L Punnett: TWH Integration OHP SI: July 17, 2014 A NIOSH Center for Excellence to Promote a Healthier Workforce TWH in the Context of Occupational Health Psychology: Integration of Health Protection & Health Promotion Laura Punnett & CPH-NEW Research Team Univ. of Massachusetts Lowell Univ. of Connecticut Health Center Univ. of Connecticut (Storrs) www.uml.edu/centers/CPH-NEW www.uml.edu/centers/CPH-NEW NIOSH “Total Worker Health™” Implement and compare multiple strategies or models for integrating two core public health areas: occupational health/safety (OHS) and health promotion (HP) Evaluate opportunities for, and obstacles to, these integration efforts Evaluate whether this strategy provides enhanced health benefits and/or greater cost-effectiveness www.uml.edu/Research/centers/CPH-NEW www.uml.edu/centers/CPH-NEW What does “integration” mean? No consensus (yet) on a single definition Levels: individual, institutional Equal weight to preventing OSH hazards and to supporting healthy behaviors Concept of the “salutogenic” organization [Henning & Reeves, 2013] www.uml.edu/centers/CPH-NEW 1
L Punnett: TWH Integration OHP SI: July 17, 2014 Selected Indicators & Metrics [Adapted from: Sorensen et al., 2013] Comprehensive program content Coordination between OSH and WHP – Policies about work env’t/organization and education & programs for individual workers Supportive policies and practices – Accountability for coordination, collaboration – Joint worker-management committees – Workers actively engaged in planning and implementation www.uml.edu/centers/CPH-NEW Obstacles to integration? Disciplinary knowledge, emphases of practitioners (& researchers) Organizational responsibilities, internal incentives [Cherniack et al. 2010] Different external requirements & incentives Different intermediate measures of success – WHP: primarily individual behaviors – OSH: primarily workplace exposures to hazards www.uml.edu/centers/CPH-NEW Why Integration? Traditional HP targets: Individuals’ exercise, diet, smoking, obesity, etc. – These affect risk of cardiovascular disease, diabetes, mental health problems, perhaps musculoskeletal disorders, other chronic disease Traditional OHS (“health protection”) targets: Workplace hazards that cause injury or illness – Broader range of possible health outcomes; many are very specific to exposures (sector) www.uml.edu/centers/CPH-NEW 2
L Punnett: TWH Integration OHP SI: July 17, 2014 Putative bright line between health problems that are and are not caused by work Work- Lifestyle- related related morbidity morbidity www.uml.edu/centers/CPH-NEW Why Integration? (2) Health behaviors (“personal” or “lifestyle” risk factors) are also affected by decision latitude & other psychosocial features in the work environment www.uml.edu/centers/CPH-NEW Recent evidence shows: the distinction is not so clear Work- Lifestyle- related related morbidity morbidity www.uml.edu/centers/CPH-NEW 3
L Punnett: TWH Integration OHP SI: July 17, 2014 Work environment factors and physical inactivity in men [Wemme et al. 2005] 0 0.5 1 1.5 2 Frequent overtime No influence on overtime “Passive” (low demands, low control) “High strain” (high demands, low control) www.uml.edu/centers/CPH-NEW Work environment factors and smoking [Radi et al. 2007] Current 35 smokers (%) Low strain Active 30 Passive 25 High strain 20 15 10 5 0 Men Women www.uml.edu/centers/CPH-NEW Work environment factors and smoking [Albertsen et al. 2006] Review of 22 prospective studies, evaluated on methodologic features High job demands: + cigs/day; + cessation; + relapse Resources at work (including job control): - cigs/day; + cessation; - relapse Social support: - cigs/day; + cessation; - relapse www.uml.edu/centers/CPH-NEW 4
L Punnett: TWH Integration OHP SI: July 17, 2014 Change in waist circumference by job strain group [Ishizaki et al. 2008] 1.8 1.6 1.4 Low/low 1.2 1.0 Low/high or 0.8 high/low 0.6 High/high 0.4 0.2 0.0 Men Women www.uml.edu/centers/CPH-NEW Risk of obesity by number of work organization hazards [Miranda, Punnett, et al.] Hazards: low decision latitude, poor co-worker support, lifting heavy loads, night work, physical assault at work in past 3 months. (Multivariable models adjusted for gender, age, education and region.) www.uml.edu/centers/CPH-NEW Job Strain, Health Behaviors, and CHD* Direct effects – e.g., CHD neuroendocrine mechanisms Psycho- social Health Behaviors stressors 32% of the effect is mediated through HB’s * * [Chandola T, et al. European Heart Journal, 2008] www.uml.edu/centers/CPH-NEW 5
L Punnett: TWH Integration OHP SI: July 17, 2014 Obesity/overweight and the role of working conditions [Champagne et al.] Physically demanding work, too fatigued to exercise or prepare healthy meals Meal breaks unpredictable and/or too short (eat fast or get fired) Harassment by supervisor or co-worker: depression Over-eating due to stress Back pain related to job demands – interfered with exercise www.uml.edu/centers/CPH-NEW Workload and Schedules Physically demanding job: – “I don’t have the desire to do exercise after standing for 15-16 hours. I just want to eat and sleep. The next day is the same thing all over again.” – “You come home and you are so tired that you either don’t want to eat, or you want to eat a lot.” Meal breaks: – “At 10:00 a.m., they give me a 15-minute break. I don’t have time to eat healthy food, even if I bring homemade food.” www.uml.edu/centers/CPH-NEW Psychosocial Stressors at Work High demands – “The work that three people used to do is given to one person. That creates more stress and eating more…” Low control – “Working in factories, you have to eat fast or you get fired.” Low social support – “A lot of harassment…it was really stressful so the depression really set in.” www.uml.edu/centers/CPH-NEW 6
L Punnett: TWH Integration OHP SI: July 17, 2014 Why Integration? (3) Socioeconomic disparities in health – Low-status, low-wage workers have higher exposures at work AND more adverse “personal” risk factors www.uml.edu/centers/CPH-NEW Socioeconomic health disparities 100% 30 Decision- making 25 80% Physical demands 20 Health 60% 15 40% 10 20% 5 0% 0 SES SES www.uml.edu/centers/CPH-NEW Implications for health disparities Workplace health promotion programs often have uneven scope – Lower participation and effectiveness among lower-SES employees Are the factors that affect low-SES employees fully taken into account? – Few decision-making opportunities, physically strenuous jobs, etc. www.uml.edu/centers/CPH-NEW 7
L Punnett: TWH Integration OHP SI: July 17, 2014 Stressful working conditions follow from design decisions in the workplace and therefore are preventable www.uml.edu/centers/CPH-NEW Work Organization “ …. the combination of the way in which work processes are designed and arranged, as well as the broader organizational practices that influence job design” (*) - determines: – physical loading patterns – “psychosocial” stressors: job demands, decision latitude, social support, job insecurity [* NIOSH, The Changing Organization of Work and the Safety and Health of Working People, 2002] www.uml.edu/centers/CPH-NEW Working conditions link to health outcomes directly, and through health behaviors Physical Employee working Organization: Health conditions • Technology Status • Structure Work org. & • Culture psychosocial e.g., MSDs, Health conditions CHD/CVD, Behaviors mental health 24 www.uml.edu/centers/CPH-NEW 8
L Punnett: TWH Integration OHP SI: July 17, 2014 Social-Ecological Model Linnan et al., 2001: “individual behavior (e.g., participation in a work-site health promotion program) is affected by multiple levels of influence” Policy Community / Society Institutional / Organizational Job / Interpersonal Intra- personal www.uml.edu/centers/CPH-NEW OSH needs to address workplace organization Identify potential obstacles to health protection measures, and how those can be addressed Increase employee decision-making opportunities (“job control”) Empower participation and creativity in problem- solving (“health self-efficacy”) Enhance interpersonal relationships at work for successful teamwork, communication, etc. www.uml.edu/centers/CPH-NEW Observed Device Use in Resident Handling vs. Perceived Time Pressure 0.014 1400% Slope of Equipment Use While Resident Handling Percent Change in Never Feeling Time Pressure 1200% 0.012 1000% 0.010 800% 0.008 600% 0.006 400% 0.004 200% 0.002 0% 0.000 -200% Center B Center C Center E Center D Center A Slope of Equipment Use While Resident Handling Over Two Years Percent Change in Never Feeling Time Pressure www.uml.edu/centers/CPH-NEW 9
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