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Total Worker Health® (TWH), an initiative of the U.S. National Institute for Occupational Safety and Health, is defined as policies, programs, and practices that integrate protection from work-related health and safety hazards by promoting efforts that advance worker well-being. Interventions that apply the TWH paradigm improve workplace health more rapidly than wellness programs alone. Evidence of the barriers and facilitators to the adoption, implementation, and long-term maintenance of TWH programs is limited. Dissemination and implementation (D&I) science, the study of methods and strategies for bridging the gap between public health research and practice, can help address these system-, setting-, and worker-level factors to increase the uptake, impact, and sustainment of TWH activities. The purpose of this paper is to draw upon a synthesis of existing D&I science literature to provide TWH researchers and practitioners with: (1) an overview of D&I science; (2) a plain language explanation of key concepts in D&I science; (3) a case study example of moving a TWH intervention down the research-to-practice pipeline; and (4) a discussion of future opportunities for conducting D&I science in complex and dynamic workplace settings to increase worker safety, health, and well-being. Published version

The future of work will include not only more small business employment, but also a need for greater consideration of more holistic approaches to addressing worker well-being. Previous research has suggested smaller firms need external assistance to add new or improve existing workplace health and safety activities. A Total Worker Health® (TWH) approach is potentially appealing to small employers as it is intended to identify and support comprehensive practices and policies that take into account the work environment (both physical and organizational) while also addressing the personal health risks of individuals, thus being more effective in preventing disease and promoting health and safety than each approach taken separately. NIOSH researchers applied the NIOSH Small Business Intervention Diffusion Model to conduct parallel community-based TWH activities in two geographically distinct communities in a large metropolitan area. Data were collected from intermediary organizations that work with or serve small businesses about their perceptions of the TWH approach as a potential service for them to offer small firms. Intermediary organizations engaged in implementation of TWH approaches with small businesses in the respective geographic areas for approximately one year. Results indicated intermediary organizations find value in providing TWH assistance to small employers, but several challenges for intermediaries implementing TWH among small employers remain.

Introduction: Calls to increase adoption and sustained use of occupational safety and health (OSH) risk information, interventions, and technology have led to a growing emphasis on the field of translation research for OSH. The wealth of information derived from other disciplines, which have already made significant advances in dissemination and implementation science, can have great instructional value, but can also be both confusing and overwhelming to apply to OSH settings. This paper aims to (1) disentangle terminology related to translation research, (2) examine pre-existing and related fields of research within clinical medicine and public health contexts, (3) consider the unique challenges to achieving success in translation within OSH settings and (4) provide suggested next steps for the OSH research community. Translation Research Components and Terminology: Consensus on definitions related to translation research for OSH are lacking, which draws from the fields of translational science and dissemination and implementation (D&I) science, but more broadly incorporates earlier stages of research. Related Fields of Research: Translation research for OSH and D&I research can be viewed as having both overlapping and divergent scopes, with each encompassing the study of a wide range of diffusion, dissemination, or implementation/de-implementation strategies. Challenges of the OSH Context: The OSH context is different in many ways from the fields where much of the translational research and D&I bodies of literature originated (e.g. clinical medicine). Practical challenges in OSH research include hard-to-reach populations, lack of buy-in among employers and employees for research participation, and sensitivity of OSH issues. Future Directions in OSH Translation Research: There is a critical need more investment in latter stages/phases of Translation Research for OSH. With more work to spread OSH innovations, researchers can begin understanding important translation questions (what works in what settings, under what conditions, and why), and how this knowledge can be generalized and applied to other areas of OSH research.

Objective:There is growing interest in the NIOSH Total Worker Health® program, specifically in the process of designing and implementing safer, health-promoting work and workplaces. A Total Worker Health (TWH) Research Methodology Workshop was convened to discuss research methods and future needs.Me

Objectives The specific objectives of the 2017 Understanding Small Enterprises Conference were to: (i) identify successful strategies for overcoming occupational safety and health (OSH (ii) disseminate best practices to research and business communities; (iii) build collaborations between different stakeholders including researchers, insurers, small enterprises, government agencies; and (iv) better inform OSH 2) what occupational health and safety looks like across different industries; 3) intervention programs (tools and resources); 4) precarious and vulnerable work and the informal sector; and 5) Total Worker Health® in SMEs. Conclusion A number of innovative initiatives were shared at the conference. Researchers must build collaborations involving a variety of stakeholder groups to ensure that OS&H solutions are successful in SMEs. Future OS&H research should continue to build upon the successful work of the 2017 Understanding Small Enterprises Conference.

The majority of the global labor force works in firms with fewer than 50 employees; firms with fewer than 250 employees make up 99% of workplaces. Even so, the lack of extensive or comprehensive research has failed to focus on occupational safety and health communication to these small- and medium-sized enterprises (SMEs). Given that the magnitude of all occupational safety and health (OSH) morbidity, mortality, and injury disproportionately occurs in businesses with fewer than 250 employees, efforts to communicate with employers to engage in preventative occupational safety and health efforts merit attention. This article provides an overview of important components that should be considered in developing an occupational safety and health (OSH) communication research strategy targeting SMEs. Such a strategy should raise awareness about the diversity and complexity of SMEs and the challenges of targeting OSH communication toward this diverse group. Companies of differing sizes (e.g. 5, 50, 500 employees) likely require differing communication approaches. Communication strategies will benefit from deconstructing the term ‘small business’ into smaller, more homogenous categories that might require approaches. Theory-based research assessing barriers, message content, channels, reach, reception, motivation, and intention to act serve as the foundation for developing a comprehensive research framework. Attention to this type of research by investigators is warranted and should be encouraged and supported. There would also be value in developing national and international strategies for research on communication with small businesses.

Despite its inclusion in models of social and ecological determinants of health, work has not been explored in most health inequity research in the United States. Leaving work out of public health inequities research creates a blind spot in our understanding of how inequities are created and impedes our progress toward health equity. We first describe why work is vital to our understanding of observed societal-level health inequities. Next, we outline challenges to incorporating work in the study of health inequities, including (1) the complexity of work as a concept; (2) work’s overlap with socioeconomic position, race, ethnicity, and gender; (3) the development of a parallel line of inquiry into occupational health inequities; and (4) the dearth of precise data with which to explore the relationships between work and health status. Finally, we summarize opportunities for advancing health equity and monitoring progress that could be achieved if researchers and practitioners more robustly include work in their efforts to understand and address health inequities.

Background Construction is a dangerous industry with a large number of small businesses. Because they require minimal resources to deliver, toolbox talks may be an ideal training format for small construction contractors. Methods Eight toolbox talks were developed, each with two versions. One version of each toolbox talk was standard and one version included a narrative and discussion questions. Participants were randomly assigned to receive the standard or the narrative version. Pre- and post-intervention surveys measured demographics, workplace safety climate, and knowledge. The post-intervention survey also measured training impact. Results Including narratives with discussion questions significantly increased knowledge gain and led to increased training impact. Less experienced workers were more likely to gain knowledge and training impact compared to more experienced workers. There were no significant changes in workplace safety climate. Conclusions The results suggest that including a narrative and discussion questions increases toolbox talk effectiveness.

Action to address workforce functioning and productivity requires a broader approach than the traditional scope of occupational safety and health. Focus on “well-being” may be one way to develop a more encompassing objective. Well-being is widely cited in public policy pronouncements, but often as “. . . and well-being” (e.g., health and well-being). It is generally not defined in policy and rarely operationalized for functional use. Many definitions of well-being exist in the occupational realm. Generally, it is a synonym for health and a summative term to describe a flourishing worker who benefits from a safe, supportive workplace, engages in satisfying work, and enjoys a fulfilling work life. We identified issues for considering well-being in public policy related to workers and the workplace.

Collaborative efforts between the National Institute for Occupational Safety and Health (NIOSH) and the American Society of Safety Engineers (ASSE) led to a report focusing on overlapping occupational vulnerabilities, specifically small construction businesses employing young, non-native workers. Following the report, an online survey was conducted by ASSE with construction business representatives focusing on training experiences of non-native workers. Results were grouped by business size (50 or fewer employees or more than 50 employees). Smaller businesses were less likely to employ a supervisor who speaks the same language as immigrant workers (p < .001). Non-native workers in small businesses received fewer hours of both initial safety training (p = .005) and monthly ongoing safety training (p = .042). Immigrant workers in smaller businesses were less likely to receive every type of safety training identified in the survey (including pre-work safety orientation [p < .001], job-specific training [p < .001], OSHA 10-hour training [p = .001], and federal/state required training [p < .001]). The results highlight some of the challenges a vulnerable worker population faces in a small business, and can be used to better focus intervention efforts. Among businesses represented in this sample, there are deflcits in the amount, frequency, and format of workplace safety and health training provided to non-native workers in smaller construction businesses compared to those in larger businesses. The types of training conducted for non-native workers in small business were less likely to take into account the language and literacy issues faced by these workers. The findings suggest the need for a targeted approach in providing occupational safety and health training to non-native workers employed by smaller construction businesses.

Background Small construction businesses (SCBs) account for a disproportionate share of occupational injuries, days lost, and fatalities in the US and other modern economies. Owner/managers of SCBs confront risks associated with their own and workers' safety and business survival, and their occupational safety and health (OSH) related values and practices are key drivers of safety and business outcomes. Given owner/mangers are the key to understanding and affecting change in smaller firms, as well as the pressing need for improved OSH in small firms particularly in construction, there is a critical need to better understand SCB owners' readiness to improve or adopt enhanced OSH activities in their business. Unfortunately, the social expectation to support safety can complicate efforts to evaluate owners' readiness. Objectives To get a more accurate understanding of the OSH values and practices of SCBs and the factors shaping SCB owners' readiness and intent to implement or improve safety and health programming by comparing their discourse on safety with their self-rated level of stage of change. Methods In-depth, semi-structured interviews were conducted with 30 SCB owner managers. Respondents were asked to self-rate their safety program activity on a 5-point scale from unaware or ignorant ('haven't thought about it at all') to actively vigilant ('well-functioning safety and health program for at least 6 months'). They were also asked to discuss the role and meaning of OSH within their trade and company, as well as attitudes and inclinations toward improving or enhancing business safety practices. Analysis and results Respondents' self-rating of safety program activity was compared and contrasted with results from discourse analysis of their safety talk, or verbal descriptions of their safety values and activities. Borrowing from normative and stage theories of safety culture and behavioral change, these sometimes contradictory descriptions were taxonomized along a safety culture continuum and a range of safety cultures and stages of readiness for change were found. These included descriptions of strong safety cultures with intentions for improvement as well as descriptions of safety cultures with more reactive and pathological approaches to OSH, with indications of no intentions for improvement. Some owner/managers rated themselves as having an effective OSH program in place, yet described a dearth of OSH activity and/or value for OSH in their business. Conclusion Assessing readiness to change is key to improving OSH performance, and more work is needed to effectively assess SCB OSH readiness and thus enable greater adoption of best practices.

A critical step toward advancing research for achieving greater impact on occupational safety and health in small businesses is to have a better understanding of what is meant by the term ‘small business’. The term needs to reflect not only the number of people employed and the financial resources of an enterprise, but also the psychosocial experience of the people that are represented in small businesses. In this article we discuss the role of several dimensions in differentially defining the small business construct, including: number of employees, business age, structure, workforce, manager centricity, and culture. As greater consensus on the small business label is reached, more focused frameworks for small business occupational safety and health research, policy and practice may be developed.

BACKGROUND: Smaller businesses differ from their larger counterparts in having higher rates of occupational injuries and illnesses and fewer resources for preventing those losses. Intervention models developed outside the United States have addressed the resource deficiency issue by incorporating intermediary organizations such as trade associations. METHODS: This paper extends previous models by using exchange theory and by borrowing from the diffusion of innovations model. It emphasizes that occupational safety and health (OSH) organizations must understand as much about intermediary organizations as they do about small businesses. OSH organizations ("initiators") must understand how to position interventions and information to intermediaries as added value to their relationships with small businesses. Examples from experiences in two midwestern states are used to illustrate relationships and types of analyses implied by the extended model. RESULTS: The study found that intermediary organizations were highly attuned to providing smaller businesses with what they want, including OSH services. The study also found that there are opinion leader organizations and individual champions within intermediaries who are key to decisions and actions about OSH programming. CONCLUSIONS: The model places more responsibility on both initiators and intermediaries to develop and market interventions that will be valued in the competitive small business environment where the resources required to adopt each new business activity could always be used in other ways. The model is a candidate for empirical validation, and it offers some encouragement that the issue of sustainable OSH assistance to small businesses might be addressed. Am. J. Ind. Med. 9999:1-10, 2013. Published 2013. This article is a U.S. Government work and is in the public domain in the USA. Language: en

Background Small businesses bear a large burden of injury and death, and are difficult to reach with occupational safety and health (OSH) information. The National Institute for Occupational Safety and Health (NIOSH) developed a pilot study testing the feasibility of fire departments disseminating OSH information to small businesses during fire inspections. Methods Two sets of postcards were developed with unique, trackable URLs for the NIOSH Small Business Resource Guide. One set was distributed by firefighters, the other was mailed to small businesses. Participating inspectors were met with to discuss their experience. Results Neither distribution method resulted in a substantial number of site visits. Inspectors believed distributing postcards was an easy addition to their duties, and saw value in safety information. Conclusions There are barriers beyond awareness of availability that prevent small business owners from seeking OSH information. Research should focus on identifying barriers and developing better OSH information diffusion mechanisms.

Despite differences in approaches to organizational problem solving, healthcare managers and organizational behavior management (OBM) practitioners share a number of practices, and connecting healthcare management with OBM may lead to improvements in patient safety. A broad needs-assessment methodology was applied to identify patient-safety intervention targets in a large rural medical center. This included a content analysis of descriptions of managers' follow-up actions to error reports for nine types of the most frequently occurring errors. Follow-up actions were coded according to the taxonomy of behavioral intervention components developed by Geller et al. (1990). Two error types were identified as targets for intervention, and the outcome of this assessment process indicated a clear need to apply OBM interventions at the management level and thus have a hospital-wide benefit to patient safety. Future implications for using a system-wide approach to identifying and classifying responses to medical er...

Although several organizational behavior management (OBM) intervention techniques have been used to improve designated behaviors related to patient safety, there remains a lack of patient-safety-focused behavioral interventions among healthcare workers. OBM interventions are often applied to needs already identified within an organization, and the means by which these needs are determined vary across applications. The current research addresses gaps in the literature by translating OBM intervention techniques to identify and improve the prevention potential of responses to reported medical errors. A content analysis of 17 months of descriptions of follow-up actions to error reports for nine types of the most-frequently occurring errors was conducted. Follow-up actions were coded according to a taxonomy of behavioral intervention components, with accompanying impact scores based on criteria developed by Geller et al. Two error types were selected for intervention, based on the highest frequency of ...

Injuries from medical sharps devices and blood-borne pathogen (BBP) exposure are a significant risk to many healthcare workers. Risk awareness communications and sharps safety strategies are key components of BBP exposure prevention efforts. The research reported here includes an evaluation of a large-scale communication intervention aimed at raising awareness among healthcare workers regarding the risks of sharps injuries and BBP exposure, as well as methods of prevention. The Stop Sticks campaign was a multi-media communication intervention targeted at multiple healthcare facilities in Columbia, South Carolina. Following a comprehensive needs assessment in each facility, tailored communications were delivered via several channels. Samples included individual hospital departments, an entire hospital, and a nursing home. Results indicate high levels of knowledge and communication channel recall, minimal attitude and behavior change, and a strong association between sharps-related safety behavior a...

Workplace injuries occur at higher rates in smaller firms than in larger firms, and the number of workplace safety activities appear to be inversely associated with those rates. Predictors of safety activities are rarely studied.This study uses data from a national random survey of firms (We found that, regardless of firm size or industry, safety activities were more common in 2002 than they were in a similar 1983 study. Having had an OSHA inspection in the last five years and firm size were stronger predictors of safety activities than industry hazardousness and manager's perceptions of hazardousness. All four variables were significant predictors (Further progress in the prevention of injuries in small firms will require attention to factors likely subsumed within the firm size variable, especially the relative lack of slack resources that might be devoted to safety activities.

Smaller firms are the majority in every industry in the US, and they endure a greater burden of occupational injuries, illnesses, and fatalities than larger firms. Smaller firms often lack the necessary resources for effective occupational safety and health activities, and many require external assistance with safety and health programming. Based on previous work by researchers in Europe and New Zealand, NIOSH researchers developed for occupational safety and health intervention in small businesses. This model was evaluated with several intermediary organizations. Four case studies which describe efforts to reach small businesses with occupational safety and health assistance include the following: trenching safety training for construction, basic compliance and hazard recognition for general industry, expanded safety and health training for restaurants, and fall prevention and respirator training for boat repair contractors. Successful efforts included participation by the initiator among the intermediaries’ planning activities, alignment of small business needs with intermediary offerings, continued monitoring of intermediary activities by the initiator, and strong leadership for occupational safety and health among intermediaries. Common challenges were a lack of resources among intermediaries, lack of opportunities for in-person meetings between intermediaries and the initiator, and balancing the exchanges in the initiator–intermediary–small business relationships. The model offers some encouragement that initiator organizations can contribute to sustainable OSH assistance for small firms, but they must depend on intermediaries who have compatible interests in smaller businesses and they must work to understand the small business social system.

Smaller businesses differ from their larger counterparts in having higher rates of occupational injuries and illnesses and fewer resources for preventing those losses. Intervention models developed outside the United States have addressed the resource deficiency issue by incorporating intermediary organizations such as trade associations.This paper extends previous models by using exchange theory and by borrowing from the diffusion of innovations model. It emphasizes that occupational safety and health (OSH) organizations must understand as much about intermediary organizations as they do about small businesses. OSH organizations ("initiators") must understand how to position interventions and information to intermediaries as added value to their relationships with small businesses. Examples from experiences in two midwestern states are used to illustrate relationships and types of analyses implied by the extended model.The study found that intermediary organizations were highly attuned to providing smaller businesses with what they want, including OSH services. The study also found that there are opinion leader organizations and individual champions within intermediaries who are key to decisions and actions about OSH programming.The model places more responsibility on both initiators and intermediaries to develop and market interventions that will be valued in the competitive small business environment where the resources required to adopt each new business activity could always be used in other ways. The model is a candidate for empirical validation, and it offers some encouragement that the issue of sustainable OSH assistance to small businesses might be addressed. Am. J. Ind. Med. 56:1442-1451, 2013. Published 2013. This article is a U.S. Government work and is in the public domain in the USA.

We evaluated the effects of a behavioral treatment on the safe passing of sharp instruments using the hands-free technique among hospital operating room personnel during surgical procedures. Treatment consisted of participative goal setting, task clarification, and feedback. The average percentage of sharp instruments passed safely increased from 32% to 64% and 31% to 70% between baseline and treatment phases in the inpatient and outpatient surgery units, respectively. Five-month follow-up data suggested maintenance of treatment effects. These findings suggest the utility of organizational behavior management strategies in reducing risky behavior in hospital settings.

We determined the meiotic origin and the stage of non-disjunction of the extra X chromosomes in two sisters with 47,XXX chromosomal complements. Segregation of the X chromosomes in all family members was analyzed using X-linked short tandem repeat polymorphic (STRP) markers. Densitometric analysis of two STRP markers confirmed that both sisters had three copies of the X chromosome and the extra X chromosomes were maternally derived. Both sisters did not share the same maternal homologue suggesting that the recurrent trisomy is non-homologous X chromosome-specific. Haplotype analysis demonstrated a reduction to homozygosity for markers examined, covering most of the length of the X chromosomes in both sisters. These findings suggested that the extra X chromosomes have derived from meiotic II non-disjunction following a nullitransitional meiosis I (MI). A lack of recombination in the X chromosomes of both sisters suggests a possible maternal genetic defect leading to an erratic recombination at MI. This information may contribute to further understanding of mechanisms leading to X chromosome non-disjunction and may assist in counseling of families with this chromosomal rearrangement.

A study of the effects of fertilizer and herbaceous competition on the survival and growth of spot-seeded oaks and walnut was established in 1979. Species included bur oak (Quercus macrocarpa), pin oak (Q. palustris), white oak (Q. alba), chestnut oak (Q. prinus), and black walnut (Juglans nigra). The treatments consisted of fertilizing with a fertilizer tablet and broadcast seeding a grass and legume mixture. All test plots were mulched with a mixture of composted sewage sludge and hardwood bark. Initial stocking of all oaks was better than 60 percent, but by the end of the sixth growing season, only bur oak had maintained a stocking level that was considered successful (70 percent). Stocking of the other oaks and walnut dropped to less than 20 percent. Evaluation of the bur oaks after 10 growing seasons showed that the saplings in the fertilizer plots had grown significantly taller than those in the other treatments; average height was 176 cm. Poorest growth was in the fertiliser plus grass plu...