TOTAL WORKER HEALTH
Activities: NIOSH Funded Research Grants
NIOSH sponsors research and training through its extramural programs, which complement the Institute's intramural programs. More information is available from the NIOSH Office of Extramural Programs.
Centers of Excellence
Oregon Healthy WorkLife Center
The Oregon Health & Science University (OHSU) collaborates with Portland State University (PSU) to administer the Oregon Healthy WorkLife Center (ORhwc), a NIOSH Center of Excellence, in partnership with Kaiser Permanente Center for Health Research (Portland) and the University of Oregon's Labor Education and Research Center (LERC). The ORhwc's approach is intervention effectiveness, focused on team-based and technology-based interventions to promote and protect health. These interventions are linked to a conceptual model that predicts changes in psychological processes that mediate behavior change—focused particularly on improved social support and reduced job stress-that will in turn produce improved lifestyle choices, safer work practices, and better psychological and physical health. The currently funded research projects include: "Health promotion intervention to reduce health risks among Correctional officers”, (Kerry S. Kuehl), "Creating health and safety "Communities of Practice" for Home Care workers” (Ryan Olson), "Team-based WorkLife and safety intervention for construction workers” (Leslie Hammer); and the translational project: "Health promotion and health protection in young workers” (Diane Rohlman). The research projects combine proven and novel intervention methods, while the translational project 'packages' proven intervention methods to be scaled for regional or national delivery. The projects use overlapping intervention strategies (independent variables) and common measures to demonstrate their effectiveness. The Oregon Healthy WorkLife Center research and translation projects implement interventions that provide both health promotion and health protection at the workplace. The Center will create a database comprised of all project data housed in a data repository for sharing within and outside the ORhwc, allowing comparisons across projects. A distinguished external advisory committee guide and evaluate the ORhwc. Interactive education programs complement the research, and results will be broadly disseminated through the ORhwc's outreach program.
Center for the Promotion of Health in the New England Workplace
The Center for the Promotion of Health in the New England Workplace (CPH-NEW) is a cooperative initiative by investigators from two major public universities in the New England area, the University of Massachusetts Lowell (UML) and the University of Connecticut (UC), along with the private sector (St. Paul Travelers Insurance Company. Genesis HealthCare Corporation. Liberty Mutual Research Institute for Safety), labor (Massachusetts Nurses Association and the Connecticut Council for Occupational Safety and Health), and state government (Massachusetts and Connecticut Departments of Public Health). The key academic departments are Work Environment at UML and Occupational and Environmental Medicine, Occupational Health Psychology, and Health Promotion at UC. Strengths of CPH-NEW lie in extensive group experience in occupational health and safety (OHS), psychology, and health promotion and education (HPE); technical expertise in survey research and biostatistics; and educational and outreach infrastructure. Cross disciplinary collaboration will rest on both project- and methodology-oriented teams as well as on the investigators strongly established relationships. "Exploratory,-Efficacy, and Effectiveness" research project #1, "Promoting Physical and Mental Health of Caregivers Through Trans-disciplinary Intervention" (Laura Punnett) will be conducted within Genesis HealthCare Corporation, a major East Coast provider of nursing home and assisted living care. A no-lift program in 217 facilities will be paired with two types of health promotion programs to compare worker health outcomes in sites with: 1) workplace intervention only; 2) workplace intervention and HPE; and 3) workplace intervention plus a participatory health promotion program. The Education, Translation, Communication and Dissemination" (Nicole Jane Champagne) project builds on Heart and Stroke Partnership plans developed by the MA and CT Departments of Health. The Center will develop curriculum and offer training sessions primarily on the relationship between work-related stress and the development of heart disease and stroke. CPE-NEW will greatly advance public health by integrating two core public health areas (OHS and HPE), thus linking primary prevention to the workplace, and the workplace to primary prevention.
University of Iowa Healthier Workforce Center for Excellence
The University of lowa Healthier Workforce Center of Excellence will extend its current research, education translation, pilot project grant program and outreach program through implementation of three Center goals: Goal 1: To design, implement, and evaluate two integrated health protection/promotion research projects, a) a participatory ergonomics program integrated with a health coach health promotion program designed to reduce ergonomic stressors, musculoskeletal disease outcomes and their related costs in window manufacturing facilities; and b) a health promotion program designed to increase healthy behaviors and improve key health indicators integrated with musculoskeletal injury risk factor reduction through health promotion/coaching and engineering training in the retail grocery trade; Goal 2: To implement and evaluate research to practice health protection/disease promotion education and training programs through a state and regional learning network; and Goal 3: To serve as a state and national information, education and policy resource on employee health programs, employee health services and employee health policy. The Center has a well-qualified leadership team and Internal Advisory Committee, has added new and highly qualified investigators, and is wisely advised by its very strong and diverse External Advisory Committee. The HWCE has documented a record of productive WorkLife research and electronic translation of its research to practice through implementation and expansion of its Healthier Workforce Learning Network (HWLN), which has forged important collaborations with the Patient Education Institute and the National Library of Medicine, and will exploit these important relationships to develop and evaluate 10 WorkLife tutorials annually, and will extend its successful HWLN-based lowa WorkLife Forum as a means to evaluate WorkLife Tutorials and other Center employee health educational programs. The HWCE Outreach Program proposes to extend its stakeholder relationships through the development of a lowa Stakeholder Advisory Committee, bi-annual conferences, bi-annual surveys, expansion of its dedicated web-site, and its state and national policy papers and advocacy.
Harvard School of Public Health Center for Excellence to Promote a Healthier Workforce
The goal of the Harvard Center for Excellence to Promote a Healthier Workforce is to establish a sustainable trans-disciplinary program devoted to research, education, and dissemination that will facilitate the integration of occupational safety and health and workplace. The long-term goal is to improve the health of workers through designing, testing, implementing, and disseminating effective worksite policies, programs, and practices that foster a healthy work environment, reduce potential hazardous job exposures, and promote safe and healthy behaviors. The center will foster and expand collaborations with diverse employers, labor unions, and intermediary organizations to help shape the center's directions and to influence the dialogue among these constituencies regarding the application of integrated approaches to worker health. The leadership of this research team conducted the first research demonstrating the worker health benefits to be derived from integration of worksite health protection and health promotion. Building on solid institutional support, they have assembled an accomplished trans-disciplinary team with a track record of collaborative research, representing the diverse disciplines of occupational health and safety, social and behavioral sciences, social epidemiology, health education, medicine, economics, engineering, health communications, organizational behavior, nursing, law, and biostatistics. The center will initiate research in two high-priority employment sectors, construction and health care, aimed at addressing priority research questions across the full span of research phases. Currently funded research projects include: Project A:”Integrated Approaches to Improving the Health and Safety of Health Care Workers” (Glorian Sorensen). The major goals of this project are to investigate the impact of work related environmental factors and health behaviors on the risk of musculoskeletal disorders in the health care setting and then determine the feasibility and efficacy of integrated policies, practices, and programs to reduce those risks. They intend to use a survey based methodology and employee databases with an overarching social epidemiological approach; Project B: Integrated Approaches to Improving the Health and Safety In Dynamic Construction Work” (Jack Denneriein). The two major goals of the project are to develop an integrated program that will address prevention and intervention for tobacco use and musculoskeletal disorder (MSD) in construction workers; and Project C: “Dissemination of Integrated Worker Health Programs among Small/Medium Employers” (Jennifer Allen). The major goal of this project is to develop methods for translating an integrated approach for workplace health promotion into practice for small and medium businesses. The project uses data collected from interviews with 20 managers to identify important factors in their decision making about program adoption and from surveys with 100 people that address design and adoption questions. The program will be piloted at three small to medium size businesses. In addition, strategically planned pilot projects will help to cultivate future research initiatives. This center’s vision is to integrate occupational health and safety and worksite health promotion that goes beyond the simple sum of the parts, to envision a new trans-disciplinary culture, science, and practice, and provide a national model for future research, education and dissemination in support of worker health.
Steps to Health: Targeting Obesity in the Health Care Workplace
Overweight and obesity increase the risk of diabetes, heart disease, and cancer. Nearly two thirds of the US population is overweight or obese, accounting for 9-10% of health care expenditures. Worksite obesity interventions to date have not typically been characterized by strong methodological designs or assessed the long-term impact of intervention strategies - neither in terms of the benefits to the participants, i.e., meeting weight and health goals, nor in terms of benefits to employers, including increased productivity and decreased health care costs. The NIOSH Work Life Initiative encourages further research in this area. The primary objective of this proposal is to compare the effectiveness of two individually tailored, integrated worksite weight management programs - Steps to Health (STH: ""usual standard of care"") and Steps to Health Plus! (STH+) using a randomized controlled trial design (n=500) and follow-up at 12, 24, and 36 months. The primary endpoint will be weight loss at 36 months, with additional analysis to determine role of social-cognitive and behavioral (diet and physical activity) factors in intervention success. Further analysis will compare reductions in workplace injuries, health care utilization and claims costs, and absenteeism/presenteeism in the two trial arms during the two years following the intervention. For these outcomes, participants will also be compared, in a prospective (non-randomized) fashion, with individuals in an observational comparison group, who meet eligibility criteria but do not take part in either of the two interventions. Finally, we will estimate the costs of the interventions relative to their effectiveness and savings, including changes in absenteeism and presenteeism, workers' compensation claims, and health claim reimbursements. The proposal takes advantage of an existing comprehensive occupational surveillance system which will permit evaluating the impact of the intervention on health care reimbursements. The study will build upon and enhance a well-established institutional employee wellness program, most of the intervention costs will be provided in kind by the institution, and the multidisciplinary research team has broad experience with behavioral interventions, obesity and the workplace, and cost effectiveness analysis. The interventions will be evaluated in a health-care worksite with a population of mixed ethnicity and socioeconomic status, allowing greater generalizability. The results of this study should be of great value to worksites considering interventions encouraging healthy weight. The intervention site is especially pertinent in that health care institutions can be models for other workplaces, and health care workers can be models for their families and patients. The workplace may be an ideal setting for reaching large populations of overweight and obese adults with weight control programs; several federal agencies have called for further pursuit of this opportunity to improve public health. Steps To Health aims to 1) help workers meet and maintain healthy weight goals through healthy eating and increased physical activity, 2) reduce the rate of work-related injuries, and 3) decrease health care expenditures associated with obesity.
SHIELD: Safety & Health Improvement: Enhancing Law Enforcement Departments
Researchers from Oregon Health & Science University have developed a science-based, team-centered, scripted peer-taught program for fire fighters improving diet and exercise behavior while reducing injury rates and costs. Those investigators are partnering with local law enforcement agencies in Oregon and SW Washington to adapt, apply and assess this work-based program among a new high risk group to improve the health and safety of law enforcement officers (LEOs). Fire fighters’ work structure is a natural fit for a team-centered format, and teammates’ social support appeared to partially mediate the intervention’s positive outcomes. Although conducive to team formation, LEOs’ work lacks the established team structure of fire fighters. This proposal will apply the team-centered intervention to LEOs and in the process, learn more about teams as vehicles of health behavior change, and their relationship with outcomes and other potential mediating variables in a multilevel ecological analytic framework. Following a 3 month pilot study with four teams, we will enroll 14 precincts and 80 teams (approximately 470 participants) of LEO work groups for a prospective, clustered randomized 2-year assessment of the intervention (40 intervention and 40 testing-only, control-condition teams). Participants will be evaluated at baseline, 12, and 24. Primary study aims are; 1) Implement a randomized controlled efficacy trial of the SHIELD intervention, a peer-led, team-based occupational wellness program, and assess its behavioral and occupational outcomes, 2) Determine relations among variables in the chain from exposure of LEO subjects to specific intervention components to changes in mediating variables to behavior changes and occupational outcomes, and 3) Perform a cost analysis to determine the economic benefit of this LEO worksite health promotion program. The intervention involves a scripted peer-taught interactive curriculum, which is delivered as twelve, one hour weekly sessions incorporated into a team’s usual work time activities, with four follow-up booster sessions after twelve months. The curriculum is designed to build understanding, healthy decision making skills and engender the social support of teammates; its content and scope reflects the core lifestyles activities used with fire fighters, along with adaptations for the needs of LEOs in domains of the team-building, family support and psychological health. Participant assessments include established survey instruments, physiological measures and selected laboratory parameters of outcomes and potential mediating variables at the individual, interpersonal and organizational levels. Intervention delivery and fidelity will be assessed. Multilevel and latent growth modeling and mediation analyses will be used to assess outcomes and the relationships among variables. At proposal completion there will be an evidenced-based, exportable occupational safety and health program for LEOs. Its critical components will be defined, and its benefits clearly determined.
The Rural Worksite Weight Management Project
The current obesity epidemic is particularly impacting rural populations. A large portion of the costs are being borne by small rural employers. Although there is potential for using these worksites for meaningful weight loss / weight maintenance initiatives, there is little evidence of such efforts at the current time. The proposed project, ""The Rural Worksite Weight Management Project"" will adapt an existing evidence-based NIH program for use in small business worksites. Aim for Healthy Weight (AFHW) has been designed and tested in primary care settings. The first aim of this proposed work is to adapt AFHW for use with groups of employees in the small business setting. Previous pilot efforts suggest that this can be readily accomplished. The second aim is the testing of this modified AFHW in eight randomly selected, size-stratified intervention sites and comparing the results with eight control sites. Outcomes of interest will include change in attitudes and behavioral intent relative to exercise and dietary change as well as change in body mass index. The New York Center for Agricultural Medicine and Health is already working with a cohort of 104 rural worksites, many of whom have already indicated a willingness to participate in the proposed study. Demonstration of meaningful impact of this worksite wellness intervention could lead to widespread dissemination of this methodology to both rural and non-rural small businesses.
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