Workshop will focus on advancing worker health and safety

An upcoming workshop will examine ways to advance scientific research into worker health and safety, and develop recommendations to guide the design of future studies.

portrait of Diane Rohlman
Diane Rohlman

The Total Worker Health® Research Methodologies Workshop, to be held be March 7-8, 2017, at the University of Iowa College of Public Health, 145 N. Riverside Dr., Iowa City, will convene a distinguished group of nationally and internationally known experts in worker safety and health, research design, and health communication.

Diane Rohlman, PhD, associate professor of occupational and environmental health and director of the Healthier Workforce Center of the Midwest, based at the University of Iowa, says the ultimate goal is to create a safe, healthy, and productive workforce.

“We know there’s more and more evidence that work impacts overall health,” she says, citing obvious hazards, including chemical exposures, to less apparent factors, such as having a stressful job or an aggressive co-worker. “What is it about the work environment that we can control to decrease some of these hazards?”

Advancing worker well-being

The National Institute for Occupational Safety and Health (NIOSH) defines Total Worker Health® as policies, programs, and practices that integrate protection from work-related safety and health hazards with promotion of injury and illness prevention efforts to advance worker well-being. NIOSH is the federal institute that conducts research and makes recommendations for preventing work-related injuries, illnesses, and deaths, under the U.S. Centers for Disease Control and Prevention (CDC.)

The workshop will include a video message from NIOSH Director Dr. John Howard to welcome the experts collaborating on the Total Worker Health® prevention approach.

“Integrated interventions that collectively address worker safety, health, and well-being help to align with the recognition that work influences overall health,” Howard says. “The Total Worker Health® philosophy advocates for the integration of occupational safety and health protection in the workplace, advancing overall worker health and well-being through the elimination or control of workplace hazards.”

Healthier Workforce Center of the Midwest logoThe Healthier Workforce Center of the Midwest – a partnership of the UI College of Public Health, Washington University in St. Louis, and the Nebraska Safety Council – is hosting the workshop.

Rohlman says the workshop will address recommendations and goals set forth in a previous National Institutes of Health “Pathways to Prevention” workshop.

Strengthening research

Experts from across the country will discuss design limitations in Total Worker Health ® research; appropriate control groups in studies to assess the effectiveness of interventions; guidelines for selecting comparison groups; and more.

Rohlman notes that literature of worker health studies on integrated interventions is sparse, with the effectiveness of those interventions and outcomes unclear.

Some studies address health and safety outcomes, such as physical and psychological well-being, health symptoms, and stress, while others address intermediate health outcomes, including tobacco cessation, weight, blood pressure, eating behaviors, and hazardous work exposures.

With limited evidence to determine overall harms or benefits of integrated interventions, however, it is difficult to assess their effectiveness, Rohlman says.

Workshop participants will develop a core set of measures and outcomes to be incorporated into all integrated intervention studies and expand research and evaluation design options to include rigorous methodologies.

Rohlman says part of the focus will include identifying methods that can be replicated across all sizes of businesses. Smaller businesses, in particular, have higher injury rates, she notes, which is often attributed to having fewer resources to devote to health initiatives.

Participants also will come up with standard methods to determine if the interventions to decrease exposures to work hazards are working or not, and develop guidelines for researchers to replicate and compare studies.

Learn more at:

A new approach for advancing worker well-being

photo of woman with back painWe all have those days—work is stressful, your cell phone keeps buzzing, you’re tired after working a double shift, and the last thing you want to do when you get home is cook a healthy meal or hit the gym. No matter what type of work we do, it can follow us home, and our personal lives don’t stop just because we’re on the clock.

“We can’t really separate work from home and home from work,” says Diane Rohlman, CPH associate professor and director of the Healthier Workforce Center of the Midwest (HWCM) based in the UI College of Public Health. “The workplace has a huge impact on our health.”

It’s no surprise that ill health and chronic conditions impact performance at work, increasing the risk for serious injury, absenteeism, and reduced productivity. However, it’s also true that work-related exposures, such as noise, chemicals, and long hours, impact health and chronic conditions.

“Our center tries to target the aspects of the workplace that increase the risk of injury and illness and mitigate those effects,” says Rohlman. “Our goal is to understand where those risk factors are coming from, and how, from the workplace perspective, to prevent them.”

Total Worker Health

The center uses the Total Worker Health™ (TWH) approach to promote a safer and healthier workforce. The National Institute of Occupational Safety and Health, which funds the HWCM along with six other centers nationwide, defines TWH as “policies, programs, and practices that integrate protection from work-related safety and health hazards with promotion of injury and illness prevention efforts to advance worker well-being.”

“It’s a holistic view of all the factors that contribute to workers’ health and well-being,” Rohlman says. In addition to workplace hazards that can result in on-the-job injuries, other influences—stress, sedentary jobs, the workplace culture—also present health risks.

“There are factors in the workplace, such as stress, that cause people to engage in unhealthy behaviors when they’re off work,” says Shelly Campo, CPH associate professor and HWCM outreach director. “There are cultures of work that can impact health behavior, too.”

For example, Rohlman once asked a construction worker why he chose to smoke during his downtime. “He said, ‘Because it’s our break, and that’s what you do.’ We need to understand more about how and why this happens so that we can protect the safety and health of our workers both in the short- and long-term,” Rohlman explains.

A Look at the Midwest

Workers in Iowa and neighboring states experience more work-related injuries and illnesses than in other parts of the U.S., according to the CDC. The region also has higher rates of heavy alcohol consumption and obesity than other areas of the country, with high rates of occupational fatalities.

Recognizing the critical needs in the region, particularly among small employers, the HWCM recently underwent an expansion to include Iowa, Nebraska, Missouri, and Kansas. The University of Iowa is working in partnership with Washington University in St. Louis and the Nebraska Safety Council to provide increased attention to these issues.

Research and Outreach

construction workersThe HWCM conducts research addressing Total Worker Health outcomes and collaborates with researchers, employers, and occupational safety and health practitioners to generate, evaluate, and disseminate best practices.

Among its numerous research projects, the center has conducted statewide surveys to identify the burden of occupational injury and illness and to identify needs of employed and self-employed workers and employers.

Investigators have also researched musculoskeletal pain (pain affecting the muscles, bones, or joints), a common complaint among workers that results in a large number of missed work days and workers’ compensation claims. Nathan Fethke, CPH associate professor of occupational and environmental health, developed and evaluated a workplace program to address musculoskeletal pain among workers in a large window manufacturing company. His research combined wellness coaching for employee-identified issues (e.g., physical activity, stress reduction, weight loss) with an ergonomic approach. 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.

The HWCM also funds pilot projects for students, new investigators, and community projects. “We try to expand the scope of research through our pilot program and engage other researchers throughout Iowa and the Midwest,” says Rohlman. “We’re able to work with a lot of small businesses—that’s one of the things that makes our center different.”

New Partnerships

One of the center’s recent projects is focusing on new employees in the construction industry. Nationally, construction is one of the most dangerous occupations and has the highest number of fatalities of any type of job. Irregular employment, lengthy commutes, multiple job sites, and long workdays can cause psychological stress and can lead to risky health behaviors such as poor diet and substance use. New construction workers are at even greater risk, according to the Bureau of Labor Statistics.

To address these issues, the HWCM is partnering with the Carpenters’ District Council of Greater Saint Louis and Vicinity and the International Brotherhood of Boilermakers, Iron Ship Builders, Blacksmiths, Forgers, and Helpers to evaluate the impact of work organization and work environment factors on the health and health behaviors of apprentices in three construction trades.

The center has also formed new partnerships with the Iowa League of Cities and the Iowa Municipal Workers’ Compensation Association. Center representatives have visited towns across Iowa, including Atlantic, Waukee, Carroll, and Fairfield, to learn about the safety and health issues facing municipal workers and the policies, programs, and practices being used to address them. Center staff have also presented at several conferences and workshops around the state.

Resources for Employees

The HWCM offers free resources for employers, including a series of short videos that assist professionals in small Midwestern businesses to identify and implement “best and promising practices” for improving worker health and well-being. The videos help small businesses use innovative techniques to tailor the Total Worker Health approach to their workplaces.

The center is eager to form new collaborations as part of its expansion and connect communities and small businesses with free resources, training, and pilot grant opportunities.

“We encourage a broad range of partners, including businesses, municipalities, not-for profit organizations, and labor unions, to collaborate with us,” says Campo.

Learn more about the center at

This story originally appeared in the Fall 2016 issue of InSight.

Expanded Healthier Workforce Center of the Midwest supports employers’ health and safety efforts

The University of Iowa recently received funding to launch and expand the Healthier Workforce Center of the Midwest, a new regional resource to help employers promote safety and health in the workplace.

The expanded center (formerly the Healthier Workforce Center for Excellence) is part of a new, five-year commitment from the National Institute for Occupational Safety and Health and will be implemented in partnership with Washington University in St. Louis and the Nebraska Safety Council. Housed in the UI College of Public Health, the center will serve as a resource for policies, programs, and practices that integrate protection from work-related safety and health hazards with health promotion to advance worker well-being.

Diane Rohlman, PhD, associate professor of occupational and environmental health and director of the Healthier Workforce Center of the Midwest (HWCMW), believes this expanded effort will better serve the needs of workplaces throughout the region.

“Our partnerships in Nebraska, Missouri, and Kansas will help us leverage even more practical and research expertise to help businesses succeed and to maximize the safety and health of our workers,” says Rohlman.

According to the U.S. Centers for Disease Control and Prevention, workers in Iowa and neighboring states experience more work-related injuries and illnesses than in other parts of the country. The region also has higher rates of unhealthy behaviors such as heavy alcohol consumption and obesity, which contribute to high rates of occupational fatalities.

HWCMW outreach director Shelly Campo, PhD, associate professor of community and behavioral health, says the center is eager to partner with a broad range of organizations including businesses, municipalities, not-for profit organizations, and labor unions.

“The center offers a variety of free resources, training, and pilot grant opportunities for community organizations, businesses, and researchers,” Campo says. “We look forward to collaborating with these partners to address workplace safety and health issues around Midwest.”

For more information, visit:


Researchers study benefits of prototype welding system

Many jobs and occupational tasks expose workers to multiple health hazards, and a recent study by researchers at the University of Iowa demonstrates the importance of using a multidisciplinary approach to hazard evaluation and control.

Welding shear stud connectors to structural steel is a common task in commercial building and bridge construction. The task requires structural ironworkers to adopt a stooped posture for prolonged periods of time, which can increase the risk back injuries. The stooped posture also increases these workers’ exposure to inhalation of welding fume containing nanoscopic metal particles, which is associated with a variety of respiratory and neurologic outcomes.

Nathan Fethke and Thomas Peters, both faculty in the Department of Occupational and Environmental Health, partnered with a local ironworker apprenticeship training facility to evaluate a novel prototype system that allows ironworkers to stand when welding shear stud connectors. Results of their evaluation were published in the April 2016 issue of The Annals of Occupational Hygiene. Compared to conventional methods, use of the prototype system substantially improved back posture and reduced the concentration of welding fume in the breathing zone.

As with most prototype designs, however, refinement is necessary before the system is usable in the field.

“The prototype was successful in reducing exposure to welding fume, but certain limitations were apparent that may necessitate additional fume control,” says Fethke. He also indicated that work is needed to increase general durability and usability of the upright system, and to reduce other aspects of biomechanical demands in addition to poor posture (such as muscle effort).

According to Fethke, a major strength of the study was its consideration of both ergonomics and industrial hygiene in the approach.

“Engineering interventions to reduce occupational injury and illness are frequently designed to address a single exposure or problem, or are evaluated using the sometimes narrow lens of one particular discipline,” Fethke noted. “I believe the multiple occupational safety and health disciplines represented on our research team greatly contributed to the overall success of the project. We also had a heck of a lot of fun working together.”

In addition to Fethke and Peters, the research team included Stephanie Leonard and Mahmoud Metwali from the Department of Occupational and Environmental Health, along with Imali Mudunkotuwa from the UI’s Department of Chemistry.

This study was supported by the Center for Construction Research and Training through its cooperative agreement with the National Institute for Occupational Safety and Health (NIOSH).

To read the full paper, visit:

Panel chaired by public health dean reports on Total Worker Health interventions

Sue Curry 2016A national panel of independent experts, chaired by University of Iowa College of Public Health Dean Sue Curry, has issued a new report evaluating the evidence for Total Worker Health interventions as well as a set of recommendations to advance the science of such efforts to improve the overall health of American workers.

The report concluded that a small body of evidence suggests that Total Worker Health (TWH) interventions — which aim to integrate injury and illness prevention efforts with work-related safety and health efforts — may help employees improve some health behaviors, but more research is necessary to determine whether these interventions decrease injuries or improve overall quality of life.

The report, published in Annals of Internal Medicine, summarizes a scientific review conducted by researchers for the Agency for Healthcare Research and Quality (AHRQ), along with expert presentations and public comment at a 1.5-day workshop held in December 2015. The report also includes a response from the National Institute of Occupational Safety and Health (NIOSH), which first introduced the TWH model in 2011.

“While evidence was slim in most areas of interest, the researchers did find limited evidence that integrated Total Worker Health interventions can improve health behaviors, such as reducing tobacco use and sedentary behavior and improving diet,” noted Curry. “Our recommendations plot a course to support continued development of the science of integrated interventions in TWH research. Included in these recommendations is the critical need for investment in infrastructure to support the development of a seminal body of research.”

The full report is available online at

‘Local ID Cards and Community Health’ discussion is May 6

Local ID Cards and Community Health

A collaborative evaluation of community-driven policies in Johnson County, IA and Washtenaw County, MI

May 6, 2016
11:30 am-1:00 pm

CBH Visiting Scholar Nicole Novak and Irund A-wan, vice president of the Center for Worker Justice of Eastern Iowa, will share the results of a collaborative evaluation of the Johnson County Community ID, a local government-issued photo ID designed to improve resource access for Johnson County residents who cannot access state ID or driver’s licenses.

They will be joined by researchers and community advocates conducting a “sister study” of the Community ID program in Washtenaw County, Michigan.


Sponsored by the University of Iowa College of Public Health and Health Equity Advancement Lab (HEAL).