A 16-Year Chronicle of Developing a Healthy Workplace Participatory Program for Total Worker Health® in the Connecticut Department of Correction: The Health Improvement through Employee Control (HITEC) Program.

Health Improvement Through Employee Control (HITEC) is a 16-year program directed toward the health of corrections personnel and developed through the application of the principles of Participatory Action Research (PAR) and participatory ergonomics. Its impetus has always been the adverse health status of the corrections workforce: early mortality, depression, obesity, and hypertension. The HITEC program trained small "Design Teams" (DTs) of front-line personnel in participatory methods for intervention design for health improvement and organizational change in line with the Total Worker Health® principles. Periodic surveys and physical testing were introduced for longitudinal assessments. Comparative interventions at comparable sites included DTs without a priori assignation, problem-focused kaizen effectiveness teams (KETs), and bargaining unit-centered DTs. DT resilience and the replacement of members who transferred facilities or retired was aided by novel cooperative administrative structures. DT-generated interventions included stress lounges, changes in critical event report writing, a joint program with trained inmates to improve air quality, and training in staff mental health and sleep behavior. A specialized peer-to-peer Health Mentoring Program (HMP) paired new officers with trained peers. Many interventions and program features were institutionalized, thus improving prospects for self-supporting program longevity. Participatory interventions designed and supported by the corrections workforce were found to be both feasible and exceptionally effective.

Peer Support Programs to Reduce Organizational Stress and Trauma for Public Safety Workers: A Scoping Review.

BACKGROUND: Public safety workers (PSWs), including correctional officers (COs), law enforcement, firefighters, emergency medical service, and military personnel, are at risk of organizational stress and burnout. Exposure to traumatic events, job hazards, injuries, fatalities, and work-related stressors such as work overload, irregular shift assignments, and lack of administrative support can negatively impact PSWs' mental health. Peer support programs (PSPs) have been cited as an intervention to address the mental health of PSWs. PURPOSE: The purpose of this review is to explore the use, including facilitators and barriers, of PSPs to reduce organizational stress and trauma for PSWs. Implications for COs will be discussed. METHOD: A scoping review was conducted using the Arksey and O'Malley methodology. A search was conducted for articles published between 1996 and 2021 using six databases. Selected articles described, implemented, or evaluated peer support as an intervention to reduce PSW organizational stress and trauma. FINDINGS: Thirteen articles met eligibility criteria. Organizational support, including policies, practices, and peer leadership training, contributed to the sustainability of PSPs. Confidentiality, trust, and shared lived experience were also essential to PSP. Stigma was identified as the primary barrier to participation. Public safety workers found PSP helpful in normalizing experiences, increasing hope, and decreasing stigma. Peer support programs also serve to bridge the gap in mental health services use. CONCLUSIONS: Peer support programs are a potential mental health intervention to reduce organizational stress and trauma for COs. Awareness of the facilitators and barriers to PSPs is the first step in developing such programs.

Qualitative Assessment of Perceived Organizational Support for Employed Breast Cancer Survivors.

OBJECTIVE: A more detailed understanding of unmet organizational support needs and workplace-based best practices for supporting cancer survivors is needed. METHODS: Ninety-four working breast cancer survivors responded to an open-ended survey question regarding the desired types of organizational support that were and were not received during early survivorship. We performed content-analysis of qualitative data. RESULTS: Major themes included instrumental support, emotional support, and time-based support. The need for flexible arrangements and reduced workloads was mostly met. Unmet needs included navigation/coordination, understanding/empathy, and time off for treatment and recovery. CONCLUSIONS: Organizational support can help cancer survivors manage their health and work roles, diminishing work-health conflict and turnover intent. Study findings can be used to design targeted interventions to fulfill cancer survivors' unmet organizational support needs, which may also apply to workers with other chronic health conditions.

Relative Importance of Incivility and Loneliness in Occupational Health Outcomes.

Researchers have studied loneliness as a modern health epidemic which is associated with myriad negative health effects, yet the literature lacks evidence of loneliness' correlates, including incivility, in the workplace. This paper not only replicates previous work on incivility, a pervasive interpersonal workplace stressor, it also contributes novel findings on the relative importance of loneliness in explaining variance in occupational health outcomes. We tested hypotheses using two cross-sectional datasets containing data from the general working population (Sample 1) and state corrections supervisors (Sample 2). Through relative importance analyses, including relative weights analysis, we found that both general and workplace loneliness explain substantial variance in several outcomes (e.g., emotional exhaustion, depression symptoms, and turnover intentions) relative to the variance explained by workplace incivility. When controlling for perceived work stress, general loneliness appears to be more important than incivility in explaining variance in emotional exhaustion, job satisfaction, and depression symptoms.

Participatory design of a sleep intervention with correctional supervisors using a root causes approach.

BACKGROUND: After a Design Team (DT) conducted a workforce health assessment of correctional supervisors, they selected sleep as an intervention priority, given its numerous health and work consequences. Existing workplace sleep interventions are designed with little worker input, but participatory solutions that incorporate workers' lived experiences and root causes of poor sleep may be more relevant, appropriate, and acceptable to end-users, resulting in better uptake. METHODS: The DT met bi-monthly to complete the Intervention Design and Analysis Scorecard (IDEAS) tool to brainstorm interventions that address root causes of poor sleep, and evaluate, rank, and select interventions for implementation. We conducted a qualitative review of meeting notes and worksheets from each IDEAS step, and present our findings on root causes and prioritized solutions. RESULTS: The DT consisted of two university researchers and seven members of a correctional supervisors' union, with 5-9 participants attending each meeting. IDEAS Steps 1-5 were completed in eight meetings over six months. Root causes of poor sleep included mind/body and environmental disruptions, and insufficient time. Three solutions were proposed: training on sleep hygiene, meditation, and sleep debt management; a sleep-tracking smartphone app; and a shared overtime policy based on splitting one 8-hour shift between two supervisors. CONCLUSIONS: This is the first known application of IDEAS to address sleep, and targeting root causes may result in more efficacious interventions for sleep improvement. Moreover, because IDEAS guides DTs in selecting solutions with the greatest perceived health benefits, reach, cost-effectiveness, and feasibility, it may result in more successful implementation.

Continuous physiological signal measurement over 24-hour periods to assess the impact of work-related stress and workplace violence.

Work-related stress has long been recognized as an essential factor affecting employees' health and wellbeing. Repeated exposure to acute occupational stressors puts workers at high risk for depression, obesity, hypertension, and early death. Assessment of the effects of acute stress on workers' wellbeing usually relies on subjective self-reports, questionnaires, or measuring biometric and biochemical markers in long-cycle time intervals. This study aimed to develop and validate the use of a multiparameter wearable armband for continuous non-invasive monitoring of physiological states. Two worker populations were monitored 24 h/day: six loggers for one day and six ICU nurses working 12-hr shifts for one week. Stress responses in nurses were highly correlated with changes in heart rate variability (HRV) and pulse transit time (PTT). A rise in the low-to high-frequency (LF/LH) ratio in HRV was also coincident with stress responses. HRV on workdays decreased compared to non-work days, and PTT also exhibited a persistent decrease reflecting increased blood pressure. Compared to loggers, nurses were involved in high-intensity work activities 45% more often but were less active on non-work days. The wearable technology was well accepted by all worker participants and yielded high signal quality, critical factors for long-term non-invasive occupational health monitoring.

Critical incident exposure among custody and noncustody correctional workers: Prevalence and impact of violent exposure to work-related trauma.

BACKGROUND: Correctional workers are at high risk for exposure to trauma, both as direct violence and as threats to their safety and well-being. The distress associated with these critical incidents (CIs) affects mental and physical health. Current tools are limited for detecting CIs in this workforce and are therefore insufficient for addressing correctional worker trauma. METHODS: Community prison employees (N = 105) self-reported CIs using the adapted Correctional Worker Critical Incident Survey (CWCIS). We examined: (1) prevalence of CIs and occurrences, (2) differences in exposures to CIs by custody and noncustody staff, and (3) differences in job satisfaction, posttraumatic stress (PTSD), lower back disease, and health behaviors, such as missed work and sleep. RESULTS: CIs occurred among most staff (59%) and more often for custody staff as compared to noncustody staff. CIs most often experienced were coworker injury, exposure to disease, and badly beaten adults (frequency 10-50). For the 1-9 frequency category, the most described events were: seeing someone dying, life threatened, and coworker injury. PTSD was identified in 44% of staff, and those who experienced CIs reported lower job satisfaction, greater feelings of PTSD, and more work absences than those not experiencing CIs (p < 0.05). CONCLUSIONS: CIs and PTSD are prevalent among custody and noncustody correctional workers; and job dissatisfaction, PTSD, and work absence are significantly worse for those who experienced CIs. The CWCIS detected CIs; future study is needed to inform trauma prevention, reduction, and rehabilitation interventions specific to correctional work.

Participatory Assessment and Selection of Workforce Health Intervention Priorities for Correctional Supervisors.

OBJECTIVE: A team of academics and unionized correctional supervisors collaborated to assess workforce health and determine intervention priorities using participatory methods and tools. METHODS: Correctional supervisors took a web-based survey. Univariate and bivariate tests examined attitudes/behaviors, exposures, and outcomes most strongly associated with health; risk based on rank within chain-of-command; and health behaviors amenable to change. We used a voting process tool to prioritize intervention topics. RESULTS: Some health behaviors and outcomes were poor (89% overweight/ obese, 41% poor-quality sleep). We also found favorable health behaviors (annual check-ups) and psychosocial conditions (meaningful work). Some health risks (excessive overtime) were not amenable to change or resisted acknowledgment (poor mental health). The team voted to develop interventions on sleep, mental health, and obesity. CONCLUSIONS: Comprehensive health assessment informed the prioritization process, enabling the team to quickly reach consensus on intervention priorities.

Comparison of the Wrist-Worn Fitbit Charge 2 and the Waist-Worn Actigraph GTX3 for Measuring Steps Taken in Occupational Settings.

OBJECTIVES: If consumer-based monitors such as Fitbit can measure activity accurately, it could provide opportunities for improved assessment of physical activity in general and at work for research purposes. The accuracy of the Fitbit has hardly been investigated in an occupational setting. METHODS: We compared measurements of steps taken at work, out-of-work, and in total of a wrist-worn Fitbit to a waist-worn Actigraph. Seventeen participants wore the Fitbit and Actigraph for 1 full workday. RESULTS: Compared with the Actigraph, the Fitbit consistently recorded more steps [mean steps at work Fitbit = 7850 (6974), Actigraph = 4396 (1991); out-of-work Fitbit = 6414 (5691), Actigraph = 4116 (3502); total Fitbit = 13 478 (10 666), Actigraph = 8009 (5167)]. CONCLUSIONS: Compared with the Actigraph, the Fitbit consistently recorded more steps at work, out-of-work, and in total. The Fitbit and Actigraph recordings were more consistent for measuring steps taken out-of-work compared with at work. Steps counts recorded by the Fitbit, especially in occupational settings, may be inaccurate.

Impact of a Total Worker Health® Mentoring Program in a Correctional Workforce.

(1) Background: Correctional Officers show signs of adverse health early in their careers. We evaluated the impact of a one-year peer health mentoring program for new officers based on a Total Worker Health® approach; (2) Methods: Cadets (n = 269) were randomly assigned to a mentored or control group. Cadets in this mixed methods design completed physical assessments, and surveys at three time points to assess demographics, health, mentoring, and workplace variables. Physical testing included several health markers. Surveys and physical data were analyzed as repeated measures. Regression analyses were used to analyze the relationship between mentoring characteristics and outcomes. A semi-structured interview of mentors was analyzed qualitatively. (3) Results: Higher mentoring frequency was associated with lower burnout. Health behaviors and outcomes declined over time in all groups, but mentees displayed slower decline for body mass index (BMI) and hypertension compared to controls. (4) Conclusions: A continuous peer health mentoring program seemed protective to new officers in reducing burnout and also declines in BMI and hypertension. Short-term physical health markers in younger officers may not be an index of psycho-social effects. A participatory design approach is recommended for a long-term health mentoring program to be both effective and sustainable.

Development and Implementation of a Total Worker Health® Mentoring Program in a Correctional Workforce.

Correctional officers (COs) are exposed to a number of occupational stressors, and their health declines early in their job tenure. Interventions designed to prevent early decline in CO health are limited. This article describes the development, implementation, and evaluation of a one-year peer health mentoring program (HMP) guided by Total Worker Health® principles and using a participatory action research to collectively address worker safety, health, and well-being of newly hired COs. The HMP aimed to provide new COs with emotional and tangible forms of support during their first year of employment, including peer coaching to prevent early decline in physical fitness and health. The development and implementation of the HMP occurred across five main steps: (1) participatory design focus groups with key stakeholders; (2) adaptation of an existing mentoring handbook and training methods; (3) development of mentor-mentee recruitment criteria and assignment; (4) designing assessment tools; and (5) the initiation of a mentor oversight committee consisting of union leadership, corrections management, and research staff. Correctional employee engagement in the design and implementation process proved to be efficacious in the implementation and adaptation of the program by staff. Support for the HMP remained high as program evaluation efforts continued.

Leisure-Time Physical Activity and General Health Mitigate Effects of Job Demands on Nonrestorative Sleep: CDC National Healthy Worksite Project.

OBJECTIVE: We sought to determine if leisure-time physical activity (LTPA) modified the adverse relationship between high job demands and nonrestorative sleep (NRS). METHODS: We conducted a multivariate logistic regression analysis among workers from the cross-sectional National Healthy Worksite Project (n = 4683) using self-report Likert-Scale data on psychological and physical demands of jobs, LTPA and general health in relation to NRS. RESULTS: Not engaging in LTPA was associated with NRS for workers with jobs at the lowest or highest levels of the physical demand scale (OR 1.64, 95% CI: 0.96-2.81, OR 2.06, 95% CI: 0.95-4.45; respectively) in comparison to those who met LTPA recommendations. When assessing psychological demands, poor general health was associated with NRS at all levels of the scale independent of LTPA. CONCLUSIONS: LTPA may reduce NRS for workers with jobs at either extreme of physical demands.

Participatory survey design of a workforce health needs assessment for correctional supervisors.

INTRODUCTION: The correctional workforce experiences persistent health problems, and interventions designed with worker participation show favorable outcomes. However, participatory intervention research often leaves workers out of the health needs assessment, the basis of interventions subsequently developed. This omission risks failure to detect factors contributing to the health and is less likely to result in primary prevention interventions. METHODS: Partnering with a correctional supervisors' union, we followed Schulz and colleagues' community-based participatory research (CBPR) methods for participatory survey design and used Healthy Workplace Participatory Program (HWPP) tools to develop a tailored survey to assess workforce health and contributing factors. Utilizing the HWPP Focus Group Guide, we generated key themes to adapt the HWPP All Employee Survey, a generic workforce health assessment, to become thorough and contextually-relevant for correctional supervisors. RESULTS: Content analysis of focus group data revealed 12 priority health concerns and contributors, including organizational culture, masculinity, work-family conflict, family support, trauma, positive job aspects, health literacy and efficacy, health/risk behaviors, sleep, obesity, and prioritizing work and income over health. Twenty-six measures were added to the generic survey, mainly health-related antecedents including knowledge, attitudes, norms, and motivation. CONCLUSION: Findings yielded new insights about supervisors' lived experiences of work and health, and resulted in a customized workforce survey. CBPR methods and HWPP tools allowed us to identify health issues that we would not have detected with conventional methods, and provide opportunities for interventions that address root causes of poor health. We share challenges faced and lessons learned using CBPR with the correctional workforce.

Progress in Corrections Worker Health: The National Corrections Collaborative Utilizing a Total Worker Health® Strategy.

OBJECTIVE: To examine National Corrections Collaborative (NCC) activities, as an outreach initiative, to advance corrections workplace health and safety research, practice, and policy through a series of applied Research to Practice (r2p) meetings informed by the Total Worker Health(Total Worker Health is a registered trademark of the U.S. Department of Health and Human Services) (TWH) strategy. METHODS: We mapped the coalescence of correctional worker health concerns, federal and national professional organization initiatives, and research activities that formed the NCC in 2014. RESULTS: During the NCC's 5-years of TWH activities, attendance increased, partner composition expanded, and themes of concern evolved. Partners were motivated to participate and work together towards building evidence for health and safety r2p. CONCLUSIONS: A unified plea to the academic and federal research communities for assistance with better evaluation instruments, data linkages, and for adopting an integrated TWH approach to workforce health and wellbeing continue to drive NCC r2p activities.

Defining 'Integration' for Total Worker Health®: A New Proposal.

The effects of work and the conditions of employment on health behaviors and intermediate health conditions have been demonstrated, to the extent that these relationships should be addressed in efforts to prevent chronic disease. However, conventional health promotion practice generally focuses on personal risk factors and individual behavior change. In an effort to find solutions to the myriad of health challenges faced by the American workforce, the U.S. National Institute for Occupational Safety and Health (NIOSH) established the Total Worker Health® (TWH) program. Originally organized around the paradigm of integrating traditional occupational safety and health protections with workplace health promotion, TWH has evolved to a broader emphasis on workplace programs for enhancing worker safety, health, and well-being. Among the research programs and approaches developed by investigators at NIOSH Centers of Excellence for TWH and elsewhere, definitions of 'integration' in workplace interventions vary widely. There is no consensus about which organizational or individual outcomes are the most salient, how much to emphasize organizational contexts of work, or which program elements are necessary in order to qualify as 'Total Worker Health'. Agreement about the dimensions of integration would facilitate comparison of programs and interventions which are self-defined as TWH, although diverse in content. The specific criteria needed to define integration should be unique to that concept-i.e. distinct from and additive to conventional criteria for predicting or evaluating the success of a workplace health program. We propose a set of four TWH-specific metrics for integrated interventions that address both program content and process: (i) coordination and interaction of workplace programs across domains; (ii) assessment of both work and non-work exposures; (iii) emphasis on interventions to make the workplace more health-promoting; and (iv) participatory engagement of workers in pivotal ways during intervention prioritization and planning to develop self-efficacy in addressing root causes, skill transfer, building program ownership, empowerment, and continuous improvement. Thus we find that integration requires organizational change, both to engage two managerial functions with different goals, legal responsibilities, and (often) internal incentives & resources, and also to orient the organization toward salutogenesis. Examples from research activity within the Center for the Promotion of Health in the New England Workplace illustrate how these criteria have been applied in practice.

Acquired and Persistent Eldercare Demands: Impact on Worker Well-Being.

Eldercare demands (ECD) may result in stress when finite resources needed to fulfill life roles (i.e., family, work) become scarce. ECD may be acquired, continue over time, or be relinquished. They thus may represent acute stress (immediate, severe) or chronic stress (persistent, milder). Workers at six U.S. manufacturing companies completed surveys (N = 520). ECD were operationalized as providing assistance to an adult aged 65+ years due to disability or illness. Workers were categorized into four ECD groups (persistent, relinquished, acquired, and none), and we examined the ECD groups' association with person-centric and work-centric outcomes. Respondents with acquired ECD had worse mental health and greater depressive symptoms than those with none, and those with persistent ECD had greater work stress and family-work conflict than those with none. Findings suggesting that acute stress is more related to person-centric outcomes and chronic stress is more related to work-centric outcomes could inform development of tailored interventions.

Examining a Comprehensive Model of Work and Family Demands, Work-Family Conflict, and Depressive Symptoms in a Sample of Correctional Supervisors.

OBJECTIVE: This study examined how work and family demands affect depressive symptoms, and the mediating roles of work-to-family conflict and family-to-work conflict in a sample of correctional supervisors. METHODS: Using a cross-sectional design, correctional supervisors working in a Northeastern state (n = 156) participated in an online survey. Structural equation modeling was used to examine direct and indirect effects between study variables. RESULTS: Amount of overtime hours worked significantly predicted work-to-family conflict (ß = 0.18, P < 0.05), and work-to-family conflict significantly predicted greater depressive symptoms (ß = 0.61, P < 0.01). Overtime work also had an indirect effect on depressive symptoms through work-to-family conflict (ß = 0.11 [95% CI 0.001-0.42]). No other statistically significant effects of relevance were found. CONCLUSIONS: Working overtime had an indirect effect on correctional supervisors' depressive symptoms, mediated by work-to-family conflict.

Correction Workers' Burnout and Outcomes: A Bayesian Network Approach.

The present study seeks to demonstrate how Bayesian Network analysis can be used to support Total Worker Health® research on correction workers by (1) revealing the most probable scenario of how psychosocial and behavioral outcome variables in corrections work are interrelated and (2) identifying the key contributing factors of this interdependency relationship within the unique occupational context of corrections work. The data from 353 correction workers from a state department of corrections in the United States were utilized. A Bayesian Network analysis approach was used to probabilistically sort out potential interrelations among various psychosocial and behavioral variables. The identified model revealed that work-related exhaustion may serve as a primary driver of occupational stress and impaired workability, and also that exhaustion limits the ability of correction workers to get regular physical exercise, while their interrelations with depressed mood, a lack of work engagement, and poor work-family balance were also noted. The results suggest the importance of joint consideration of psychosocial and behavioral factors when investigating variables that may impact health and wellbeing of correction workers. Also, they supported the value of adopting the Total Worker Health® framework, a holistic strategy to integrate prevention of work-related injury and illness and the facilitation of worker well-being, when considering integrated health protection and promotion interventions for workers in high-risk occupations.

A Participatory Action Research Approach to Mental Health Interventions among Corrections Officers: Standardizing Priorities and Maintaining Design Autonomy.

A central dilemma in Participatory Action Research (PAR) is to establish participant decision authority on interventions while adhering to rigorous research practices. We faced this dilemma as part of an ongoing multi-site field research project in the corrections sector, where semi-autonomous union-based Design Teams (DTs) address worker health issues and design interventions. Employee focus groups and surveys elicited areas of concern, pointing to four topics in particular: overtime and sleep, work-family balance, physical fitness, and mental health; these were later expanded to eight priority areas. Quantitative rankings were generated by focus groups of line-level employees and supervisors. A multi-level, iterative priority selection process averaged focus group ratings of topic importance and also difficulty to address separately. Areas of job stress and mental health had highest importance but were also considered most difficult to address. A labor-management steering committee reviewed and endorsed the rankings and transmitted these to newly formed DTs. In principle, each DT was free to establish a different topic for initial intervention but they all chose the most important and difficult to address topics. This structured multi-tiered participatory process preserved ownership by all parties. Balancing participant autonomy and efficient prioritization of topics among multiple interest groups in this PAR effort met research methods needs and also made it easier for DTs to focus on the difficult and stigmatized area of mental health in the correctional workforce.