Ekenga, PhD, a faculty member at Washington University at St. Louis, is examining factors that influence return to work as well as the quality of life for early-stage breast cancer survivors. Dr. Ekenga and her colleagues have already found that African American women, women with more fatigue, and uninsured or publicly insured women were less likely to have returned to work two years after initial diagnosis. The study results will be published in an upcoming issue of the journal, Cancer.
Corrections officers experience high rates of depression, obesity, musculoskeletal disorders, and heart disease. A pilot study was conducted by Lisa Jaegers, Ph.D., OTR/L at one urban and two rural jails in Missouri to determine corrections officer health and safety needs. The study found that job stress influenced the likelihood of workers experiencing depression. Proposed solutions were generated through participatory meetings which involved corrections officers and researchers. Potential solutions included recognition of positive work performance, enforcement of policies to take breaks, rotation of shifts, expansion of training, offering fresh food options, and reduction of the officer-resident ratio. A follow-up study is exploring work-related health changes over time to inform workplace interventions. The work has expanded to state systems and collaborations with national projects to advance corrections workplace health and safety using Total Worker Health.
Total Worker Health in Home-Based Childcare Workers
Consider how tired you are after spending a day with a toddler. Now multiply that experience with several children. Home-based child care workers likely experience occupational hazards including exposures risk factors for musculoskeletal problems, job strain, and the stress of managing the care of children while reassuring parents. However, little has been done to address the needs of these workers. A team of University of Iowa faculty led by Assistant Professor Matt Nonnenmann were awarded a pilot grant from the Healthier Workforce Center at the University of Iowa to identify common musculoskeletal problems and job strain that these workers experience. The long term goal of this project is to collect preliminary data for the development of a workplace intervention. Data collection is ongoing, however to date, the team has held one focus group and collected internet-based questionnaire data from 40 child care workers. Preliminary results suggest that 35% of these workers have experience an injury related to work, with the majority being a result of “overexertion and bodily reaction.” Of the body areas examined in the questionnaire, low-back pain was experience by 68% of respondents who reported an work-related injury with lifting items or children being the most common reported cause of the pain. Future research should consider interventions to reduce lifting activities associated with work in home based-child care.
Participatory Program for Designing Workplace Health Interventions
The workplace presents both challenges and opportunities for promoting worker health. Employee wellness programs are common, but their focus is often on the personal behaviors of workers that occur outside of the workplace and fail to recognize the workplace as a contributing factor in employee health. These programs are usually developed at the corporate level with little input from workers, resulting in poor worker participation and effectiveness. Ann Marie Dale, PhD from Washington University School of Medicine in St. Louis, received a pilot grant from the Healthier Workforce Center at the University of Iowa to test a participatory health promotion program in a retail work setting. The goal of the program was to form an advisory team of retail workers who could identify a safety and health issues at their store and to develop feasible workplace interventions to address the issues. Six retail workers participated in a worker Health Team to design an intervention from brainstorming to design process and relied on survey and focus group data form earlier formative evaluation work that identified workplace barriers and facilitators to employee health. Information was presented to the Health Team using an experience map to tell the story of “a day in the life of a retail worker”; the map provided a visual graphic, displaying a variety of information about work activities and thoughts and mood states over the work day and health data of the workforce. Throughout the design process, the Health Team and facilitator met one hour each week for eight weeks. Their interventions focused on improving store communication and educated employees on general health topics including healthy eating. The intervention activities developed by the Health Team are currently being evaluated by store management.
Violence Prevention Policies, Programs, and Practices in a National Sample of Mid-Sized Employers
Understanding how workplace violence prevention policies, programs, and practices compare with industry standards was added in a study by Carri Casteel and her colleagues with pilot project funding from the University of Iowa’s Healthier Workforce Center, one of four centers of excellence in Total Worker Health from the National Institute of Occupational Safety and Health. The team was particularly interested in understanding how policies, practices and programs vary by employer size. A survey was completed by members and key stakeholders of the Association of Threat Assessment Professionals whose members are large corporations and national sample of small and mid-sized businesses from the Dunn and Bradstreet business listing. Findings suggest that nearly all large businesses (97%) and small and mid-sized businesses (91%) have a workplace violence prevention program. Nearly all had policies for unacceptable behavior, anti-harassment and discrimination and a code of business conduct/ethics. Nearly 95% of large businesses and 83% of small businesses had policies on reporting of circumstances that raise employee safety concerns such as safety, substance use, and weapons on-site. Overall larger employers had more industry standards in place than small and mid-sized companies with the exception of policies allowing employers to inspect employer work spaces and/or devices which is more common in smaller employers. Reports of violence and possession of weapons were more frequent at larger companies and were more likely to include investigations. Findings and reports were shared in 2014 and 2015 at the Association of Threat Assessment Professionals which includes safety directors at Fortune 500 companies.
Inertial Measurement Units as a Tool for Simultaneous Worker Health Protection and Promotion
Nursing is physically demanding, placing nurses at risk for injuries, fatigue and poorer health outcomes when compared to other professions. In an effort to improve work conditions for nurses, hospitals have been shifting the way that they assign nurses to patients. Traditionally, hospitals use a total patient care model where a single nurse is assigned to several patients who may be located in different areas of the hospital. In contrast, in pod models, nurses work as a team in a particular physical area of the hospital. While pod models have resulted in improved patient access, professional communication, and job satisfaction among nursing personnel, the effects of pod nursing on other important outcomes related to nurse health such as exposure to physical risk factors, work-related fatigue, and physical activity have not been explored. Mark Schall, a postdoctoral research fellow and former trainee in the NIOSH funded Heartland Education and Research Center, and Nathan Fethke, a professor of Occupational and Environmental Health, received funding from the Healthier Workforce Center to examine the health impacts of the pod approach on nurses. Their research suggests that while pod nursing may be helpful for improving patient care and job satisfaction, the pod assignments did not result in less physical risks for nurses. Nurses in both job assignment models have similar job demands and risks. Results were published in Applied Ergonomics entitled, Working posture and physical activity among registered nurses and Evaluation of four sensor locations for physical activity assessment.
Total Worker Health™ among College Seniors and Recent Graduates
Differences in health and safety risks of those working in college versus recent graduates may be different. If so, different types of programs, policies, and practices may be needed to keep those workers safe and healthy. In March of 2015, a survey was conducted with recent alumni and undergraduate seniors at Grinnell College to examine trends in the transition from school to work. The study was funded by a pilot grant to Sophia Chiu, MD, MPH, from the Healthier Workforce Center for Excellence at the University of Iowa, one of four national centers in Total Worker Health™ funded by the National Institute for Occupational Safety and Health (NIOSH). Seventy students and 257 alumni completed the survey, which examined trends in workplace, personal risk factors, and injuries. Chiu and her colleagues compared the results from the 57 students and 212 alumni holding jobs. Current students and recent alumni answered very similarly on a number of factors, including no differences in perceptions of wellness, general health, injury rates, water consumption, stress, number of days of moderate or vigorous physical activity and weight, or management support for workplace health and safety. In general, all of these results were in a healthy direction with the exception being feeling stressed sometimes to fairly often. Differences were seen in safety training (students more likely), work life balance (students more supported), and personal health (students felt more supported). In terms of unhealthy personal risks, alumni used more smokeless tobacco than students. However, most personal risks were higher in students including hookah use, sedative use, ecstasy use, binge drinking, eating more sugar, eating more fast food, and eating fewer meals from home. Results suggest Total Worker Health™ needs may vary between students and recent college alumni.
Health Worksite Physical Activity Intervention For Ambulatory Clinic Registered Nursing Staff
Nursing is recognized as one of the most hazardous occupations, and nurses often work long and irregular work hours limiting their opportunities for engaging in healthy behaviors such as physical activity. Physical activity is not only good for the health of the employee, but can reduce safety risks and the number of sick days and work productivity. Sharon Tucker, a nursing professor at the University of Iowa, and her colleagues conducted a project funded by the Healthier Workforce Center at the University of Iowa to test the effectiveness of a workplace intervention with hospital nurses to increase low intensity physical activity on the job through workstation treadmills, walking meetings, stair climbing, gaming, and 3-minute video clips. Reinforcing text messages were also provided to employees. The intervention was successful in increasing physical activity in the workday by 22 minutes and decreasing absenteeism without reducing self-reported work productivity which is critical to other workplaces adopting these programs.
Efficacy of a Combined Ergonomic Health Promotion Intervention on Employee Health
Keeping employees healthy who work in sedentary jobs is an important public health problem. Recently, Lucas Carr, a professor of Health and Human Physiology, was funded by the Healthier Workforce Center to test an intervention to help office workers be more active. The intervention included replacing office workers’ sedentary workstations with active workstations and ergonomic adjustments to each employee’s workstation. The active workstation included a pedal machine that workers could use while engaging in regular work tasks at their desks. Those workers who received the intervention significantly increased the percent of daily work time spent engaging in physical activity. They used the pedal machines for nearly 50 minutes per day. Those that used the pedal machines also showed changes in multiple health outcomes including resting heart rate, weight, and percent body fat. These findings suggest that providing sedentary employees access to a relatively low cost, portable pedal machine that allows for engaging in light intensity activity while at work is an effective and potentially sustainable approach for improving the health of sedentary working adults. Results were published in the American Journal of Preventive Medicine in January 2016 entitled, Total Worker Health intervention increased activity of sedentary workers. Dr. Carr was also featured in over 100 news outlets including The Atlantic, Yahoo News, Christian Science Monitor, Consumer Reports on Health, Science Daily, and Iowa Public Radio.
Personal Noise Exposure Assessment Study for Food Servers Workers in Locally Owned Restaurants
Restaurants can be noisy workplaces for employees serving or preparing food, but little is known about their risk of hearing loss. Deirdre Green, a trainee in the NIOSH funded Heartland Education and Research Center, and Renée Anthony, a faculty member in Occupational and Environmental Health, recently conducted a study funded by the Healthier Workforce Center at the University of Iowa to examine noise exposures in restaurants. Their study evaluated full shift noise exposure to workers at six college-town restaurants to examine risk factors associated with noise exposures on both days and weekends. Participants included cooks, counter attendants, bartenders, and waiters at full-service restaurants with bar service and at limited service restaurants that provided counter service only. Nearly 8% of the noise levels measured exceeded recommended guidelines from the National Institute for Occupational Safety and Health for maximum noise exposure. Those working in full service restaurants compared to counter-only services and cooks were exposed to more excessive noise than others. Fall semester and weekend exposures to noise were higher than those in the summer or weekends. These results suggest that workers in these environments may require interventions to protect their hearing. Results were published in the Journal of Occupational & Environmental Hygiene in July 2015, entitled Occupational Noise Exposure of Employees at Locally-Owned Restaurants in a College Town.
Evaluating Stress Resilience: An Intervention to Reduce Stress and CVD Risk Factors in Police
Police often experience high levels of stress and a high incidence of cardiovascular disease. Sandra Ramey, a nursing professor, was recently funded by the Healthier Workforce Center to address this important need. Results from an intervention she developed and tested indicated improvement in resilience to stress, positive changes in heart rate, and lower levels of post-traumatic stress disorder and vital exhaustion, which include feeling of excessive fatigue, increased irritability and feeling demoralized. Understanding the levels of stress officers report and how to modify their reaction to stress may likely reduce rates of cardiovascular disease in police officers and may help police departments retain their employees. Results from the project were disseminated at the Total Worker Health Symposium in Bethesda MD, the American Public Health Association Annual Meeting in New Orleans, and to large audiences of police leaders at the International Association of Chiefs of Police in Alexandria, VA. Dr. Ramey provided testimony regarding ways to improve police officers’ health and wellness during President Obama’s Task Force [on 21st Century Policing] meeting in Washington on Monday, Feb. 23, 2013. Most recently, this research was highlighted in the September 2015 issue of Charting Nursing’s Future, a newsletter published by the Robert Wood Johnson Foundation.
Reducing Injuries and Helping the Bottom Line: Safety & Health in Midwest Businesses
A regional survey was conducted in Iowa, Kansas, Missouri, and Nebraska to assess the current level of adoption and integration of health and safety efforts among small employers. Findings revealed that nearly 87% of small employers have at least one safety program and 62% have at least one wellness program. The majority involved employees across departments and organizational levels in the design and implementation of programs/policies with the exception of top management. The HWC uses this information to improve outreach and education in the region including making the business case for why Total Worker Health efforts reduce injuries and help the bottom line.
Moving the Needle on Safety and Health in Nebraska
The Nebraska Safety Council/WorkWell is a NIOSH Total Worker Health Affiliate and a vital partner in the Healthier Workforce Center of the Midwest. They reach 554 Nebraska businesses ranging in size from 8 to 18,000 employees. They are currently revising safety and wellness courses and materials to reflect best practices in Total Worker Health. In 2017, 22 businesses were recognized by the Safety Program. All award recipients had below average injury/illness rates for the previous year. In addition, the Wellness Program has been able to demonstrate a 13% statewide reduction in tobacco use, a 26% increase in those meeting the Surgeon General Physical Activity Guidelines, and a 5% reduction in obesity. Seat belt use increased from 83 to 86%. Counties with greater employer and employee involvement saw even higher gains in use.
UI’s Healthier Workforce Center Creates Video Series to Promote Total Worker Health®
Employers are eager to learn about evidence-based programs, practices, and policies to improve their employees’ safety and health and to improve their organization’s bottom line. To meet that need, the University of Iowa’s Healthier Workforce Center for Excellence (HWCE) has created a series of free online videos designed to help small businesses utilize innovative techniques to incorporate programs, policies, and practices that can be tailored to their workplace. The video series combines interviews with small business leaders and occupational safety and health researchers. The series includes best practices in development, implementation, and evaluation of workplace programs. Taking a Total Worker Health® approach, a strategy developed by the National Institute for Occupational Safety and Health (NIOSH) that integrates occupational safety and health protection with workplace policies, programs and practices that promote health and prevent disease to advance worker safety, health and well-being, the Total Worker Health Essentials video series addresses development, implementation and evaluation. Short videos are also available that address additional topics identified by employers including ergonomics, stress, and safety. All videos include tips from small Midwestern businesses. The videos are available at HWCE.org.
Real Iowans Research Initiative Provides Statewide Data on Iowa Workforce
The Real Iowans Research Initiative arose out of the need for baseline, evidence-based data on the statewide workforce. More specifically, the initiative aimed to document Iowan’s perceptions and experiences related to health status, health care, prevention, employment and wellness. In 2010, the HWCE joined with the State Public Policy Group and David P. Lind & Associates to assess health care needs and views of Iowa employees, as well as non-employed Iowans. The Initiative engaged nearly 1200 Iowans from diverse sectors and population groups through three strategies: 1) personal interviews of Iowa stakeholders in key sectors, 2) focus groups of underserved and under-represented groups who were less likely to vote or participate in a telephone survey and 3) a population-based survey of Iowans registered to vote, ages 18-65.
Survey results were joined and analyzed with data from the Iowa Employer Benefits Study©. Findings provide valuable statewide estimates of workplace wellness program adoption among employers by size and location as well as individual health status, prevention behaviors and productivity measures by employment status. Results were compiled into two technical reports, Iowans Speak Out on Their Health and The Rural-Urban Divide, which can be accessed on the Healthier Workforce Center for Excellence website. Manuscripts were also published in the Journal of Occupational and Environmental Medicine and the American Journal of Health Promotion.
Casey Chosewood Shares Insights on His Work in Total Worker Health™ and Employment and Training Opportunities at NIOSH and CDC
Getting more skilled workers interested in careers and training opportunities in Total Worker Health and working at NIOSH and CDC is essential. In April 2015, Dr. L. Casey Chosewood, Director of the National Institute of Occupational Safety and Health (NIOSH) Office for Total Worker Health®, met with more than 30 graduate and postdoctoral students and occupational medicine residents at the University of Iowa’s College of Public Health. Dr. Chosewood gave an overview of career and fellowship opportunities at CDC and NIOSH including options many may not have considered prior to his talk such as the Epidemiological Intelligence Service. The opportunity was organized by the UI College of Public Health’s Healthier Workforce Center for Excellence (HWCE), one of NIOSH’s four Total Worker Health® Centers for Excellence, and the Heartland Center for Occupational Health & Safety.
Symposium Broadens View of Worker Safety and Health
Employers increasingly believe both safety and health are critical to the well-being of their workers and their businesses and are eager to learn and share the latest evidence-based strategies. In April 2015, more than 100 practitioners, employers, academics and students attended the 17th Annual Occupational Health Symposium which focused on Total Worker Health™. The conference was jointly sponsored by the National Institute of Occupational and Environmental Health’s funded Healthier Workforce Center for Excellence (HWCE) and the Heartland Center for Occupational Health & Safety in the College of Public Health at the University of Iowa. Dr. L. Casey Chosewood, Director of the NIOSH’s Total Worker Health Program, emphasized the importance of looking at the broader picture of worker well-being and how it is not reasonable to expect people to change their behavior when the environment is not facilitating their safe and healthy choices. Business leaders and researchers shared their expertise in addressing safety, ergonomics, psychosocial stress, prolonged sitting/lack of movement, fatigue, poor work organization and unhealthy food choices, all of which can be hazard in the workplace.
JOEM Total Worker Health Supplement Adds to Research Foundation for Total Worker Health™
The Healthier Workforce Center at the University of Iowa coordinated the publication of a Total Worker Health Supplement in the Journal of Occupational and Environmental Medicine in November 2013. Manuscript content was based on presentations from the 2012 Total Worker Health™ Symposium, also coordinated by the Center. The supplement is publicly available by open access and includes opening comments from NIOSH Director, Dr. John Howard, a commentary with experts’ views on Total Worker Health, seven reviews, four research articles and three research-to-practice articles. The supplement is considered foundational for expanding the scientific rationale for advancing the field of Total Worker Health and can be accessed at http://journals.lww.com/joem/toc/2013/12001.
2012 Total Worker Health™ Symposium Unites NIOSH & TWH Centers for Excellence
The University of Iowa Healthier Workforce Center for Excellence (HWCE) in the College of Public Health hosted the “Total Worker Health Symposium: Safe, Healthy and Cost-Effective Solutions” on November 29-30, at the Marriott Hotel in Coralville, IA. The Symposium convened researchers from NIOSH and all four of the NIOSH Total Worker Health™ Centers of Excellence for a Healthier Workforce to advance this critical research area. Community members and stakeholders from across Iowa and beyond were all in attendance. The symposium presented from the NIOSH-funded Centers of Excellence and NIOSH intramural research, documented the benefits and challenges of integrated health promotion and health protection in the workplace, and identified research gaps in this field that need to be addressed. Researchers and stakeholders came together from 18 states and Washington DC.