Vital Signs: Health Worker-Perceived Working Conditions and Symptoms of Poor Mental Health - Quality of Worklife Survey, United States, 2018-2022.

Introduction: Health workers faced overwhelming demands and experienced crisis levels of burnout before the COVID-19 pandemic; the pandemic presented unique challenges that further impaired their mental health. Methods: Data from the General Social Survey Quality of Worklife Module were analyzed to compare self-reported mental health symptoms among U.S. adult workers from 2018 (1,443 respondents, including 226 health workers) and 2022 (1,952, including 325 health workers). Logistic regression was used to examine associations between health workers' reported perceptions of working conditions and anxiety, depression, and burnout. Results: From 2018 to 2022, health workers reported an increase of 1.2 days of poor mental health during the previous 30 days (from 3.3 days to 4.5 days); the percentage who reported feeling burnout very often (11.6% to 19.0%) increased. In 2022, health workers experienced a decrease in odds of burnout if they trusted management (odds ratio [OR] = 0.40), had supervisor help (OR = 0.26), had enough time to complete work (OR = 0.33), and felt that their workplace supported productivity (OR = 0.38), compared with those who did not. Harassment at work was associated with increased odds of anxiety (OR = 5.01), depression (OR = 3.38), and burnout (OR = 5.83). Conclusions and implications for public health practice: Health workers continued to face a mental health crisis in 2022. Positive working conditions were associated with less burnout and better mental health. CDC's National Institute for Occupational Safety and Health has developed a national campaign, Impact Wellbeing, to provide employers of health workers with resources to improve the mental health of these workers.

Occupational Medicine and Total Worker Health®: from preventing health and safety risks in the workplace to promoting health for the total well-being of the worker.

The COVID-19 pandemic has highlighted the importance of Public Health interventions for global social and economic development. Still, the community's well-being depends on each individual's health. In addition to pandemics, health conditions can be altered by chronic degenerative diseases, aging, disabilities, and work. Personal behaviors such as poor nutrition, lack of physical activity, tobacco use, excessive alcohol consumption, and drug use can also affect health and safety at work. In the last twenty years, we have witnessed rapid changes in the nature of work, workplace and workforce. In parallel, there is increasing attention to fatigue, psychosocial risks and the achievement of decent, sustainable and healthy work as societal goals. Consequently, in 2011, NIOSH developed Total Worker Health®, a holistic approach to worker well-being to help improve worker health and safety. More recently, in Italy, the Ministry of Health has provided for the preparation of projects according to the "Total Worker Health (TWH)" approach in the National Prevention Plan for the five years 2020-2025. As indicated by the Ministry, the strategic role of the occupational physician is fundamental, being the only figure of occupational safety and health professionals able to integrate the health and safety of workers with their well-being to reach the Total Worker Health.

Proposed Framework for Developing and Evaluating Total Worker Health® Education and Training Programs.

OBJECTIVE: Propose a framework for developing and evaluating Total Worker Health® education and training efforts by implementing institutions. METHODS: Review of Total Worker Health (TWH) information from symposia, workshops, academic offerings, and publications, along with a review of education and training development and evaluation resources applicable across various disciplines. RESULTS: Examples of knowledge, skills, and abilities (KSAs) for each TWH core competency, and a framework for developing and evaluating a TWH competency-based education or training program. CONCLUSIONS: The proposed set of KSAs and framework for developing and evaluating TWH education or training programs may inform future pilot testing of KSAs and framework by implementing institutions and help to standardize practices across the discipline. Academic, business, community, labor, and government stakeholders are encouraged to provide further input to assist in its maturation and uptake.

Fatalities Involving Substance Use Among US Oil and Gas Extraction Workers Identified Through an Industry Specific Surveillance System (2014-2019).

OBJECTIVE: Characteristics of oil and gas extraction (OGE) work, including long hours, shiftwork, fatigue, physically demanding work, and job insecurity are risk factors for substance use among workers. Limited information exists examining worker fatalities involving substance use among OGE workers. METHODS: The National Institute for Occupational Safety and Health's Fatalities in Oil and Gas Extraction database was screened for fatalities involving substance use from 2014 through 2019. RESULTS: Twenty-six worker deaths were identified as involving substance use. Methamphetamine or amphetamine was the most common substances (61.5%) identified. Other contributing factors were lack of seatbelt use (85.7%), working in high temperatures (19.2%), and workers' first day with the company (11.5%). CONCLUSIONS: Employer recommendations to mitigate substance use-related risks in OGE workers include training, medical screening, drug testing, and workplace supported recovery programs.

Expanding the Focus of Occupational Safety and Health: Lessons from a Series of Linked Scientific Meetings.

There is widespread recognition that the world of work is changing, and agreement is growing that the occupational safety and health (OSH) field must change to contribute to the protection of workers now and in the future. Discourse on the evolution of OSH has been active for many decades, but formalized support of an expanded focus for OSH has greatly increased over the past 20 years. Development of approaches such as the National Institute for Occupational Safety and Health (NIOSH)'s Total Worker Health® concept and the World Health Organization (WHO)'s Healthy Workplace Framework are concrete examples of how OSH can incorporate a new focus with a wider view. In 2019, NIOSH initiated a multi-year effort to explore an expanded focus for OSH. This paper is a report on the outputs of a three-year cooperative agreement between NIOSH and The University of Texas School of Public Health, which led to subject matter expert workshops in 2020 and an international conference of global interest groups in 2021. This article traces the background of these meetings and identifies and assesses the lessons learned. It also reviews ten thematic topics that emerged from the meetings: worker health inequalities; training new OSH professionals; future OSH research and practice; tools to measure well-being of workers; psychosocial hazards and adverse mental health effects; skilling, upskilling and improving job quality; socioeconomic influences; climate change; COVID-19 pandemic influences; and strategic foresight. Cross-cutting these themes is the need for systems and transdisciplinary thinking and operationalization of the concept of well-being to prepare the OSH field for the work of the future.

NIOSH Responds to the U.S. Drug Overdose Epidemic.

The United States is experiencing an evolving and worsening drug overdose epidemic. Although the rate of drug use among workers has remained relatively stable, the risk of overdose and death among drug users has not, as illicit drugs have increased in potency and lethality. The cumulative impacts of COVID-19 and the opioid crisis increase the likelihood of illness and death among workers with opioid use disorder. Workplaces represent a critical point of contact for people living in the United States who are struggling with or recovering from a substance use disorder, and employment is a vital source of recovery "capital." The benefits of addressing substance use in the workplace, supporting treatment, and employing workers in recovery are evident. The National Institute for Occupational Safety and Health has published research to inform policy and practice toward prevention efforts and has developed accessible resources and toolkits to support workers, employers, and workplaces in combatting the opioid overdose crisis and creating safer, healthier communities.

How Will the Future of Work Shape OSH Research and Practice? A Workshop Summary.

Growth of the information economy and globalization of labor markets will be marked by exponential growth in emerging technologies that will cause considerable disruption of the social and economic sectors that drive the global job market. These disruptions will alter the way we work, where we work, and will be further affected by the changing demographic characteristics and level of training of the available workforce. These changes will likely result in scenarios where existing workplace hazards are exacerbated and new hazards with unknown health effects are created. The pace of these changes heralds an urgent need for a proactive approach to understand the potential effects new and emerging workplace hazards will have on worker health, safety, and well-being. As employers increasingly rely on non-standard work arrangements, research is needed to better understand the work organization and employment models that best support decent work and improved worker health, safety, and well-being. This need has been made more acute by the SARS-CoV-2 global pandemic that has resulted in dramatic changes in employment patterns, millions of lost jobs, an erosion of many economic sectors, and widespread disparities which further challenge occupational safety and health (OSH) systems to ensure a healthy and productive workplace. To help identify new research approaches to address OSH challenges in the future, a virtual workshop was organized in June 2020 with leading experts in the fields of OSH, well-being, research methods, mental health, economics, and life-course analysis. A paradigm shift will be needed for OSH research in the future of work that embraces key stakeholders and thinks differently about research that will improve lives of workers and enhance enterprise success. A more transdisciplinary approach to research will be needed that integrates the skills of traditional and non-traditional OSH research disciplines, as well as broader research methods that support the transdisciplinary character of an expanded OSH paradigm. This article provides a summary of the presentations, discussion, and recommendations that will inform the agenda of the Expanded Focus for Occupational Safety and Health (Ex4OSH) International Conference, planned for December 2021.

How Will the Future of Work Shape the OSH Professional of the Future? A Workshop Summary.

Rapid and profound changes anticipated in the future of work will have significant implications for the education and training of occupational safety and health (OSH) professionals and the workforce. As the nature of the workplace, work, and the workforce change, the OSH field must expand its focus to include existing and new hazards (some yet unknown), consider how to protect the health and well-being of a diverse workforce, and understand and mitigate the safety implications of new work arrangements. Preparing for these changes is critical to developing proactive systems that can protect workers, prevent injury and illness, and promote worker well-being. An in-person workshop held on February 3-4, 2020 at The University of Texas Health Science Center (UTHealth) School of Public Health in Houston, Texas, USA, examined some of the challenges and opportunities OSH education will face in both academic and industry settings. The onslaught of the COVID-19 global pandemic reached the United States one month after this workshop and greatly accelerated the pace of change. This article summarizes presentations from national experts and thought leaders across the spectrum of OSH and professionals in the fields of strategic foresight, systems thinking, and industry, and provides recommendations for the field.

Toward an Expanded Focus for Occupational Safety and Health: A Commentary.

Powerful and ongoing changes in how people work, the workforce, and the workplace require a more holistic view of each of these. We argue that an expanded focus for occupational safety and health (OSH) is necessary to prepare for and respond rapidly to future changes in the world of work that will certainly challenge traditional OSH systems. The WHO Model for Action, various European efforts at well-being, and the Total Worker Health concept provide a foundation for addressing changes in the world of work. However, a paradigm expansion to include the recognition of worker and workforce well-being as an important outcome of OSH will be needed. It will also be vital to stimulate transdisciplinary efforts and find innovative ways to attract and train students into OSH professions as the paradigm expands. This will require active marketing of the OSH field as vibrant career choice, as a profession filled with meaningful, engaging responsibilities, and as a well-placed investment for industry and society. An expanded paradigm will result in the need for new disciplines and specialties in OSH, which may be useful in new market efforts to attract new professionals. Ultimately, to achieve worker and workforce well-being we must consider how to implement this expanded focus.

Total Worker Health® 2014⁻2018: The Novel Approach to Worker Safety, Health, and Well-Being Evolves.

Background: The objective of this article is to provide an overview of and update on the Office for Total Worker Health® (TWH) program of the Centers for Disease Control and Prevention's National Institute for Occupational Safety and Health (CDC/NIOSH). Methods: This article describes the evolution of the TWH program from 2014 to 2018 and future steps and directions. Results: The TWH framework is defined as policies, programs, and practices that integrate protection from work-related safety and health hazards with promotion of injury and illness prevention efforts to advance worker well-being. Conclusions: The CDC/NIOSH TWH program continues to evolve in order to respond to demands for research, practice, policy, and capacity building information and solutions to the safety, health, and well-being challenges that workers and their employers face.

Implications of applying cumulative risk assessment to the workplace.

Multiple changes are influencing work, workplaces and workers in the US including shifts in the main types of work and the rise of the 'gig' economy. Work and workplace changes have coincided with a decline in unions and associated advocacy for improved safety and health conditions. Risk assessment has been the primary method to inform occupational and environmental health policy and management for many types of hazards. Although often focused on one hazard at a time, risk assessment frameworks and methods have advanced toward cumulative risk assessment recognizing that exposure to a single chemical or non-chemical stressor rarely occurs in isolation. We explore how applying cumulative risk approaches may change the roles of workers and employers as they pursue improved health and safety and elucidate some of the challenges and opportunities that might arise. Application of cumulative risk assessment should result in better understanding of complex exposures and health risks with the potential to inform more effective controls and improved safety and health risk management overall. Roles and responsibilities of both employers and workers are anticipated to change with potential for a greater burden of responsibility on workers to address risk factors both inside and outside the workplace that affect health at work. A range of policies, guidance and training have helped develop cumulative risk assessment for the environmental health field and similar approaches are available to foster the practice in occupational safety and health.

Research Methodologies for Total Worker Health®: Proceedings From a Workshop.

OBJECTIVE: There is growing interest in the NIOSH Total Worker Health program, specifically in the process of designing and implementing safer, health-promoting work and workplaces. A Total Worker Health (TWH) Research Methodology Workshop was convened to discuss research methods and future needs. METHODS: Twenty-six experts in occupational safety and health and related fields reviewed and discussed current methodological and measurement issues and those showing promise. RESULTS: TWH intervention studies face the same challenges as other workplace intervention studies and some unique ones. Examples are provided of different approaches and their applications to TWH intervention studies, and desired developments in the TWH literature. CONCLUSIONS: This report discusses and outlines principles important to building the TWH intervention research base. Rigorous, valid methodologic, and measurement approaches are needed for TWH intervention as well as for basic/etiologic, translational, and surveillance research.

The Perils of Integrating Wellness and Safety and Health and the Possibility of a Worker-Oriented Alternative.

In response to the article by Michael B. Lax, MD entitled "The perils of integrating wellness and safety and health and the possibility of a worker-oriented alternative," the National Institute for Occupational Safety and Health (NIOSH) provides updated information on the current focus and priorities and addresses concerns raised regarding the Total Worker Health® initiative. Many of the concerns and criticisms in the report echo those NIOSH publicly shares on a regular basis. The theory and practice of Total Worker Health (TWH) continues to evolve in response to valuable stakeholder input like that provided by Dr. Lax. In 2015, NIOSH updated the TWH concept to emphasize the main focus of TWH is the primacy of traditional health protection which prioritizes employer responsibilities for the organization of work over individual worker health behaviors. NIOSH acknowledges the past lack of "fit" between theory and practice in some publications of TWH-funded grantees as Dr. Lax points out. NIOSH is hopeful that the solicitation of new research, which is now underway, will clarify the work-centered priorities for TWH-funded research. Based on input from Dr. Lax and other stakeholders, NIOSH looks forward to contributing more effectively to protecting and promoting worker safety and health in the new twenty-first century world of work.

Intervention effects on safety compliance and citizenship behaviors: Evidence from the Work, Family, and Health Study.

We tested the effects of a work-family intervention on employee reports of safety compliance and organizational citizenship behaviors in 30 health care facilities using a group-randomized trial. Based on conservation of resources theory and the work-home resources model, we hypothesized that implementing a work-family intervention aimed at increasing contextual resources via supervisor support for work and family, and employee control over work time, would lead to improved personal resources and increased employee performance on the job in the form of self-reported safety compliance and organizational citizenship behaviors. Multilevel analyses used survey data from 1,524 employees at baseline and at 6-month and 12-month postintervention follow-ups. Significant intervention effects were observed for safety compliance at the 6-month, and organizational citizenship behaviors at the 12-month, follow-ups. More specifically, results demonstrate that the intervention protected against declines in employee self-reported safety compliance and organizational citizenship behaviors compared with employees in the control facilities. The hypothesized mediators of perceptions of family-supportive supervisor behaviors, control over work time, and work-family conflict (work-to-family conflict, family-to-work conflict) were not significantly improved by the intervention. However, baseline perceptions of family-supportive supervisor behaviors, control over work time, and work-family climate were significant moderators of the intervention effect on the self-reported safety compliance and organizational citizenship behavior outcomes.

Advancing workplace health protection and promotion for an aging workforce.

OBJECTIVE: To explore issues related to the aging workforce, including barriers to integrating health protection and promotion programs, and provide recommendations for best practices to maximize contributions by aging workers. METHODS: Workgroups reviewed literature and case studies to develop consensus statements and recommendations for a national approach to issues related to older workers. RESULTS: Consensus statements and actions steps were identified for each of the Summit goals and call-to-action statements were developed. CONCLUSIONS: A national dialogue to build awareness of integrated health protection and promotion for the aging workforce is needed. Workers will benefit from improved health and performance; employers will realize a more engaged and productive workforce; and the nation will gain a vital, competitive workforce.