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OBJECTIVE:The aim of the study was to evaluate the effect on health outcomes of an early or immediate return-to-work (RTW) after acute low back pain (LBP). METHODS:A longitudinal cohort of workers (N = 557) consulting for uncomplicated LBP were assessed on demographic, pain, occupational, and psychosocial variables. Pain and function were assessed at 3-month postpain onset. We tested the longitudinal effects of an early RTW on 3-month outcomes. RESULTS:Pain and function improved more rapidly for workers with an immediate (30.7%) or early (1 to 7 days) RTW (36.8%). Eleven demographic, health, or workplace variables were identified as potential confounds, but controlling for these factors only partially attenuated the benefits of an early RTW. CONCLUSIONS:An early RTW improves acute LBP and functional recovery, and alternate confounding explanations only partially eclipse this therapeutic effect.

OBJECTIVE:--There is a dearth of information on the extent to which diabetic patients receive care congruent with the chronic care model (CCM) and evidence-based behavioral counseling. This study evaluates a new instrument to fill this gap. RESEARCH DESIGN AND METHODS--A heterogeneous sample of 363 type 2 diabetic patients completed the original Patient Assessment of Chronic Illness Care (PACIC), along with additional items that allowed it to be scored according to the \"5As\" (ask, advise, agree, assist, and arrange) model of behavioral counseling. We evaluated relationships between survey scores and patient characteristics, quality of diabetes care, and self-management. RESULTS:--Findings replicated those of the initial PACIC validation study but with a much larger sample of diabetic patients and more Latinos. Areas of CCM activities reported least often were goal setting/intervention tailoring and follow-up/coordination. The 5As scoring revealed that patients were least likely to receive assistance with problem solving and arrangement of follow-up support. Few demographic or medical characteristics were related to PACIC or 5As scores, but survey scores were significantly related to quality of diabetes care received and level of physical activity. CONCLUSIONS:--The PACIC and the new 5As scoring method appear useful for diabetic patients. Its use is encouraged in future research and quality improvement studies.

Objectives. We examined the relationship between smoking and work–family conflict among a sample of New England long-term-care facility workers. Methods. To collect data, we conducted in-person, structured interviews with workers in 4 extended-care facilities. Results. There was a strong association between smoking likelihood and work–family conflict. Workers who experienced both stress at home from work issues (i.e., work-to-home conflict) and stress at work from personal issues (i.e., home-to-work conflict) had 3.1 times higher odds of smoking than those who did not experience these types of conflict. Workers who experienced home-to-work conflict had an odds of 2.3 compared with those who did not experience this type of conflict, and workers who experienced work-to-home conflict had an odds of 1.6 compared with workers who did not experience this type of conflict. Conclusions. The results of this study indicate that there is a robust relationship between work–family conflict and smoking, but that this relationship is dependent upon the total amount of conflict experienced and the direction of the conflict.

There is a broad literature linking social support to health, which includes evidence that social support from supervisors is positively associated with worker health. In addition, once workers experience a health concern, supervisors may play a key role in supporting workers, keeping them on the job despite health issues. However, there are few studies that investigate the day-to-day strategies supervisors utilize to support their workers and help them stay on the job despite health concerns. The study presented in this paper addresses this gap. Thirty-two supervisors from three companies were interviewed about their experiences supporting and accommodating skilled workers during flare-ups of a health condition. A grounded theory approach was used to analyze the text data and identify themes. Three key themes emerged from the data: 1) workplace policies provide the structure for mutual problem solving; 2) communication skills and existing relationships increase supervisor effectiveness; and 3) strategies were aimed at individual, interpersonal, and institutional supports. Supervisors regularly interact with workers to support and accommodate episodes of illness or pain. While supervisors employ novel and effective strategies, there is an opportunity to improve the range of strategies, better understand and utilize company policies, and facilitate appropriate communication about worker health concerns.

Objectives. To investigate racial/ethnic and language differences in the effectiveness of the Massachusetts Childhood Obesity Research Demonstration (MA-CORD) study among children aged 2 to 4 years enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Methods. We performed a multisector quasiexperimental study in 2 MA-CORD intervention communities and 1 comparison community. Using WIC data from 2010 to 2015, we examined intervention effect on child weight and behavior outcomes by child race/ethnicity and parental primary language using multilevel linear regression models with an interaction term. Results. Non-Hispanic Black children exposed to the intervention demonstrated a greater decrease in body mass index (BMI) than did other children (P < .05). Racial/ethnic minority children in the comparison site had greater increases in BMI than did their White counterparts (P < .05). There were no differences in intervention effectiveness by race/ethnicity or language for health behaviors. Conclusions. White children demonstrated decreased BMI in both the intervention and control groups. However, intervention minority children demonstrated greater improvements in BMI than did control minority children. Public Health Implications. To reduce racial/ethnic disparities, we need to disseminate effective obesity prevention interventions during early childhood in low-income settings.

Meal breaks promote occupational health and safety; however, less is known about supervisors’ support for nurses’ meal breaks. In this study, the researchers tested whether the frequency of meal breaks was positively related to supervisors’ support of nurses’ meal breaks, and whether more frequent meal breaks were associated with less psychological distress. This study is based on a cross-sectional survey of 1,595 hospital nurses working on 85 units supervised by nursing directors. Specific meal-break support was measured at the nursing director level; frequency of meal breaks and psychological distress were measured at the individual nurse level. Multilevel adjusted models showed a positive association between supervisors’ support for meal breaks and the frequency of nurses’ meal breaks (β = .16, p < .001). Moreover, nurses who took meal breaks more frequently reported lower psychological distress (β = −.09, p < .05). Meal breaks might be daily opportunities to promote mental health and fatigue recovery and provide downtime.

OBJECTIVE:This study reports findings from a proof-of-concept trial designed to examine the feasibility and estimates the efficacy of the “Be Well, Work Well” workplace intervention. METHODS:The intervention included consultation for nurse managers to implement changes on patient-care units and educational programming for patient-care staff to facilitate improvements in safety and health behaviors. We used a mixed-methods approach to evaluate feasibility and efficacy. RESULTS:Using findings from process tracking and qualitative research, we observed challenges to implementing the intervention due to the physical demands, time constraints, and psychological strains of patient care. Using survey data, we found no significant intervention effects. CONCLUSIONS:Beyond educating individual workers, systemwide initiatives that respond to conditions of work might be needed to transform the workplace culture and broader milieu in support of worker health and safety.

OBJECTIVE:The aim of this study was to investigate relationships between worksite organizational characteristics (size, industrial sector, leadership commitment, and organizational supports) and integrated approaches to protecting and promoting worker health implemented in smaller enterprises. METHODS:We analyzed web-based survey data of Human Resource Managers at 114 smaller enterprises (<750 employees) to identify organizational factors associated with levels of integrated approaches among their worksites. RESULTS:The companies’ mean integration score was 13.6 (SD = 9.6) of a possible 44. In multivariate analyses, having a safety committee (P = 0.035) and top leadership support for health promotion (HP) (P = 0.004) were positively associated with higher integration scores. CONCLUSIONS:Smaller enterprises in one U.S. region have relatively low levels of implementing integrated safety and promotion approaches. Having a safety committee and leadership support for HP may be important contributors to implementing integrated approaches in smaller enterprises.

OBJECTIVE:We explored associations between organizational factors (size, sector, leadership support, and organizational capacity) and implementation of occupational safety and health (OSH) and worksite health promotion (WHP) programs in smaller businesses. METHODS:We conducted a web-based survey of human resource managers of 117 smaller businesses (<750 employees) and analyzed factors associated with implementation of OSH and WHP among these sites using multivariate analyses. RESULTS:Implementation of OSH, but not WHP activities, was related to industry sector (P = 0.003). Leadership support was positively associated with OSH activities (P < 0.001), but negatively associated with WHP implementation. Organizational capacity (budgets, staffing, and committee involvement) was associated with implementation of both OSH and WHP. Size was related to neither. CONCLUSIONS:Leadership support and specifically allocated resources reflecting that support are important factors for implementing OSH and WHP in smaller organizations.

Research increasingly supports the conclusion that well-designed programs delivered over the Internet can produce significant weight loss compared to randomized controlled conditions. Much less is known about four important issues addressed in this study: (1) which recruitment methods produce higher eHealth participation rates, (2) which patient characteristics are related to enrollment, (3) which characteristics are related to level of user engagement in the program, and (4) which characteristics are related to continued participation in project assessments. We recruited overweight members of three health maintenance organizations (HMOs) to participate in an entirely Internet-mediated weight loss program developed by HealthMedia, Inc. Two different recruitment methods were used: personal letters from prevention directors in each HMO, and general notices in member newsletters. The personal letters were sent to members diagnosed with diabetes or heart disease and, in one HMO, to a general membership sample in a particular geographic location. Data were collected in the context of a 2x2 randomized controlled trial, with participants assigned to receive or not receive a goal setting intervention and a nutrition education intervention in addition to the basic program. A total of 2311 members enrolled. Bivariate analyses on aggregate data revealed that personalized mailings produced higher enrollment rates than member newsletters and that members with diabetes or heart disease were more likely to enroll than those without these diagnoses. In addition, males, those over age 60, smokers, and those estimated to have higher medical expenses were less likely to enroll (all P < .001). Males and those in the combined intervention were less likely to engage initially, or to continue to be engaged with their Web program, than other participants. In terms of retention, multiple logistic regressions revealed that enrollees under age 60 (P < .001) and those with higher baseline self-efficacy were less likely to participate in the 12-month follow-up (P = .03), but with these exceptions, those participating were very similar to those not participating in the follow-up. A single personalized mailing increases enrollment in Internet-based weight loss. eHealth programs offer great potential for recruiting large numbers of participants, but they may not reach those at highest risk. Patient characteristics related to each of these important factors may be different, and more comprehensive analyses of determinants of enrollment, engagement, and retention in eHealth programs are needed.