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Background: The objective of this article is to provide an overview of and update on the Office for Total Worker Health® (TWH) program of the Centers for Disease Control and Prevention’s National Institute for Occupational Safety and Health (CDC/NIOSH). Methods: This article describes the evolution of the TWH program from 2014 to 2018 and future steps and directions. Results: The TWH framework is defined as policies, programs, and practices that integrate protection from work-related safety and health hazards with promotion of injury and illness prevention efforts to advance worker well-being. Conclusions: The CDC/NIOSH TWH program continues to evolve in order to respond to demands for research, practice, policy, and capacity building information and solutions to the safety, health, and well-being challenges that workers and their employers face.

OBJECTIVES:The U.S. population is experiencing a demographic transition resulting in an aging workforce. The objective of this article is to elucidate and expand an approach to keep that workforce safe, healthy, and productive. METHODS:This article elucidates the framework for the National Center for Productive Aging at Work of the National Institute for Occupational Safety and Health. Subject matter experts used a snowball method to review published literature to substantiate elements in the framework. RESULTS:Evidence-based literature supports a productive aging framework for the workforce involving the following elements1) life span perspective; 2) comprehensive and integrated approaches to occupational safety and health; 3) emphasis on positive outcomes for both workers and organizations; and 4) supportive work culture for multigenerational issues. CONCLUSION:The productive aging framework provides a foundational and comprehensive approach for addressing the aging workforce.

Major life changes may play a causative role in health through lifestyle factors, such as alcohol. The objective was to examine the impact of stressful life events on heavy alcohol consumption among French adults. Trajectories of excessive alcohol consumption in 20,625 employees of the French national gas and electricity company for up to 5 years before and 5 years after an event, with annual measurements from 1992. We used repeated measures analysis of time series data indexed to events, employing generalized estimating equations. For women, excessive alcohol use increased before important purchase (p = 0.021), children leaving home (p<0.001), and death of loved ones (p = 0.03), and decreased before widowhood (p = 0.015); in the year straddling the event, increased consumption was observed for important purchase (p = 0.018) and retirement (p = 0.002); at the time of the event, consumption decreased for marriage (p = 0.002), divorce, widowhood, and death of loved one (all p<0.001), and increased for retirement (p = 0.035). For men, heavy alcohol consumption increased in the years up to and surrounding the death of loved ones, retirement, and important purchase (all p<0.001), and decreased after (all p<0.001, except death of loved one: p = 0.006); at the time of the event, consumption decreased for all events except for children leaving home and retirement, where we observed an increase (all p<0.001). For women and men, heavy alcohol consumption decreased prior to marriage and divorce and increased after (all p<0.001, except for women and marriage: p = 0.01). Stressful life events promote healthy and unhealthy alcohol consumption. Certain events impact alcohol intake temporarily while others have longer-term implications. Research should disentangle women's and men's distinct perceptions of events over time.

[...]experts have called for innovative and responsive occupational safety and health (OSH) approaches to better understand burgeoning future of work issues, help harness presented opportunities, and address exhibited challenges [2,3,4,5]. [...]workers and employers will be more likely to thrive and productively contribute to their communities and the Nation. 2. Though overall CO physical and mental health decline during the study, participating mentors note several social benefits of the program, such as opportunities to learn more about themselves and form meaningful relationships with co-worker mentees. Collins and colleagues [16] survey directors of nursing at nursing homes, using the Workplace Integrated Safety and Health (WISH) instrument to assess TWH polices, programs, and practices related to leadership commitment, participation, supportive working conditions, comprehensive and collaborative strategies, and adherence to federal and state regulations and ethical norms.

Objectives. We evaluated the association of household-level stressors with depressive symptoms among low-wage nursing home employees. Methods. Data were collected in 2006 and 2007 from 452 multiethnic primary and nonprimary wage earners in 4 facilities in Massachusetts. We used logistic regression to estimate the association of depressive symptoms with household financial strain, food insufficiency, and work–family spillover (preoccupation with work-related concerns while at home and vice versa). Results. Depressive symptoms were significantly associated with household financial strain (odds ratio [OR] = 1.82; 95% confidence interval [CI] = 1.03, 3.21) and food insufficiency (OR = 2.10; 95% CI = 1.10, 4.18). Among primary earners, stratified analyses showed that food insufficiency was associated with depressive symptoms (OR = 3.60; 95% CI = 1.42, 9.11) but financial strain was not. Among nonprimary wage earners, depressive symptoms correlated with financial strain (OR = 3.65; 95% CI = 1.48, 9.01) and work–family spillover (OR = 3.22; 95% CI = 1.11, 9.35). Conclusions. Household financial strain, food insufficiency, and work–family spillover are pervasive problems for working populations, but associations vary by primary wage earner status. The prevalence of food insufficiency among full-time employees was striking and might have a detrimental influence on depressive symptoms and the health of working-class families.

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. METHODS:Twenty-six experts in occupational safety and health and related fields reviewed and discussed current methodological and measurement issues and those showing promise. RESULTS:TWH intervention studies face the same challenges as other workplace intervention studies and some unique ones. Examples are provided of different approaches and their applications to TWH intervention studies, and desired developments in the TWH literature. CONCLUSIONS:This report discusses and outlines principles important to building the TWH intervention research base. Rigorous, valid methodologic, and measurement approaches are needed for TWH intervention as well as for basic/etiologic, translational, and surveillance research.

Objectives: To explore the association of baseline co-worker social support with follow-up measures of health care use and sickness absence. Methods: Data were obtained on 1240 employees from 33 worksites, through Promoting Activity and Changes in Eating, a group randomized weight maintenance trial. Co-worker social support, health care utilization, and absenteeism were assessed via a self-reported questionnaire. Generalized Estimating Equations were employed using STATA version 10. Results: Higher baseline co-worker social support was significantly associated with a greater number of doctors' visits (P = 0.015). Co-worker social support was unrelated to number of hospitalizations, emergency department visits, or absenteeism. Conclusions: The relationship between co-worker social support and health care utilization and absenteeism is complex and uncertain. Future studies should measure more specific outcomes, incorporate important mediating variables, and distill how social networks influence these outcomes.

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. To explore relationships between concerns and physical activity and body mass index (BMI) among a racially/ethnically diverse low-income population. Method. A cross-sectional survey documented behavioral risks among racially/ethnically diverse low-income residents in the Boston area (2005-2009). Multivariable logistic regressions were conducted in 2012 for each concern, using SAS version 9.2. Results. Those very/moderately concerned about weight were more likely to have higher BMIs, be in the preparation/action stage, received behavioral counseling, participated in a weight management program, and be interested in participating in one in the future. Those very/moderately concerned about physical activity were more likely to have higher BMIs, received behavioral counseling, and participated in a physical activity program. Conclusion. Individuals with elevated BMIs or low levels of physical activity are concerned. While level of concern is important, these findings suggest that it is not likely to be a sufficient catalyst to behavior change.

Purpose: To assess the association between intention to quit smoking and perceptions of household environmental risks among racially/ethnically diverse residents of lowincome housing. Methods: Baseline data were collected from 2007 to 2009 for the Health in Common Study, which assessed social and physical determinants of cancer risk-related behaviors among residents of 20 low-income housing developments in the Greater Boston metropolitan area. Participants were surveyed about their tobacco use and concerns about household exposures. Household environmental inspections were also conducted to identify conditions associated with increased risk of exposure to indoor environmental agents, including pesticides, mold, and cleaning products. Results: Intention to quit smoking was associated with a greater degree of concern about exposures in the home, yet not with the actual presence of household hazards, as identified by home inspections and survey findings. Conclusions: An ecological approach targeting multiple levels of influence may help to highlight the importance of both quitting tobacco and reducing potential household environmental exposures as part of comprehensive efforts to promote individual and household health.