Preventing workplace violence

crime scene for vehicle search protect by yellow caution tapeInjury of death on the job is often associated with machinery in the agricultural and manufacturing sectors. What doesn’t come as readily to mind is workplace violence—bullying by a colleague or assault by an angry client are just two examples of violence on the job. And yet American workers experience nearly two million incidents of workplace violence every year.

Researching the causes and prevention of such violence, and then working in the field to establish consistent and affordable practices is at the heart of the work of the University of Iowa’s Injury Prevention Research Center (IPRC).

Established in 1991 with core funding from the Centers for Disease Control and Prevention, the center is multidisciplinary in its scope, and has been involved in bringing together research, policy, and practice to address everything from bullying by school kids to the recent heroin and opioid crisis and from drowsy driving to tractor injuries.

Preventing Armed Robbery 

Some of the center’s current work can be traced back to the early 1990s at the University of California, Los Angeles where then assistant professor Corinne Peek-Asa was directing a graduate student named Carri Casteel. As epidemiologists interested in the high rate of fatalities associated with armed robberies, the two women created a study focused on small, independently owned businesses, including convenience stores, motels, late-night restaurants, and liquor stores.

“At the time, armed robbery was responsible for 84 percent of workplace violence,” says Casteel. Casteel and Peek-Asa’s primary goal was to identify affordable prevention measures and to educate business owners about them.

Prevention strategies varied. They discovered that business owners were willing to devote resources to security equipment such as surveillance cameras, but owners were unaware of less expensive and more effective approaches such as cash control, increased visibility and lighting, and employee training. Lack of implementation of the less expensive but more effective strategies clued Casteel and Peek-Asa into the need for research that translated evidence-based practices into small business settings.

For example, they discovered that blocking access to a business after hours via window grates and other structural enhancements reduces visibility and actually leads robbers to prey on the establishment when it is open, putting more people—both employees and customers— in harm’s way. Keeping too much cash on the premises also attracts robbers, whereas announcing that a minimal amount of money is in the register and maintaining a regular deposit schedule also prevents robberies.

Extending the Study

Peek-Asa and Casteel successfully tested the effectiveness of their prevention program with liquor stores in Santa Monica, Calif., before embarking on a larger study of nearly 500 “mom and pop” grocery stores throughout Los Angeles. Tracking businesses for a full year and partnering with the Los Angeles Police Department to receive outcomes of robbery-related injuries, they found that their strategies significantly reduced employees-related assaults.

In 2008, the director of safety and research for the National Institute of Occupational Safety and Health (NIOSH), an agency of the Centers for Disease Control, reached out to the pair to pilot a variation of their program. This time, the program would be delivered by police officers rather than by researchers. Peek-Asa had recently joined the faculty of the University of Iowa College of Public Health, where she is now a professor of occupational and environmental health. Working in conjunction with the International Crime Free Association, she and Casteel — now an associate professor in the same department at the UI — piloted the program in six communities nationally, including Iowa City, Cedar Rapids, and Coralville.

Peek-Asa says the program was a success in that, “we learned a lot about dissemination and working with law enforcement. This is important because after a robbery, one of small businesses’ point of connection is with the police.”

However, the rapid turnover of personnel on police forces also made it difficult to maintain consistency in delivering the material. The project continues and is now disseminated online, with a community leader gathering an advisory team to help identify partners.

Types of Workplace Violence

Robbery is but one example of workplace violence. Casteel and Peek-Asa have created a well-respected and recognized topology of workplace violence. They identify four different kinds of workplace violence:

  • the perpetrator has criminal intent against the business, such as in a robbery;
  • the main relationship is a service relationship between the perpetrator and the business, such as when a patient becomes angry at his or her treatment in a hospital;
  • the perpetrator is a current or former worker who is disgruntled at the business;
  • the perpetrator has a personal relationship with a worker, such as in a domestic violence situation.

One industry that has notoriously high rates of assault against workers by clients is health care. Unlike small, independent businesses, however, it is an industry that benefits from strong advocacy groups. One such group, the Emergency Nursing Association, worked with California’s Office of Occupational Safety to create the nation’s first hospital security act in 1995.

To study the effectiveness of this new law, Peek-Asa and Casteel compared security measures and violent event rates in California’s hospitals to those in New Jersey, which did not then have a similar law. They found a 48 percent reduction in assault rates among emergency department and psychiatric unit workers. Based on the success of the California law, the pair worked closely with stakeholders to help advocate for a similar law in New Jersey.

“Seeing our research culminate in policy change was very satisfying,” says Casteel.

Protecting Employees

IPRC has more recently been involved in a project with one of the world’s largest corporations— The Boeing Company. “Boeing is very proactive in recognizing and responding to the threat of workplace violence,” says Casteel, “particularly in the form of worker-on-worker violence.”

They partnered with Boeing’s threat assessment team to run simulations and assess how important such organized teams and clear protocol are to mitigating workplace violence. The answer? Very. The only scenario that proved challenging despite the protocols was one involving stalking. This is an area that Peek-Asa and Casteel believe most workplaces underestimate as potentially dangerous, and yet it’s also an area where businesses have a surprising degree of ability to help control and diminish potential risk.

“When someone is being stalked or is the victim of domestic violence, they still have to go to work,” notes Peek-Asa. This puts them in danger as the would-be perpetrators know when and where to find them. But what many businesses don’t fully appreciate is that they can control the environment by providing the employee with an escort or working with the police. In some cases, businesses can even take out a restraining order when the individual cannot.

“We really want to take the lessons we learned with Boeing,” says Peek-Asa, “and apply them to mid-size and smaller businesses. We want these lessons to be applicable to the kinds of businesses we have here in Iowa.”

This story originally appeared in the Fall 2016 issue of InSight

Encouraging the art of empathy

illustrations of young people with laptop, backpacksI AM FROM FRIED MOZZARELLA.



These are words written by Cedar Rapids, Iowa, middle school students who participated in an activity to get them talking about bullying and identity using art and expression. First, the students answered questions like: What is your favorite food? What is your favorite season? What is something cruel that has been said to you? Then, the students put the words “I am from” in front of their responses, creating poems to share with their peers.

The “I am from” poem helps students learn that we all share experiences of pain and joy and have something to learn about everyone. It is just one of many activities described in a new web toolkit launched in early 2016 called HEAR: Helping Educators Use Art to Reduce Bullying. The toolkit, aimed at teachers, youth group leaders, and others working with middle and high school students, is a collaboration between the University of Iowa College of Public Health, UI Injury Prevention Research Center (IPRC), and Working Group Theater based in Iowa City.

Emotions and Empathy

Focusing on the emotional side of bullying is exactly what researchers hope will help create empathy among students and a culture that does not accept bullying behavior.

“Current bullying prevention programs take a traditional approach, providing information in a classroom, much like math and reading are taught,” says Corinne Peek-Asa, director of the IPRC and principal investigator of the HEAR project. “However, teenage brains have a very active emotional center, and neurological research shows that the intellectual area of their brains — those that allow mature decision making — are not fully mature until teenagers reach their early 20’s.”

The HEAR web toolkit is an extension of the Out of Bounds project, a play about cyberbullying commissioned by Hancher and funded by the Iowa Arts Council. The Working Group Theater (WGT) began developing the play in 2013, around the same time that Marizen Ramirez, associate director for science at the IPRC, was conducting research on the effectiveness of anti-bullying policies in Iowa schools. The team sponsored a community event to gather feedback and inform the play’s development.

The WGT also interviewed local families, guidance counselors, and police officers about their experiences with bullying. The outcome: Out of Bounds toured 18 schools in eastern Iowa in 2013 and later won a prestigious award that helped support a national tour in early 2016.

illustration of a young woman talking on a cell phoneThe Moment of Choice

Jennifer Fawcett, one of the founders of WGT, said former friends of a young woman who was interviewed for the Out of Bounds project knew what they were supposed to do as bystanders in a bullying situation, but still chose not to do it.

“With the play, and then the toolkit activities, we wanted to pinpoint that moment of choice so students would think about what kind of choice they would make,” Fawcett says.

“The problem with an issue like bullying is that it can be reduced to slogans which are easy to say, but very hard to do,” Fawcett continues. “The exercises in the HEAR toolkit give students an opportunity to reflect on how bullying affects their lives. They get to literally practice different behaviors and explore how they could effectively change the climate of their schools.”

In 2015, both the play and the toolkit were tested with students in five Cedar Rapids middle schools as part of a service learning course funded by the Roy J. Carver Charitable Trust and IPRC. In the course, led by IPRC researchers, 10 UI students first learned about the epidemiology of bullying and building community partnerships, and tried out several of the activities to use at the schools.

The UI students and several teachers then led the activities in participating classrooms. The UI students’ survey found that about 95 percent of the teachers at the middle schools had a positive or very positive impression of the play, and more than 90 percent felt their students were very or somewhat motivated to implement anti-bullying strategies after seeing it. The HEAR activities were also viewed favorably: “Teachers said that the activities encouraged reflection on bullying and allowed the students to creatively share their thoughts,” says Ramirez.

Creating a Positive Environment

Some HEAR activities focus on expressive and reflective writing: an anti-bullying poster, a letter to a bullying victim and perpetrator, and an anti-bullying pledge. Others center on drama, like acting out a real-life bullying situation and exploring ways to handle the conflict.

And with cyberbullying on the rise, other activities have students develop an anti-bullying Twitter campaign or draw a “selfie” of themselves—and then have their peers provide positive comments on it. Students thus have the opportunity to practice using positive language to change the impact of bullying.

“Bullying is a complicated issue, and this toolkit is one way we can encourage empathy and help youth create a positive environment,” says Peek-Asa.

The web toolkit is free and available at

This story originally appeared in the Spring 2016 issue of InSight

IPRC receives Safe States President’s Award

The University of Iowa Injury Prevention Research Center (IPRC) was recently honored with the 2016 Safe States Alliance President’s Award. This award recognizes a member who has been instrumental in assisting the Safe States Alliance president in achieving the organizational priorities of the alliance.

In presenting the award, Binnie LeHew, president of the Safe States Alliance, said all the IPRC staff members have been “critical to the Iowa Department of Public Health’s ability to build our injury and violence prevention program.” She added, “There have been many instances in which they came through when I was looking for a resource, help to finish a project, or brainstorm ideas for our national violence and injury prevention work.”

Lisa Roth, deputy director of the IPRC, accepted the award on behalf of the center.

The IPRC is based in the UI College of Public Health and is directed by Corinne Peek-Asa. The Safe States Alliance is a national non-profit organization and professional association whose mission is to strengthen the practice of injury and violence prevention.

From left: Lisa Roth, Carri Casteel, John Lundell, Binnie LeHew, Corinne Peek-Asa, and Marizen Ramirez
From left: Lisa Roth, Carri Casteel, John Lundell, Binnie LeHew, Corinne Peek-Asa, and Marizen Ramirez

Researchers create arts-based anti-bullying toolkit

Researchers at the University of Iowa College of Public Health’s Injury Prevention Research Center (IPRC) have collaborated with a local theater group to develop a toolkit of arts-based activities aimed at bullying prevention.

Logo for HEAR - Helping Educators Use Art to Reduce BullyingThe web-based toolkit includes activities such as reflexive writing, games, photo voice, and “complete the scene” short plays. It also includes information for the activity leaders on how to prepare for the activities and have productive conversations about a difficult subject.

According to Dr. Corinne Peek-Asa, professor of occupational and environmental health, the toolkit was tested through a College of Public Health service learning class. “The feedback we received was very positive,” she says. “The students and teachers really enjoyed this interactive approach to addressing bullying.”

The kit is free and can be used by anyone interested in bullying prevention activities, including schools, youth groups, after school program, churches, and clubs. There are a number activities for different age groups, but any activity can be modified to fit a particular age group.

HEAR (Helping Educators use Art to Reduce bullying) is collaboration between the IPRC and Working Group Theater that began with the creation of “Out of Bounds,” a play developed for student audiences in elementary, junior, and high schools to spark conversation about bullying.

Neurological research shows that adolescent and teenage brains have a very active emotional center, making them receptive to arts-based messaging. By stimulating an emotional reaction to bullying, researchers hope teens will better understand bullying behavior and how to prevent it.

The HEAR toolkit is available at: