Addressing Health Care Workers' Mental Health: A Systematic Review of Evidence-Based Interventions and Current Resources.

Background. Mental health is declining in health care workers. Objectives. To provide a comprehensive assessment of intervention literature focused on the support and treatment of mental health within the health care workforce. Search Methods. We searched online databases (e.g., Medline, PsycINFO). Selection Criteria. We selected manuscripts published before March 2022 that evaluated the target population (e.g., nurses), mental health outcomes (e.g., burnout, depression), and intervention category (e.g., mindfulness). Data Collection and Analysis. Of 5158 publications screened, 118 interventions were included. We extracted relevant statistics and information. Main Results. Twenty (17%) earned study quality ratings indicating design, analysis, and implementation strengths. Randomized controlled trials were used by 52 studies (44%). Thirty-eight percent were conducted in the United States (n = 45). Ninety (76%) reported significant changes, and 46 (39%) reported measurable effect sizes. Multiple interventions significantly reduced stress (n = 29; 24%), anxiety (n = 20; 17%), emotional exhaustion or compassion fatigue (n = 16; 14%), burnout (n = 15; 13%), and depression (n = 15; 13%). Authors' Conclusions. Targeted, well-designed mental health interventions can improve outcomes among health care workers. Public Health Implications. Targeted health care‒focused interventions to address workers' mental health could improve outcomes within this important and vulnerable workforce. (Am J Public Health. 2024;114(S2):S213-S226. https://doi.org/10.2105/AJPH.2023.307556).

Primary Prevention of Weight Gain Among New Bus Operators: Results of the "Success & Health Impacts For Transit operators during Onboarding" (SHIFT Onboard) Pilot Study.

OBJECTIVE: This study aimed to test the feasibility and efficacy of an enhanced onboarding intervention to prevent weight gain and support the early job success of new bus operators. METHODS: Control participants ( n = 9) completed usual practice new employee training and onboarding. Intervention participants ( n = 14) completed five supplemental trainings and four online challenges during their first year. Primary outcomes were body weight, dietary behaviors, physical activity, and sleep duration/quality. Early job success was evaluated with measures of newcomer adjustment. RESULTS: The difference between intervention and control participants in body weight change at 12-month was -6.71 lb (Cohen's d = -1.35). Differences in health behavior changes were mixed, but newcomer adjustment changes favored the intervention group. CONCLUSIONS: Results support the feasibility of enhanced onboarding for bus operators to prevent worsening health while simultaneously advancing their success as new employees.

Bus Operators' Body Weight Changes During Their First 2 Years of Work: A Retrospective Survey.

OBJECTIVE: To empirically assess retrospective reports of weight changes during bus operators' first years on the job, and to investigate experienced and desired training topics for new operators. METHODS: Bus operators (n = 261) completed an online survey on topics of early weight changes and training experiences. RESULTS: Operators reported gaining an average of 7.64 lb (SD = 16.36) during their first year. Further weight gain was not reported during the second year. Most operators reported that health-related topics were not addressed during their initial training. Stress management and healthy eating were the operators' two most desired topics to be included in their initial training. CONCLUSION: Bus operators reported medically meaningful weight gain during their first year of work and a desire for more health-related training. Objective research to document the magnitude of this hazard, and contributing working conditions, is needed.

Magnitude of behavioral deficits varies with job-related chlorpyrifos exposure levels among Egyptian pesticide workers.

Chronic occupational exposure to organophosphorus pesticides (OPs) is consistently associated with deficits on behavioral tests when compared to unexposed comparison groups. However, a dose-response relationship has yet to be established, leading some to doubt an association between occupational OP exposure and behavioral deficits. Pesticide application teams in Egypt who are primarily exposed to one OP, chlorpyrifos (CPF), were recruited into a field assessment. Trail Making A and the more challenging Trail Making B tests were administered to 54 engineers (who supervise the pesticide application process, usually from the side of the field), 59 technicians (who guide the pesticide applicators in the field), 31 applicators (who mix and apply pesticides using knapsack sprayers), and 150 controls (who did not work in the fields) at two different times during the OP application season as well as immediately after applications had ended and 1.5 months later. All participants were males since only males work on pesticide application teams in Egypt. Urinary levels of 3,5,6-trichloro-2-pyridinol (TCPy), a specific metabolite of CPF, confirmed the pattern of lower to higher CPF exposures from engineers to technicians to applicators, and these were all greater than urinary metabolite levels in controls. A consistent relationship between job title and performance speed on the behavioral task was observed: Controls had the best (fastest) performance on Trail Making A and B tests throughout the application season, and applicators had significantly slower performance than engineers on Trail Making A (p = 0.015) and B (p = 0.003). However, individual urinary TCPy, blood acetylcholinesterase (AChE) and butyrylcholinesterase (BuChE) levels did not predict individual performance. This study identifies a dose-related effect based on job title, which serves as a surrogate for chronic exposure in that differing job titles exhibit varying group exposure levels. The results establish that chronic occupational exposure to chlorpyrifos is neurotoxic and suggest that the classic biomarkers of recent CPF exposure are not predictive of chronic exposure effects.

Total Worker Health® Intervention for Construction Workers Alters Safety, Health, Well-Being Measures.

OBJECTIVE: The aim of this study was to evaluate the effectiveness of a 14-week Total Worker Health (TWH) intervention designed for construction crews. METHODS: Supervisors (n = 22) completed computer-based training and self-monitoring activities on team building, work-life balance, and reinforcing targeted behaviors. Supervisors and workers (n = 13) also completed scripted safety and health education in small groups with practice activities. RESULTS: The intervention led to significant (P < 0.05) improvements in family-supportive supervisory behaviors (d = 0.72). Additional significant improvements included reported frequency of exercising 30 minutes/day and muscle toning exercise (d = 0.50 and 0.59), family and coworker healthy diet support (d = 0.53 and 0.59), team cohesion (d = 0.38), reduced sugary snacks and drinks (d = 0.46 and d = 0.46), sleep duration (d = 0.38), and objectively-measured systolic blood pressure (d = 0.27). CONCLUSION: A TWH intervention tailored for construction crews can simultaneously improve safety, health, and well-being.

Computer-based training (CBT) intervention reduces workplace violence and harassment for homecare workers.

BACKGROUND: The study examines the effectiveness of a workplace violence and harassment prevention and response program with female homecare workers in a consumer driven model of care. METHODS: Homecare workers were randomized to either; computer based training (CBT only) or computer-based training with homecare worker peer facilitation (CBT + peer). Participants completed measures on confidence, incidents of violence, and harassment, health and work outcomes at baseline, 3, 6 months post-baseline. RESULTS: Homecare workers reported improved confidence to prevent and respond to workplace violence and harassment and a reduction in incidents of workplace violence and harassment in both groups at 6-month follow-up. A decrease in negative health and work outcomes associated with violence and harassment were not reported in the groups. CONCLUSION: CBT alone or with trained peer facilitation with homecare workers can increase confidence and reduce incidents of workplace violence and harassment in a consumer-driven model of care.

Weight Control Intervention for Truck Drivers: The SHIFT Randomized Controlled Trial, United States.

OBJECTIVES: To evaluate the effectiveness of the Safety and Health Involvement For Truckers (SHIFT) intervention with a randomized controlled design. METHODS: The multicomponent intervention was a weight-loss competition supported with body weight and behavioral self-monitoring, computer-based training, and motivational interviewing. We evaluated intervention effectiveness with a cluster-randomized design involving 22 terminals from 5 companies in the United States in 2012 to 2014. Companies were required to provide interstate transportation services and operate at least 2 larger terminals. We randomly assigned terminals to intervention or usual practice control conditions. We assessed participating drivers (n = 452) at baseline and 6 months. RESULTS: In an intent-to-treat analysis, the postintervention difference between groups in mean body mass index change was 1.00 kilograms per meters squared (P < .001; intervention = -0.73; control = +0.27). Behavioral changes included statistically significant improvements in fruit and vegetable consumption and physical activity. CONCLUSIONS: Results establish the effectiveness of a multicomponent and remotely administered intervention for producing significant weight loss among commercial truck drivers.

Interactive training improves workplace climate, knowledge, and support towards domestic violence.

BACKGROUND: As Intimate Partner Violence (IPV) affects the workplace, a supportive workplace climate is important. The study evaluated the effectiveness of an "IPV and the Workplace" training on workplace climate towards IPV. METHODS: IPV training was provided to 14 intervention counties and 13 control counties (receiving training 6 months delayed). Measures included workplace climate surveys, IPV knowledge test, and workplace observations. RESULTS: (i) Training significantly improved supervisor knowledge on IPV and received positive evaluations, (ii) training improved workplace climate towards IPV significantly which was maintained over time, and (iii) after the training, supervisors provided more IPV information to employees and more IPV postings were available in the workplace. CONCLUSIONS: The study provides evidence to support on-site interactive, computer based training as a means for improved workplace safety. IPV and the Workplace training effectively increased knowledge and positively changed workplace climate. Am. J. Ind. Med. 59:538-548, 2016. © 2016 Wiley Periodicals, Inc.

Sleep, Dietary, and Exercise Behavioral Clusters Among Truck Drivers With Obesity: Implications for Interventions.

OBJECTIVE: The objectives of the study were to describe a sample of truck drivers, identify clusters of drivers with similar patterns in behaviors affecting energy balance (sleep, diet, and exercise), and test for cluster differences in health safety, and psychosocial factors. METHODS: Participants' (n = 452, body mass index M = 37.2, 86.4% male) self-reported behaviors were dichotomized prior to hierarchical cluster analysis, which identified groups with similar behavior covariation. Cluster differences were tested with generalized estimating equations. RESULTS: Five behavioral clusters were identified that differed significantly in age, smoking status, diabetes prevalence, lost work days, stress, and social support, but not in body mass index. Cluster 2, characterized by the best sleep quality, had significantly lower lost workdays and stress than other clusters. CONCLUSIONS: Weight management interventions for drivers should explicitly address sleep, and may be maximally effective after establishing socially supportive work environments that reduce stress exposures.

Effectiveness of total worker health interventions.

Total Worker Health (TWH) was introduced and the term was trademarked in 2011 by the National Institute for Occupational Safety and Health (NIOSH) to formally signal the expansion of traditional occupational safety and health (OSH) to include wellness and well-being. We searched PubMed, PsycINFO, and other databases using keywords TWH, health promotion, health protection, and variants for articles meeting the criteria of (a) employing both occupational safety and/or health (OSH, or health protection) and wellness and/or well-being (health promotion, or HP) in the same intervention study, and (b) reporting both OSH and HP outcomes. Only 17 published studies met these criteria. All but 1 of the 17 TWH interventions improved risk factors for injuries and/or chronic illnesses, and 4 improved 10 or more risk factors. Several TWH interventions reported sustained improvements for over a year, although only 1 is readily available for dissemination. These results suggest that TWH interventions that address both injuries and chronic diseases can improve workforce health effectively and more rapidly than the alternative of separately employing more narrowly focused programs to change the same outcomes in serial fashion. These 17 articles provide useful examples of how TWH interventions can be structured. The promise of simultaneous improvements in safety, health, and well-being leads to the call to pursue TWH research to identify and disseminate best practices.

Longitudinal assessment of occupational exposures to the organophosphorous insecticides chlorpyrifos and profenofos in Egyptian cotton field workers.

Chlorpyrifos (CPF) and profenofos (PFF) are organophosphorus (OP) insecticides that are applied seasonally in Egypt to cotton fields. Urinary trichloro-2-pyridinol (TCPy), a specific CPF metabolite, and 4-bromo-2-chlorophenol (BCP), a specific PFF metabolite, are biomarkers of exposure, while inhibition of blood butyrylcholinesterase (BChE) and acetylcholinesterase (AChE) activities are effect biomarkers that may be associated with neurotoxicity. Urinary TCPy and BCP and blood BChE and AChE activities were measured in 37 adult Egyptian Ministry of Agriculture workers during and after 9-17 consecutive days of CPF application followed by an application of PFF (9-11 days), and a second CPF application (5 days) in 2008. During the OP applications, urinary TCPy and BCP levels were significantly higher than baseline levels, remained elevated following the application periods, and were associated with an exposure related inhibition of blood BChE and AChE. Analysis of blood AChE levels before and after the PFF application period suggests that individual workers with peak BCP levels greater than 1000 µg/g creatinine exhibited further inhibition of blood AChE with PFF application, demonstrating that PFF exposure had a negative impact on AChE activity in this highly exposed worker population. While large interindividual differences in exposure were observed throughout this longitudinal study (peak urinary BCP and peak TCPy levels for individuals ranging from 13.4 to 8052 and 16.4 to 30,107 µg/g creatinine, respectively), these urinary biomarkers were highly correlated within workers (r=0.75, p<0.001). This suggests that the relative exposures to CPF and PFF were highly correlated for a given worker. The variable exposures between job classification and work site suggest that job title and work location should not be used as the sole basis for categorizing OP exposures when assessing neurobehavioral and other health outcomes in Egyptian cotton field workers. Together, these findings will be important in educating the Egyptian insecticide application workers in order to encourage the development and implementation of work practices and personal protective equipment to reduce their exposure to CPF and PFF.

Reconsideration of the WHO NCTB strategy and test selection.

The World Health Organization-recommended neurobehavioral core test battery (NCTB) became the international standard for identifying adverse human behavioral effects due to neurotoxic chemical exposure when it was first proposed in 1983. Since then the WHO NCTB has been repeatedly cited as the basis for test selection in human neurotoxicology research. A discussion group was held before the International Symposium on Neurobehavioral Methods and Effects in Occupational and Environmental Health to review the NCTB and reconsider its tests. The workshop made three consensus recommendations to the International Congress on Occupational Health (ICOH) Scientific Committee on Neurotoxicology and Psychophysiology (SCNP):. 1. A 'screening' battery of broadly sensitive tests is needed as guidance to the field of human neurotoxicology 2. The SCNP should convene a panel to reconsider the functions measured and the tests in the WHO NCTB 3. Three disciplines should be represented in the panel recommending a revised NCTB: neuropsychology; experimental psychology; neurology. This recommendation will be pursued at the next meeting of the International Congress on Occupational Health (ICOH) Scientific Committee on Neurotoxicology and Psychophysiology (SCNP).

Exploring workplace violence among home care workers in a consumer-driven home health care program.

Nominal research has examined sexual harassment and workplace violence against home care workers within consumer-driven home care models such as those offered in Oregon. This study examined home care workers' experiences of violence while providing care to consumer employers, the patients who hire and manage home care workers. Focus groups and interviews were conducted in Oregon with 83 home care workers, 99 Oregon Department of Human Services (DHS) employees, and 11 consumer employers. Home care workers reported incidents of workplace physical violence (44%), psychological abuse (65%), sexual harassment (41%), and sexual violence (14%). Further, three themes were identified that may increase the risk of workplace violence: (1) real and perceived barriers to reporting violence; (2) tolerance of violence; and (3) limited training to prevent violence. To ensure worker safety while maintaining quality care, safety policies and training for consumer employers, state DHS employees, and home care workers must be developed.

A brief history of INA and ICOH SCNP: International Neurotoxicology Association and International Congress on Occupational Health Scientific Committee on Neurotoxicology and Psychophysiology.

Two international scientific societies dedicated to research in neurotoxicology and neurobehavioral toxicology are the International Neurotoxicology Association (INA) and the International Congress on Occupational Health International Scientific Committee on Neurotoxicology and Psychophysiology (ICOH SCNP). From June 5-10, 2011 these two societies held a joint conference in Xi'an China entitled the Xi'an International Neurotoxicology Conference, Neurotoxicity and Neurodegeneration: Local Effect and Global Impact. At the conference two featured talks presented a brief history of the two societies. This article is a synthesis and expansion of those two presentations. The history of INA and ICOH SCNP is described in relation to the antecedent events leading to the formation of the two societies, their parallel developments, the nature of the societies and their scientific conferences, and a brief description of some of their accomplishments. Together, the historical development of these two societies is an important component of the development of the scientific discipline of neurotoxicology.

Integration of epidemiology and animal neurotoxicity data for risk assessment.

Most human health risk assessments are based on animal studies that can be conducted under conditions where exposure to multiple doses of a single chemical can be controlled. Data from epidemiology studies also provide valuable information about human exposure and response to pesticides. Human studies have the potential of evaluating neurobehavioral and other outcomes that may be more difficult to evaluate in animals. The human data together with animal data can contribute to a weight-of-evidence analysis in the characterization of human health risks. Epidemiology data do, however, pose challenges with respect to characterizing human health risks. Similarly, animal data at high doses or routes of exposure not typical for humans also pose challenges to dose-response evaluations needed for risk assessments. This paper summarizes some of the presentations given at a symposium held at the Xi'an, China, International Neurotoxicology Conference held in June 2011. This symposium brought together scientists from government, industry and academia to discuss approaches to evaluating and conducting animal and human neurotoxicity studies for risk assessment purposes, using the pesticides paraquat and chlorpyrifos as case studies.

Experimental strategy for translational studies of organophosphorus pesticide neurotoxicity based on real-world occupational exposures to chlorpyrifos.

Translational research is needed to understand and predict the neurotoxic consequences associated with repeated occupational exposures to organophosphorus pesticides (OPs). In this report, we describe a research strategy for identifying biomarkers of OP neurotoxicity, and we characterize pesticide application workers in Egypt's Menoufia Governorate who serve as our anchor human population for developing a parallel animal model with similar exposures and behavioral deficits and for examining the influence of human polymorphisms in cytochrome P450 (CYP) and paraoxonase 1 (PON1) enzymes on OP metabolism and toxicity. This population has previously been shown to have high occupational exposures and to exhibit a broad range of neurobehavioral deficits. In addition to observational studies of work practices in the field, questionnaires on demographics, lifestyle and work practices were administered to 146 Egyptian pesticide application workers applying pesticides to the cotton crop. Survey results indicated that the application workforce uses standard operating procedures and standardized equipment provided by Egypt's Ministry of Agriculture, which provides a workforce with a stable work history. We also found that few workers report using personal protective equipment (PPE), which likely contributes to the relatively high exposures reported in these application workers. In summary, this population provides a unique opportunity for identifying biomarkers of OP-induced neurotoxicity associated with occupational exposure.

Biomarkers of chlorpyrifos exposure and effect in Egyptian cotton field workers.

BACKGROUND: Chlorpyrifos (CPF), a widely used organophosphorus pesticide (OP), is metabolized to CPF-oxon, a potent cholinesterase (ChE) inhibitor, and trichloro-2-pyridinol (TCPy). Urinary TCPy is often used as a biomarker for CPF exposure, whereas blood ChE activity is considered an indicator of CPF toxicity. However, whether these biomarkers are dose related has not been studied extensively in populations with repeated daily OP exposures. OBJECTIVE: We sought to determine the relationship between blood ChE and urinary TCPy during repeated occupational exposures to CPF. METHODS: Daily urine samples and weekly blood samples were collected from pesticide workers (n=38) in Menoufia Governorate, Egypt, before, during, and after 9-17 consecutive days of CPF application to cotton fields. We compared blood butyrylcholinesterase (BuChE) and acetylcholinesterase (AChE) activities with the respective urinary TCPy concentrations in each worker. RESULTS: Average TCPy levels during the middle of a 1- to 2-week CPF application period were significantly higher in pesticide applicators (6,437 µg/g creatinine) than in technicians (184 µg/g) and engineers (157 µg/g), both of whom are involved in supervising the application process. We observed a statistically significant inverse correlation between urinary TCPy and blood BuChE and AChE activities. The no-effect level (or inflection point) of the exposure-effect relationships has an average urinary TCPy level of 114 µg/g creatinine for BuChE and 3,161 µg/g creatinine for AChE. CONCLUSIONS: Our findings demonstrate a dose-effect relationship between urinary TCPy and both plasma BuChE and red blood cell AChE in humans exposed occupationally to CPF. These findings will contribute to future risk assessment efforts for CPF exposure.

Correlating neurobehavioral performance with biomarkers of organophosphorous pesticide exposure.

There is compelling evidence that adverse neurobehavioral effects are associated with occupational organophosphorous pesticide (OP) exposure in humans. Behavioral studies of pesticide applicators, greenhouse workers, agricultural workers and farm residents exposed repeatedly over months or years to low levels of OPs reveal a relatively consistent pattern of neurobehavioral deficits. However, only two studies have demonstrated a link between neurobehavioral performance and current biomarkers of OP exposure including blood cholinesterase (ChE) activity and urinary levels of OP metabolites. A variety of reasons may explain why so few studies have reported such correlations, including differing individual and group exposure histories, differing methodologies for assessing behavior and exposure, and lack of a reliable index of exposure. Alternatively, these data may suggest that current biomarkers (ChE, urine metabolites) are neither predictive nor diagnostic of the neurobehavioral effects of chronic OP pesticide exposures. This review focuses on the evidence that neurobehavioral performance deficits are associated with occupational OP pesticide exposure and concludes that research needs to return to the basics and rigorously test the relationships between neurobehavioral performance and both current (ChE and urine metabolites) and novel (e.g., inflammation and oxidative stress) biomarkers using human and animal models. The results of such studies are critically important because OP pesticides are widely and extensively used throughout the world, including situations where exposure controls and personal protective equipment are not routinely used.

Clarifying work-family intervention processes: the roles of work-family conflict and family-supportive supervisor behaviors.

Drawing on a conceptual model integrating research on training, work­family interventions, and social support, we conducted a quasi-experimental field study to assess the impact of a supervisor training and self-monitoring intervention designed to increase supervisors' use of family-supportive supervisor behaviors. Pre- and postintervention surveys were completed, 9 months apart, by 239 employees at 6 intervention (N = 117) and 6 control (N = 122) grocery store sites. Thirty-nine supervisors in the 6 intervention sites received the training consisting of 1 hr of self-paced computer-based training, 1 hr of face-to-face group training, followed by instructions for behavioral self-monitoring (recording the frequency of supportive behaviors) to facilitate on-the-job transfer. Results demonstrated a disordinal interaction for the effect of training and family-to-work conflict on employee job satisfaction, turnover intentions, and physical health. In particular, for these outcomes, positive training effects were observed for employees with high family-to-work conflict, whereas negative training effects were observed for employees with low family-to-work conflict. These moderation effects were mediated by the interactive effect of training and family-to-work conflict on employee perceptions of family-supportive supervisor behaviors. Implications of our findings for future work­family intervention development and evaluation are discussed.