The integrated model: implications for worksite health promotion and occupational health and safety practice

The relationship between perceived health and psychosocial risk in women in the service sector (cleaning)

BACKGROUND

Cleaning is considered a female-dominant occupation. Women cleaning workers present a high risk of suffering impaired health probably as a result of performing low-skilled tasks. However, to date, no studies have been found that examine the health status of female cleaning workers in Spain.

OBJECTIVES

The objectives were to 1) determine the level of perceived health in a sample of female cleaning workers, 2) evaluate the main psychosocial risks they face, 3) explore the relationship between perceived health and psychosocial risk factors, and 4) compare the perceived health of those women who present some psychosocial risk factor and those who do not.

METHODS

This is a multi-centered cross-sectional study carried out in the service sector of a Spanish company. The final sample was composed of 455 female cleaning workers. Sociodemographic variables, perceived health status and psychosocial risk factors were assessed.

RESULTS

Women presented a high perception of health status. The main psychosocial risk was lack of acknowledgement by their superiors, which affected 25.2% (n = 111) of the sample. Moderate negative correlations (r=-.222 to -.442; p <  .01) were identified between perceived health and evident psychosocial risks. Those women who presented some psychosocial risk (n = 174; 38.3%) had a worse state of perceived health in all variables studied.

CONCLUSION

Presence of psychosocial risk had a relationship with a worse health perception. This article highlights the need to orient preventive actions in the psychosocial field. The COVID-19 pandemic represents a new situation to renew the health promotion between cleaning workers.

Relationship between the status of occupational health management and job satisfaction among farmers: A health promotion approach

BACKGROUND

Job satisfaction is one of the most important issues related to human resources in the organization which can reduce organizational productivity. In this regard, occupational health is an important science related to the health of the workforce in any organization, paying attention to it will help health promotion. The aim of the present study was to determine the relationship between the status of occupational health management and job satisfaction among farmers with a health promotion approach.

MATERIALS AND METHODS

This cross-sectional study was conducted in 2020. The number of 209 farmers from all villages of Zabol was included by census method. Data were collected using a researcher-made questionnaire that consisting of three sections of demographic information, occupational safety and health status, and standard job satisfaction questionnaire. At first, the validity and reliability of the questionnaire were evaluated. In addition, 5-10 staff working in Agricultural Jihad Organization were asked about the content, clarity, and simplicity of the questionnaire terms. Content validity index and content validity ratio indexes were calculated as 0.68 and 0.83 for occupational health management and 0.69 and 0.83 for job satisfaction questionnaires, respectively. Instrument reliability was also assessed using the Cronbach's alpha coefficient, which was 0.872. Finally, after verifying the validity and reliability of the instrument, a questionnaire was used to collect the research data. Shapiro-Wilk, Wilcoxon, and Spearman correlation tests were used to analyze the findings. The collected data were analyzed using SPSS software version 19. Armonk; NY, USA: IBM Corp.

RESULTS

The results of the study indicate that occupational health management was at a moderate to a high level (3.701) and job satisfaction (3.381) was at a moderate to a high level. The standard regression coefficient between occupational health management and job satisfaction was obtained as 0.571. With a confidence of 95%, it can be stated that occupational health management in Zabol city under the supervision of jihad-e-agriculture organization has a significant impact on farmers' job satisfaction. In addition, the research findings confirmed a positive and significant relationship between occupational health management and job satisfaction of employed farmers and showed that the implementation of occupational safety and health programs in the jihad-e-agriculture organization can affect the job satisfaction of farmers.

CONCLUSION

According to the evaluation of research findings, job satisfaction and occupational health management in the Agricultural Jihad Organization are relatively favorable among farmers in Zabol city. It was argued that there is a relationship between occupational health management and job satisfaction, that the implementation of programs related to occupational safety and health management system such as Health and Safety Executive will promote health.

Integrative prevention and coordinated action toward primary, secondary and tertiary prevention in workplaces: A scoping review

BACKGROUND

Integrated approaches are valued in several occupational health strategic programmatic orientations. A better understanding of the use of integrative prevention in coordinating measures is needed to develop its use in workplaces.

OBJECTIVE

Identify workplace integrative prevention approaches and definitions of prevention (primary, secondary and tertiary) in the literature.

METHODS

A scoping review was conducted following Arksey and O'Malley (2005). The literature search was carried out in three databases without date restrictions. In order to be retained, the articles needed to address at least two levels of prevention using an integrative approach in a workplace setting. A qualitative analysis was conducted.

RESULTS

The review yielded 16 published articles between 1995 and 2017. The articles addressed mental health, musculoskeletal disorder prevention and comprehensive approaches. Integrative prevention approaches are diverse and are not always named as such. Prevention definitions are not homogenous.

CONCLUSIONS

This review identified some of the integrative prevention characteristics aimed at coordinated action for prevention in the workplace and to clarify measures taken at different levels of prevention. Further studies are needed to elaborate on the implementation of integrative prevention in the workplace.

Intermediary Perspectives on Total Worker Health in Small Businesses

The future of work will include not only more small business employment, but also a need for greater consideration of more holistic approaches to addressing worker well-being. Previous research has suggested smaller firms need external assistance to add new or improve existing workplace health and safety activities. A Total Worker Health^® (TWH) approach is potentially appealing to small employers as it is intended to identify and support comprehensive practices and policies that take into account the work environment (both physical and organizational) while also addressing the personal health risks of individuals, thus being more effective in preventing disease and promoting health and safety than each approach taken separately. NIOSH researchers applied the NIOSH Small Business Intervention Diffusion Model to conduct parallel community-based TWH activities in two geographically distinct communities in a large metropolitan area. Data were collected from intermediary organizations that work with or serve small businesses about their perceptions of the TWH approach as a potential service for them to offer small firms. Intermediary organizations engaged in implementation of TWH approaches with small businesses in the respective geographic areas for approximately one year. Results indicated intermediary organizations find value in providing TWH assistance to small employers, but several challenges for intermediaries implementing TWH among small employers remain.

Results from a pre-post, uncontrolled pilot study of a mindfulness-based program for early elementary school teachers

Background

Mindfulness-based programs are a novel and promising approach for supporting teachers’ occupational health and well-being. Although rationales for mindfulness programs for teachers have been offered, the empirical research base evaluating approaches for educating teachers in mindfulness is still developing. This study reports the findings of a pilot study of a mindfulness-based program. This study is unique in that it is one of the only studies of the Mindfulness-Based Emotional Balance (MBEB) program to focus on early elementary teachers, to be implemented by a new instructor, and to recruit teachers via extrinsic motivators.

Methods

A pre-post, uncontrolled pilot study of a 27.5-h mindfulness-based program for teachers was conducted with 21 pre-kindergarten–third-grade teachers from the Pacific Northwest of the USA. Program acceptability was assessed based on attendance and teacher reports of program benefits. Effect sizes for within-person changes (from pre- to post-program) in teachers’ skills and mindsets, well-being, occupational health, and teaching practices were calculated. Teachers also suggested improvements to the program.

Results

With regard to program attendance and acceptability, teachers attended 87% of sessions, with 58% of teachers reporting a personal benefit and 58% of teachers reporting a professional benefit of the program. Effect sizes for changes in teachers’ skills and mindsets ranged from small to large, |d| = 0.30 to 0.83, and ranged from small to medium for changes in teachers’ well-being |d| = 0.07 to 0.48, occupational health |d| = 0.14 to 0.39, and teaching practices |d| = 0.15 to 0.48. Teachers suggested shortening the program and linking it more closely to their work in the classroom.

Conclusions

This study suggests that the MBEB program may be beneficial to early elementary teachers, even when implemented by someone other than the program developer, and when provided with extrinsic motivation to participate (more closely mapping to a larger-scale trial of the program). Teachers’ suggestions regarding program length and structure are considered, along with useful avenues for future research on mindfulness-based programs for teachers.

Perceived Stress and Health among Home Care Aides: Caring for Older Clients in a Medicaid-Funded Home Care Program

Home care aides (HCAs) provide housekeeping and personal care services to help older clients remain in the community. However, little is known about the health of HCAs, who themselves constitute an underserved population. The goal of this study was to investigate how HCAs' work and life contexts manifest themselves in HCAs' health as perceived by HCAs. Six focus groups were conducted with HCAs (N=45). Analysis revealed how HCAs' work-and life-related stress accumulated over time and affected HCAs' health and interaction with their older clients. Home care aides were interested in personal health promotion and client well-being. Home care aides may constitute an underused resource for the care of older adults with disabilities. Information about intricately intertwined work and life contexts should inform policymakers and home care providers in their efforts to improve the quality of publicly funded home care services.

Prospective Evaluation of Fidelity, Impact and Sustainability of Participatory Workplace Health Teams in Skilled Nursing Facilities

Organizational features of work often pose obstacles to workforce health, and a participatory change process may address those obstacles. In this research, an intervention program sought to integrate occupational safety and health (OSH) with health promotion (HP) in three skilled nursing facilities. Three facilities with pre-existing HP programs served as control sites. The intervention was evaluated after 3-4 years through focus groups, interviews, surveys, and researcher observations. We assessed process fidelity in the intervention sites and compared the two groups on the scope of topics covered (integration), program impact, and medium-term sustainability. The intervention met with initial success as workers readily accepted and operationalized the concept of OSH/HP integration in all three intervention facilities. Process fidelity was high at first but diminished over time. At follow-up, team members in two intervention sites reported higher employee engagement and more attention to organizational issues. Two of the three control facilities remained status quo, with little OSH/HP integration. The intervention had limited but positive impact on the work environment and health climate: staff awareness and participation in activities, and organizational factors such as decision-making, respect, communication, and sharing of opinions improved slightly in all intervention sites. Resources available to the teams, management support, and changing corporate priorities affected potential program sustainability.

Employee Sleep and Workplace Health Promotion: A Systematic Review

OBJECTIVE

Workplace-based employee health promotion programs often target weight loss or physical activity, yet there is growing attention to sleep as it affects employee health and performance. The goal of this review is to systematically examine workplace-based employee health interventions that measure sleep duration as an outcome.

DATA SOURCE

We conducted systematic searches in PubMed, Web of Knowledge, EMBASE, Scopus, and PsycINFO (n = 6177 records).

STUDY INCLUSION AND EXCLUSION CRITERIA

To be included in this systematic review, studies must include (1) individuals aged >18 years, (2) a worker health-related intervention, (3) an employee population, and (4) sleep duration as a primary or secondary outcome.

RESULTS

Twenty studies met criteria. Mean health promotion program duration was 2.0 months (standard deviation [SD] = 1.3), and mean follow-up was 5.6 months (SD = 6.5). The mean sample size of 395 employees (SD = 700.8) had a mean age of 41.5 years (SD = 5.2). Measures of sleep duration included self-report from a general questionnaire (n = 12, 66.6%), self-report based on Pittsburgh Sleep Quality Index (n = 4, 22.2%), and self-report and actigraphy combined (n = 5, 27.7%). Studies most commonly included sleep hygiene (35.0%), yoga (25.0%), physical activity (10.0%), and cognitive-behavioral therapy for insomnia (10.0%) interventions. Across the interventions, 9 different behavior change techniques (BCTs) were utilized; the majority of interventions used 3 or fewer BCTs, while 1 intervention utilized 4 BCTs. Study quality, on average, was 68.9% (SD = 11.1). Half of the studies found workplace-based health promotion program exposure was associated with a desired increase in mean nightly sleep duration (n = 10, 50.0%).

CONCLUSIONS

Our study findings suggest health promotion programs may be helpful for increasing employee sleep duration and subsequent daytime performance.

Inter-rater reliability of an observation-based ergonomics assessment checklist for office workers

OBJECTIVES

To establish the inter-rater reliability of an observation-based ergonomics assessment checklist for computer workers.

METHODS

A 37-item (38-item if a laptop was part of the workstation) comprehensive observational ergonomics assessment checklist comparable to government guidelines and up to date with empirical evidence was developed. Two trained practitioners assessed full-time office workers performing their usual computer-based work and evaluated the suitability of workstations used. Practitioners assessed each participant consecutively. The order of assessors was randomised, and the second assessor was blinded to the findings of the first. Unadjusted kappa coefficients between the raters were obtained for the overall checklist and subsections that were formed from question-items relevant to specific workstation equipment.

RESULTS

Twenty-seven office workers were recruited. The inter-rater reliability between two trained practitioners achieved moderate to good reliability for all except one checklist component.

CONCLUSIONS

This checklist has mostly moderate to good reliability between two trained practitioners. Practitioner Summary: This reliable ergonomics assessment checklist for computer workers was designed using accessible government guidelines and supplemented with up-to-date evidence. Employers in Queensland (Australia) can fulfil legislative requirements by using this reliable checklist to identify and subsequently address potential risk factors for work-related injury to provide a safe working environment.

Efficacy of Office Ergonomics Education

The incidence of musculoskeletal injuries associated with computer use is increasing. Education has been advocated as a prevention method for reducing the incidence and severity of musculoskeletal injuries. Although the inclusion of education in musculoskeletal injury prevention programs has become a popular practice, the efficacy of educational programming is poorly defined in the literature. The present study was designed to investigate the efficacy of worker education programs in preventing musculoskeletal injuries in a population of reservation center employees who spend the majority of their work day using the computer. Participants were randomly assigned to one of three study groups (control, traditional education, or interactive education). Data collection utilized self-report surveys and observational checklists to collect data prior to intervention and at approximately 3, 6, and 12 months post intervention. Preliminary analysis of the data seems to indicate that, overall, education does have some impact on worker comfort, work area configuration, and worker postures.

From Theory to Practice: A Determinants Approach to Workplace Health Promotion in Small Businesses

A determinants approach to workplace health promotion focuses on the sources of health and ill health in the workplace itself. Key practice requirements of such an approach include the capacity to shift focus beyond the individual to the work environment, to cross disciplinary and jurisdictional boundaries in identifying problems and solutions, to foster health promotion self-sufficiency within the workplace, to enable worker participation in the process, and to adapt practice strategies to a business setting. This article identifies the challenges of such practice by reference to the experiences of health promoters in a Canadian public health department who attempted a determinants-centered stress reduction program for small-sized businesses. Findings under-score the significance for workplace health promotion of the broader structural context in which the workplace and the intervention are located, of differing perspectives between health professionals and workplace parties, and of conflicting professional accountabilities. Possibilities for addressing these challenges are considered.

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.

Integrating health promotion with quality improvement in a Swedish hospital

Integration of workplace employee health promotion (HP) and occupational health and safety (OHS) work into organizational quality improvement systems is suggested as a way to strengthen HP and OHS activities in an organization. The aim of this article was to study what consequences integration of HP, OHS and a quality improvement system called kaizen has on the frequency and type of HP and OHS activities. A quasi-experimental study design was used where an integration of the three systems for HP, OHS respectively kaizen, was performed at six intervention units at a Swedish hospital. The remaining six units served as controls. Document analysis of all employees' written improvement suggestions (kaizen notes) during 2013 was conducted. The findings show that the intervention group had more suggestions concerning HP and OHS (n = 114) when compared with the control group (n = 78) and a greater variety of HP and OHS suggestions. In addition, only the intervention group had included HP aspects. In both groups, most kaizen notes with health consideration had a preventive focus rather than rehabilitative. The intervention, i.e. the integration of HP, OHS and kaizen work, had a favourable effect on HP and OHS work when compared with the controls. The results of the study support that this system can work in practice at hospitals.

Labor unions: a public health institution

Using a social-ecological framework, we drew on a targeted literature review and historical and contemporary cases from the US labor movement to illustrate how unions address physical and psychosocial conditions of work and the underlying inequalities and social determinants of health. We reviewed labor involvement in tobacco cessation, hypertension control, and asthma, limiting articles to those in English published in peer-reviewed public health or medical journals from 1970 to 2013. More rigorous research is needed on potential pathways from union membership to health outcomes and the facilitators of and barriers to union-public health collaboration. Despite occasional challenges, public health professionals should increase their efforts to engage with unions as critical partners.

Empowering individuals to integrate work and life: insights for management development

Purpose

– In efforts to improve employee recruitment and retention and enhance productivity and morale, organizations have implemented policies and practices (e.g. flextime, telework to address employee work-life concerns). However, there is mixed evidence regarding their effectiveness. The purpose of this paper is to complement work-life policies, initiatives aimed at empowering employees with the knowledge and skills to manage multiple life roles may be valuable. Little information is available regarding the nature or effectiveness of such initiatives. Through an in-depth analysis of one initiative, Total Leadership, the authors provide insights that can be used in the selection, design, implementation, and evaluation of work-life empowerment efforts.

Design/methodology/approach

– The authors use a mixed methods approach to explore the experiences of 316 participants in the Total Leadership program. Self-assessments (pre and post) were analyzed using quantitative methods (e.g. Cohen’s d-value). Inductive and iterative qualitative methods were employed to understand the types of experiments participants created as part of the program.

Findings

– The authors found that participants reported significant increases in satisfaction and performance in all domains of life (work, home, community, and self). Further, the authors identified nine types of experiments that individuals used to enhance performance in all life domains. Implications for management development specialists are provided.

Originality/value

– This study provides unique and valuable insight for those interested in supporting employee work-life development, leadership, and performance in all domains of life. It represents one of the first efforts to provide evidence-based guidance for the design and implementation of such initiatives.

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.

A multilevel model of organizational health culture and the effectiveness of health promotion

PURPOSE

Organizational health culture is a health-oriented core characteristic of the organization that is shared by all members. It is effective in regulating health-related behavior for employees and could therefore influence the effectiveness of health promotion efforts among organizations and employees. This study applied a multilevel analysis to verify the effects of organizational health culture on the organizational and individual effectiveness of health promotion.

DESIGN

At the organizational level, we investigated the effect of organizational health culture on the organizational effectiveness of health promotion. At the individual level, we adopted a cross-level analysis to determine if organizational health culture affects employee effectiveness through the mediating effect of employee health behavior.

SETTING

The study setting consisted of the workplaces of various enterprises.

SUBJECTS

We selected 54 enterprises in Taiwan and surveyed 20 full-time employees from each organization, for a total sample of 1011 employees.

MEASURES

We developed the Organizational Health Culture Scale to measure employee perceptions and aggregated the individual data to formulate organization-level data. Organizational effectiveness of health promotion included four dimensions: planning effectiveness, production, outcome, and quality, which were measured by scale or objective indicators. The Health Promotion Lifestyle Scale was adopted for the measurement of health behavior. Employee effectiveness was measured subjectively in three dimensions: self-evaluated performance, altruism, and happiness.

ANALYSIS

Following the calculation of descriptive statistics, hierarchical linear modeling (HLM) was used to test the multilevel hypotheses.

RESULTS

Organizational health culture had a significant effect on the planning effectiveness (β = .356, p < .05) and production (β = .359, p < .05) of health promotion. In addition, results of cross-level moderating effect analysis by HLM demonstrated that the effects of organizational health culture on three dimensions of employee effectiveness were completely mediated by health behavior.

CONCLUSION

The construct connections established in this multilevel model will help in the construction of health promotion theories. The findings remind business executives that organizational health culture and employee health behavior help improve employee effectiveness.

Assessment of a Worksite Health Promotion Readiness Checklist

OBJECTIVE

To assess the utility of a Worksite Health Promotion Readiness Checklist (WRCL) designed to evaluate the worksite's readiness for implementing health promotion and health protection programs.

METHODS

The WRCL was pilot tested in worksites with (WHPy) and without (WHPn) health promotion programs. The two parts of WRCL scores (observational and administrative) for WHPy and WHPn sites were compared within and between the worksites to establish WRCL utility and sensitivity.

RESULTS

Observational WRCL (completed by two observers per site) demonstrated high interrater reliability (P < 0.05) for most items. Administrative WRCL (completed by three administrators per site) showed some discrepant responses between administrators. Overall, both sections of WRCL produced higher scores for WHPy sites.

CONCLUSIONS

WRCL could be a valid and reliable instrument to measure readiness of a worksite toward health promotion and health protection programs.

Statement on national worklife priorities

The National Institute for Occupational Safety and Health (NIOSH) WorkLife Initiative (WLI) [http://www.cdc.gov/niosh/worklife] seeks to promote workplace programs, policies, and practices that result in healthier, more productive employees through a focus simultaneously on disease prevention, health promotion, and accommodations to age, family, and life stage. The Initiative incorporates the Institute's foundational commitment to workplaces free of recognized hazards into broader consideration of the factors that affect worker health and wellbeing. Workplace hazards, such as physical demands, chemical exposures, and work organization, often interact with non-work factors such as family demands and health behaviors to increase health and safety risks. New workplace interventions being tested by the first three NIOSH WLI Centers of WorkLife Excellence are exploring innovative models for employee health programs to reduce the human, social, and economic costs of compromised health and quality of life. Many parties in industry, labor, and government share the goals of improving employee health while controlling health care costs. NIOSH convened a workshop in 2008 with representatives of the three Centers of Excellence to develop a comprehensive, long-range strategy for advancing the WorkLife Initiative. The recommendations below fall into three areas: practice, research, and policy. Responding to these recommendations would permit the WorkLife Center system to establish a new infrastructure for workplace prevention programs by compiling and disseminating the innovative practices being developed and tested at the Centers, and elsewhere. The WLI would also extend the customary scope of NIOSH by engaging with multiple NIH Institutes that are already generating research-to-practice programs involving the working-age population, in areas such as chronic disease prevention and management. Research to Practice (r2p) is a concept focused on the translation of research findings, technologies, and information into evidence-based prevention practices and products that are adopted in the workplace or other "real-world" settings. NIOSH's goal is to overcome the translational issues that now prevent state-of-the-art occupational health, health promotion, and chronic disease research findings from benefiting working age populations immediately, regardless of workplace size, work sector, or region of the country.

Using organization theory to understand the determinants of effective implementation of worksite health promotion programs

The field of worksite health promotion has moved toward the development and testing of comprehensive programs that target health behaviors with interventions operating at multiple levels of influence. Yet, observational and process evaluation studies indicate that such programs are challenging for worksites to implement effectively. Research has identified several organizational factors that promote or inhibit effective implementation of comprehensive worksite health promotion programs. However, no integrated theory of implementation has emerged from this research. This article describes a theory of the organizational determinants of effective implementation of comprehensive worksite health promotion programs. The model is adapted from theory and research on the implementation of complex innovations in manufacturing, education and health care settings. The article uses the Working Well Trial to illustrate the model's theoretical constructs. Although the article focuses on comprehensive worksite health promotion programs, the conceptual model may also apply to other types of complex health promotion programs. An organization-level theory of the determinants of effective implementation of worksite health promotion programs.

A framework for the concurrent consideration of occupational hazards and obesity

Occupational hazards and obesity can lead to extensive morbidity and mortality and put great financial burden on society. Historically, occupational hazards and obesity have been addressed as separate unrelated issues, but both are public health problems and there may be public health benefits from considering them together. This paper provides a framework for the concurrent consideration of occupational hazards and obesity. The framework consists of the following elements: (i) investigate the relationship between occupational hazards and obesity, (ii) explore the impact of occupational morbidity and mortality and obesity on workplace absence, disability, productivity and healthcare costs, (iii) assess the utility of the workplace as a venue for obesity prevention programs, (iv) promote a comprehensive approach to worker health and (v) identify and address the ethical, legal and social issues. Utilizing this framework may advance the efforts to address the major societal health problems of occupational hazards and obesity.

Do neighborhood economic characteristics, racial composition, and residential stability predict perceptions of stress associated with the physical and social environment? Findings from a multilevel analysis in Detroit

As the body of evidence linking disparities in the health of urban residents to disparate social, economic and environmental contexts grows, efforts to delineate the pathways through which broader social and economic inequalities influence health have burgeoned. One hypothesized pathway connects economic and racial and ethnic inequalities to differentials in stress associated with social and physical environments, with subsequent implications for health. Drawing on data from Detroit, Michigan, we examined contributions of neighborhood-level characteristics (e.g., poverty rate, racial and ethnic composition, residential stability) and individual-level characteristics (e.g., age, gender) to perceived social and physical environmental stress. We found that neighborhood percent African American was positively associated with perceptions of both social and physical environmental stress; neighborhood percent poverty and percent Latino were positively associated with perceived physical environmental stress; and neighborhood residential stability was negatively associated with perceived social environmental stress. At the individual level, whites perceived higher levels of both social and physical environmental stress compared to African American residents of the same block groups, after accounting for other variables included in the models. Our findings suggest the importance of understanding and addressing contributions of neighborhood structural characteristics to perceptions of neighborhood stress. The consistency of the finding that neighborhood racial composition and individual-level race influence perceptions of both social and physical environments suggests the continuing importance of understanding the role played by structural conditions and by personal and collective histories that vary systematically by race and ethnicity within the United States.

Process evaluation results from the Healthy Directions-Small Business study

The Healthy Directions-Small Business randomized, controlled study aimed to reduce cancer risk among multiethnic workers in small manufacturing businesses by increasing fruit and vegetable consumption, physical activity, and daily multivitamin in take and decreasing consumption of red meat. The intervention incorporated participatory strategies and was built on a social-contextual framework that addressed people with varying cultural backgrounds and literacy levels. In addition, the intervention aimed to reduce worker exposure to occupational hazards. Process evaluation was conducted using quantitative and qualitative research methods. Quantitative results showed high levels of worker awareness of and participation in programs. Qualitative findings suggested that management support, worker input, and a history of social interaction between workers and management may have contributed to high participation rates. Future studies need to examine characteristics associated with participation and nonparticipation of both managers and nonmanagers to increase the likelihood of participation and ultimately improve health behavior.

Engaging urban residents in assessing neighborhood environments and their implications for health

Researchers have worked to delineate the manner in which urban environments reflect broader social processes, such as those creating racially, ethnically and economically segregated communities with vast differences in aspects of the built environment, opportunity structures, social environments, and environmental exposures. Interdisciplinary research is essential to gain an enhanced understanding of the complex relationships between these stressors and protective factors in urban environments and health. The purpose of this study was to examine the ways that multiple factors may intersect to influence the social and physical context and health within three areas of Detroit, Michigan. We describe the study design and results from seven focus groups conducted by the Healthy Environments Partnership (HEP) and how the results informed the development of a survey questionnaire and environmental audit tool. The findings from the stress process exercise used in the focus groups described here validated the relevance of a number of existing concepts and measures, suggested modifications of others, and evoked several new concepts and measures that may not have been captured without this process, all of which were subsequently included in the survey and environmental audit conducted by HEP. Including both qualitative and quantitative methods can enrich research and maximize the extent to which research questions being asked and hypotheses being tested are driven by the experiences of residents themselves, which can enhance our efforts to identify strategies to improve the physical and social environments of urban areas and, in so doing, reduce inequities in health.

[Is it possible to sustain health promotion programs in private companies? The case of four Quebec private companies of blue collar workers]

OBJECTIVE

Sustained health promotion programmes in the workplace (HPPW) continues to be a public health challenge. This article presents an evaluation of the implementation and sustainability of such programmes in private blue-collar companies in Quebec to shed light on issues specific to this type of setting.

METHOD

A multiple case (4 sites), longitudinal (7 years) and interpretive study method was used. The interpretation framework considered that the implementation and sustainability of HPPW in companies are the result of organizational learning in health promotion, determined by the strategies of individuals in a position of control who shape the decisional processes related to these programmes.

RESULTS

After seven years of observation, two of the four sites had continued their HPPW, although these programmes were no longer applied within these companies. The health promotion organizational learning processes in both sites were defined according to targeted organizational purposes set by the decision-makers who supported HPPW. However, these gains were largely lost when HPPW were no longer retained as a component of their organizational development strategy.

DISCUSSION

The organizational conditions that are conducive to HPPW are difficult to put together and sustain in companies like those in our study. Businesses implement these programmes mainly for the organizational benefits they expect to reap in the short term, whereas improvement in the health of workers in the longer term is not a priority.

Application of health promotion theories and models for environmental health

The field of environmental health promotion gained new prominence in recent years as awareness of physical environmental stressors and exposures increased in communities across the country and the world. Although many theories and conceptual models are used routinely to guide health promotion and health education interventions, they are rarely applied to environmental health issues. This article examine show health promotion theories and models can be applied in designing interventions to reduce exposure to environmental health hazards. Using the Community Action Against Asthma (CAAA) project as an example, this article describes the application of these theories and models to an intervention aimed at reducing environmental triggers for childhood asthma. Drawing on the multiple theories and models described, a composite ecological stress process model is presented, and its implications for environmental health promotion discussed.

Reducing occupation-based disparities related to tobacco: roles for occupational health and organized labor

BACKGROUND

Persistent and growing occupation-based disparities related to tobacco pose a serious public health challenge. Tobacco exacts a disproportionate toll on individuals employed in working class occupations, due to higher prevalence of smoking and exposure to secondhand smoke among these workers compared to others.

METHODS

We provide an overview of recent advances that may help to reduce these disparities, including research findings on a successful social contextual intervention model that integrates smoking cessation and occupational health and safety, and a new national effort to link labor unions and tobacco control organizations around their shared interest in reducing tobacco's threat to workers' health.

CONCLUSIONS

Implications of these efforts for future research and action are discussed.

Worker-trainers as evaluators: a case study of a union-based health and safety education program

The United Automobile Workers uses worker-trainers to deliver health and safety education training to its members. The union has experimented with worker-trainers participating in program evaluation. Worker-trainers participated in the design and conduct of a telephone survey of training impact, and of an on-site survey of trainee perceptions of a large-scale program. Worker evaluators were able to analyze data and give a highly successful presentation of results to trainees at the large-scale program. The incorporation of workers as evaluators is a key step toward the goal of worker empowerment. The involvement of program participants in their program's evaluation can enhance the quality and usefulness of work-site health and safety programs in general.

Reducing social disparities in tobacco use: a social-contextual model for reducing tobacco use among blue-collar workers

In the United States in 1997, the smoking prevalence among blue-collar workers was nearly double that among white-collar workers, underscoring the need for new approaches to reduce social disparities in tobacco use. These inequalities reflect larger structural forces that shape the social context of workers' lives. Drawing from a range of social and behavioral theories and lessons from social epidemiology, we articulate a social-contextual model for understanding ways in which socioeconomic position, particularly occupation, influences smoking patterns. We present applications of this model to worksite-based smoking cessation interventions among blue-collar workers and provide empirical support for this model. We also propose avenues for future research guided by this model.

Organizational influence on working people's occupational noise protection in Hong Kong

INTRODUCTION

While there is some evidence of the influences of personal knowledge and organizational factors on workers' hearing protection, a causal model examining relationships between these variables is lacking.

METHOD

To create and test such a model, this study collected data from 1,701 workers in Hong Kong through a random sample telephone survey.

RESULTS

Fitting the model to the data revealed that organizational regulation of occupational noise protection was a root cause of workers' protective behavior, whereas workers knowledge about the protection exhibited only a minimal effect.

CONCLUSIONS

These findings cast doubt on the significance of personal knowledge as a unique factor contributing to noise protection. The study also finds that organizational regulation was predictable by a number of organizational and industrial factors.

IMPACT ON INDUSTRY

To prevent occupational deafness, organizational regulation accompanied by regular inspection and a norm of noise protection is important.

Comprehensive Health Promotion Interventions at the Workplace: Experiences With Health Circles in Germany

Health circles, the central element of a comprehensive health promotion approach that has been developed in Germany in recent years, emphasize organizational and psychosocial factors while actively involving employees in the process. Through an extensive review the authors identified 11 studies, presenting the results of 81 health circles. The scientific quality of the data is limited: only 3 studies used (nonrandomized) control groups, whereas the remaining studies are based on retrospective before-and-after comparison. Nonetheless, the available data suggest that health circles are an effective tool for the improvement of physical and psychosocial working conditions and have a favorable effect on workers' health, well-being, and sickness absence. More rigorous studies are needed to confirm these results.

Social context for workplace health promotion: feasibility considerations in Costa Rica, Finland, Germany, Spain and Sweden

We constructed a simple, flexible procedure that facilitates the pre-assessment of feasibility of workplace health promotion (WHP) programmes. It evaluates cancer hazards, workers' need for hazard reduction, acceptability of WHP, and social context. It was tested and applied in 16 workplace communities and among 1085 employees in industry, construction, transport, services, teaching and municipal works in Costa Rica, Finland, Germany, Spain and Sweden. Social context is inseparable from WHP. It covers workers' organizations and representatives, management, safety committees, occupational health services, health and safety enforcement agencies, general health services, non-government organizations, insurance systems, academic and other institutions, regulatory stipulations pertaining WHP, and material resources. Priorities, risk definitions, attitudes, hazard profiles, motivations and assessment methods were highly contextual. Management preferred passive interventions, helping cover expert costs, participating in planning and granting time. Trade unions, workers' representatives, safety committees and occupational health services appeared to be important operational partners. Occupational health services may however be loaded with curative and screening functions or be non-existent. We advocate participatory, multifaceted WHP based on the needs and empowerment of the workers themselves, integrating occupational and lifestyle hazards. Workforce in irregular and shift work, in agriculture, in small enterprises, in the informal sector, and immigrant, seasonal and temporary workers represent groups in need of particular strategies such as community health promotion. In a more general framework, social context itself may become a target for intervention.

Changes in postural risk and general health associated with a participatory ergonomics education program used by heavy video display terminal users: a pilot study

To determine if a brief, participatory ergonomics education program was associated with changes in work posture and general health of heavy video display terminal (VDT) users, 23 full-time VDT users participated in an on-site, small-group, 60-minute ergonomics education session and 1 week later an individual 15-minute follow-up session at their workstation. Posture was assessed by a blinded tester who scored videotape records to complete the Postural and Repetitiveness Risk Factors Index (PRRI), and general health status was assessed via self-administered Short-Form 36 Health Survey (SF-36) questionnaire before the intervention and again 5 weeks later. Five weeks after the 60-minute session, PRRI scores were 19% lower than were preintervention scores (p < 0.01), indicating lower postural risk. SF-36 physical (2% higher) and mental (4% higher) component scores were not statistically different, however, before and after intervention (p > 0.05). Although the participatory ergonomics education program was associated with improved work posture (PRRI scores) after 5 weeks, general physical and mental health (SF-36 scores) did not change within this time period. These results suggest that a participatory ergonomics program, which is of short duration and minimally disruptive to the normal workplace routine, may have a rapid effect on improving work posture. Although awkward posture is thought to be a risk factor for work-related musculoskeletal disorders, multigroup and long-term randomized trials are required to establish the effectiveness of participatory ergonomics programs in reducing the incidence and severity of musculoskeletal disorders associated with heavy VDT use.

Assessment of feasibility of workplace health promotion

BACKGROUND

A simple empirically based method for assessment of the feasibility of workplace health promotion programs is described, focusing on cancer hazards (lifestyles, workplace hazards, deficient early detection). The basic components of feasibility are addressed: extent of hazards; needs of employees for hazard reduction and acceptability of WHP; and social context.

METHODS

The procedure consists of six modules: guidelines on feasibility assessment; employee questionnaire; interview checklists for probing attitudes of management and partners (social context); data form; debriefing; and assessment of feasibility. Pretesting was completed in 16 workplace communities representing industry, construction, transport, telecommunications, health care, lodging and catering, teaching, and municipality jobs in five countries; a total of 1,085 subjects completed the employee questionnaire on health hazards, needs, and acceptability.

RESULTS

The method demonstrated its utility in obtaining and summarizing the necessary data. Feasibility was assessed for the 16 test communities.

CONCLUSION

The procedure can be customized; it has a high degree of face validity or understandability, and it is applicable in a wide variety of settings.

Worksite tobacco control programs: the role of occupational health

Worksite tobacco control initiatives face a crucial challenge: the growing occupational disparity in smoking prevalence. Blue-collar workers are more likely to be smokers than workers are in white-collar jobs. Blue-collar workers also experience a high prevalence of hazardous exposures on the job. Given these multiple risks, it is imperative that successful comprehensive programs be developed to promote and protect the health of blue-collar workers. Although evidence is still accruing about the efficacy of workplace interventions integrating tobacco control and occupational health, it is possible to identify promising intervention strategies by drawing on the preliminary evidence on effective worksite interventions. The effectiveness of worksite tobacco control interventions will be enhanced when coordinated interventions aim to promote cessation among individual smokers, build social support for quitting and social norms that support non-smoking, engage management in assuring a healthy work environment, involve workers' families in non-smoking initiatives, and provide links to community and public policy initiatives that support tobacco control as well as a broader effort promoting worker health.

The Fort McMurray Demonstration Project in Social Marketing: theory, design, and evaluation

CONTEXT

The Fort McMurray Demonstration Project in Social Marketing is a multifaceted program that applies the techniques of social marketing to health and safety. This paper describes the origins of the project and the principles on which it was based. VENUE: Fort McMurray, in the province of Alberta, Canada, was selected because the community had several community initiatives already underway and the project had the opportunity to demonstrate "value added."

CONCEPT

The project is distinguished from others by a model that attempts to achieve mutually reinforcing effects from social marketing in the community as a whole and from workplace safety promotion in particular.

DESIGN

Specific interventions sponsored by the project include a media campaign on cable television, public activities in local schools, a community safety audit, and media appearance by a mascot that provides visual identity to the project, a dinosaur named "Safetysaurus." The project integrated its activities with other community initiatives.

MAIN OUTCOME MEASURES

The evaluation component emphasizes outcome measures. A final evaluation based on injury rates and attitudinal surveys is underway.

RESULTS

Baseline data from the first round of surveys have been compiled and published. In 1995, Fort McMurray became the first city in North America to be given membership in the World Health Organization's Safe Community Network.

Health behavior, quality of work life, and organizational effectiveness in the lumber industry

A major incentive for work-site health promotion activities has been the promise of increased company profitability. Some critics have challenged the economic argument based on distal outcomes such as increased employee longevity and less morbidity later in life. The purpose of this study was to examine the relationships between employee health behavior, quality of work life, and proximal organizationally valued outcomes. Data were collected from a stratified random sample of employees working at Pacific Lumber Company (N = 146), the largest single-site lumber mill in California. Although employee sleep patterns predicted health care utilization and psychological well-being, for the most part employee health behaviors were not strong predictors of proximal organizational effectiveness factors. However, quality-of-work-life factors significantly predicted organizational commitment, absenteeism, and tardiness frequency. The findings suggest the value of improving the system of work in which employees are embedded as part of comprehensive work-site health promotion efforts.

Impact of the Working Well Trial on the worksite smoking and nutrition environment

This article reports the effect of a worksite cancer control intervention on aspects of the physical and social environment related to dietary and smoking behaviors of employees. Data are from 111 intervention and control worksites that participated in the Working Well Trial. Employee surveys and interviews with key organizational informants assessed environmental and normative changes relevant to nutrition and tobacco use. Results indicated significant effects of the intervention on all nutrition outcomes: access to healthy food, nutritional information at work, and social norms regarding dietary choice. Significant benefits were not found for smoking norms or smoking policies. However, changes occurred in both the control and intervention sites on these variables. This first large analysis of environmental and normative effects of a worksite intervention is consistent with the employee behavior change findings for the trial and serves as a model for future analyses of multilevel worksite health promotion programs.

Personal responsibility for health? A review of the arguments and the evidence at century's end

This article examines the continuing controversies regarding personal versus social responsibility for health as they are being played out at the turn of the century. Following a brief examination of the contested meaning of "personal responsibility for health" in recent historical context, attention is focused on the arguments for and against holding the individual to be primarily accountable for his or her health behavior. The paper then makes the case for more balanced, ecological approaches that stress individual responsibility for health within the context of broader social responsibility. The article concludes by briefly summarizing the Canadian approach to health promotion as a useful example of what such a balanced, ecological approach might look like.

The effects of a health promotion-health protection intervention on behavior change: the WellWorks Study

OBJECTIVES

This study assessed the effects of a 2-year integrated health promotion-health protection work-site intervention on changes in dietary habits and cigarette smoking.

METHODS

A randomized, controlled intervention study used the work site as the unit of intervention and analysis; it included 24 predominantly manufacturing work sites in Massachusetts (250-2500 workers per site). Behaviors were assessed in self-administered surveys (n = 2386; completion rates = 61% at baseline, 62% at final). Three key intervention elements targeted health behavior change: (1) joint worker-management participation in program planning and implementation, (2) consultation with management on work-site environmental changes, and (3) health education programs.

RESULTS

Significant differences between intervention and control work sites included reductions in the percentage of calories consumed as fat (2.3% vs 1.5% kcal) and increases in servings of fruit and vegetables (10% vs 4% increase). The intervention had a significant effect on fiber consumption among skilled and unskilled laborers. No significant effects were observed for smoking cessation.

CONCLUSIONS

Although the size of the effects of this intervention are modest, on a populationwide basis effects of this size could have a large impact on cancer-related and coronary heart disease end points.

Social support and readiness to make dietary changes

This article examines the relationship between reported social support and readiness to increase fruit and vegetable consumption, based on the Transtheoretical Stage of Change Model. Data were collected as part of the baseline assessments for a work site intervention study promoting increased consumption of fruits and vegetables. Among workers who did not live alone, household support was significantly higher for those of Hispanic and African American heritage than other groups, and was also higher among men, nonsmokers, and those living with adults compared to those living only with children. In multivariate analyses, coworker support was significantly associated with being in preparation compared to precontemplation/contemplation. Household support was not significantly related to readiness to change in multivariate analyses. The effectiveness of work site nutrition education interventions is likely to be enhanced by teaching participants to provide social support to coworkers and family members.

Relationship of organizational characteristics of Canadian workplaces to anti-smoking initiatives

BACKGROUND

In Canada, with universal single-payer health care insurance and a lower proportion of the gross domestic product going to health care costs, employers may be less motivated than their U.S. counterparts to develop health promotion programs for their employees. This study determined the extent to which nongovernmental workplaces in Canada have made smoking-related information, policies, and programs available to their employees. Several characteristics of those workplaces most likely to have engaged in such activities were identified.

METHODS

A secondary analysis of data collected in the 1992 National Workplace Survey was conducted. All Canadian provinces, except Saskatchewan, were included. Dunn and Bradstreet's register of companies was used to select companies randomly from those with 20 or more employees. Questionnaires were distributed to 10000 workplaces. The response rate was 35.5% (N = 3,549). There were no significant differences found between responders and nonresponders in a phone survey.

RESULTS

One-half of workplaces reported some kind of smoking-related initiative. Most of the initiatives were smoking policies; only 11.7% of workplaces provided smoking cessation programs. The number of employees and the number of other lifestyle and occupational health and safety programs available are most predictive of smoking-related programs.

CONCLUSIONS

If Canadians are going to achieve a smoke-free society, greater efforts to assist smokers to quit will be necessary. The workplace provides an excellent opportunity for such efforts. Health promotion advocates must communicate the cost savings and other benefits to employers garnered from workplace smoking reduction efforts.