Services

Participating core and specialty programs: Center for Workers’ Compensation Studies, Occupational Health Equity, Small Business Assistance, Safe●Skilled●Ready Workforce, and Translation Research.

Employers, researchers, nongovernmental organizations, workers, and policy makers will use NIOSH information to improve safety, and health among contingent workers and workers in non-standard work arrangements in the service sector.

NOTE: Goals in bold in the table below are priorities for extramural research.

  Health Outcome Research Focus Worker Population* Research Type
A Acute and chronic disease, Fatal and non-fatal injuries Characterizing contingent workers and risk factors Contingent workers; young workers and other vulnerable populations Surveillance research
B Fatal and non-fatal injuries, Musculoskeletal disorders (MSDs) Employer ambiguity, inadequate occupational safety and health training, and lack of programs Contingent workers; young workers and other vulnerable populations Intervention Translation
C Heat-related illnesses Employer ambiguity, inadequate OSH training, and lack of programs Non-standard work arrangements (including seasonal outdoor workers) Intervention
Translation

* See definitions of worker populations

Activity Goal 7.5.1 (Intervention Research): Conduct studies to develop and assess the effectiveness of interventions at temporary employment agencies to improve safety and health for temporary agency workers in the services sector.

Activity Goal 7.5.2 (Translation Research): Conduct translation research to understand barriers and aids to implementing effective safety and health interventions at temporary employment agencies in the services sector.

Activity Goal 7.5.3 (Surveillance Research): Conduct surveillance research to better characterize the risk factors for contingent workers and workers in non-standard work arrangements in the services sector.

Burden

Contingent work is prevalent in the Services sector. Occupational hazards for these workers are the same or greater compared with those for workers in standard work arrangements in the same industry. Among all workers, there were 829 fatalities among contract employees in 2015 (17% of all workplace deaths). In the Service Sector, there were 139 fatalities among contract employees (29% of Service sector fatalities) [BLS 2016].

Occupational hazards can be greater for temporary agency workers because of a lack of clarity about which employer is responsible for their safety and the fact that they are more often likely to be performing a job for the first time. A hazard of temporary work is psychological morbidity possibly being related to job insecurity [Virtanen et al. 2005]. Other hazards are dependent on the work environment at the host establishment, which can be influenced by lack of training, protective measures, and adequate supervision.

Temporary employment services is within the top 20 industries with the largest wage and salary employment growth. Temporary agency workers report much higher levels of job stress, and experience about twice the number of poor physical and mental health days due to stress, than other service workers. Temporary agency workers are often employed in Construction and Manufacturing but a recent article about workers in Washington State, found that temporary agency workers working in the Construction and Manufacturing industries had more than a two- to four-fold higher rate-ratio than construction or manufacturing workers in standard work arrangements. For all major injury types suffered by construction and manufacturing temporary agency workers, medical only claims were 88 to 300% higher than those for workers in standard arrangements [Smith et al. 2010].

Need

Little surveillance information on contingent workers is available. Key data sources on work arrangements categorize workers different ways, and sometimes the categorization is very broad to combine temporary workers with long term contract workers. This lack of knowledge is a research gap that needs to be filled. Consistent and tested questions need to be added to the major sources of labor statistics and work-related health data so that this worker population can be better understood. Tracking of contingent worker’s safety is lacking (GAO, 2015). Surveillance methods are not only needed to determine job types but also to count and record job risks and injuries and illnesses.

Temporary agency workers do not have clearly defined supervisory support for training and for expressing job concerns. Economic analysis, small business research, and other types of intervention research are needed to assist both host and client employers in creating a safe and healthy workplace, and improving well-being for temporary agency workers.

There is inadequate occupational safety and health training among temporary agency workers where socioeconomic and racial/ethnic disparities exist. This training should inform them of what is expected of their employer and host company. There are proven effective interventions to reduce the risk of health and safety hazards. These known interventions and employer and host company responsibilities need to be conveyed to temporary agencies and workers to improve health and safety in the workplace. Intervention and translation research is especially needed for young workers, seasonal outdoor workers, and other vulnerable worker populations.

Employers, unions, insurers, health and safety professionals, government agencies, and academicians effectively integrate protection from work-related safety and health hazards with promotion of injury and illness prevention efforts to advance worker well-being (i.e. Total Worker Health [TWH] approach) in the Services sector.

NOTE: Goals in bold in the table below are priorities for extramural research

  Health Outcome Research Focus Worker Population* Research Type
A Fatal and non-fatal injuries; illnesses Work and non-work factors that contribute to worker safety, health, and well-being (i.e. Total Worker Health [TWH] approach) Services workers, especially vulnerable workers and small businesses Intervention
B Fatal and non-fatal injuries; illnesses Improve data around risks to worker safety, health, and well-being  Services workers, especially vulnerable workers and small businesses Surveillance research
C Fatal and non-fatal injuries; illnesses Barriers and facilitators to implementing TWH research findings Services workers, especially vulnerable workers and small businesses Translation
D Fatal and non-fatal injuries; illnesses Evaluate the effectiveness, adoption, successful implementation, and sustainment of TWH polices, practices and programs Services workers, especially vulnerable workers and small businesses Intervention
Translation

* See definitions of worker populations

Activity Goal 7.15.1 (Intervention Research): Conduct studies to develop and assess the effectiveness of Interventions that integrate protection from work-related safety and health hazards with promotion of injury and illness prevention efforts to advance worker well-being in Services.

Activity Goal 7.15.2 (Translation Research): Conduct translation research to understand barriers and aids to implementing policies, programs, and practices that integrate protection from work-related safety and health hazards with promotion of injury and illness prevention efforts in Services.

Activity Goal 7.15.3 (Surveillance Research): Conduct surveillance research to better track risks to worker safety, health and well-being in Services.

Burden

In 2017, the Bureau of Labor Statistics (BLS) estimated that there were nearly 73 million workers in the services sector [BLS 2018]. Several subsectors within the services sector experience particularly elevated rates of injuries, fatalities, and chronic health conditions. More specifically, building and dwellings service (i.e. maintenance and landscape workers), food services, waste management and remediation services, and accommodations (hotel workers) had the highest number of fatalities and/or rates of injuries with days away from work [BLS 2015a,b, 2017]. For instance, data from both the Ohio Bureau of Worker’s Compensation and BLS indicated that building maintenance and repair, janitorial, cleaning, garbage collection, and hotel workers all have elevated rates of MSDs. [BLS 2015b; Meyers et al 2017]. Further, workers in accommodation, food, and waste remediation services have also been found to have higher rates of cardiovascular disease/stroke [CDC 2014].  Workplace factors of concern among workers in the services sector include multiple types of workplace stressors (e.g., physical exertion and physical inactivity, excessive heat or cold, noise, long work hours, shift work, job strain, low-decision latitude, and other psychosocial factors) [Kivimacki 2015; Theorell et al. 2016].

In the services sector, 89% of the 3 million firms have fewer than than 20 employees, and these small businesses typically have limited access to health and safety specialists [U.S. Census Bureau 2011]. Managers in smaller businesses often work in isolation without sufficient access to peer opinion and industry best practices. These factors not only reduce prevention activities but may also reduce the reporting of illnesses and injuries to government agencies, insurance companies, and other organizations [Morse et al. 2004].

Many businesses in services industries employ workers that are vulnerable to higher rates of morbidity and mortality due to their age, ethnic background, language, gender, education level or lack of long-term job stability. Many of these workers are immigrants whose exposures and health outcomes are exacerbated due to stressors, including many types of occupational health disparities [Landsbergis et al 2014]. These workers may not report injuries or suggest job aids because of their vulnerabilities. They may be more likely to be required to do some of the most physically challenging jobs, and may face additional challenges associated with job insecurity and low wages.

Systemic changes to our economy and socio-demographic workforce factors are ren­dering some past approaches to protecting workers ineffective. Increasingly, employ­ers face tighter profit margins, demanding timelines and global completion. Workers and employers must navigate new types of work arrangements, the aging of the workforce, high levels of work-related stress, and the growing challenges of both work and home life. Many enterprises continue to confront the legacy hazards of the traditional workplace, such as traumatic injury, chemical exposures, and shift work. At the same time, scientific evidence now supports what many safety and health professionals, as well as workers themselves, have long suspected—that risk factors in the workplace can contribute to common health problems previously considered unrelated to work.

Need

Total Worker Health promotes the integration of occupational safety and health (OSH) protection with workplace policies, programs, and practices to prevent injury and illness and advance overall health and well-being through research, interventions, partnerships, and capacity-building to meet the needs of the 21st century workforce. Evidence suggests that integrating occupational safety and health protection program activities with health promotion program activities may be more effective for safeguarding worker safety, health, and well-being than either of these programmatic activities on their own [Sorensen et al. 2013; NIOSH 2012; DeJoy 1993; Sauter 2013]. Despite these developments, there is need for continued research to better understand the benefits of integrated approaches to prevention and to promote more comprehensive intervention, especially among certain occupations and vulnerable worker groups, such as immigrants and young workers. Given that the majority of employers in the Services sector have fewer than 20 employees, studies to identify effective outreach methods through trusted partners are needed for all workers in the services sector, particularly among workers in small businesses and among immigrant populations.

BLS [2015a]. Census of fatal occupational injuries summary, 2014. Washington, DC: U.S. De­partment of Labor, Bureau of Labor Statistics, http://www.bls.gov/news.release/cfoi.nr0.htm.

BLS [2015b]. Employer-reported workplace injuries and illnesses in 2014. Table 2. Washing­ton, DC: U.S. Department of Labor, Bureau of Labor Statistics, http://www.bls.gov/news.release/pdf/osh.pdfpdf iconexternal icon.

BLS [2016]. Census of Fatal Occupational Injuries. Washington, DC: U.S. Department of Labor, Bureau of Labor Statistics, https://www.bls.gov/iif/oshwc/cfoi/cfch0014.pdfpdf iconexternal icon.

BLS [2017]. TABLE R8. Incidence rates for nonfatal occupational injuries and illnesses involving days away from work per 10,000 full-time workers by industry and selected events or exposures leading to injury or illness, private industry, 2015. Washington, DC: U.S. Department of Labor, Bureau of Labor Statistics, https://www.bls.gov/iif/oshcdnew.htm

BLS [2018]. Table 18. Employed persons by detailed industry, sex, race, and Hispanic or Latino ethnicity, 2017. Washington, DC: U.S. Department of Labor, Bureau of Labor Statistics, https://www.bls.gov/cps/cpsaat18.pdfCdc-pdfExternalpdf iconexternal icon

CDC [2014]. Prevalence of coronary heart disease or stroke among workers aged <55 years — United States, 2008–2012. MMWR 63(30):645-649.

DeJoy D, Southern D [1993]. An integrative perspective on work-site health promotion. J Occup Med 35, 1221–1230.

Kivimaki M, Kawachi I [2015]. Work stress as a risk factor for cardiovascular disease. Curr Cardiol Rep 17:74.

Landsbergis PA, Grzywacz JG, LaMontagne AD [2014]. Work organization, job insecurity, and occupational health disparities. Am J Ind Med 57(5):495-515.

Meyers AR, Al-Tarawneh IS, Wurzelbacher SJ, Bushnell PT, Lampl MP, Bell J, Bertke SJ, Robins DR, Tseng C, Wei C, Raudabaugh JA, Schnorr TM [2017]. Applying machine learning to workers’ compensation data to identify industry-specific ergonomic and safety prevention priorities — Ohio, 2001–2011. Manuscript submitted for publication.

Morse T, Dillon C, Weber J, Warren N, Bruneau H, Fu R. 2004. Prevalence and reporting of occupational illness by company size: Population trends and regulartory implications. Am J Ind Med 45:361–370.

NIOSH [2012]. Research Compendium; The NIOSH Total Worker Health™ Program: Seminal Research Papers 2012; Cincinnati, OH: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health. DHHS (NIOSH) Publication No. 2012-146.

Sauter SL [2013]. Integrative approaches to safeguarding the health and safety of workers. Ind Health 51, 559–561.

Smith CK, Silverstein BA, Bonauto DK, Adams D, Fan ZJ [2010]. Temporary workers in Washington state. Am J Ind Med 53(2):135-145.

Theorell T, Jood K, Jarvholm LS, Vingard E, Perk J, Ostergren PO, Hall C [2016]. A systematic review of studies in the contributions of the work environment to ischaemic heart disease development. Eur J Public Health 26:470-477.

Virtanen M, Kivimaki M, Jeonsuu M, Virtanen P, Elovainio M, Vahtera J [2005]. Temporary employment and health: a review. Int J of Epi 34:610-622.

Note: Goal 7.15 was added in October 2019.

Page last reviewed: April 24, 2018