Defining a Culture of Health in the Workplace No abstract available

Literature Review of Policy Implications From Findings of the Center for Work, Health, and Well-being Objective: To review the publications of a Total Worker Health Center® of Excellence, the Harvard T.H. Chan School of Public Health Center for Work, Health, and Well-being, in order to identify research findings relevant to either organizational or public policies. Methods: Two researchers independently reviewed 57 publications from 2011 to 2019 to identify cross-cutting themes that focus on working conditions or related health outcomes and their organizational and public policy implications. Results: Twelve cross-cutting themes were identified with their respective organizational and public policy implications. Several policy implications cut across work-related themes. Conclusions: Policy implications of TWH® research will aid in setting priorities to translate this from research into practice in future studies and help identify gaps that we and others can use to plan future TWH® research.

Direct and Indirect Cost of Obesity Among the Privately Insured in the United States: A Focus on the Impact by Type of Industry Objective: To evaluate obesity-related costs and body mass index (BMI) as a cost predictor among privately insured employees by industry. Methods: Individuals with/without obesity were identified using the Optum Health Reporting and Insights employer claims database (January, 2010 to March, 2017). Direct/indirect costs were reported per-patient-per-year (PPPY). Multivariate models were used to estimate the association between obesity and high costs (more than or equal to 80th percentile) by industry. Results: Overall (N = 86,221), direct and absenteeism/disability cost differences between class I obesity (BMI 30.0 to 34.9) and reference were $1,775 and $617 PPPY, respectively (P < 0.05). Among employees with obesity (BMI more than or equal to 30), highest total costs were observed in the government/education/religious services, food/entertainment services, and technology industries. Class I obesity increased the odds of high costs (more than or equal to 80th percentile) within each industry (odds ratios vs reference = 1.09–5.17). Conclusions: Obesity (BMI more than or equal to 30) was associated with high costs among employees of major US industries.

Mortality Among Men and Women in the North American Synthetic Rubber Industry, 1943 to 2009 Objective: To evaluate 1943 to 2009 mortality among 22,785 synthetic rubber industry employees. Methods: Standardized mortality ratio (SMR) and internal Cox regression analyses. Results: Among hourly employees with more than or equal to 10 years worked and more than or equal to 20 years since hire, SMRs were elevated for leukemia (SMR = 139, 95% confidence interval [CI] = 106 to 179), non-Hodgkin lymphoma (NHL) (SMR = 136, CI = 102 to 177), bladder cancer (SMR = 148, CI = 110 to 195) and, for women only, lung cancer (SMR = 225, CI = 103 to 427). Butadiene and styrene exposure-response trends were positive for leukemia and bladder cancer but not for NHL or for lung cancer among women. Conclusions: Results support a causal relationship between butadiene and leukemia. Interpretation of results for lung cancer among women and for bladder cancer is uncertain because of inability to control for smoking and inadequate or inconsistent support from other studies for an association between butadiene or styrene and the latter cancers.

Cost, Gain, and Health: Theoretical Clarification and Psychometric Validation of a Work Stress Model With Data From Two National Studies Objective: The aim of this study was to test nonsymmetric effects of cost/gain imbalance at work on depression, based on the effort–reward imbalance (ERI) model. Methods: Study participants were derived from two large national studies from Germany and Sweden. Associations between the ERI scales, including the effort–reward (E–R) ratio in 2016 and depression (in 2016 for German sample, and in 2018 for Swedish sample) were examined by multivariable logistic regression. Results: In both samples, high cost/low gain, but not low cost/high gain, is associated with depression, with a 3- to 5-fold elevated risk in the highest decile of the E–R ratio. Conclusions: The short version of the ERI questionnaire is a psychometrically useful tool for epidemiological research. The finding demonstrating nonsymmetric effects of cost/gain imbalance contributes to a theoretical clarification of this stress–theoretical model.

Self-Reported Health and Metal Body Burden in an Electronic Waste Recycling Community in Northeastern Thailand Objective: This study aims to summarize electronic waste (e-waste) worker health; examine associations between health and sociodemographic characteristics; and metal body burden. Methods: In 2016, 131 e-waste recycling workers were enrolled in the study, completed a questionnaire, and gave blood and urine samples for heavy metal concentration assessment (lead, cadmium, copper, zinc, nickel). The relationship between symptoms, general health, and metals is assessed via generalized estimating equation models (adjusted for age, education, sex, and village). Results: Cadmium in blood and copper in serum were most consistently associated with higher odds of poor health and prevalence of symptoms. We found inconsistent results between general health, symptom severity, and urinary nickel. Higher blood lead levels (BLL) were associated with fewer self-reported symptoms. Conclusions: Exposure to certain metals in e-waste recycling communities may adversely impact health status.

Unpacking the Associations Between Perceived Cultural Support and Employee Health: The Approach of Social Capital Objective: The aim of this study was to examine the associations between workplace culture supporting health and self-rated health through social capital and stress. Methods: Structural equation modeling analysis was performed on data from employees of an insurance organization (N = 725). Results: Significant associations were found among participation of sports events, social capital, workplace culture of health, occupational perceived stress, and self-rated health (P < 0.001). The relationship between stress and self-rated health was stronger for employees at lower hierarchical levels than the ones at higher hierarchical levels (P < 0.001). Conclusions: Findings show that social capital and stress are mediators in the association between perceived cultural support and self-rated health. Strong support for health in the culture is associated with positive self-rated health. Well-being strategies focusing on social capital and encouraging healthy behaviors are likely to have increased effectiveness.

A 37-year Update on Mortality Patterns in an Expanded Cohort of Vermont Talc Miners and Millers Objectives: The aim of this study was to update a cohort of Vermont talc workers to include 37 additional years of follow-up time. Methods: Standardized mortality ratios (SMR) and 95% confidence intervals (CIs) were calculated for 70+ causes of death. US population mortality rates were used as reference. Results: All-cause mortality was 30% higher than the US population (SMR 133.4, 95% CI, 119.7 to 148.3). Significant elevations occurred in nonmalignant respiratory disease (NMRD) (SMR 273.0, 95% CI, 210.2 to 348.6) and other nonmalignant respiratory disease (ONMRD) (SMR 413.1, 95% CI, 287.7 to 574.5). ONMRD was elevated across all length of employment categories and a test for linear trend was significant (P = 0.007). Conclusions: This study provides further evidence that excess deaths among Vermont talc workers are due largely to excess mortality from NMRD; there is no evidence of increased risk of respiratory cancer.

Pulmonary Function Testing in Dentists Versus Controls: A Pilot Study Exploring the Potential Respiratory-Related Occupational Hazards of Dentistry Objective: Minimal research exists evaluating respiratory-related occupational hazards associated with dentistry in the United States. The purpose of this study was to evaluate the pulmonary function of dentists as compared with controls. Methods: This is a case-control study evaluating pulmonary function in dentists versus controls. Outcomes included measurements of percent predicted FEV1 (FEV1%), percent of predicted FVC (FVC%), and forced expiratory volume in one second (FEV1)/forced vital capacity (FVC). Results: Our findings indicate that dentists had a statistically significant lower percent predicted FEV1% (P < 0.05) and FVC% (P < 0.05) compared with controls. The prevalence of abnormal FVC% and FEV1% was greater among dentists, but only the increase in abnormal FEV1% approached significance. Conclusions: Dentists had lower percent predicted values for FVC% and FEV1% versus controls. More research is required to further investigate the association between the dental profession and pulmonary function in dentists.

Process Evaluation of the BearStand Behavioral Intervention: A Social Cognitive Theory-Based Approach to Reduce Occupational Sedentary Behavior Objective: Describe the process evaluation of the behavioral intervention group of a multicomponent workplace intervention, BearStand, to reduce employees’ sitting time using sit-stand workstations and behavioral strategies. Methods: Process evaluation metrics: dose delivered, dose-received exposure, dose-received satisfaction, and context were collected using an online survey. Participants included employees of a US university. Results: Overall, 38 of 52 participants completed the process evaluation. The majority were satisfied (53%) with the intervention. Participants’ interactions with intervention materials decreased over time (73.7%, week 1, to 52.6%, week 13), and 42% and 33% of participants used suggested videos and apps, respectively. Participants found goal setting and self-regulation strategies to be the most helpful and identified workplace-related contextual barriers that impacted intervention engagement. Conclusions: Future interventions should incorporate more engaging materials for participants, reduce contextual barriers, and facilitate use of apps and videos.