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.

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.

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.

Associations Among Work and Family Health Climate, Health Behaviors, Work Schedule, and Body Weight.

OBJECTIVES: Correctional employees exhibit elevated obesity rates. This study examines interrelations among health behaviors, health climate, body mass index (BMI), and work schedule. METHODS: Using survey results from correctional supervisors (n = 157), mediation and moderated-mediation analyses were performed to examine how health behaviors explain relationships between obesity, work health climate (WHC) and family health climate (FHC), and work schedule. RESULTS: Over 85% of the sample was overweight/obese (mean BMI = 30.20). Higher WHC and FHC were associated with lower BMI, mediated by nutrition, and physical activity. The interaction effect between health behavior and work schedule revealed a protective effect on BMI. Overtime shift work may share a relationship with BMI. CONCLUSIONS: Findings may have implications for reexamining organizational policies on maximum weekly overtime in corrections. They provide direction for targeted obesity interventions that encourage a supportive FHC and promote healthy behaviors among supervisors working overtime.

Work Characteristics as Predictors of Correctional Supervisors' Health Outcomes.

OBJECTIVE: This study examined associations among health behaviors, psychosocial work factors, and health status. METHODS: Correctional supervisors (n = 157) completed a survey that assessed interpersonal and organizational views on health. Chi-square and logistic regressions were used to examine relationships among variables. RESULTS: Respondents had a higher prevalence of obesity and comorbidities compared with the general US adult population. Burnout was significantly associated with nutrition, physical activity, sleep duration, sleep quality, diabetes, and anxiety/depression. Job meaning, job satisfaction, and workplace social support may predict health behaviors and outcomes. CONCLUSIONS: Correctional supervisors are understudied and have poor overall health status. Improving health behaviors of middle-management employees may have a beneficial effect on the health of the entire workforce. This paper demonstrates the importance of psychosocial work factors that may contribute to health behaviors and outcomes.

Process evaluation of two participatory approaches: Implementing total worker health® interventions in a correctional workforce.

BACKGROUND: Correctional Officers (COs) have among the highest injury rates and poorest health of all the public safety occupations. The HITEC-2 (Health Improvement Through Employee Control-2) study uses Participatory Action Research (PAR) to design and implement interventions to improve health and safety of COs. METHOD: HITEC-2 compared two different types of participatory program, a CO-only "Design Team" (DT) and "Kaizen Event Teams" (KET) of COs and supervisors, to determine differences in implementation process and outcomes. The Program Evaluation Rating Sheet (PERS) was developed to document and evaluate program implementation. RESULTS: Both programs yielded successful and unsuccessful interventions, dependent upon team-, facility-, organizational, state-, facilitator-, and intervention-level factors. CONCLUSIONS: PAR in corrections, and possibly other sectors, depends upon factors including participation, leadership, continuity and timing, resilience, and financial circumstances. The new PERS instrument may be useful in other sectors to assist in assessing intervention success. Am. J. Ind. Med. 59:897-918, 2016. © 2016 Wiley Periodicals, Inc.

Cardiovascular and stress responses to short-term noise exposures-A panel study in healthy males.

BACKGROUND: While previous epidemiological studies report adverse effects of long-term noise exposure on cardiovascular health, the mechanisms responsible for these effects are unclear. We sought to elucidate the cardiovascular and stress response to short-term, low (31.5-125Hz) and high (500-2000Hz) frequency noise exposures. METHODS: Healthy male (n=10) participants were monitored on multiple visits during no noise, low- or high-frequency noise exposure scenarios lasting 40min. Participants were fitted with an ambulatory electrocardiogram (ECG) and blood pressure measures and saliva samples were taken before, during and after noise exposures. ECGs were processed for measures of heart rate variability (HRV): high-frequency power (HF), low-frequency power (LF), the root of the mean squared difference between adjacent normal heart beats (N-N) intervals (RMSSD), and the standard deviation of N-N intervals (SDNN). Systolic blood pressure (SBP), diastolic blood pressure (DPB), and pulse were reported and saliva was analyzed for salivary cortisol and amylase. Multivariate mixed-effects linear regression models adjusted for age were used to identify statistically significant difference in outcomes by no noise, during noise or after noise exposure periods and whether this differed by noise frequency. RESULTS: A total of 658, 205, and 122, HRV, saliva, and blood pressure measurements were performed over 41 person days. Reductions in HRV (LF and RMSSD) were observed during noise exposure (a reduction of 19% (-35,-3.5) and 9.1% (-17,-1.1), respectively). After adjusting for noise frequency, during low frequency noise exposure, HF, LF, and SDNN were reduced (a reduction of 32% (-57,-6.2), 34% (-52,-15), and 16% (-26,-6.1), respectively) and during high frequency noise exposure, a 21% (-39,-2.3) reduction in LF, as compared to during no noise exposure, was found. No significant (p<0.05) changes in blood pressure, salivary cortisol, or amylase were observed. CONCLUSIONS: These results suggest that exposure to noise, and in particular, to low-frequency noise, negatively impacts HRV. The frequencies of noise should be considered when evaluating the cardiovascular health impacts of exposure.

Demographic, health-related, and work-related factors associated with body mass index and body fat percentage among workers at six Connecticut manufacturing companies across different age groups: a cohort study.

BACKGROUND: Effective workplace interventions that consider the multifactorial nature of obesity are needed to reduce and prevent obesity among adults. Furthermore, the factors associated with obesity may differ for workers across age groups. Therefore, the objective of this study was to identify demographic, health-related, and work-related factors associated with baseline and changes in body mass index (BMI) and body fat percentage (BFP) and among Connecticut manufacturing workers acrossage groups. METHODS: BMI and BFPof 758 workers from six Connecticut manufacturing companies were objectively measuredat two time points approximately 36 months apart. Demographic, health-related, and work-related factors wereassessed via questionnaire. All variables were included in linear regression models to identify factors associated with baseline and changes in BMI and BFP for workers in 3 age groups: <45 years (35 %), 45-55 years (37 %), >55 years (28 %). RESULTS: There were differences in baseline and changes in BMI and BFP among manufacturing workers across age groups. Being interested in changing weight was significantly (p < 0.01) associated with higher baseline BMI and BFP across all age categories. Other factors associated with higher baseline BMI and BFP differed by age group and included: male gender (BMI p = 0.04), female gender (BFP p < 0.01), not having a college education (BMI p = 0.01, BFP p = 0.04), having childcare responsibilities (BMI p = 0.04), and working less overtime (p = 0.02) among workers in the <45 year age category, male gender (BMI p = 0.02), female gender (BFP p < 0.01) and reporting higher stress in general (BMI p = 0.04) among workers in the 45-55 year age category, and female gender (BFP p < 0.01) and job tenure (BFP p = 0.03) among workers in the >55 year age category. Few factors were associated with change in BMI or BFP across any age category. CONCLUSIONS: Among manufacturing workers, we identified associations between individual, health-related, and work-related factors and baseline BMIand BFP that differed by age. Such results support the use of strategies tailored to the challenges faced by workers in specific age groups rather than adopting a one size fits all approach. Effective interventions should consider a full range of individual, health-related, and work-related factors. More work must be done to identify factors or strategies associated with changes in obesity over time.

Musculoskeletal disorder symptoms in correction officers: why do they increase rapidly with job tenure?

OBJECTIVE: In this study, we sought to explain the rapid musculoskeletal symptomatology increase in correction officers (COs). BACKGROUND: COs are exposed to levels of biomechanical and psychosocial stressors that have strong associations with musculoskeletal disorders (MSDs) in other occupations, possibly contributing to their rapid health deterioration. METHOD: Baseline survey data from a longitudinal study of COs and manufacturing line workers were used to model musculoskeletal symptom prevalence and intensity in the upper (UE) and lower (LE) extremity. Outcomes were regressed on demographics and biomechanical and psychosocial exposures. RESULTS: COs reported significantly higher prevalence and intensity of LE symptoms compared to the industrial workers. In regression models, job tenure was a primary driver of CO musculoskeletal outcomes. In CO models, a single biomechanical exposure, head and arms in awkward positions, explained variance in both UE and LE prevalence (ß of 0.338 and 0.357, respectively), and low decision latitude was associated with increased LE prevalence and intensity (ß of 0.229 and 0.233, respectively). Manufacturing models were less explanatory. Examining demographic associations with exposure intensity, we found none to be significant in manufacturing, but in CO models, important psychosocial exposure levels increased with job tenure. CONCLUSION: Symptom prevalence and intensity increased more rapidly with job tenure in corrections, compared to manufacturing, and were related to both biomechanical and psychosocial exposures. Tenure-related increases in psychosocial exposure levels may help explain the CO symptom increase. APPLICATION: Although exposure assessment improvements are proposed, findings suggest focusing on improving the psychosocial work environment to reduce MSD prevalence and intensity in corrections.

Understanding speech when wearing communication headsets and hearing protectors with subband processing.

An adaptive, delayless, subband feed-forward control structure is employed to improve the speech signal-to-noise ratio (SNR) in the communication channel of a circumaural headset/hearing protector (HPD) from 90 Hz to 11.3 kHz, and to provide active noise control (ANC) from 50 to 800 Hz to complement the passive attenuation of the HPD. The task involves optimizing the speech SNR for each communication channel subband, subject to limiting the maximum sound level at the ear, maintaining a speech SNR preferred by users, and reducing large inter-band gain differences to improve speech quality. The performance of a proof-of-concept device has been evaluated in a pseudo-diffuse sound field when worn by human subjects under conditions of environmental noise and speech that do not pose a risk to hearing, and by simulation for other conditions. For the environmental noises employed in this study, subband speech SNR control combined with subband ANC produced greater improvement in word scores than subband ANC alone, and improved the consistency of word scores across subjects. The simulation employed a subject-specific linear model, and predicted that word scores are maintained in excess of 90% for sound levels outside the HPD of up to ∼115 dBA.

Engaging in job-related activities is associated with reductions in employment problems and improvements in quality of life in substance abusing patients.

Reinforcement-based interventions are highly efficacious in the treatment of substance use disorders, and their benefits can extend to other areas of functioning as well. In particular, reinforcing participation in job-related activities may be useful for improving employment outcomes, which in turn may enhance quality of life and decrease substance use. These secondary analyses compared substance abusing patients randomized with reinforcement interventions (N = 185) who selected and completed two or more job-related activities during treatment versus those who did not. Patients who completed two or more job-related activities during treatment had significantly greater reductions in employment-related problems and improvements in quality of life than those who completed only one or no job-related activities, even after controlling for baseline differences that may impact employment outcomes. Further, patients who completed employment activities remained in treatment significantly longer and achieved greater durations of abstinence than those who did not. These data suggest that reinforcing job-attainment activities may have broad beneficial effects. Reinforcement interventions should be considered for enhancing employment skills training acquisition more generally.