Total Worker Health Exclusive

Nonstandard and Precarious Work: New Insights and Interventions

Christina Welter, DrPH, Clinical Assistant Professor, Outreach Director, Center for Healthy Work, University of Illinois at Chicago
Elizabeth Fisher, CHES, Center Coordinator, Center for Healthy Work, University of Illinois at Chicago

Precarious employment is a complex problem for an increasing number of workers in all economic sectors, resulting in adverse worker, family, and community health outcomes. Characterized by low wages, hazardous conditions, few benefits, and limited opportunities for workplace participation or advancement, precarious jobs preclude workplace-based health interventions. Workplace-based interventions also disregard political, economic, and social factors that lead to the fracturing of traditional employer–employee relationships and discriminatory practices. Policy, systems, and environmental (PSE) initiatives may help improve health for workers in precarious jobs by addressing community and structural-level barriers to health.¹

Staff and participants from the University of Illinois at Chicago Center for Healthy Work.

Healthy Communities through Healthy Work* (HCHW) is a participatory action research (PAR) outreach project of the University of Illinois at Chicago Center for Healthy Work, which explores strategies to address precarious work and health through PSE change. In spring 2017, the first PAR phase focused on “pre-understanding of the context” through environmental scanning. HCHW researchers conducted 55 interviews with national, state, and local organizations across sectors.

The project cataloged more than 230 partner initiatives that advance worker health. Results indicate that in comparison with labor organizations, public health/healthcare (PHHC) organizations emphasize trainings and internal business programs over public policy activities. Findings identified knowledge gaps about precarious employment in PHHC organizations. Results highlighted a lack of collaboration between public health, healthcare, and labor sectors, despite their understanding that work is a social determinant of health. Findings helped develop the next PAR phase, an intersectoral capacity-building initiative, titled the Healthy Work Collaborative to Map Action for Social Change (HWC).

Through an application process, the HWC invited PHHC to engage with labor, government, and non-profit organizations to address a work-related issue affecting the communities they serve. It selected eight teams of multi-sectoral partners to participate in a six-session exploratory process. Representatives from the labor sector provided technical assistance and facilitated training on Power Mapping, Theory of Change, and Action Planning. This assistance and training helped PHHC organizations define precarious work and build organizational capacity to create PSE change. Through this process, the HWC teams began

• Developing an understanding of precarious work and pathways to healthier work
• Exploring PSE change that addresses health in the context of precarious employment
• Building intersectoral networks to further social change
• Preparing deliverables, detailed work plans, and recommendations for initiatives.

The HWC teams are looking forward to moving into the implementation phase in fall 2018 with various projects:

• Developing trainings for hospital workers to identify and address workplace exploitation in their patient population
• Articulating the local health department’s role in addressing precarious work (health promotion, enforcement of labor laws, advocacy to promote fair wages)
• Surveying community health workers in Illinois to better understand their working conditions and their role in public health systems
• Identifying best practices for increasing diversity by changing worksite hiring policies
• Organizing to support the collective action and power-building of non-unionized hospital workers to improve labor standards.

 

For more information about the Center for Healthy Work, please check out our website or contact us directly at healthywork@uic.edu.

Editors’ Note: To learn more about nonstandard work arrangements, please view the NIOSH Total Worker Health Webinar “A New Look at the Way We Work: Nonstandard Work Arrangements and Their Impacts on Worker Safety and Health.”

*Healthy Communities through Healthy Work personnel includes: Elizabeth Jarpe-Ratner, PhD, MST, MPH, Tessa Bonney, PhD (C), MPH, Devangna Kapadia, MS, MPH, Eve Pinsker, PhD, Marsha Love, MA, MA, Anna Yankelev, MPH(c), MBA (C), Joseph Zanoni, PhD, MILR

Updates from the NIOSH Office for Total Worker Health

New article highlights research methodology for Total Worker Health

Sara Tamers, PhD, MPH, Research Program Team Lead, NIOSH Office for Total Worker Health

On March 7 and 8, 2017, the University of Iowa’s College of Public Health and Healthier Workforce Center of the Midwest hosted a Total Worker Health Research Methodology Workshop. An executive planning committee consisting of several Total Worker Health (TWH) experts and NIOSH personnel helped plan and implement the workshop. The 26 invited workshop participants were leading researchers in the field of TWH and other pertinent areas.

There were multiple goals for the workshop. The first was to respond to two of the eight recommendations put forth by the independent panel of the Pathways to Prevention 2015 Workshop, co-sponsored by NIH and NIOSH: Total Worker Health: What’s Work Got to Do With It? These recommendations were (1) to expand research and evaluation design options to include a range of rigorous methodologies and (2) to develop a core set of measures and outcomes for incorporation into all integrated intervention studies. The second goal was to respond to the intermediate and activity/output goals (Sections 1.3.2–1.3.6) to apply and develop rigorous, standardized methods for TWH interventions, as outlined in NIOSH’s National Total Worker Health Agenda (NORA).

The Journal of Occupational and Environmental Medicine recently published a peer-reviewed article on the workshop proceedings. It summarizes the discussions at the workshop and subsequent working group meetings, highlights current TWH methodological and measurement approaches, and suggests others that participants believe could advance the field through rigorous and repeatable TWH intervention research.

Overlapping Vulnerabilities in the Aging Workforce Webinar

Social and economic dynamics and structures shape the experience of aging. Aging does not happen in a vacuum. A comprehensive perspective of productive aging—the support of safe and healthy work environments through integrated strategies that allow workers to be safe, healthy, and productive at all ages—must consider how factors such as class, race, and gender and economic trends (e.g., growth of the temporary workforce) can all contribute to the vulnerability of aging workers to occupational illness and injury. The objective of this third installment of the Productive Aging and Work webinar is to explore from three complementing views how the social and economic context can influence the occupational safety and health experience of aging workers. First, Dr. Joanne Crawford of the Institute of Occupational Medicine in Edinburg, Scotland will discuss issues related to gender and age, focusing on older women in the context of occupational safety and health. Second, Dr. Jennifer Swanberg of Providence College, will focus on low-wage older workers and health disparities. Finally, Dr. Richard Johnson of the Urban Institute will present on the socioeconomic factors that influence work experiences and transitions into retirement of vulnerable populations. Register now to join us Tuesday, October 30^th from 12:00 PM to 1:30 PM ET. Free continuing education credits for this activity are pending.

New Insights into the Opioid Crisis and Work: Important Information for Workers and Employers

NIOSH’s Framework to Address the Opioid Crisis

Please join us in a special presentation of the NIOSH TWH Webinar Series focused on new research at the important intersection of work and the nation’s opioid crisis. Register now to join us Tuesday, November 6^th from 1:00-2:30 PM ET for this event. In this webinar, you will hear from national experts: Chris Cain, CIH of the Center for Construction Research and Training (CPWR), Letitia Davis, ScD, EdM of the Massachusetts Department of Public Health, and Sara Luckhaupt, MD, MPH of the NIOSH Division of Surveillance, Hazard Evaluations, and Field Studies. The presenters will share their latest insights related to the risks of opioid use, misuse, and overdose in worker populations. The presentation will explore critical insights into potential work-related antecedents and risks factors for opioid misuse, the latest data on opioid overdose by industry and occupation; and primary, secondary, and tertiary prevention methods and interventions. The presentation will also provide an introduction to the “NIOSH Responds to the Opioid Crisis’ framework, helping to address the challenges facing our nation’s workers and workplaces related to opioids.

Updates from the NIOSH Centers of Excellence for Total Worker Health

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

Congratulations to Suzanne Nobrega, MS, recipient of the Eusebio Rial-González Innovation & Practice Award in Occupational Health Psychology, for promoting the field through innovative research and practice. Ms. Nobrega will receive the award at the 13^th European Academy of Occupational Health Psychology Conference in September in Lisbon, Portugal.

CPH-NEW has a new online education program for healthcare workers. Ergonomics in Healthcare: A Continuing Education Program for Nurses, Nursing Assistants, and Healthcare Managers is free and meets the requirements for 5 contact hours. The six self-paced modules aim to reduce risks of work-related musculoskeletal disorders. Participants will learn to identify and eliminate or reduce hazards associated with patient handling and other tasks, using ergonomic principles, work practice, and administrative controls. They will learn the essentials of a multi-component safe patient-handling and mobility program and how to make the business case for it. Visit www.uml.edu/cphnewCE to learn more about this resource.

Oregon Healthy Workforce Center (OHWC)

To promote its Total Worker Health Toolkits and resources, OHWC has launched an exciting new website, YourWorkpath.com. This platform houses workplace safety, health, and well-being resources such as the toolkits to help employers design a healthier and safer workplace. YourWorkpath focuses on delivering low-cost and free resources to organizations of different sizes and industries. If you are an employee, safety/wellness practitioner, or organizational leader looking for resources, use the website’s live-chat feature or contact form so that OHWC can point you to the resources that best fit your needs. The YourWorkpath blog offers actionable guidance and insights.

OHWC’s featured event this quarter was the Occupational Health Psychology Summer Institute focused on the theme, Translation of Workplace Interventions: Dissemination and Implementation. L. Casey Chosewood (NIOSH), Lisa Brosseau (University of Illinois), Sabrina Freewyn (SAIF Corp, NIOSH TWH Affiliate), Steve Hunt & Autumn Krauss (SAP Success Factors), Amy Beacom (Center for Parental Leave Leadership), Anna Meiners (Cascade Centers Inc.), and other speakers, including several OHWC members, shared experiences and expertise on issues integral to the process of translation. The audience sparked discussions on identifying practical solutions for translation, dissemination, and implementation challenges. Speakers and attendees left the event feeling motivated to make meaningful, scientifically informed differences in the lives of workers. Read more about the Summer Institute and access recordings here.

Connect with OHWC via its YouTube channel; its blog on Oregon and the Workplace; its Toolkit Kiosk and Resource Directory; and its updates on Twitter.

University of Illinois at Chicago Center for Healthy Work

The Center for Healthy Work’s Greater Lawndale Healthy Work (GLHW) project has launched a survey on precarious employment. Project researchers are surveying 500 residents of North Lawndale and Little Village to collect information on the type and nature of their work, working conditions, ability to exercise workplace rights, and the impact of work on health in these communities. Community resources and organizations are important in understanding worker health and safety. The GLHW team hopes to help community groups recognize worker health as community health, address worker health in ongoing community health efforts, and create new total worker health interventions. The GLHW project has also launched the North and South Lawndale Community Resource Guide in both English and Spanish.

University of Iowa Healthier Workforce Center of the Midwest (HWCMW)

Diane Rohlman, PhD, and Kevin Kelly, PhD, are serving as guest editors for a special issue of the International Journal of Environmental Research and Public Health, titled “Using Total Worker Health to Advance Worker Health and Safety.” Authors are invited to submit manuscripts by October 8, 2018. Visit the special issue website for more information. Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click to go to the submission form. Manuscripts can be submitted until the deadline. All papers will be peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles, as well as short communications are invited.

New TWH podcasts and videos will be released this Fall/Winter, so stay connected with the HWCMW on Twitter, YouTube, and Facebook or subscribe to the monthly e-bulletin for updates.

News from NIOSH TWH Affiliates and Partners

Join us in welcoming five new NIOSH TWH Affiliates!

Center for Social Epidemiology (CSE): This private, non-profit foundation (501c.3), established in 1988, aims to promote public awareness of the role of work organization and psychosocial work stress (occupational stress) in the etiology of chronic illness, including psychological disorders and cardiovascular disease.

For 30 years now, the CSE has translated primary sources of relevant information on work stress research for the public and has facilitated communication among occupational health researchers interested in the relationship between the work environment, the individual, and health. CSE activities include collaborating on occupational health research projects with the University of California, Irvine, Center for Occupational and Environmental Health; presenting at scientific conferences; writing scientific articles, books (such as Unhealthy Work: Causes, Consequences, Cures [Baywood, 2009]), book chapters, and news articles; and maintaining the website unhealthywork.org. In 2016, the CSE began developing a documentary, Working on Empty, and recently it initiated the Healthy Work Campaign. This national public health campaign aims to reduce work stressors and improve job quality by educating, assessing, equipping, and inspiring action from individuals, organizations, and all healthy-work stakeholders.

Miami Occupational Research Group (MORG): Established in 2003 at the University of Miami Miller School of Medicine, MORG studies the impact of organizational- and worker-level factors on the health and safety of U.S. workers—particularly minority worker populations—over their working life course. Since its inception, the MORG has evolved into a transdisciplinary team of occupational health and safety researchers and practitioners focused on preventing and controlling disease and enhancing safety at the jobsite. It conducts national and state-level epidemiologic surveillance, supports the design and implementation of workplace interventions and evaluation of research-to-practice solutions, and provides health and safety education to worker groups. The MORG works with community stakeholders, local and state government agencies, unions, and professional safety organizations to share research findings through strategic partnerships with worker groups throughout Florida. Its educational and research efforts in worker safety and health and health promotion, especially among racial/ethnic minority workers, have been featured in both Spanish- and English-language news media at the local, state, and national levels. Current research projects span workers employed in Florida’s construction, green-collar, health and human services, first responder, and fishing industries.

The National Park Service joins the NIOSH TWH Affiliates network.

National Park Service (NPS): The NPS has over 400 park areas and regional and program offices across the United

States, Virgin Islands, Puerto Rico, Guam, and American Samoa.  There are over 22,000 employees (permanent and seasonal) in diverse locations, ranging from the most densely populated urban areas to the most remote areas. The NPS released the Safety, Health, and Wellness Strategy in October 2015. The strategy uses a model of continuous improvement to create a sustainable culture of safety, health, and well-being for all park workers. Its implementation involves meeting performance tiers with a web-based tool (e-Tool), which guides parks and offices in developing and enhancing their safety, health, and wellness programs.

University of New Hampshire Department of Nursing: Here, faculty aim to improve the learning and working environments for nursing students and other faculty, as well as the practice environments for all nurses. Projects to date have focused on investigating student, faculty, and nurse experiences of bullying, by surveying public school nurses and clinical faculty in New Hampshire and Massachusetts nursing programs. Within the College of Health and Human Services, faculty across disciplines are exploring the concept of “overload” as an occupational hazard in the health care professions. Department faculty are involved in the National Academy of Medicine’s Action Collaborative on Clinician Well-Being and the American Nurses Association’s Professional Issues Panel Advisory Committee, focusing on the contribution of workplace design and organizational processes to the perpetuation of violence directed at health care workers.

University of New Hampshire Institute on Disability: The New Hampshire Occupational Health Surveillance Program in the Institute on Disability at the University of New Hampshire aims to provide meaningful statistics to identify priority occupational safety and health issues in the state. This includes reports on various core occupational health indicators based on measures of health (work-related disease, injury, or disability) or factors associated with health, such as workplace exposures, hazards, or interventions. Research focuses on characterizing risk factors tied to workplace injury and illness, such as occupational poisonings, work-related asthma, and exposure to lead, and on understanding how injury and illness data may inform state and national policymaking. The program works with many community, business, and advocacy partners in the state to study under-reporting and under-recording of work-related injuries and illnesses; barriers to safe and healthy working conditions; and disparities experienced by New Hampshire’s most vulnerable workers.

Updates from NIOSH TWH Affiliates

Interdisciplinary Center for Healthy Workplaces (ICHW) at UC Berkeley

The ICHW at UC Berkeley and Transamerica Center for Health Studies® (TCHS) are releasing an evidence-based analysis, Increasing Participation Rates in Wellness Programs for Small and Medium Organizations: Technical Report. This report analyzes how elements of workplace wellness programs can be applicable to organizations of any size or industry and how organizations can engage employees more effectively to increase and sustain participation.

The technical report includes the following:

• Literature review
• Employer testimonials from small to medium-size organizations
• Employee and employer survey analysis
• Resources for implementing workplace wellness programs.

In addition, ICHW created an interactive assessment tool to guide users on selecting workplace wellness programs that fit their company culture and employee needs. The tool also links to the Finding Fit Employer Guide so users can learn more about addressing an organization’s resources and constraints.

Nebraska Safety Council

The Nebraska Safety Council Conference and Trade Show will convene on October 10 in York, Nebraska. Keynote speakers and breakout sessions will highlight safety and wellness topics. Nebraska Governor’s Wellness Award winners (Sowers & Growers) will be honored at the event. In 2019, a Harvester level award will be added to the program to recognize employers who have incorporated Total Worker Health programs, policies, and practices into their organizations. A pre-conference session on October 9 will include the inaugural Worker 360° training, introducing participants to Total Worker Health through integrated safety and well-being topics.

New Publications and Resources

Five New Publications from NIOSH Centers of Excellence for Total Worker Health

Development and validation of a veteran-supportive supervisor behavior measure. OHWC researchers used data from nearly 500 post-9/11 veterans and service members employed across industries and organizations to understand veteran-supportive supervisor behaviors. Results show that such behaviors are significantly related to work-family and well-being outcomes, at higher levels than other measures of supervisor support.

Double- and triple-duty caregiving men: An examination of subjective stress and perceived schedule control. Researchers from OHWC examined stress appraisals and perceived schedule control among men working in nursing home facilities who also provide unpaid family caregiving roles for children, older adults, or both. Results indicate that workplace-only and double- and triple-duty caregivers appraised primary stress similarly, but schedule control served as a stress buffer for men with multiple caregiving obligations.

Impact of a safe resident handling program in nursing homes on return-to-work and re-injury outcomes following work injury. This study from CPH-NEW researchers explored the impact of a Safe Resident Handling Program (SRHP) on length of disability and re-injury following work-related injuries of nursing home workers. Results indicate that this SRHP reduced overall injury rates while improving long-term return-to-work success by reducing rates of re-injury.

Measuring best practices for workplace safety, health, and wellbeing: The Workplace Integrated Safety and Health Assessment. Researchers at the Harvard T.H. Chan School of Public Health Center for Work, Health, and Well-Being developed an assessment to understand effective workplace organizational policies, programs, and practices that focus on working conditions. The Workplace Integrated Safety and Health (WISH) assessment identifies best practices for protecting and promoting worker safety, health, and well-being.

Preventing opioid use disorders among fishing industry workers. Fishing industry workers are at high risk for work-related musculoskeletal disorders and injuries and face high stress and physically taxing job duties. In this study, CPH-NEW researchers conducted interviews to examine risk factors and possible workplace and community solutions to prevent opioid use disorders in fishing industry workers.

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

September

5^th to 7^th—CPH-NEW Outreach Co–Principal Investigators Robert Henning, PhD, and Suzanne Nobrega, MS, presented a symposium at the 13^th European Academy of Occupational Health Psychology Conference–University Institute of Lisbon (ISCTE-IUL) in Lisbon, Portugal. The symposium title is A Second Generation of Tools and Approaches Developed by the Center for the Promotion of Health in the New England Workforce for Supporting Employee Participation in Total Worker Health® Programs. To get more information, visit the European Academy of Occupational Health Psychology website.

18^th—Harvard T.H. Chan School of Public Health Center for Work, Health, & Well-being Associate Director Dr. Jack Dennerlein will present a webinar titled A Total Worker Health® Intervention on Commercial Construction Sites at 2:00 PM ET, as part of the Work Wellness and Disability Prevention Institute (WWDPI) seminar series. For information, visit https://www.wwdpi.org/Webinars/Pages/Webinar.aspx?wbID=214.

27^th to 29^th—Dr. L. Casey Chosewood of the NIOSH Office for TWH will provide an update on the latest TWH research and discuss the NIOSH portfolio related to interactions of occupational and personal risks factors for health and well-being outcomes at the Pan-American Occupational and Environmental Health Conference in Rio de Janeiro, Brazil.

October

1^st—CDR Heidi Hudson, MPH, of the NIOSH Office for TWH will be presenting a keynote on TWH at the inaugural 2018 Workplace Safety and Wellness Conference hosted by the Northern Kentucky Chamber of Commerce in Erlanger, Kentucky.

11^th—Harvard Center Director Dr. Glorian Sorensen will be a keynote speaker at the Worksite Wellness Council of Massachusetts (WWCMA) Conference, Innovation in Worksite Wellness: Elevating the Standard of Well-Being. The conference will be at Gillette Stadium in Foxboro.

16^th to 18^th—Harvard Center Associate Director Dr. Jack Dennerlein and Principal Investigator Dr. Erika Sabbath will present at the National Occupational Injury Research Symposium (NOIRS) in

Morgantown, West Virginia. Dr. Dennerlein will present “Safety Climate and its Relationship with Construction Company Safety Management Systems and Programs” and “Testing the Associations between Leading and Lagging Indicators in a Contractor Safety Pre-Qualification Database.” Dr. Sabbath will present “The Inequality Paradox: Hospital-Based Safe Patient Handling Intervention Decreases Overall Worker Injuries and Pain, but Widens Socioeconomic Disparities.” Bradley Evanoff, MD, MPH, of the Healthier Workforce Center of the Midwest will present “Influence of Work Organization and Environment on Health and Productivity Outcomes among Construction Apprentices: A Total Worker Health® Approach.”

17^th—Diane Rohlman, PhD, and Jaime Strickland, MA, of the Healthier Workforce Center of the Midwest will present “Influence of Work Organization and Environment on Health Behaviors of Construction Apprentices” at the 15^th Annual Greater St. Louis Safety & Health Conference.

18^th to 19^th—Dr. L. Casey Chosewood will participate in a two day workshop with the University of California’s Healthy Campus Network, hosted in Los Angeles, California. The session is the 3rd annual Healthy Campus Network Conference and will be focused on Building and Sustaining a Culture of Health for the state university system’s students, faculty and staff.

November

13^th to 14^th—CPH-NEW Investigator Alicia Kurowski, ScD, will present a workshop on “Getting Started with Total Worker Health in Your Organization” at the American Society of Safety Professionals (ASSP) 20th Annual New England Area Professional Development Conference, in Southbridge, Massachusetts. For registration and information, visit the ASSP website.

30^th—The Oregon Healthy Workforce Center will host its fall symposium, titled Emergency Preparedness and Disaster Response for the Workplace: From Awareness to Action, at the University Place Hotel in Portland, Oregon. Online registration opens in September.

December

4^th to 6^th—Harvard Center Principal Investigator Les Boden and Post-Doc Maria Andree Lopez Gomez will be attending the National Council for Occupational Safety and Health (COSH) Conference on Worker Safety and Health in Baltimore, Maryland.

Contributors

Editorial Board

L. Casey Chosewood, MD, MPH, Executive Editor

CDR Heidi Hudson, MPH, Editor-in-Chief

Reid Richards, Managing Editor

Seleen Collins, Copy Editor

Margaret Bertsch, NIOSH Web Editor

Steve Leonard, NIOSH Web Publisher

Please send your comments and suggestions to us at twh@cdc.gov.

This newsletter is published quarterly via email by the National Institute for Occupational Safety and Health Total Worker Health^® Program to inform members of the public health community as well as interested members of the general public of program-related news, new publications, and updates on existing activities and initiatives.