Assessing and intervening on OSH programmes: effectiveness evaluation of the Wellworks-2 intervention in 15 manufacturing worksites

Safety and Health Management System, Safety Climate, and Accident Occurrences in Hospitals: The Study of Needlestick, Sharp Injuries and Recidivism Rates

Background

Hospital Safety and Health Management System (HSH-MS) and Hospital Safety Climate (HSC) are the significant elements to develop safe work practices. The current study aimed to examine the dimensions of HSH-MS and HSC and the association with the prevalence of Needlestick and Sharp Injury (NSI) and NSI recidivism.

Materials and Methods

A cross-sectional study was conducted among 1070 nurses in Iranian hospitals (89% response rate).

Results

More than 54% (n = 579) had sustained at least 1 NSI in the previous year. The NSI recidivism rate was 8.6% and recidivists were more likely to be younger, female, married, with higher Body Mass Index (BMI), and on night shift. Two aspects of HSH-MS including management leadership and employee participation were associated with the incidence of NSIs Odds Ratio (OR): 1.91 and 95% Confidence Interval (CI): 0.69-1.21; OR: 1.29 and 95% CI: 0.92-1.82) and NSI recidivism rate (OR: 1.98 and 95% CI: 0.55-1.74; OR: 1.12 and 95% CI: 0.83-1.49). Furthermore, three dimensions of HSC comprising management support (OR: 1.02 and 95% CI: 0.93-1.11 for NSIs; OR: 1.21 and 95% CI: 0.77-1.22 for NSI recidivism), absence of job hindrances (OR: 1.06 and 95% CI: 0.98-1.16 for NSIs; OR: 1.11 and 95% CI: 0.96-1.30 for NSI recidivism) and cleanliness/orderliness (OR: 1.07 and 95% CI: 0.98-1.08 for NSIs; OR: 0.84 and 95% CI: 0.87-0.97 for NSI recidivism) were correlated with reduced NSIs risk.

Conclusions

This study suggests that HSH-MSs and employees' safety climate are significant factors, which are correlated with not only the prevalence of recurrent NSIs but also the single NSI in hospitals.

Evaluation of Occupational Health and Safety Management of Listed Companies in China’s Energy Industry Based on the Combined Weight-Cloud Model: From the Perspective of FPE Information Disclosure

Protecting labor safety and health and actively carrying out occupational safety and health management (OSHM) is a common need worldwide, and it is also one of the important efforts of Chinese enterprises under the background of promoting the implementation of the Healthy China strategy. Based on in-depth thinking on the current stage of OHSM, this study incorporated “management framework, management process, management effectiveness” (FPE) into an integrated framework and constructed an FPE evaluation system for enterprise OHSM. This study innovatively collected and refined FPE information from the perspective of information disclosure and used the combined weight cloud model to evaluate the occupational health and safety management level (OHSML) of 69 listed companies in China’s energy industry from 2009–2019. The results showed the following. (1) The OHSML of most listed companies in China’s energy industry was still at a low-end level. Among the companies that have issued relevant information reports, only 5.58% (S = 30) of the sample companies’ OHSML were at an acceptable level (Level IV) or declarable level (Level V). The OHSML comprehensive evaluation level of 92.56% (S = 498) of the sample companies was between the transitional level (Level III) and the improved level (Level II). (2) During 2009–2019, although the annual OHSML of listed companies in China’s energy industry showed an upward trend, the growth rate was low, and even the OHSML of some listed companies in the energy industry showed the characteristics of reduced fluctuations. (3) From the perspective of the PFT three-dimensional subsystem level of OHSM, the evaluation level of the governance framework subsystem was the highest, whereas the evaluation level of the management process subsystem and the management effectiveness subsystem were relatively low. Finally, according to the relevant results, some suggestions were proposed to improve the OHSML of listed companies in China’s energy industry. These findings can provide guidance for companies to improve their OSHM performance.

Ergonomic work from home and occupational health problems amid COVID-19

BACKGROUND: The COVID-19 pandemic has displaced millions of people worldwide, forcing them to work from home offices in a situation of “new normal". Many home office workers were pushed to work in less than ideal settings in the pandemic situation. Work from home causes complications for employees related to their home workplaces lacking appropriate support from the employers. OBJECTIVE: This article aims to analyse how pandemic has changed and affected workplace ergonomics. We addressed, amidst the pandemic, how work is being performed, the layout of the workplace, and its effects on an employee at home workplace. METHODS: In this descriptive study, we used chain referral sampling to collect data from 273 home-based faculty members employed in the universities and HEIs of Pakistan. Finally, we used inferential statistics for our data analysis. RESULTS: Results showed that employees faced problems because they had no prior training for setting up an ergonomically proper workspace. According to the results based on home-based ergonomic examinations, difficulties were associated with using laptops, desktop computers, and nonadjustable seats with no functionalities of flexibility and armrests. CONCLUSIONS: It is vital to employ appropriate instruments and mechanisms, like risk assessment, feedback for the actions performed, and the deployment of adaptive measures (similar to the preventive system of management of occupational safety and health - OSH). These tools must be regularly utilised and/or modified as the scenario changes.

The associations between occupational health and safety management system programming level and prior injury and illness rates in the U.S. dairy industry

U.S. dairy workers suffer occupational injuries and illnesses at rates higher than the national average. Occupational health and safety management systems (OHSMS) have been proposed as a way to reduce injuries and illnesses for businesses of all types and sizes. The Occupational Safety and Health Administration (OSHA) On-Site Consultation Service provides assistance establishing an OHSMS to U.S. businesses. As part of this service, the consultants determine the level of OHSMS programming using the Safety and Health Program Assessment Worksheet (Revised OSHA Form 33). A total of 167 dairy industry records were obtained from OSHA. Forty-five of those records had both injury rate and OHSMS data. Using these records, a Spearman Rank-Order correlation was used to determine the strength and significance of the associations between prior injury rates and OSHA measured OHSMS programming level for dairy operations. Additional analyses were conducted to examine potential relationships between workforce size, injury rates, and OHSMS programming levels. There was a negative correlation between OHSMS programming level and injury rates, both for the overall OHSMS and by OHSMS component. Management Leadership was the OHSMS component most strongly associated with lower injury and illness rates. OHSMS interventions, as part of a comprehensive risk management approach for the U.S. dairy industry, may be warranted to help reduce the unacceptable number of injury and illnesses in the U.S. dairy industry. Further research is needed to determine if similar relationships between OHSMS programming and injury rates occur in other industries.

Building Capacity for Integrated Occupational Safety, Health, and Well-Being Initiatives Using Guidelines for Total Worker Health® Approaches

OBJECTIVES

To describe the process used to build capacity for wider dissemination of a Total Worker Health® (TWH) model using the infrastructure of a health and well-being vendor organization.

METHODS

A multiple-case study mixed-methods design was used to learn from a year-long investigation of the experiences by participating organizations.

RESULTS

Increased capacity for TWH solutions was observed as evidenced by the participation, plans of action, and experience ratings of the participating organizations. The planning process was feasible and acceptable, although the challenges of dealing with the COVID-19 pandemic only afforded two of the three worksites to deliver a comprehensive written action plan.

CONCLUSIONS

A suite of services including guidelines, trainings, and technical assistance is feasible to support planning, acceptable to the companies that participated, and supports employers in applying the TWH knowledge base into practice.

Organizational Perspectives on How to Successfully Integrate Health Promotion Activities into Occupational Health and Safety

OBJECTIVE

There is increasing recognition of the value of integrating efforts to promote worker health with existing occupational health and safety activities. This paper aimed to identify facilitators, barriers and recommendations for implementing integrated worker health approaches.

METHODS

Thirteen stakeholders from different job sectors participated in a workshop that targeted key issues underlying integrated worker health approaches in their own and other organizations. Included were participants from human resources, occupational health and safety, government, and unions. Thematic analysis and an online ranking exercise identified recommendation priorities and contributed to a conceptual framework.

RESULTS

Participants highlighted the importance of planning phases in addition to implementation and evaluation. Themes highlighted organizational priorities, leadership buy-in, external pressures, training, program promotion and evaluation metrics.

CONCLUSIONS

Findings provide practical directions for integrating worker health promotion and safety and implementation steps.

The Impact of Enforcement Capabilities on the Effectiveness of Public Assessment on Occupational Safety

(1) Objective: The objective of this study was to evaluate the effect of enforcement capabilities on the efficacy of two public interventions to improve occupational safety in olive mills. (2) Method: The difference in efficacy was evaluated by comparing the risks detected in two groups in an initial assessment (with visits in the 2006-2008 period) to the risks detected in a later assessment, either after an intervention by Authorized Technicians with enforcement capabilities or after an intervention by Technical Advisors without enforcement capabilities (2011-2013). The assessments identified risks in the companies, according to a specific risk map for olive oil mill enterprises. (3) Results: Statistically significant differences were observed in the comparison of the risk reductions of the two groups, with regard to the initial assessment. The greatest reductions in risk were found in the companies that received interventions by Authorized Technicians with enforcement capabilities, in the sections of individual protection equipment and the storage of dangerous products. (4) Conclusion: Interventions by Authorized Technicians with enforcement capabilities are more effective than interventions by Technical Advisors without enforcement capabilities.

Interventions to Reduce Exposures in the Workplace: A Systematic Review of Intervention Studies Over Six Decades, 1960-2019

Background: Reducing occupational ill-health from chemical and biological agents is realized primarily through the mitigation and elimination of hazardous exposures. Despite evidence of declining exposure in European and North-American workplaces, comprehensive studies of the effectiveness of workplace interventions for reducing hazardous exposure and associated work-related ill-health seem rare. We reviewed occupational intervention studies targeting exposure to chemical and biological agents, and determined trends in frequency and quality of such studies. Methods: We searched Embase, Medline, and Web of Science for peer-reviewed original articles on occupational intervention studies published 1960-2019, aimed at reducing workers' exposure to dusts, gases, fumes, or liquids of chemical, biological, or mineral nature, or workers' risks for associated health outcomes. The frequency of articles, intervention types, intervention endpoints, and study quality of published intervention studies between 1960 and 2019 and according to 10-year intervals were analyzed. Results: Of 3,663 retrieved articles, 146 intervention studies were identified and reviewed, of which 63 concerned control measures, 43 behavioral change, 28 use of personal protective equipment, and 12 workplace policies. Intervention endpoints were occupational exposures (73%), health outcomes (22%), and a combination of both (5%). Of reviewed studies, 38% involved a control group, 16% randomized the intervention, 86% were planned interventions, and 86% compared exposure or health outcomes pre and post intervention. Over time the number of intervention studies identified in this search increased from none during 1960-1969 to ~60 during 2000-2009 and 2010-2019, respectively. The study quality improved over time, with no studies during 1960-1989 that complied with the highest quality criteria. During 2000-2009 and 2010-2019 16 and 12% of studies, respectively, were judged to be of highest quality. Conclusion: Despite an improvement over the last six decades in the frequency and quality of intervention studies targeting exposure to chemicals and biological agents, the absolute number of intervention studies remains low, particularly when considering only high quality studies. Occupational exposure to chemical and biological agents is still causing excessive disease in workforces worldwide. To reduce occupational ill-health caused by these exposures, it is important to expand the evidence on (cost-)effectiveness and transferability of interventions to reduce exposure and health effects.

Measuring Best Practices for Workplace Safety, Health, and Well-Being: The Workplace Integrated Safety and Health Assessment

OBJECTIVE

To present a measure of effective workplace organizational policies, programs, and practices that focuses on working conditions and organizational facilitators of worker safety, health and well-being: the workplace integrated safety and health (WISH) assessment.

METHODS

Development of this assessment used an iterative process involving a modified Delphi method, extensive literature reviews, and systematic cognitive testing.

RESULTS

The assessment measures six core constructs identified as central to best practices for protecting and promoting worker safety, health and well-being: leadership commitment; participation; policies, programs, and practices that foster supportive working conditions; comprehensive and collaborative strategies; adherence to federal and state regulations and ethical norms; and data-driven change.

CONCLUSIONS

The WISH Assessment holds promise as a tool that may inform organizational priority setting and guide research around causal pathways influencing implementation and outcomes related to these approaches.

Implementation of Safety Management System for Improving Construction Safety Performance: A Structural Equation Modelling Approach

The construction industry contributes to a large proportion of industrial injury and mortality. It is of high importance to evaluate the effectiveness of the Safety Management System (SMS). In particular, it is necessary to compare the quality and level of achievement of SMS and safety performance of a construction project. However, a sizeable sample of construction accidents is often not available. Therefore, possible proxies to indicate the safety performance were established. Moreover, the motivation factors which characterize the quality and level of achievement should be identified. In this study, a structural model has been established to examine the relationship between the SMS implementation and operational & safety performance of the construction projects. Results of the structural model illustrated the relationship between (i) SMS implementation and project safety outcome, (ii) SMS implementation and five motivation factors, and (iii) project safety outcome and six proxies. Results of this study have unfolded the motivation factors in SMS implementation and their subsequent effects on project performance, throwing light on the need to enhance the safety management practice in order to reduce accidents and injuries in the construction industry in the long run.

Strategies to improve the implementation of workplace-based policies or practices targeting tobacco, alcohol, diet, physical activity and obesity

BACKGROUND

Given the substantial period of time adults spend in their workplaces each day, these provide an opportune setting for interventions addressing modifiable behavioural risk factors for chronic disease. Previous reviews of trials of workplace-based interventions suggest they can be effective in modifying a range of risk factors including diet, physical activity, obesity, risky alcohol use and tobacco use. However, such interventions are often poorly implemented in workplaces, limiting their impact on employee health. Identifying strategies that are effective in improving the implementation of workplace-based interventions has the potential to improve their effects on health outcomes.

OBJECTIVES

To assess the effects of strategies for improving the implementation of workplace-based policies or practices targeting diet, physical activity, obesity, tobacco use and alcohol use.Secondary objectives were to assess the impact of such strategies on employee health behaviours, including dietary intake, physical activity, weight status, and alcohol and tobacco use; evaluate their cost-effectiveness; and identify any unintended adverse effects of implementation strategies on workplaces or workplace staff.

SEARCH METHODS

We searched the following electronic databases on 31 August 2017: CENTRAL; MEDLINE; MEDLINE In Process; the Campbell Library; PsycINFO; Education Resource Information Center (ERIC); Cumulative Index to Nursing and Allied Health Literature (CINAHL); and Scopus. We also handsearched all publications between August 2012 and September 2017 in two speciality journals: Implementation Science and Journal of Translational Behavioral Medicine. We conducted searches up to September 2017 in Dissertations and Theses, the WHO International Clinical Trials Registry Platform, and the US National Institutes of Health Registry. We screened the reference lists of included trials and contacted authors to identify other potentially relevant trials. We also consulted experts in the field to identify other relevant research.

SELECTION CRITERIA

Implementation strategies were defined as strategies specifically employed to improve the implementation of health interventions into routine practice within specific settings. We included any trial with a parallel control group (randomised or non-randomised) and conducted at any scale that compared strategies to support implementation of workplace policies or practices targeting diet, physical activity, obesity, risky alcohol use or tobacco use versus no intervention (i.e. wait-list, usual practice or minimal support control) or another implementation strategy. Implementation strategies could include those identified by the Effective Practice and Organisation of Care (EPOC) taxonomy such as quality improvement initiatives and education and training, as well as other strategies. Implementation interventions could target policies or practices directly instituted in the workplace environment, as well as workplace-instituted efforts encouraging the use of external health promotion services (e.g. gym membership subsidies).

DATA COLLECTION AND ANALYSIS

Review authors working in pairs independently performed citation screening, data extraction and 'Risk of bias' assessment, resolving disagreements via consensus or a third reviewer. We narratively synthesised findings for all included trials by first describing trial characteristics, participants, interventions and outcomes. We then described the effect size of the outcome measure for policy or practice implementation. We performed meta-analysis of implementation outcomes for trials of comparable design and outcome.

MAIN RESULTS

We included six trials, four of which took place in the USA. Four trials employed randomised controlled trial (RCT) designs. Trials were conducted in workplaces from the manufacturing, industrial and services-based sectors. The sample sizes of workplaces ranged from 12 to 114. Workplace policies and practices targeted included: healthy catering policies; point-of-purchase nutrition labelling; environmental supports for healthy eating and physical activity; tobacco control policies; weight management programmes; and adherence to guidelines for staff health promotion. All implementation interventions utilised multiple implementation strategies, the most common of which were educational meetings, tailored interventions and local consensus processes. Four trials compared an implementation strategy intervention with a no intervention control, one trial compared different implementation interventions, and one three-arm trial compared two implementation strategies with each other and a control. Four trials reported a single implementation outcome, whilst the other two reported multiple outcomes. Investigators assessed outcomes using surveys, audits and environmental observations. We judged most trials to be at high risk of performance and detection bias and at unclear risk of reporting and attrition bias.Of the five trials comparing implementation strategies with a no intervention control, pooled analysis was possible for three RCTs reporting continuous score-based measures of implementation outcomes. The meta-analysis found no difference in standardised effects (standardised mean difference (SMD) -0.01, 95% CI -0.32 to 0.30; 164 participants; 3 studies; low certainty evidence), suggesting no benefit of implementation support in improving policy or practice implementation, relative to control. Findings for other continuous or dichotomous implementation outcomes reported across these five trials were mixed. For the two non-randomised trials examining comparative effectiveness, both reported improvements in implementation, favouring the more intensive implementation group (very low certainty evidence). Three trials examined the impact of implementation strategies on employee health behaviours, reporting mixed effects for diet and weight status (very low certainty evidence) and no effect for physical activity (very low certainty evidence) or tobacco use (low certainty evidence). One trial reported an increase in absolute workplace costs for health promotion in the implementation group (low certainty evidence). None of the included trials assessed adverse consequences. Limitations of the review included the small number of trials identified and the lack of consistent terminology applied in the implementation science field, which may have resulted in us overlooking potentially relevant trials in the search.

AUTHORS' CONCLUSIONS

Available evidence regarding the effectiveness of implementation strategies for improving implementation of health-promoting policies and practices in the workplace setting is sparse and inconsistent. Low certainty evidence suggests that such strategies may make little or no difference on measures of implementation fidelity or different employee health behaviour outcomes. It is also unclear if such strategies are cost-effective or have potential unintended adverse consequences. The limited number of trials identified suggests implementation research in the workplace setting is in its infancy, warranting further research to guide evidence translation in this setting.

Workers' compensation insurer risk control systems: Opportunities for public health collaborations

INTRODUCTION

Workers' compensation (WC) insurers offer services and programs for prospective client selection and insured client risk control (RC) purposes. Toward these aims, insurers collect employer data that may include information on types of hazards present in the workplace, safety and health programs and controls in place to prevent injury/illness, and return-to-work programs to reduce injury/illness severity. Despite the potential impact of RC systems on workplace safety and health and the use of RC data in guiding prevention efforts, few research studies on the types of RC services provided to employers or the RC data collected have been published in the peer-reviewed literature.

METHODS

Researchers conducted voluntary interviews with nine private and state-fund WC insurers to collect qualitative information on RC data and systems.

RESULTS

Insurers provided information describing their RC data, tools, and practices. Unique practices as well as similarities including those related to RC services, policyholder goals, and databases were identified.

CONCLUSIONS

Insurers collect and store extensive RC data, which have utility for public health research for improving workplace safety and health.

PRACTICAL APPLICATIONS

Increased public health understanding of RC data and systems and an identification of key collaboration opportunities between insurers and researchers will facilitate increased use of RC data for public health purposes.

Supporting a Culture of Health in the Workplace: A Review of Evidence-Based Elements

OBJECTIVE

To identify and evaluate the evidence base for culture of health elements.

DATA SOURCE

Multiple databases were systematically searched to identify research studies published between 1990 and 2015 on culture of health elements.

STUDY INCLUSION AND EXCLUSION CRITERIA

Researchers included studies based on the following criteria: (1) conducted in a worksite setting; (2) applied and evaluated 1 or more culture of health elements; and (3) reported 1 or more health or safety factors.

DATA EXTRACTION

Eleven researchers screened the identified studies with abstraction conducted by a primary and secondary reviewer. Of the 1023 articles identified, 10 research reviews and 95 standard studies were eligible and abstracted.

DATA SYNTHESIS

Data synthesis focused on research approach and design as well as culture of health elements evaluated.

RESULTS

The majority of published studies reviewed were identified as quantitative studies (62), whereas fewer were qualitative (27), research reviews (10), or other study approaches. Three of the most frequently studied culture of health elements were built environment (25), policies and procedures (28), and communications (27). Although all studies included a health or safety factor, not all reported a statistically significant outcome.

CONCLUSIONS

A considerable number of cross-sectional studies demonstrated significant and salient correlations between culture of health elements and the health and safety of employees, but more research is needed to examine causality.

Implementation of safety management systems in Hong Kong construction industry - A safety practitioner's perspective

INTRODUCTION

In the 1980s, the safety management system (SMS) was introduced in the construction industry to mitigate against workplaces hazards, reduce the risk of injuries, and minimize property damage. Also, the Factories and Industrial Undertakings (Safety Management) Regulation was introduced on 24 November 1999 in Hong Kong to empower the mandatory implementation of a SMS in certain industries including building construction. Therefore, it is essential to evaluate the effectiveness of the SMS in improving construction safety and identify the factors that influence its implementation in Hong Kong.

METHOD

A review of the current state-of-the-practice helped to establish the critical success factors (CSFs), benefits, and difficulties of implementing the SMS in the construction industry, while structured interviews were used to establish the key factors of the SMS implementation.

RESULTS

Results of the state-of-the-practice review and structured interviews indicated that visible senior commitment, in terms of manpower and cost allocation, and competency of safety manager as key drivers for the SMS implementation. More so, reduced accident rates and accident costs, improved organization framework, and increased safety audit ratings were identified as core benefits of implementing the SMS. Meanwhile, factors such as insufficient resources, tight working schedule, and high labor turnover rate were the key challenges to the effective SMS implementation in Hong Kong.

PRACTICAL APPLICATIONS

The findings of the study were consistent and indicative of the future development of safety management practice and the sustainable safety improvement of Hong Kong construction industry in the long run.

Lost in translation: The challenge of adapting integrated approaches for worker health and safety for low- and middle-income countries

OBJECTIVES

To describe the process of adapting an intervention integrating occupational safety and health (OSH) and health promotion for manufacturing worksites in India and the challenges faced in implementing it; and explore how globalization trends may influence the implementation of these integrated approaches in India and other low- and middle-income countries (LMICs).

METHODS

This study-conducted in 22 manufacturing worksites in Mumbai, India-adapted and implemented an evidence-based intervention tested in the U.S. that integrated OSH and tobacco control. The systematic adaptation process included formative research and pilot testing, to ensure that the tested intervention was tailored to the local setting. We used qualitative methods and process evaluation to assess the extent to which this intervention was implemented, and to explore barriers to implementation.

RESULTS

While participating worksites agreed to implement this intervention, not all components of the adapted intervention were implemented fully in the 10 worksites assigned to the intervention condition. We found that the OSH infrastructure in India focused predominantly on regulatory compliance, medical screening (secondary prevention) and the treatment of injuries. We observed generally low levels of leadership support and commitment to OSH, evidenced by minimal management participation in the intervention, reluctance to discuss OSH issues with the study team or workers, and little receptivity to recommendations resulting from the industrial hygienist's reports.

CONCLUSION

India presents one example of a LMIC with a rising burden of non-communicable diseases and intensified exposures to both physical and organizational hazards on the job. Our experiences highlight the importance of national and global trends that shape workers' experiences on the job and their related health outcomes. Beyond a singular focus on prevention of non-communicable diseases, coordinated national and international efforts are needed to address worker health outcomes in the context of the conditions of work that clearly shape them.

Developing leading indicators from OHS management audit data: Determining the measurement properties of audit data from the field

INTRODUCTION

OHS management audits are one means of obtaining data that may serve as leading indicators. The measurement properties of such data are therefore important. This study used data from Workwell audit program in Ontario, a Canadian province. The audit instrument consisted of 122 items related to 17 OHS management elements. The study sought answers regarding (a) the ability of audit-based scores to predict workers' compensation claims outcomes, (b) structural characteristics of the data in relation to the organization of the audit instrument, and (c) internal consistency of items within audit elements.

METHOD

The sample consisted of audit and claims data from 1240 unique firms that had completed one or two OHS management audits during 2007-2010. Predictors derived from the audit results were used in multivariable negative binomial regression modeling of workers' compensation claims outcomes. Confirmatory factor analyses were used to examine the instrument's structural characteristics. Kuder-Richardson coefficients of internal consistency were calculated for each audit element.

RESULTS

The ability of audit scores to predict subsequent claims data could not be established. Factor analysis supported the audit instrument's element-based structure. KR-20 values were high (≥0.83).

CONCLUSIONS

The Workwell audit data display structural validity and high internal consistency, but not, to date, construct validity, since the audit scores are generally not predictive of subsequent firm claim experience. Audit scores should not be treated as leading indicators of workplace OHS performance without supporting empirical data.

PRACTICAL APPLICATIONS

Analyses of the measurement properties of audit data can inform decisionmakers about the operation of an audit program, possible future directions in audit instrument development, and the appropriate use of audit data. In particular, decision-makers should be cautious in their use of audit scores as leading indicators, in the absence of supporting empirical data.

Key Organizational Characteristics for Integrated Approaches to Protect and Promote Worker Health in Smaller Enterprises

OBJECTIVE

The aim of this study was to investigate relationships between worksite organizational characteristics (size, industrial sector, leadership commitment, and organizational supports) and integrated approaches to protecting and promoting worker health implemented in smaller enterprises.

METHODS

We analyzed web-based survey data of Human Resource Managers at 114 smaller enterprises (<750 employees) to identify organizational factors associated with levels of integrated approaches among their worksites.

RESULTS

The companies' mean integration score was 13.6 (SD = 9.6) of a possible 44. In multivariate analyses, having a safety committee (P = 0.035) and top leadership support for health promotion (HP) (P = 0.004) were positively associated with higher integration scores.

CONCLUSIONS

Smaller enterprises in one U.S. region have relatively low levels of implementing integrated safety and promotion approaches. Having a safety committee and leadership support for HP may be important contributors to implementing integrated approaches in smaller enterprises.

Integrating worksite health protection and health promotion: A conceptual model for intervention and research

There is increasing recognition of the value added by integrating traditionally separate efforts to protect and promote worker safety and health. This paper presents an innovative conceptual model to guide research on determinants of worker safety and health and to inform the design, implementation and evaluation of integrated approaches to promoting and protecting worker health. This model is rooted in multiple theories and the premise that the conditions of work are important determinants of individual safety and health outcomes and behaviors, and outcomes important to enterprises such as absence and turnover. Integrated policies, programs and practices simultaneously address multiple conditions of work, including the physical work environment and the organization of work (e.g., psychosocial factors, job tasks and demands). Findings from two recent studies conducted in Boston and Minnesota (2009-2015) illustrate the application of this model to guide social epidemiological research. This paper focuses particular attention on the relationships of the conditions of work to worker health-related behaviors, musculoskeletal symptoms, and occupational injury; and to the design of integrated interventions in response to specific settings and conditions of work of small and medium size manufacturing businesses, based on a systematic assessment of priorities, needs, and resources within an organization. This model provides an organizing framework for both research and practice by specifying the causal pathways through which work may influence health outcomes, and for designing and testing interventions to improve worker safety and health that are meaningful for workers and employers, and responsive to that setting's conditions of work.

Organizational Characteristics Influence Implementation of Worksite Health Protection and Promotion Programs: Evidence From Smaller Businesses

OBJECTIVE

We explored associations between organizational factors (size, sector, leadership support, and organizational capacity) and implementation of occupational safety and health (OSH) and worksite health promotion (WHP) programs in smaller businesses.

METHODS

We conducted a web-based survey of human resource managers of 117 smaller businesses (<750 employees) and analyzed factors associated with implementation of OSH and WHP among these sites using multivariate analyses.

RESULTS

Implementation of OSH, but not WHP activities, was related to industry sector (P = 0.003). Leadership support was positively associated with OSH activities (P < 0.001), but negatively associated with WHP implementation. Organizational capacity (budgets, staffing, and committee involvement) was associated with implementation of both OSH and WHP. Size was related to neither.

CONCLUSIONS

Leadership support and specifically allocated resources reflecting that support are important factors for implementing OSH and WHP in smaller organizations.

Integrated approach to health screening of former department of energy workers detects both occupational and non-occupational illness

BACKGROUND

The National Supplemental Screening Program (NSSP) uses a Total Worker Health(TM) approach to address U.S. Department of Energy (DOE) former worker health. This article provides the design of the integrated occupational health screening and promotion program.

METHODS

The NSSP implemented a web-based relational health records system to process demographic, exposure, and clinical data. We present medical findings for 12,000 DOE former workers that completed an initial NSSP medical screening between October 1, 2005 and October 4, 2013. We discuss the DOE former worker participant population and the exposure-based and non-occupational medical screening tests used.

RESULTS

The NSSP identified potential occupationally related health conditions in 40.5% of those screened. Notably, we identified 85.8% of participants with addressable non-occupational health conditions, many of which were previously undiagnosed.

CONCLUSION

The NSSP demonstrates that the identification of potential occupational health issues in conjunction with addressable non-occupational health conditions provides former workers with information to more effectively manage health.

Characteristics of Employees of Small Manufacturing Businesses by Occupation: Informing Evidence-Based Intervention Planning

OBJECTIVES

We examined characteristics of employees in six occupational categories in small manufacturing businesses (20-150 employees).

METHODS

We analyzed survey data from 47 businesses (n = 2577 employees; 86% response rate) and examined relationships between job type and sociodemographic, health, and organizational support characteristics. Analyses were adjusted for age and sex, and company as a random effect.

RESULTS

Smoking rates were highest for production workers (33%), production managers (27%), and support staff (28%) and lowest for managers (11%) (P <0.001). Job stress was higher for production workers and support staff than managers (P < 0.0001). Managers perceived social capital (P<0.001), safety climate (P < 0.0001) and support for smoking cessation (P < 0.001) higher than production managers, production workers, and support staff.

CONCLUSIONS

Differences in characteristics by occupation call for integrated interventions that target working class employees, leverage the influence of production managers, and enhance organizational support.

Experiences recruiting Indian worksites for an integrated health protection and health promotion randomized control trial in Maharashtra, India

This article provides an overview of the recruitment strategies utilized in the Mumbai Worksites Tobacco Control Study, a cluster randomized trial testing the effectiveness of an integrated tobacco control and occupational safety and health program in Indian manufacturing worksites. From June 2012 to June 2013, 20 companies were recruited. Companies were identified using association lists, referrals, internet searches and visits to industrial areas. Four hundred eighty companies were contacted to validate information, introduce the study and seek an in-person meeting with a company representative. Eighty-three company representatives agreed to meet. Of those 83 companies, 55 agreed to a formal 'pitch meeting' with key decision makers at the company. Seventy-seven recruitment 'pitches' were given, including multiple meetings in the same companies. If the company was interested, we obtained a letter of participation and employee roster. Based on this experience, recommendations are made that can help inform future researchers and practitioners wishing to recruit Indian worksites. When compared with recruitment of US manufacturing worksites, recruitment of Indian worksites lacked current industrial lists of companies to serve as a sampling frame, and required more in-person visits, incentives for control companies and more assurances around confidentiality to allow occupational safety and health experts into their worksite.

Workplace mental health: developing an integrated intervention approach

BACKGROUND

Mental health problems are prevalent and costly in working populations. Workplace interventions to address common mental health problems have evolved relatively independently along three main threads or disciplinary traditions: medicine, public health, and psychology. In this Debate piece, we argue that these three threads need to be integrated to optimise the prevention of mental health problems in working populations.

DISCUSSION

To realise the greatest population mental health benefits, workplace mental health intervention needs to comprehensively 1) protect mental health by reducing work-related risk factors for mental health problems; 2) promote mental health by developing the positive aspects of work as well as worker strengths and positive capacities; and 3) address mental health problems among working people regardless of cause. We outline the evidence supporting such an integrated intervention approach and consider the research agenda and policy developments needed to move towards this goal, and propose the notion of integrated workplace mental health literacy.

SUMMARY

An integrated approach to workplace mental health combines the strengths of medicine, public health, and psychology, and has the potential to optimise both the prevention and management of mental health problems in the workplace.

Health promotion in smaller workplaces in the United States

Most American workplaces are smaller, with fewer than 1,000 employees. Many of these employees are low-wage earners and at increased risk for chronic diseases. Owing to the challenges smaller workplaces face to offering health-promotion programs, their employees often lack access to health-promotion opportunities available at larger workplaces. Many smaller employers do not offer health insurance, which is currently the major funding vehicle for health-promotion services. They also have few health-promotion vendors to serve them and low internal capacity for, and commitment to, delivery of on-site programs. The programs they offer, whether aimed at health promotion alone or integrated with health protection, are rarely comprehensive and are understudied. Research priorities for health promotion in smaller workplaces include developing programs feasible for the smallest workplaces with fewer than 20 employees. Policy priorities include incentives for smaller workplaces to implement comprehensive programs and an ongoing system for monitoring and evaluation.

Integrated worker health protection and promotion programs: overview and perspectives on health and economic outcomes

OBJECTIVE

To describe integrated worker health protection and promotion (IWHPP) program characteristics, to discuss the rationale for the integration of occupational safety and health and worksite health promotion programs, and to summarize what is known about the impact of these programs on health and economic outcomes.

METHODS

A descriptive assessment of the current state of the IWHPP field and a review of studies on the effectiveness of IWHPP programs on health and economic outcomes were undertaken.

RESULTS

Sufficient evidence of effectiveness was found for IWHPP programs when health outcomes were considered. Impact on productivity-related outcomes is considered promising, but inconclusive, whereas insufficient evidence was found for health care expenditures.

CONCLUSIONS

Existing evidence supports an integrated approach in terms of health outcomes but will benefit significantly from research designed to support the business case for employers of various company sizes and industry types.

Integration of health protection and health promotion: rationale, indicators, and metrics

OBJECTIVE

To offer a definition of an "integrated" approach to worker health and operationalize this definition using indicators of the extent to which integrated efforts are implemented in an organization.

METHODS

Guided by the question-How will we know it when we see it?-we reviewed relevant literature to identify available definitions and metrics, and used a modified Delphi process to review and refine indicators and measures of integrated approaches.

RESULTS

A definition of integrated approaches to worker health is proposed and accompanied by indicators and measures that may be used by researchers, employers, and workers.

CONCLUSIONS

A shared understanding of what is meant by integrated approaches to protect and promote worker health has the potential to improve dialogue among researchers and facilitate the research-to-practice process.

Characteristics of effective health and safety committees: survey results

BACKGROUND

Although perhaps the most common worker-management structure, there has been surprisingly little research on describing and evaluating the characteristics of health and safety committees.

METHODS

A survey of 380 health and safety committee members from 176 manufacturing workplaces was supplemented with administrative data and compared with reported workers' compensation rates. Survey respondents also reported perceptions of overall safety, committee, effectiveness, committee activities, and "best practices."

RESULTS

Extensive descriptive data is presented, including a mean of 8.7 members per committee spending 1,167 hr per year on committee business for an estimate of $40,500 worth of time per committee. Higher speed to correct action items, a focus on ergonomics, and planning for safety training was associated with lower injury rates. The discrepancy between managers and hourly committee members in estimating overall safety was strongly positively associated with injury rates.

CONCLUSIONS

Communications and worker involvement may be important to address discrepancy issues. Prospective studies are needed to distinguish directionality of associations.

Review of preventative behavioural interventions for dermal and respiratory hazards

BACKGROUND

No previous systematic review of the evidence base has been undertaken to help occupational health professionals understand how to reliably lower the instance of occupational ill-health through reducing risk-taking behaviour.

AIMS

To evaluate the effectiveness and processes of occupational-based behavioural interventions for workers exposed to dermal and respiratory hazards.

METHODS

A systematic review was conducted. Sixteen electronic databases were searched using key words. Bibliography, health and safety websites and hand searches of key journals were also undertaken. Articles were included if they evaluated an intervention targeting workers' behavioural compliance, addressed dermal or respiratory hazards, used before and after measures with a control group comparison and used behaviour-related exposure indicators such as airborne exposure, health effects, behaviour observations and self-reported work practices. Data were extracted according to potential sources of bias, impact and behavioural change processes used.

RESULTS

Ten of 550 articles identified as potentially relevant were included. A predominance of small effect sizes, particularly for larger samples, demonstrated limited but positive impact upon exposure. Studies contained too much heterogeneity for reliable meta-analysis. None of the studies covered the full range of behaviour change components necessary for reducing exposure risk.

CONCLUSIONS

We conclude that future interventions could enhance their effectiveness through improving design quality, reporting and basing their content upon evidence-based behavioural change approaches. Using a comprehensive range of evidence-informed behaviour change ingredients should improve occupational health professional's ability to reliably reduce occupational ill-health where exposure cannot totally be designed out of the workplace.

A framework for evaluating OSH program effectiveness using leading and trailing metrics

INTRODUCTION

Many employers and regulators today rely primarily on a few past injury/ illness metrics as criteria for rating the effectiveness of occupational safety and health (OSH) programs. Although such trailing data are necessary to assess program success, they may not be sufficient for developing proactive safety, ergonomic, and medical management plans.

METHODS

The goals of this pilot study were to create leading metrics (company self-assessment ratings) and trailing metrics (past loss data) that could be used to evaluate the effectiveness of OSH program elements that range from primary to tertiary prevention. The main hypothesis was that the new metrics would be explanatory variables for three standard future workers compensation (WC) outcomes in 2003 (rates of total cases, lost time cases, and costs) and that the framework for evaluating OSH programs could be justifiably expanded. For leading metrics, surveys were developed to allow respondents to assess OSH exposures and program prevention elements (management leadership/ commitment, employee participation, hazard identification, hazard control, medical management, training, and program evaluation). After pre-testing, surveys were sent to companies covered by the same WC insurer in early 2003. A total of 33 completed surveys were used for final analysis. A series of trailing metrics were developed from 1999-2001 WC data for the surveyed companies. Data were analyzed using a method where each main 2003 WC outcome was dichotomized into high and low loss groups based on the median value of the variable. The mean and standard deviations of survey questions and 1999-2001 WC variables were compared between the dichotomized groups. Hypothesis testing was performed using F-test with a significance level 0.10.

RESULTS/DISCUSSION

Companies that exhibited higher musculoskeletal disorder (MSD) WC case rates from 1999-2001 had higher total WC case rates in 2003. Higher levels of several self-reported OSH program elements (tracking progress in controlling workplace safety hazards, identifying ergonomic hazards, using health promotion programs) were associated with lower rates of WC lost time cases in 2003. Higher reported exposures to noise and projectiles were also associated with higher rates of WC cases and costs in 2003.

IMPACT ON INDUSTRY

This research adds to a growing body of preliminary evidence that valid leading and trailing metrics can be developed to evaluate OSH effectiveness. Both the rating of OSH efforts and the regular trending of past loss outcomes are likely useful in developing data-driven improvement plans that are reactive to past exposures and proactive in identifying system deficiencies that drive future losses.

(Mis)understanding Safety Culture and Its Relationship to Safety Management

Although the concept of safety culture was coined in relation to major accidents like Chernobyl and Piper Alpha, it has been embraced by the safety community at large as a cause for unsafe practice. In this article, three approaches to safety culture are discussed in terms of their underlying concepts of culture and organizational culture. Culture is an intangible, fuzzy concept encompassing acquired assumptions that is shared among the members of a group and that provides meaning to their perceptions and actions and those of others. The basic assumptions that form the essence of a culture are shared, yet tacit, convictions, which manifest themselves subtly in the visible world. As applied by safety researchers, the culture concept is deprived of much of its depth and subtlety, and is morphed into a grab bag of behavioral and other visible characteristics, without reference to the meaning these characteristics might actually have, and often infused with normative overtones. By combining the three approaches, we can resurrect the notion of safety culture and strengthen its analytical potential in understanding the development and implementation of safety management systems.

Risk factors for worker injury and death from occupational light vehicles crashes in New South Wales (Australia)

BACKGROUND/AIM

To identify risk and protective factors for crash casualty outcomes in occupational light vehicles (OLV), a previously under-recognized work context for injuries and fatalities.

METHODS

A register-based study was conducted using linked vehicle crash and registration data (n = 13,491) for the Australian state of New South Wales. Univariate and multivariate analyses were undertaken to assess the relationship between casualty outcomes and variables drawn from four domains of potential determinants of severity: user, vehicle, road, and work organization factors.

RESULTS

Nineteen percent of OLV crashes had OLV-user casualties (n = 2,506) and 1% fatalities (n = 34). Adjusted casualty risk factors included tired driver (OR 2.1, 95% CI 1.5-2.7), no seat belt use (OR 1.8, 95% CI 1.4-2.3), and excessive speed (OR 1.4, 95% CI 1.2-1.6). Adjusted fatality risk factors were no seat belt (OR 12.9, 95% CI 4.9-34.3) and high-speed zone crash (OR 5.0, 95% CI 2.1-12.3).

CONCLUSIONS

OLV users are at risk from both recognized road risks and hazards specific to OLV use. Findings suggest that risk reduction could be improved by the use of safer vehicles, fatigue management, and journey planning.

Measurement properties of occupational health and safety management audits: a systematic literature search and traditional literature synthesis

OBJECTIVE

The measurement properties of Occupational Health and Safety (OHS) management audits might be important in some applications, especially when audit scores are treated as performance measures. The review, therefore, sought to identify and summarize the research evidence on the measurement properties (e.g., reliability, validity) of methods of OHS management audit.

METHODS

Bibliographic databases in business, medicine and OHS were systematically searched. Evidence from relevant publications was synthesized using traditional narrative review methods.

SYNTHESIS

The literature on the measurement properties of OHS management audit methods is sparse. Seventeen relevant audit methods were identified. Content validity was demonstrated for only five audit methods. Inter-rater reliability was formally tested for only three audit methods and construct validity for only one. There were no studies of test-retest reliability or responsiveness. The investigations of inter-rater reliability (i.e., consistency among auditors) showed that it is often unacceptably low.

CONCLUSION

There is a research gap concerning the measurement properties of OHS management audit methods. The available research raises questions about the properties of audit methods in current use.

An impact evaluation of a federal mine safety training regulation on injury rates among US stone, sand, and gravel mine workers: an interrupted time-series analysis

OBJECTIVES

We evaluated the impact of a safety training regulation, implemented by the US Department of Labor's Mine Safety and Health Administration (MSHA) in 1999, on injury rates at stone, sand, and gravel mining operations.

METHODS

We applied a time-series design and analyses with quarterly counts of nonfatal injuries and employment hours from 7998 surface aggregate mines from 1995 through 2006. Covariates included standard industrial classification codes, ownership, and injury severity.

RESULTS

Overall crude rates of injuries declined over the 12-year period. Reductions in incident rates for medical treatment only, restricted duty, and lost-time injuries were consistent with temporal trends and provided no evidence of an intervention effect attributable to the MSHA regulation. Rates of permanently disabling injuries (PDIs) declined markedly. Regression analyses documented a statistically significant reduction in the risk rate in the postintervention time period (risk rate = 0.591; 95% confidence interval = 0.529, 0.661).

CONCLUSIONS

Although a causal relationship between the regulatory intervention and the decline in the rate of PDIs is plausible, inconsistency in the results with the other injury-severity categories preclude attributing the observed outcome to the MSHA regulation. Further analyses of these data are needed.

A hazardous substance exposure prevention rating method for intervention needs assessment and effectiveness evaluation: the Small Business Exposure Index

AIMS

This paper describes the refinement and adaptation to small business of a previously developed method for systematically prioritizing needs for intervention on hazardous substance exposures in manufacturing worksites, and evaluating intervention effectiveness.

METHODS

We developed a checklist containing six unique sets of yes/no variables organized in a 2 x 3 matrix of exposure potential versus exposure protection at three levels corresponding to a simplified hierarchy of controls: materials, processes, and human interface. Each of the six sets of indicator variables was reduced to a high/moderate/low rating. Ratings from the matrix were then combined to generate an exposure prevention 'Small Business Exposure Index' (SBEI) Summary score for each area. Reflecting the hierarchy of controls, material factors were weighted highest, followed by process, and then human interface. The checklist administered by an industrial hygienist during walk-through inspection (N = 149 manufacturing processes/areas in 25 small to medium-sized manufacturing worksites). One area or process per manufacturing department was assessed and rated. A second hygienist independently assessed 36 areas to evaluate inter-rater reliability.

RESULTS

The SBEI Summary scores indicated that exposures were well controlled in the majority of areas assessed (58% with rating of 1 or 2 on a 6-point scale), that there was some room for improvement in roughly one-third of areas (31% of areas rated 3 or 4), and that roughly 10% of the areas assessed were urgently in need of intervention (rated as 5 or 6). Inter-rater reliability of EP ratings was good to excellent (e.g., for SBEI Summary scores, weighted kappa = 0.73, 95% CI 0.52-0.93).

CONCLUSION

The SBEI exposure prevention rating method is suitable for use in small/medium enterprises, has good discriminatory power and reliability, offers an inexpensive method for intervention needs assessment and effectiveness evaluation, and complements quantitative exposure assessment with an upstream prevention focus.

Justice at work, job stress, and employee health

A small but growing literature has documented an association between justice at work and employee health. However, the pathways and mechanisms underlying this association are not well understood. This article proposes a conceptual framework that bridges the organizational justice, occupational stress, and occupational epidemiology literatures. Justice appraisals are proposed to be both important mediators and moderators in the causal flow from exposure to the organizational environment to employee health. The potential role of justice in enhancing employee health is compared to that of the well-established concepts of social support and job control. Directions for future research are suggested, along with strategies for overcoming challenges inherent in this multidisciplinary area of research. Implications for work-site health interventions are discussed.

Development of a Mental Health Action Checklist for Improving Workplace Environment as means of Job Stress Prevention

An action checklist for improving the workplace environment by means of enhancing mental health of workers (Mental Health Action Check List: MHACL) was developed. The use of the checklist for primary prevention was examined. MHACL was developed through three steps: (1) Review of related references and collection of improvement examples for designing a draft MHACL; (2) pilot application of the draft at industrial workplaces and trials at workshops of occupational health staff; and (3) proposing a new MHACL for general use in industry. Workplace improvement actions related to mental health were listed in eight technical areas. From 84 workplaces in Japan, 201 such actions were collected. Typical improvement action phrases were extracted based on these examples, and a draft MHACL containing 40 generally applicable actions were prepared. This draft was applied to selected workplaces for its use as a tool for group discussion. Then, the utility of the checklist was discussed by 105 occupational health staff working in public service offices. The workshop suggested modifications of the draft MHACL including improved check items and usage procedures and the need to use easy-to-understand actions. The final version of the MHACL comprised 30 items in six technical areas: A) sharing work planning, B) work time and organization, C) ergonomic work methods, D) workplace environment, E) mutual support in the workplace, and F) preparedness and care. A new action checklist was proposed for use as a means of changing existing workplace environments and proposing practical actions for improving it. The checklist was confirmed to be useful for organizing workplace-level discussion for identifying immediate improvements at the workplace. The checklist is expected to be widely applied for promoting primary prevention measures in terms of better mental health.

Profile of machine safety in small metal fabrication businesses

BACKGROUND

Metal working has been identified as an industry with one of the highest rates of non-fatal injury in the United States. However, the systematic evaluation of machine-related hazards is lacking.

METHODS

The Minnesota Machine Guarding Study evaluates the effectiveness of a peer-based technical and educational intervention designed to reduce exposure to amputation hazards among workers in small machining/metal working businesses. The data presented here provide a profile of machine guarding in small (5-100 employees) metal fabrication businesses in Minnesota. A set of checklists to quantify machine-guarding practices were developed. Up to 25 randomly selected machines were evaluated in each facility. In addition, walk-through surveys were conducted to assess machine-related safety practices and programs (e.g., lock out-tag out).

RESULTS

A total of 824 machines were evaluated. Overall, 55% (SD 11%) of items addressing machine guarding were present. No single machine complied with all critical safety requirements. Shops with safety committees tended to have better scores than did shops without safety committees. Thirty-five percent of all businesses had established machine guarding procedures and 17% provided training in machine guarding (e.g., use of machine guards and devices in daily operations) to their employees.

CONCLUSIONS

These data indicate that machine guarding and related safety programs in small metal fabrication businesses were inadequate. The data also suggest that safety committees are an important component in improving machine safety and related programs in small businesses.

Small business owners' health and safety intentions: a cross-sectional survey

BACKGROUND

Little is known about the variables underlying small business owners' behavioural intentions toward workplace health and safety. This project explores the relationship between three mediating variables (Attitude Toward Safety, Subjective Norm and Perceived Behavioural Control) and owners' Intentions Toward Safety, following the Theory of Planned Behaviour. We also investigate the role of beliefs underlying each mediating variable.

METHODS

Seven hundred businesses (5-50 employees) were randomly selected from 4084 eligible companies in a manufacturing business database (SIC codes 24 to 39). The 348 respondents are on average 51 yrs of age, 86% male, 96% white and have 2 to 4 years of post-secondary school.

RESULTS

All three mediator variables are significantly correlated with Intentions Toward Safety; Attitude Toward Safety shows the strongest correlation, which is confirmed by path analysis. Owners with higher attitudes toward safety have a higher probability of believing that improving workplace health and safety will make employees' healthier and happier, show that they care, increase employee productivity, lower workers' compensation costs, increase product quality and lower costs.

CONCLUSION

These results suggest that interventions aimed at increasing owners' health and safety intentions (and thus, behaviours) should focus on demonstrating positive employee health and product quality outcomes.

Improving the prevention and control of hazardous substance exposures: a randomized controlled trial in manufacturing worksites

BACKGROUND

New measures of exposure prevention (EP) activity were used to evaluate the effectiveness of a 16-month management-focused intervention addressing hazardous substance exposures in manufacturing work settings.

METHODS

EP efforts were assessed using a rating scheme developed for this study. The rating scheme yields a set of measures of exposure potential and protection, which are combined into an overall EP summary rating. A randomized, controlled design was used to assess intervention effectiveness. Fifteen large manufacturing worksites completed the 16-month intervention and follow-up assessments. Analyses were conducted on the 107 production processes assessed at both baseline and final.

RESULTS

Patterns of improvement within the intervention condition were consistent with the intervention emphasis on upstream or source-focused intervention; whereas patterns in controls were consistent with prevalent practice (more downstream, worker-focused). A mixed model analysis of variance showed greater improvement in EP ratings in intervention versus controls, but the difference in improvement was moderate and statistically non-significant.

CONCLUSIONS

This study has demonstrated that EP efforts in the manufacturing sector can be systematically assessed across the full range of hazardous substances in use, and that such assessments can serve both needs assessment and effectiveness evaluation functions. Findings suggest that more sustained or intense management-focused intervention would significantly improve EP activity in manufacturing settings.

A study of the implementation process of an intervention to prevent work-related skin problems in wet-work occupations

OBJECTIVES

The objective of the present implementation study is to document how an intervention to reduce work-related skin problems by means of implementing an evidence-based skin protection programme in six gut-cleaning departments in swine slaughterhouses was understood, accepted and carried out. The association between the degree of implementation and the reduction of work-related skin problems in each department is examined. The intervention included a top-down strategy with establishment of a management system focusing on skin risks and a bottom-up strategy with participation of a selected group of shop floor workers and the safety representative, as change agents, as well as an empowerment-based educational programme, where the middle management and representatives from the top management also participated.

METHODS

The study design was a randomized controlled intervention study with a 1-year study period. The outcome of the intervention was evaluated by telephone interviews. Data on the implementation process consisted of self-administered questionnaires, focus interviews and compiled written materials. Four indexes referring to the management system and the change agents' intervention activities were constructed. Finally, the Pearson correlation coefficient was used to test the correlation between the degree of implementation and the eczema frequency at 1-year follow-up.

RESULTS

There was a statistically significant association (p < 0.05) between both the index for the combined implementation method and the eczema frequency after 1 year of intervention, and between the activities of the change agents and the eczema frequency. In contrast to this there was only a weak association between the establishment of a formal management system alone and the outcome.

CONCLUSION

The study evidences that a combination of a top-down and a bottom-up implementation method is effective to reduce work-related skin problems, and that the process of implementation is a significant determinant of the overall results.

Characterizing the Burden of Occupational Injury and Disease

OBJECTIVES

To review the literature on the burden of occupational disease and injury and to provide a comprehensive characterization of the burden.

METHODS

The scientific and governmental literature from 1990 to the present was searched and evaluated. Thirty-eight studies illustrative of the burden of occupational disease were reviewed for findings, methodology, strengths, and limitations.

RESULTS

Recent U.S. estimates of occupational mortality and morbidity include approximately 55,000 deaths (eighth leading cause) and 3.8 million disabling injuries per year, respectively. Comprehensive estimates of U.S. costs related to these burdens range between dollar 128 billion and dollar 155 billion per year. Despite these significant indicators, occupational morbidity, mortality, and risks are not well characterized in comparative burden assessments.

CONCLUSIONS

The magnitude of occupational disease and injury burden is significant but underestimated. There is a need for an integrated approach to address these underestimates.