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Total Worker Health in Action: January 2013

Volume 2 Number 1 January 2013

Managers’ Buzz


The New Year holds much promise for Total Worker Health®. In fact, 2013 may well become the year of disease prevention and health promotion! This abundance of opportunity can be credited to the Affordable Care Act and its provisions related to wellness programs.

NIOSH Director, John Howard, M.D., spoke eloquently about this coming shift in national consciousness in November at the first Symposium on Total Worker Health® sponsored by the University of Iowa’s NIOSH-funded Healthier Workforce Center of Excellence. During his opening remarks, Dr. Howard briefly discussed the three new proposed rules jointly released by Departments of Health and Human Services, Labor, and the Treasury. (read more about the TWH® Symposium in News from Our Partners)

Casey Chosewood

Of these rules, the one that focuses on employer wellness programs has the most potential to directly affect the Total Worker Health® community. This proposed rule will expand the ability of employers to reward workers who achieve health improvement goals. Beginning in 2014, the health care law will allow employers to increase incentives for participation in programs that require an employee to achieve an agreed-upon wellness goal (health-contingent wellness programs). Specifically, employers will be able to increase incentives from the currently allowable 20% to as much as 30% of an employee’s insurance costs, and in some cases as much as 50%. Examples of health-contingent wellness programs include: programs that provide a reward to those who do not use, or decrease their use of, tobacco; programs that provide a reward to those who achieve a specified cholesterol level or weight. To protect employees from unfair practices, the proposed regulations will require health-contingent wellness programs to follow rules designed for employees who need wellness-related accommodations. Employers may continue to support “participatory wellness programs” which generally are available without regard to an individual’s health status. These include, for example, programs that reimburse for the cost of membership in a fitness center; that provide a reward to employees for attending a monthly, no-cost health education seminar; or that provides a reward to employees who complete a health risk assessment without requiring them to take further action.

Anita Schill

Summing up his assessment of the intersection of Total Worker Health® and the proposed rule on wellness programs, Dr. Howard proclaimed that, “occupational health is economic health.” He challenged occupational safety and health professionals and health promotion professionals to play a vital role in assuring the nation’s return on investment in disease prevention and health promotion. He concluded, “[w]e need to integrate these new [workplace prevention] rules into our thinking, our programs and our research…and we need to show the results.”

This issue of TWH® in Action! showcases results from Total Worker Health® leaders. In Total Worker Health® Exclusive, Dr. Naomi Swanson discusses the implications of job stress and health, particularly among women. She provides comprehensive organizational strategies that employers can use to reduce stress in developing a Total Worker Health® Program.

In this month’s Promising Practices for Total Worker Health®, learn how Ohio is taking action to control the escalating costs of workers’ compensation through a workplace wellness grant program. Read how a private workers’ compensation insurer in Colorado is supporting Total Worker Health® by determining how health protection and health promotion benefit the Colorado economy and community at large in New Initiatives and Resources

As always, we hope this newsletter inspires you to become a Total Worker Health® advocate. Share your comments and stories about TWH® in Action! with us on Twitter (@NIOSH_TWH), on the NIOSH Total Worker Health® LinkedIn Group, or send us an email at


Promising Practices for Total Worker Health®

In Promising Practices for Total Worker Health® we share examples of how employers from across the country and from a wide range of industries are taking steps to effectively integrate both health promotion and health protection in their workplaces.

If your organization is proactively integrating health protection and health promotion to prevent injury and illness and advance the well-being of your workers, please email us at

Disclaimer: The mention of organizations and commercial entities and products in this article is for illustrative purposes only and does not represent an endorsement by NIOSH, CDC or the US Department of Health and Human Services.

State Workers’ Compensation Program Taking a Lead on Workplace Wellness


In 2010, 25 to 29 percent of Ohio’s adult population was considered obese (body mass index equal to or greater than 30) and the largest percent of Ohio’s workforce was between the ages of 45 to 54. While these statistics are comparable to what is occurring nationwide, the Ohio Bureau of Workers’ Compensation (OBWC) is leading the way for Total Worker Health®.

Helping employers improve the health and wellness of their workers, as well as save money, OBWC established a Workers’ Compensation Workplace Wellness Grant Program in 2012. The program’s goal is to limit and control the escalating cost of workers’ compensation claims by helping employers develop health promotion programs for their employees. The secondary goals are to reduce health-care costs for employers, as well as improve the health and well-being of the workforce.

How much money can employers qualify for through the grant? Up to $4 million over a four-year period has been allocated for the Workplace Wellness Grants. Eligible employers can receive up to $15,000 over four years. The amount per employee is graduated each year as OBWC takes employee participation into consideration when awarding and renewing the grant. These funds are intended to supplement the cost of a wellness program, not fully fund it.

Who’s Eligible to Participate? All Ohio employers (public and private) participating in the state-funded workers’ compensation program are eligible for the grant. Self-insured employers are not eligible. Eligible employers are those who do not currently have an operational wellness program, defined as a health risk appraisal (HRA), biometric assessment, and other activities designed to reduce health risk factors. If however, the employer uses both HRAs and biometric screenings, and designs programs based on the results from HRAs and biometric screenings, the employer will not qualify. As an example, if an employer currently offers HRAs and biometric screenings, but does not create any programs from the results of the HRAs and biometric screenings, the employer would be eligible for a grant.

What type of wellness activities would qualify? Once an employer is approved for the grant, they are to contract with a third-party wellness program vendor, who will be providing the HRA and biometric screenings as well as implementing subsequent wellness activities. Wellness activities may include weight-loss management programs, educational seminars on improving health, physical fitness activities and nutritional counseling to benefit the participating employees.

Will OBWC evaluate the impact of wellness on workplace safety? At the end of each year, each employer enrolled in the grant program will share their aggregate data on costs and employee health risk factors with OBWC. Additionally, each employer will fill out a case study questionnaire. OBWC will use the information to assess the impact of wellness on workplace safety, the frequency and severity of workers’ compensation claims, and to establish best practices for the implementation of workplace wellness programs.

To learn more about OBWC’s Workplace Wellness Grant Program, visit:

Editors’ Notes:

  1. In 2012, the NIOSH Total Worker Health® Program supported funding for a four-year project led by the Small Business and Outreach Assistance Program that aims to work with Ohio and Northern Kentucky community organizations, such as the OBWC, as well as occupational health clinics, public health departments of local governments, and chambers of commerce, to explore opportunities for offering TWH® resources to small businesses. For more information, contact Dr. Ray Sinclair at
  2. Recently, Pinnacol Insurance Company, Colorado’s leading provider of workers’ compensation insurance, donated $500,000 to the University of Colorado to establish the Center for Worker Health and Environment. Read more about this new Center in News from Our Partners.

Total Worker Health Exclusive®

Women and Stress at Work

BY: Naomi Swanson, Ph.D., Chief of Organizational Science and Human Factors Branch, NIOSH

Early in the 20th century, only one in seven women were employed outside the home. Today, most women work, with women constituting 47% of the labor force. A consequence of this is that women are now exposed to many workplace hazards, including occupational stress. Occupational (or job) stress is a prevalent problem in the United States, with between a third to nearly a half of workers routinely reporting high levels of job stress. Certain job conditions have been well-established as stressors. These include heavy workload demands, little control over work, unclear or conflicting job roles, poor relationships with coworkers and supervisors, and unchallenging, repetitive, or monotonous work. Women experience additional job stressors that may affect men to a lesser degree. Since women often have primary responsibility for children and household chores, achieving an acceptable work-family balance can be challenging. In some jobs in which women predominate, such as nursing and customer service, long or irregular hours, shiftwork, and stressful interactions with patients or customers are common.

High levels of job stress can have both short- and long-term health and behavioral consequences. Job stress has been linked with a host of health effects such as depression, anxiety, headaches, stomach aches, insomnia, fatigue, job dissatisfaction and burnout. Increasing evidence links job stress with chronic disease, such as cardiovascular disease. Stress can also influence health behaviors related to the treatment or control of diseases. For example, high stress levels can be detrimental for diabetics by directly affecting blood glucose levels through physiological mechanisms or indirectly by affecting adherence to diet and activity regimens.

The traditional means of dealing with job stress has been through workplace health promotion programs, such as exercise programs and training in stress management techniques or through counseling offered by employee assistance programs (EAPs). However, while health promotion programs and EAPs may help employees better deal with job stress; they do not remove the sources of stress from the workplace. A better approach is one which combines efforts to identify and remove the sources of stress with programs to help employees better manage job stress. Job stressors can be identified through surveys and discussions with employees, and can be addressed through changes in workplace policies or job redesign (such as allowing greater employee discretion over how they complete their work). Workplace policies that address work schedule flexibility, telework, dependent care, and career development/advancement are particularly beneficial to women. Such efforts are most effective when done with employee input and participation, and provide long-term benefits to employee health and productivity.

Efforts to reduce or eliminate stressors need to be augmented with stress reduction techniques that can help employees immediately deal with the negative effects of job stress. These techniques can include relaxation training, training in coping techniques that reduce stress, wellness activities that target health behaviors that can impact stress, such as exercise or nutrition programs, and counseling programs that target psychological health. Especially for women, strong social networks, including those established in the workplace, can encourage participation in health screenings, treatment compliance, and establishment of healthier behaviors. Organizational policy considerations for lowering stress and improving overall health in the workplace are listed in below.

Policy Considerations for Lowering Stress and Improving Overall Health in the Workplace:
  • Teleworking and flex-schedule policies
  • Job-sharing, phased retirement options
  • Healthy commuting supports and incentives
  • Smoke-free building and campuses
  • Healthy foods, healthy meetings and green/sustainable environments policies
  • Peer support and mentoring programs
  • Policies promoting volunteering and community service
  • Time off work for health promotion, physical activity, screenings, healthcare visits
  • Robust non-discrimination, diversity and cultural awareness/sensitivity programs
  • Continuing education, distance learning, and other training supports
  • Incentives for health program participation and engagement


Centers for Disease Control and Prevention, US Department of Health and Human Services. (2011). Workplace Health Promotion Resources. Retrieved September 2012 from

Veterans Health Administration. (2011). Employee Health Promotion Disease Prevention Guidebook, July 2011. Retrieved September 2012 from

United States Office of Personnel Management. (2012). Site for Federal Worksite Wellness Resources. Retrieved September 2012 from

For more information about job stress and stress intervention and management strategies, see the NIOSH “Stress at Work” publication, the “Stress at Work” website, and the NIOSH Science Blog.

Updates from NIOSH Centers of Excellence to Promote a Healthier Workforce

The Center for the Promotion of Health in the New England Workplace (CPH-NEW)

Get the latest from CPH-NEW, by signing up here for their newly released eNewsletter! See below for Highlights from the December issue.

  • Learn about the next generation of a NIOSH-funded study, “Health Improvement through Employee Control,” HITEC II. Building upon the existing research activities with the Connecticut Department of Corrections, this study tests new participatory program models aimed at preventing deterioration of correctional officer health profiles typically seen in the first years of employment.
  • Read about work-related predictors of weight gain, and examples of healthy work organization policies and environmental supports for workplace weight management programs in CPH News and Views.

Harvard School of Public Health Center for Work, Health, and Well-being

A new publication by from the Harvard School of Public Health Center for Work, Health and Well-being suggests that the higher the levels of reported work-family conflict, the greater the risk that health care workers will suffer from neck and other types of musculoskeletal pain. Results pertaining to measurement of work-family conflict and self-reported musculoskeletal pain indicated that patient care staff—about 1,200 nurses and other patient care workers at two Boston-based hospitals—reported high conflict between their job duties and obligations at home had about two times greater chance of suffering from neck or shoulder pain in the last three months, as compared with those who did not report high conflict. Workers with the highest work-life imbalance had a nearly three times greater risk of reporting arm pain during that same period, as compared with those who did not report high levels of conflict. The results suggest that work–family conflict could be an important domain for health promotion and workplace policy development among hospital patient care workers. The study was published in the September 27, 2012 online version of the American Journal of Industrial Medicine by lead author Dr. Seung-Sup Kim, postdoctoral scientist and professorial lecturer in environmental and occupational health at George Washington University School of Public Health and Health Services.

University of Iowa Healthier Workforce Center for Excellence (HWCE)

Stay Connected with the University of Iowa HWCE! Sign up for the University of Iowa Healthier Workforce Bulletin. Follow HWCE on Twitter (@UIHWCE) and Pinterest.

Help guide future outreach efforts! Take a short survey, developed by HWCE, on the successes and challenges with implementing and sustaining workplace health and safety programs. Please click on the 3-4 minute survey and share your stories with us.

Oregon Healthy Workforce Center (ORhwc)

The Oregon Healthy Workforce Center announces the recipient of 2012 Pilot Funding Project. Laurel Kincl, PhD, Assistant Professor of the Environmental and Occupational Health and Safety Program and Simon Driver, PhD, Associate Professor of the Exercise and Sports Science Program at Oregon State University will lead the project called Be Active, Work Safe: A Novel Program for People with a Disability. The project will seek to develop, test, and disseminate a web-based intervention that integrates basic occupational health and safety skills into an evidence-based health promotion model to improve the health and safety of workers with a disability. Learn more about this project on the Oregon Healthy Workforce Center webpage.

New Course! Excellence in Worksite Wellness: Taking your program to the next level. Jointly sponsored by the Oregon Healthy Workforce Center, Oregon OSHA, ASSE Columbia-Willamette Chapter, SAIF Corporation and the Portland Business Journal, the course will be part of the 2013 Oregon Governor’s Occupational Safety and Health Conference held at the Oregon Convention Center on Thursday, March 7, 2013. Save the date and look for program details on the GOSH website.

News from our Partners

total worker health symposium graphic

Total Worker Health® Symposium Shares Best Practices in Integrated Worker Health Programs

On November 29-30, 2012 in Coralville, Iowa, the University of Iowa Healthier Workforce Center for Excellence (HWCE) in the College of Public Health hosted the “Total Worker Health Symposium: Safe, Healthy and Cost-Effective Solutions”. As the first symposium on Total Worker Health®, it brought together national experts from across the country, from federal government agencies. Research was presented by each of the four NIOSH Total Worker Health® Centers of Excellence, representatives from NIOSH, and an Iowa panel on providing “Affordable Health Care for Iowa Employers and Employees.” Over 120 people from 18 states and Washington, D.C. attended.

University of Iowa alumnus and College of Public Health Board of Advisors founding member, Martin Sepulveda, FACP, IBM Fellow and Vice President, summarized national, and global, trends that will impact workforce health, productivity and sustainability in his talk “From Worker Health to “Citizen Health”: Roles of Health Care Delivery, Public Health and Big Data Transformations”.

“The symposium addressed issues of immediate concern to Iowa workers and employers – how to make the workplace safer and healthier, how to increase productivity and how to control health care costs,” says James Merchant, HWCE director and professor of occupational and environmental health. A central theme for the symposium was the introduction of the concept of Total Worker Health®, a strategy from NIOSH, integrating occupational safety and health protection with health promotion to prevent worker injury and illness and to advance health and well-being.

Presentation slides are available on the HWCE website at Video clips and posters from the event will also be posted in the near future. Questions related to the Symposium or to the HWCE may be sent to Jenny Hall, Outreach Director, at

Colorado’s leading provider of workers’ compensation insurance funds new Center for Worker Health and Environment

man working out in a gym

Over the last six years, the NIOSH-funded Mountain and Plains Education and Research Center (MAP ERC) has been working to improve the health and safety of workers through training, education, research and community partnerships. Spanning from the borders of Canada to Mexico, the MAP ERC helps meet the occupational health needs of a 7-state region including Colorado, New Mexico, Arizona, Montana, Wyoming, North Dakota and South Dakota.

As work in the area continues to expand, the MAP ERC group at the Colorado School of Public Health is taking the next leap in health protection and health promotion by forming the school’s new Center for Worker Health and Environment with the help of a generous gift of $500,000 from Pinnacol Assurance, Colorado’s leading provider of workers’ compensation insurance. The Center advances its mission of improving health and safety both at work and home with a portfolio of programs ranging from assessing the impact of health risk management programs in Colorado small businesses to improving outcomes for injured workers by improving chronic-pain management through provider education.

Funding from Pinnacol Assurance’s philanthropic gift and support from NIOSH will help develop and launch Colorado Health Links®, a program designed to improve the health of Colorado businesses, workers and their families. This multi-year program provides certification and recognition for Colorado small businesses that have developed successful worksite health protection and health promotion programs. It also provides seed funding for small businesses that may be facing barriers but that are seeking to develop a culture of health and adopt best practices for health promotion programs at work.

“The Center and Colorado Health Links® are the next steps to improving the health of Coloradans,” said Dr. Lee Newman, Director of the MAP ERC. “With the support of partners like Pinnacol Assurance, our colleagues at NIOSH and the Centers of Excellence to Promote a Healthier Workforce and small businesses throughout the state, the program will determine the most practical ways of improving the health of workers and their families. The program will also establish what works specific to small businesses and how health protection and health promotion benefit the Colorado economy and community at large.”

The new program and its home center will leverage the school’s existing expertise in wellness and workplace safety, alongside its established relationships with community partners and NIOSH.

To learn more about Colorado Health Links® and other Colorado School of Public Health’s worker health and safety programs, visit the Center for Worker Health and Environment,

New Initiatives and Resources

Canada is the first in the world to set a national standard on workplace mental health

woman using a standing desk

Would a national standard work in the US? What would a standard in the US look like? Join the discussion on LinkedIn

New on the NIOSH Science Blog: NIOSH Takes a Stand

Recently, we launched an internal NIOSH pilot program to explore the use of sit and stand work stations as part of a workplace health and well-being initiative to reduce sedentary work in our workplace. The pilot program was inspired by emerging research on the impact of sedentary work (Van der Ploe, Chey, et al, 2012) on employee health and by new employer initiatives that aim to decrease sedentary work. Follow our progress on the blog!

Is sleep deprivation impacting your personal and work life? Do your employees suffer from fatigue?

Listen and learn about the serious health, safety and productivity effects of sleep deprivation and fatigue on every aspect of your life, your employees and your kids! Join Cathy Hansell, host of Safety Breakthrough Talk Radio, as she discusses the impacts of sleep deprivation and fatigue with NIOSH’s Dr. Sara Luckhaupt. Click to listen to the podcast here.

TWH® Fast Facts:

Presenteeism occurs when employees are physically present at work but not able to work at full capacity due to an underlying health condition or concern. The Economics Cross-sector Program at NIOSH recognizes presenteeism as an economic factor affecting productivity and is focusing on improving the understanding of how economic factors, management strategies, and demographic trends affect worker safety and health. In a 2012 NIOSH Science blog, Making the Case for Paid Sick Leave, the Economics Program mentions, “employers may benefit from improved productivity if paid sick leave helps reduce absenteeism, or unscheduled leave, and “presenteeism,” or the problem of sick workers continuing to work while not fully productive.”

Upcoming Conferences, Webinars and Trainings in Support of NIOSH Total Worker Health®

Speaking Engagements

Dr. Sara Luckhaupt is presenting on Total Worker Health® at the Kentucky Municipal Environmental Safety & Health Association Meeting held March 5 – 8, 2013 at the Cincinnati Airport Marriott.

Ms. Constance Franklin is presenting on Total Worker Health® at the Deep South Center for Occupational Health and Safety Symposium on Emerging Issues in Occupational Safety and Health held Thursday, April 11, 2013 in Opelika, Alabama.

Dr. L. Casey Chosewood is speaking at the American Association of Occupational Health Nurses (AAOHN) National Conference held April 15 – 18, 2013 in Las Vegas, Nevada.

Dr. L. Casey Chosewood is moderating a session on Maximizing the Health of an Aging Workforce at the 2013 American Occupational Health Conference held April 28 – May 1, 2013 in Los Angeles, California.

Dr. L. Casey Chosewood is speaking on Industrial Hygienist’s Guide to Total Worker Health® at the American Industrial Hygiene Conference & Exposition (AIHce) held May 18 – 23, 2013 in Montreal, Canada.

Conferences and Webinars

Free Webinar on “A Community Based Proactive Health Care Model for Small Businesses” from the Health Enhancement Research Organization (HERO). Held January 23, 2013; 1:00-2:00pm Central Time. To register, click here.

Dr. Anita Schill is presenting via webinar, The Power of Total Worker Health®. The webinar is co-sponsored by American Association of Occupational Health Nurses (AAOHN) and the International Association for Worksite Health Promotion (IAWHP) and will be held on February 5, 2013 from 1:00pm to 2:00 pm EST. To register, click here.

CDC’s National Healthy Worksite Program Webinar: Community Partnership Building held Monday, February 11 from 1-2 p.m. EDT. Featured speakers include Dawn Robbins, BA of Oregon Public Health Institute; Monica Vinluan, JA of YMCA of the USA; and, Andrew Webber, BA of the National Business Coalition on Health. To register visit:

Work, Stress and Health 2013: Protecting and Promoting Total Worker Health®
Will be Held at the Westin Bonaventure Hotel and Suites, Los Angeles, California, May 16 –19, 2013. To learn more, visit

Please send your comments and suggestions to us at