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Total Worker Health in Action: December 2018

Advancing worker safety, health, and well-being

Volume 7 Number 4 December 2018

Director’s Buzz

L. Casey Chosewood, MD, MPH

In our final issue of 2018, I’d like to reflect on the accomplishments of the NIOSH TWH program this year, only possible because of the wonderful partnerships and collaborations with all of you. Thank you for help and dedication. Together, we:

  • Explored the latest approaches for worker safety, health, and well-being, alongside almost 400 researchers and practitioners, at the 2nd International Symposium to Advance Total Worker Health®
  • Published more than 50 original research and practice articles, many peer-reviewed, detailing the growing evidence base for TWH approaches (including 13 you can find in this issue’s New Publications)
  • Hosted 4 webinars with expert speakers on topics related to: vulnerabilities in the aging workforce, use of survey data to craft TWH interventions, the opioid crisis and work, and functional outcomes in workers after injury or illness (if you missed these, find archived recordings here)
  • Expanded our NIOSH TWH Affiliate Program partnerships to 44 non-profit, academic, government and membership organizations seeking to share TWH with their own workers and networks (meet our newest Affiliates in News from NIOSH TWH Affiliates and Partners)

While we end this year on a high note with all we’ve accomplished together, the work of protecting and advancing the safety, health, and well-being of workers continues. In this issue, I’m pleased to share a follow-up from our earlier webinar, jointly sponsored with the NIOSH Center for Workers’ Compensation Studies, on the importance of integrating functional outcomes with clinical measures. See the guest-authored special commentary in the TWH Exclusive for more.

Promising Practices returns in this issue, with a feature on the police department in Bend, Oregon. Hear about the steps they’ve taken to keep officers returning to work safely after experiencing on-the-job injuries. Their force is also taking mental health concerns seriously, a growing challenge in occupational safety and health among workers around the nation. Read about their innovative approaches in this issue’s Promising Practices.

Making the business case for TWH approaches is an important component for implementing a successful, sustainable workplace safety and health program. This issue’s Updates from the Office for TWH highlights the newly relaunched Making the Business Case webpage on the NIOSH TWH website. I hope this webpage offers insight into the value of investing in comprehensive, integrated approaches to occupational safety and health initiatives.

I’m looking forward with excitement to what’s to come in 2019. To stay up-to-date on the latest Total Worker Health news, research, events, and more, please join the conversation on Twitter (@NIOSH_TWH), on the NIOSH Total Worker Health LinkedIn Group, or by email at

Total Worker Health Exclusive: A Perspective from an Occupational Health Physician

Editors’ Note: Each year, millions of American workers develop health conditions that may temporarily or permanently remove them from the workforce. Although most individuals are able to work again after a brief recovery period, in approximately 10% of cases, workers incur injuries or illnesses severe enough to lead to prolonged or permanent withdrawal from the workforce. For workers and their families, life disruptions caused by serious illness or injury are compounded by the economic impact of being out of work. Although workers’ compensation and other programs assist injured and ill workers, these programs do not fully cover economic loss and the health care costs related to the injury or illness. Nor can these programs begin to fully recover the personal costs and burdens of significant life disruptions. By considering functional outcomes with Total Worker Health approaches in workplaces, occupational safety and health practitioners may begin to better address the challenges faced by workers experiencing these injuries and illnesses. In our invited guest commentary below, Dr. Moses makes the passionate case to occupational health practitioners on why they should focus not only on delivering quality care, but also squarely on improving measures of functional outcomes in ill and injured workers.

X.J. Ethan Moses, MD, MPH

Function Matters to Workforce Health

By X.J. Ethan Moses, MD, MPH
Associate Medical Director, Colorado Division of Workers’ Compensation
President, Rocky Mountain Academy of Occupational and Environmental Medicine

“It is time for a paradigm shift in occupational and environmental medical practice. Let’s build upon our attention on quality to also focus on functional outcomes.”

Better function equals a better outcome

The occupational and environmental medicine community is appropriately obsessed with quality of care. But what is “quality care?” Accreditation standards have dramatically improved healthcare delivery. Evidence-based medical treatment guidelines have helped guide appropriate clinical practice. The recent link between patient satisfaction scores and reimbursement has led to improved levels of customer service.

But with all this emphasis on quality, why haven’t disability costs declined? The national cost of caring for those who are functionally disabled is the highest in history at over $160 billion per year,1,2 and continues to rise at an unsustainable rate. And, sixty percent of those absent from their job for five weeks will never return to work.3

Quality measures addressing structure, process, and patient experience are all vitally important, but as healthcare providers, many of us have neglected quality measures related to functional outcomes. This is not true of all outcomes. After all, healthcare providers will regularly monitor the hemoglobin A1c of their patients with diabetes, so why do they not routinely measure the quality of life of their patients? Why ignore something so ultimately vital as a patient’s ability to function at home and work?

It is time for a new philosophy based on function. Functional status, the ability to perform activities of daily living, needs to be viewed as an important measure of health. We must realize that work is not only a healthy human activity, but also that work can help individuals regain their health. By regularly using functional outcome measures, healthcare providers can manage patients experiencing functional disability preventively.

There are many free functional outcome measures that have been appropriately validated, such as the Oswestry Disability Index and the QuickDASH. These and other functional outcome measures are routinely used in evidence-based research, but they are rarely used in evidence-based treatment. Perhaps occupational medicine providers can change their perspective by regularly measuring the quality of their care by routinely assessing its impact on the recovery of function. Because, doesn’t better function equal a better outcome?

The use of functional outcomes, integrated with current evidence-based clinical practice, can significantly improve the lives of patients and workers. If patients are better, then the societal impact of disability will decrease, the quality of workers’ lives will improve, and organizations and workers can be better positioned to thrive and perform more productively.

Once the physical, occupational, psychosocial, and societal impacts of illness and injury are recognized, it becomes clear that functional outcome measures must be implemented into daily medical practice.

In short, function matters to workforce health.

For more information on functional outcome measures, see the recommendations in the American College of Occupational and Environmental Medicine position paper at: here

To learn more about this topic, please view the recent NIOSH TWH webinar in conjunction with the NIOSH Center for Workers’ Compensation Studies on Integrating Functional Outcomes with Clinical Measures here.

1 O’Leary P, Boden LI, Seabury SA, Ozonoff A, Scherer E. Workplace injuries and the take-up of Social Security Disability Benefits. Soc Secur Bull. 2012;72:1–14.
2 Social Security Administration Office of Retirement and Disability Policy Office of Research, Evaluation, and Statistics. Annual Statistical Report on the Social Security Disability Insurance Program, 2014. Washington, DC: SSA Publication No. 13-11826; November 2015.
3 Wynne R, MacAnaney D. Employment and disability: Back to work strategies. Dublin: European Foundation for the Improvement of Work and Living Conditions; 2004. 128 p.

Promising Practices for Total Worker Health

Chia-Chia Chang, MPH, MBA, NIOSH Office for Total Worker Health

The logo for the Below 100 program, a national program aimed at reducing line-of-duty deaths for police officers.

The logo for the Below 100 program, a national program aimed at reducing line-of-duty deaths for police officers.

Award-winning culture and support system for police well-being

The City of Bend (Oregon) Police Department recognized that law enforcement officers are exposed to many hazards and job stressors, such as night shift, physical work, dangerous work, and traumatic events. These lead to increased risk for mental illness and suicide, as well as heart disease and workplace injuries. With over 100 sworn officers serving a city of more than 90,000 people, the Department developed a comprehensive, multi-pronged initiative that has already started to produce positive outcomes.

Safety First

The Bend Police Department has many programs in place to protect the health and safety of its officers. For instance, it adopted the Below 100 program, a national program aimed at reducing line-of-duty deaths to fewer than 100 per year nationwide. In addition to having five Below 100 instructors on staff, the Department incorporated Below 100 curriculum into its annual training as well as training events. Officers achieve 100% compliance in seat belt and ballistic vest use, and wear first aid kits with tourniquets on their body at all times for rapid access in an emergency. To reduce motor vehicle crashes, the Department provides two weeks of skid car training annually. The Department also provides 40 hours of Crisis Intervention Team (CIT) training and has three officers on a full-time Community Response Team. These officers work with the local mental health department to build relationships with the people in need. For rapid access to information, all officers have an agency-provided smartphone, along with internal social media and collaboration platforms to share patrol information. These tools have better connected each of the officers to their colleagues and have also contributed to the solving of criminal cases.

The Hierarchy of Controls Applied to NIOSH Total Worker Health®

The Hierarchy of Controls Applied to NIOSH Total Worker Health®

Redesigning Work and Developing Health-Supportive Policies

Based on the hierarchy of controls conceptual model for TWH, the top priorities for advancing worker well-being are elimination and substitution of hazards. When these are not possible, the next priority is to redesign the work environment. For first responders such as police officers, night shifts cannot be eliminated or substituted. The Department redesigned shift work to minimize the number of shifts that an officer works after midnight. Officers rotate shifts every two months so that there are no more than four months of night shift per year.

Another key policy of the Department to support health is providing officers one hour of on-duty time for physical fitness. They can spend the time working out individually or participating in one of the four one-hour yoga classes held at the police station. By 2017, almost 700 officers had participated in the yoga classes. In addition, officers on the night shift have one hour of duty time twice a week for functional fitness training, led by the team sergeant. By providing on-duty time for these activities, the Department has redesigned work to prioritize the health and safety of its officers.

Access to Mental Health Support

Officers participating in a mindfulness session.

Officers participating in a mindfulness session.

According to the hierarchy of controls applied to TWH, when hazards cannot be eliminated, substituted, or redesigned, the remaining intervention options are education and encouragement of personal change. Because many of the stressors faced by police officers on the job cannot be avoided, the Bend Police Department provides opportunities to enhance individual skill-building. Their yoga classes serve double duty by helping to prevent injuries and by reducing stress. Another on-duty-time provision allows patrol officers to participate in a ten-minute guided mindfulness session at the end of every shift. This initiative was created to help officers decompress before returning to their families and to facilitate stress management throughout their careers. Furthermore, twice a year, the Department hosts locally a three-day mindfulness retreat attended by officers from all over North America to enhance resiliency and improve focus and performance. Finally, to demonstrate its commitment to normalizing mental health services, the Bend Police Department partners with the Bend Fire Department to fund a Proactive Psychologist position for twenty hours a week. The psychologist, who is available onsite for building relationships prior to critical incidents, has had more than 100 contacts with police and fire personnel. These contacts have resulted in more than 30 referrals to local clinicians covered by the insurance program.

The Sergeant Johnny Lawrence Program

In December 2015, a well-respected and long-time member of the Department, Sgt. Johnny Lawrence, died of a heart attack at the age of 43. Within a few months of that, Sgt. Scott Vincent also lost his brother, who had been a police officer, to a heart attack. The Department created the Johnny Lawrence Program to provide comprehensive health screenings for officers on cardiac and mental health, diet, sleep, and fitness. A mental health screening showed that staff shortage was the biggest contributor to organizational stress and that fatigue was the biggest contributor to operational stress. About half of the officers signed up for the Johnny Lawrence Program, resulting in many referrals for follow-up.

Family and Peer Support

The Department created a Spouse and Family Support Program, which offers social events, including joint events with the Bend Fire Department; safety training on issues such as firearm safety; education programs such as estate planning; and support systems for childcare and meals. There is also a 15-person Peer Support Team comprising staff selected by fellow officers, who receive a 36-hour training in peer support to aid colleagues during professional and personal times of need.

The city of Bend, Oregon seen at night.

The city of Bend, Oregon seen at night.


With a 75% total participation rate in all safety, health, and well-being programs, the Bend Police Department has started to see positive outcomes. The Department is collaborating with Oregon State University to track occupational safety and health data. In 2015, the first year of the program, the number of workplace injury claims and costs decreased by over 40% and 68%, respectively, from the year before. In 2016, although injuries increased by 30%, the injuries resulted in fewer lost days and lower workers’ compensation claims. These decreases led to a 55% reduction in cost of injuries and 26% reduction in days lost to injuries. The Department’s efforts were recognized this year through the Destination Zero Officer Wellness Award, given to law enforcement agencies by the National Law Enforcement Officers Memorial Fund. This award acknowledges effective officer safety and wellness initiatives that help drive down the risk factors proven to lead to injuries and deaths among officers. “Our men and women are our most valuable asset,” says Sgt. Vincent. The Department will continue to work with Oregon State University to track data, share results with other police departments, and improve officer safety and well-being.

Updates from the NIOSH Office for Total Worker Health

New Webpage about Making the Business Case for Total Worker Health

Sarah Mitchell, MPH, ORISE Fellow, NIOSH Office for Total Worker Health

Today’s employers are challenged not only by well-recognized risks of hazards and injuries—such as traumatic injuries and chemical exposures—but also by complex, emerging issues such as shifting employment relationships, work-related stress disorders, an aging workforce, and chronic diseases. Using TWH strategies in your workplace may have a positive, long-term impact on your workers’ health, safety, and well-being and on your organization’s bottom line.

Interested in implementing the TWH approach at your workplace? New information is now available to help you make the business case for Total Worker Health, on the recently revised Making the Business Case for Total Worker Health® webpage. This page has new topics, including the difference between the TWH approach and worksite wellness programs, and the difference between Return on Investment and Value of Investment. In addition, find different ways that TWH strategies can improve worker well-being and organizational performance. The new page provides an updated and compelling argument for employers to implement workplace safety and health programs, policies, and practices in line with a TWH approach.

Updates from the NIOSH Centers of Excellence for Total Worker Health

Center for Health, Work & Environment (CHWE)

The Center has expanded its signature program, Health Links™, nationally. CHWE researchers are collaborating with other NIOSH Centers of Excellence for TWH and TWH Affiliates to deliver Health Links as a resource and a mentoring program that champions health and safety at work to organizations in every state. Having conducted pilot testing of expansion in Colorado, Florida, and Oregon, the Center has spent the past year preparing for this Fall’s launch of an updated website, a new model for organizational-level advising, and new TWH tools.

Drs. Lee Newman and Joshua Scott from CHWE are leading a collaborative effort to continue the development and dissemination of guidelines that academic institutions can use for defining the core principles, competencies, skills, and knowledge needs of future TWH professionals and practitioners. The new Total Worker Health Education, Training, and Capacity Building Workgroup (TeTRAC) is composed of representatives from the NIOSH Office for TWH, other NIOSH Centers of Excellence for TWH, and TWH Affiliates, including academic institutions that have begun developing educational programs. The workgroup is building on efforts that began at the first and second international Total Worker Health symposia and at a November 2017 workshop held at the University of North Carolina. It has established a timeline for creating, writing, and seeking stakeholder input on a manuscript regarding TWH education.

A new collaboration between the Center and United Way in Austin, Texas, will work to engage the business community to promote family-friendly workplace policies and practices. United Way will lead the Early Matters Greater Austin Alliance to promote the Health Links Family-Friendly Assessment Tool among employers over the next year. The collaborative also will evaluate business engagement, existing workplace initiatives, and policy change.

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

Congratulations to CPH-NEW investigator William Shaw, PhD, for his recent grant award with the Connecticut Department of Labor to address growing work disability in the state. The project, Retaining Employment and Talent after Injury/Illness Network (RETAIN-CT), is part of a national effort led by the U.S. Department of Labor (DOL) Office of Disability Employment Policy, in partnership with the DOL’s Employment and Training Administration and the Social Security Administration. RETAIN-CT is a state-level, multi-stakeholder collaborative policy and training intervention to improve long-term return-to-work and stay-at home outcomes for workers with musculoskeletal concerns. Consistent with a TWH approach, the project focuses on Connecticut workers with either occupational or non-occupational musculoskeletal disorders. Learn more about the RETAIN-CT project here:

CPH-NEW News and Views Emerging Topics brief: A healthy sleep intervention for correctional supervisors. Correctional supervisors (i.e., lieutenants, captains, counselor supervisors) are an understudied and overlooked occupational group. This News and Views brief describes use of the CPH-NEW Healthy Workplace Participatory Program (HWPP)’s All Employee Survey and Focus Group Guide to assess sleep quality and quantity among correctional supervisors.

CPH-NEW News and Views Emerging Topics brief: Lobstermen participate in ergonomics research on breaking down traps. Lobstermen are exposed to multiple ergonomic risk factors during their normal operations on the water. In this News and Views brief, researchers outline ways to reduce ergonomic risks involved in the break down of lobster traps from a participatory approach.

Harvard T.H. Chan School of Public Health Center for Work, Health, & Well-being

The Harvard T.H. Chan School of Public Health Center for Work, Health, & Well-being is collaborating with Massachusetts Senior Care (the trade association for nursing facilities) in survey recruitment for the Center’s Enterprise Outcomes research study. The study aims include describing the degree to which nursing homes implement TWH approaches, as reflected in their scores on the Center’s Workplace Integrated Safety and Health (WISH) survey tool, and determining associations between nursing home use of an integrated approach and annual rates of occupational injury and indicators of patient care quality.

Oregon Healthy Workforce Center (OHWC)

The Oregon Health Workforce Center and the Oregon Institute of Occupational Health Sciences has launched two new outreach and education efforts. A new podcast, “What’s Work Got To Do With It?” is geared toward sharing the public health relevance of workplace safety, health, and well-being. The podcast will dig into the science behind the biological impact of our environment and explore how conditions like work hours, occupational stress, and workplace safety can affect our health and what we can do to prevent negative consequences and promote well-being. The podcast is available on iTunes and Google Play. Click to find out how to listen to it. OHWC views this podcast as a new avenue to shine light on Total Worker Health issues among audiences within and outside the workplace.

OHWC also launched its new Total Worker Health Dissertation Award Program. This program is designed to encourage and support doctoral student research in the important emerging discipline of TWH. OHWC invites applications from doctoral students in Region X (Oregon, Washington, Idaho, and Alaska) whose dissertations are focused on the integration of (or interactions between) worker safety, health, and well-being. Click here to access the call for proposals.

We extend congratulations to Dede Montgomery, OHWC’s Outreach Director, for earning the Distinguished Industrial Hygienist Award from the Pacific Northwest Section of the American Industrial Hygiene Association.

University of Illinois at Chicago Center for Healthy Work

In November 2018, the Healthy Work Collaborative to Map Action for Social Change released community mini-grants for implementation of projects aligned with the Healthy Communities through Healthy Work priority areas. The priorities area are precarious work, intersectoral collaboration, and policy, systems, and environmental change. Mini-grant projects will take place from November 2018 through July 2019.

The Greater Lawndale Healthy Work project has completed data collection with concept mapping, interviews, focus groups, and community surveys. Analysis and action mapping to identify community interventions are in progress. In addition, the Greater Lawndale Healthy Work project presented “Concept mapping to understand how work impacts health at the community level” at the American Public Health Association Annual Event in November 2018.

News from NIOSH TWH Affiliates and Partners

Join us in welcoming three new NIOSH TWH Affiliates!

City of Eugene Oregon logo

City of Eugene, OR: Home to more than 167,000 people, Eugene is one of Oregon’s largest cities and serves as an employment hub for the region. The City of Eugene is committed to supporting the health and livability of the entire community, including those who live and work in Eugene. As part of the commitment, the City promotes Total Worker Health®, aimed at enhancing worker well-being on-the-job and off-the-job. The City sponsors a variety of well-being focused initiatives and is consistently recognized as one of the top Healthiest Oregon employers. City staff are consistently envisioning and implementing innovative ways to promote well-being on-the-job and off-the-job. While on-the-job, staff contribute to an award-winning, wellness-focused organization. After hours, staff maximize all the region has to offer – from outdoor activities to art and cultural experiences. This holistic approach to on-the-job and off-the-job wellness enriches a thriving community.

St. Lukes Health System logo

St. Luke’s Health System: St. Luke’s is Idaho’s only locally owned, Idaho-based, not-for-profit health system and was founded in 1902. It has been named one of the Top 15 Health Systems in the United States for five consecutive years by Truven Health Analytics, now part of IBM Watson Health. St. Luke’s is physician led, and committed to improving the health of its employees and the communities it serve, and to continually advancing quality, best practices and value.

University of Rochester logo

University of Rochester: The University of Rochester (UR), which includes the UR Medical Center and Strong Memorial Hospital, is one of the nation’s top-tier research universities. With more than 30,000 employees, the University is the largest private employer in the Western New York region and fifth largest in New York State. It has a strong commitment to employee safety, health, and wellness. UR will leverage Total Worker Health resources and integrate its initiatives to optimize faculty and staff well-being and productivity while minimizing injury, impairment, and disability.

Updates from NIOSH TWH Affiliates


Capping a year and a half of hard work by a multidisciplinary project team, six TWH eLearning modules are now available. Each 5-minute module includes a video, a “body” poster that describes the impact of each topic on the body, and an interactive “hunt and find” game to look for hazards related to the topic at work and at home. The modules cover the following topics:

New Publications and Resources

From CDC and NIOSH

Expert interviews from the CDC Workplace Health Resource Center
Listen to new interviews with subject matter experts on topics including depression in the workplace and substance misuse in the workplace. Dr. Casey Chosewood serves as moderator for two of the featured interviews.

Research methodologies for Total Worker Health®: Proceedings from a workshop
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. The Journal of Occupational and Environmental Medicine recently published this peer-reviewed article on the workshop proceedings.

Using Naloxone to reverse opioid overdose in the workplace: Information for employers and workers
NIOSH developed this factsheet to help employers and workers understand the risk of opioid overdose and help them decide if they should establish a workplace naloxone availability and use program.

Using Total Worker Health® concepts to reduce fatigue among retail workers
This NIOSH Workplace Solutions document describes organizational practices related to scheduling, flexibility, and the work environment that can help address the causes and consequences of fatigue among retail workers.

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

Are fire stations contributing to cancer risk?
In this digital magazine article, Harvard Center researchers describe a project exploring the connection between poor air quality and adverse health outcomes at Boston Fire Department station houses. Data showed that particulate levels were highest in apparatus bays, likely indicating an indoor air contaminant.

Chronic low back pain: A successful intervention for desk-bound workers.
In this commentary article, a Harvard Center researcher explores a small, experimental study demonstrating the positive effects of an intervention aimed at decreasing sedentary behavior for desk-bound workers with chronic low back pain.

Cohort profile: The Boston Hospital Workers Health Study.
Harvard Center researchers describe the innovative creation of an integrated health and safety database of employees and their work environment throughout the greater Boston, Massachusetts, area. This article highlights the cohort as well as key findings from the database and related publications.

Employee perceptions of safety, health, and well-being: Focus group findings from one Veterans Affairs medical center.
Harvard Center researchers conducted focus groups at a Veterans Affairs medical center to understand (1) how the work environment and conditions of work influence employee safety, health, and well-being; (2) what programs, policies, and practices promote and protect the safety and health of employees; and (3) how employee safety, health, and well-being affect the organizational mission. Results indicate that common themes to address include stressful working conditions, health hazards, and organization factors.

Health Links™ annual report: The state of healthy business in Colorado.
The annual report of the CHWE Health Links™ program outlines organizational participation and impacts of the program from 2017 to 2018.

Knee pain in nursing home workers after implementation of a safe resident-handling program.
CPH-NEW researchers explored work-related and personal factors associated with knee pain among nursing home employees 5 years after implementation of a safe resident-handling program. Results indicate that body mass index, hours worked per week, and psychological job demands are all predictors of knee pain in nursing home workers.

Mental health expenditures: Association with workplace incivility and bullying among hospital patient care workers.
Harvard Center researchers explored the connection between workplace bullying and health plan claims for mental health diagnoses. Results indicate that workers experiencing incivility or bullying had greater odds of any mental health claims.

Prescription opioid epidemic: Do veterinarians have a dog in the fight?
In this editorial article, CHWE researchers outline recommendations for the veterinary, public health, pharmaceutical, and regulatory communities to devote time and resources to assess and intervene on the issue of prescription opioid diversion in veterinary medicine.

Protecting mental health of hospital workers after mass casualty events: A social work imperative.
In this commentary, researchers from the Harvard Center discuss roles that both employee assistance programs and medical social workers can play in supporting the mental health and well-being of hospital staff before, during, and after a mass casualty event. In addition, the commentary provides recommendations for how to codify these steps into hospital and citywide disaster response plans.

Reoccurring injury, chronic health conditions, and behavioral health: Gender differences in the causes of workers’ compensation claims.
Researchers from CHWE examined how work and nonwork health-related factors contribute to workers’ compensation claims by gender. Results indicate for both women and men, having incurred a prior workers’ compensation claim increased the odds of a future claim. Behavioral health risk factors increased the odds of having a claim more among women than among men.

Supervisor support training effects on veteran health and work outcomes in the civilian workplace.
Researchers from OHWC developed and evaluated a supervisor supportive training intervention for veterans. Although data did not indicate direct effects of the intervention on health and work outcomes, qualitative data support existing literature on the positive effects of organizational programs for both supervisors and employees.

The impact of heat and impaired kidney function on productivity of Guatemalan sugarcane workers.
CHWE researchers evaluated the relationship between temperature exposure, kidney function, and two measures of productivity—tons of commodity produced and job attrition—of 4,095 Guatemalan sugarcane cutters over a 6-month harvest. Results show that heat extremes may be associated with loss of agricultural worker productivity and employment, especially among those with impaired kidney function.

The relationship between organizational policies and practices and work limitations among a group of hospital patient care workers.
Researchers from the Harvard Center examined relationships between organizational policies and practices and work limitations in hospital workers. The results show that organizational policies and practices that promote supportive environments and foster improvements in ergonomics may help reduce work limitations.

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


6th—Chia-Chia Chang, MBA of the NIOSH Office for TWH and Sabrina Freewynn of SAIF presented Total Worker Health®: Integrating Health as an Injury Prevention Strategy at The National Workers’ Compensation and Disability Conference and Expo in Las Vegas, Nevada.

7th— The Healthy Communities through Healthy Work project members Christina Welter, DrPH, MPH; Lorraine Conroy, ScD, MS; and Tessa Bonney, MPH presented a webinar, The Healthy Work Collaborative: Addressing Precarious Work through Social Change, from 1:30 to 2:30 p.m. Central time, in collaboration with the Work, Wellness, and Disability Prevention Institute.

January 2019

11th—Dr. Kent Anger of the Harvard Center will present a webinar, How TWH Intervention Research Employs the Hierarchy of Controls, at 2:00 p.m. Eastern time, in collaboration with the Work, Wellness, and Disability Prevention Institute. Registration is available online.

14th— Dr. Jody Hoffer Gittell will present at a seminar co-sponsored by the Center for Work, Health, & Well-being and the Harvard Education and Research Center (ERC) at 1:00 p.m. Eastern time, at the Harvard T.H. Chan School of Public Health.

February 2019

12th—Dr. Glorian Sorensen of the Harvard Center and Dr. Casey Chosewood of the NIOSH Office for TWH will participate in a webinar co-sponsored by the University of Texas School of Public Health in Houston, the Society for Petroleum Engineers, and other oil and gas partners in Houston. Registration details are forthcoming.

March 2019

28th—Dr. Glorian Sorensen of the Harvard Center will present “Measuring Best Practices for Workplace Safety, Health, and Well-Being,” as part of the Work Wellness and Disability Prevention Institute webinar series, at 2:00 p.m. Eastern time.


July 8-10, 2019

The International Labour Organization’s 6th Annual Regulating for Decent Work Conference will take place in Geneva, Switzerland. Abstract submission is open until January 31, 2019.

September 4-7, 2019

The Association of Occupational Health Professionals in Healthcare (AOHP) Annual Conference will take place in Baltimore, Maryland. Abstract submission is open until January 31, 2019.

November 6-9, 2019

The 13th International Conference on Occupational Stress and Health, “Work , Stress and Health 2019: What Does the Future Hold?,” will be held at the Sheraton Philadelphia Downtown, Nov. 6-9, 2019, with preconference workshops and opening events on November 6. This conference is organized by the American Psychological Association, NIOSH, and the Society for Occupational Health Psychology. Abstract submission is open until January 28, 2019.


Editorial Board

L. Casey Chosewood, MD, MPH, Executive Editor

CDR Heidi Hudson, MPH, Editor-in-Chief

Reid Richards, Managing Editor

Seleen Collins, Copy Editor

Mary Micciche, NIOSH Web Editor

Steve Leonard, NIOSH Web Publisher

Please send your comments and suggestions to us at

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.