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Background. Shift work is characterized by employees working outside the standard hours of 7:00 am to 6:00 pm. Because shift work includes night work, the normal sleep–wake cycle (circadian rhythm) is disrupted, with potential consequences for shift workers’ physical and mental health. Objectives. To assess the pooled effects of shift work on mental health and to evaluate whether these differ in men and women. Search Methods. We searched PubMed, Scopus, and Web of Science databases for peer-reviewed or government reports published up to August 2018 Selection Criteria. To be included, studies had to be longitudinal or case–control studies of shift work exposure associated with adverse mental health outcomes. For subanalyses, we grouped these outcomes as anxiety symptoms, depressive symptoms, or general poor mental health symptoms. Data Collection and Analysis. We followed the Meta-Analysis of Observational Studies in Epidemiology Group guidelines. We extracted adjusted risk estimates for each study to calculate pooled effect sizes (ESs) using random effect models and metaregression analysis to explore sources of heterogeneity. Main Results. We included 7 longitudinal studies, with 28 431 unique participants. Shift work was associated with increased overall risk of adverse mental health outcomes combined (ES = 1.28; 95% confidence interval [CI] = 1.02, 1.62; I 2  = 70.6%) and specifically for depressive symptoms (ES = 1.33; 95% CI = 1.02, 1.74; I 2  = 31.5%). Gender differences explained more than 90% of heterogeneity, with female shift workers more likely to experience depressive symptoms than female non–shift workers (odds ratio = 1.73; 95% CI = 1.39, 2.14). Authors’ Conclusions. To our knowledge, this is the first meta-analysis to investigate the pooled effects of shift work on the risk of poor mental health, including subanalyses by type of poor mental health and gender. Shift workers, particularly women, are at increased risk for poor mental health, particularly depressive symptoms. Public Health Implications. Depression accounts for 4.3% of the global burden of disease and incidence, with mental disorders worldwide predicted to cost US $16.3 million by 2030. With 1 in 5 people in the United States and Europe doing shift work, and the increased risk of poor mental health among shift workers, shift work industries are a priority context for reducing this burden. Workplace health promotion programs and policies are needed to minimize shift workers’ risk of poor mental health.

Objective This systematic review aimed to provide an overview of the effectiveness of health promotion interventions at the workplace on physical and mental health outcomes related to chronic diseases. Methods A search for reviews published between 2009 and 2018 was performed in electronic databases. References of the included reviews were checked for additional reviews. Workplace health promotion interventions were included if they studied metabolic risk factors as important predictors of type 2 diabetes mellitus (T2DM) and cardiovascular diseases (CVD) or if they studied mental or musculoskeletal health outcomes. Review quality was assessed using the AMSTAR checklist. Results Of the 23 reviews included, 9 were of high quality. For weight-related outcomes, there was strong evidence for favorable effects of workplace interventions, especially for interventions targeting physical activity and/or diet. For the remaining metabolic risk factors, there was no evidence for a positive effect of workplace health promotion interventions due to the absence of high quality reviews and mixed conclusions between the reviews. There was also strong evidence for a positive, small effect on the prevention of mental health disorders of workplace psychological interventions, especially those that use e- health and cognitive behavioral therapy techniques. Furthermore, strong evidence was found for the prevention of musculoskeletal disorders through workplace interventions, especially resistance exercise training. Conclusions This review found evidence for the effectiveness of workplace interventions on the prevention of weight-related outcomes as well as mental health and musculoskeletal disorders. Future research is however needed on the factors that contribute to the successful implementation of an intervention.

Digital technologies are increasingly integrating into people's daily living environments such as schools, sport clubs, and health care facilities. These settings play a crucial role for health promotion and prevention because they affect the health of their members, as the World Health Organization has declared. Implementing digital health promotion and prevention in settings offers the opportunity to reach specific target groups, lower the costs of implementation, and improve the health of the population. Currently, there is a lack of scientific evidence that reviews the research on digital health promotion and prevention in settings. This scoping review aims to provide an overview of research targeting digital health promotion and primary prevention in settings. It assesses the range of scientific literature regarding outcomes such as applied technology, targeted setting, and area of health promotion or prevention, as well as identifies research gaps. The scoping review was conducted following the Levac, Colquhoun, and O'Brien framework. We searched scientific databases and gray literature for articles on digital setting-based health promotion and prevention published from 2010 to January 2020. We included empirical and nonempirical publications in English or German and excluded secondary or tertiary prevention and health promotion at the workplace. From 8888 records, the search resulted in 200 (2.25%) included publications. We identified a huge diversity of literature regarding digital setting-based health promotion and prevention. The variety of technology types extends from computer- and web-based programs to mobile devices (eg, smartphone apps) and telemonitoring devices (sensors). We found analog, digital, and blended settings in which digital health promotion and prevention takes place. The most frequent analog settings were schools (39/200, 19.5%) and neighborhoods or communities (24/200, 12%). Social media apps were also included because in some studies they were defined as a (digital) setting. They accounted for 31.5% (63/200) of the identified settings. The most commonly focused areas of health promotion and prevention were physical activity (81/200, 40.5%), nutrition (45/200, 22.5%), and sexual health (34/200, 17%). Most of the interventions combined several health promotion or prevention methods, including environmental change; providing information, social support, training, or incentives; and monitoring. Finally, we found that the articles mostly reported on behavioral rather than structural health promotion and prevention. The research field of digital health promotion and prevention in settings is heterogeneous. At the same time, we identified research gaps regarding the absence of valid definitions of relevant terms (eg, digital settings) and the lack of literature on structural health promotion and prevention in settings. Therefore, it remains unclear how digital technologies can contribute to structural (or organizational) changes in settings. More research is needed to successfully implement digital technologies to achieve health promotion and prevention in settings.

The workplace is a promising setting for health promotion as workers spend a lot of time at work, and existing social networks for social support could be used to change behavior and enhance health. Workplace health promotion programs could be a way to improve workers' health and can for example include elements of support, policies, or environmental changes to encourage healthy behavior. Traditionally, programs have focused on providing workers with advice on how to change their behavior. Such programs have been criticized because they do not take a broader perspective such as the environment. However, still many of these traditional programs are offered to employees and evaluated. The effects of such programs remain disappointing thus far. Here, Robroek et al reflect on the body of research regarding workplace health promotion. They also describe gaps in the literature, most notably regarding the need for more targeted workplace health promotion, a systems approach for workplace health promotion, and the delivery of workplace health promotion. Furthermore, they propose some research agenda concerning workplace health promotion.

Objectives Using an employer's perspective, this study aimed to compare the immediate and longer-term impact of workplace ergonomics and neck-specific exercise versus ergonomics and health promotion information on health-related productivity among a general population of office workers and those with neck pain. Methods A prospective one-year cluster randomized trial was conducted. Participants received an individualized workstation ergonomics intervention, combined with 12 weeks of either workplace neck-specific exercises or health promotion information. Health-related productivity at baseline, post-intervention and 12-months was measured with the Health and Work Performance Questionnaire. Intention-to-treat analysis was performed using multilevel mixed models. Results We recruited 763 office workers from 14 organizations and allocated them to 100 clusters. For the general population of office workers, monetized productivity loss at 12 months [AU$1464 (standard deviation [SD] 1318) versus AU$1563 (SD=1039); P=0.023]; and presenteeism at 12 months [2.0 (SD 1.2) versus 2.4 (SD 1.4); P=0.007] was lower in the exercise group compared to those in the health promotion information group. For office workers with neck pain, exercise participants had lower sickness absenteeism at 12 months compared to health promotion information participants [0.7 days (SD 1.0) versus 1.4 days (SD 3.1); P-=0.012], despite a short-term increase in sickness absenteeism post-intervention compared to baseline for the exercise group [1.2 days (SD 2.2) versus 0.6 days (SD 0.9); P<0.001]. Conclusion A workplace intervention combining ergonomics and neck-specific exercise offers possible benefits for sickness presenteeism and health-related productivity loss among a general population of office workers and sickness absenteeism for office workers with neck pain in the longer-term.

Background Since 2015, workplace health promotion measures (WHPM) are implemented in the German Federal Armed Forces to promote the health of military and civilian employees and thus improve the ability to defend state interests. Here the aim is to evaluate associations between participation in WHPM and absenteeism, presenteeism and health behavior. Methods A longitudinal observational study (T0: 06-09/2022; T1: 06-09/2023; T2: 06-09/2024) was conducted. Each survey invitation was addressed to around 200.000 employees of the GFAF (full survey). Employees who participated in at least two out of the three surveys were included (first participation: baseline: BL, last participation: follow up: FU). Results In T0 23.568 (10.5%), T1 14.059 (6%), T2 13.551 (6%) employees participated. N = 7.183 participated in at least two surveys (military: 49%, women (w): 35.1%; mean age 43.42 ± SD 10.37 years). A proportion of 48.8% (BL vs. 54.1% FU) of employees participating in WHPM reported presenteeism (no WHPM: BL: 53.7%; FU: 58.2%) with a relative increase in both groups (WHPM: +10.9%, no WHPM: +8.4%; OR 0.96; 95% CI [0.85, 1.07]). The chance of male employees to report presenteeism was 26% lower than in female employees (OR 0.74; 95% CI [0.65, 0.85]). Employees reporting depressive thoughts had a significant higher chance to report presenteeism (OR 2.24; 95% CI [1.39, 3.73]). For employees participating in WHPM the chance of reporting absenteeism was 22% higher (OR 1.22; 95% CI [0.91, 1.64]), but employees participating in WHPM reported healthier nutrition behaviour (OR 1.27 (95% CI [1.10, 1.46]) as well as more regular physical activity (OR 1.62; 95% CI [1.40, 1.87]). Conclusions WHPM have not shown to have a significant effect on presenteeism and absenteeism. Sex/gender and further subgroups have to be taken into consideration to design adequate measures. Nevertheless, the reported improvement of health behavior may lead to better health and thus less days of incapacity to work. Key messages • Workplace health promotion measures have not shown to have a significant effect on presenteeism and absenteeism. • Workplace health promotion measures have shown to have a significant effect on healthy nutrition and physical activity.

Background Since 2015, workplace health promotion measures (WHPM) are implemented in the German Federal Armed Forces. In order to increase its attractiveness as an employer, employees are offered the possibility to work from home. The aim is to descriptively evaluate associations between working from home (WFH) and health status, quality of life, main diseases reported and health behavior. Methods From 06-09/2022 a cross sectional study was conducted. All military and civilian employees of the German Federal Armed Forces (∼220.000) were invited to participate in the study. The survey was conducted online and paper-based. Results A total of 23.568 (11%) of all employees participated in the survey (mean age 42 ± 11.34 years (y); 29% women (w); military: 13.697 (58%); WFH: mean age 46,27 ± 9,91 years; w: 13% (899/6.736); men (m): 8,7% (1.433/16.530); no WFH: mean age 41,5 ± 11,41 years; w: 86,7% (5837/6736), m: 91,3% (15.097/16.530). A proportion of 10% (2.342/23.315) stated that they work entirely or partly from home. 47.1% (535/1.135) of employees working from home participated in WHPM measures. A proportion of 79.3% (no WFH: 73.6%) rated their quality of life and 66.2% (no WFH: 70.2%) their general health as good/very good, although 38.7% (no WFH: 33.4%) reported muscular and skeletal complaints and 15.1% high blood pressure (no WFH: 13.1%). 79.5% of employees working from home (no WFH: 77.5%) reported physical activity and a healthy diet 81.2% (no WFH: 76.9%). 19.1% (no WFH: 12.3%) indicated a regular intake of dietary supplements. Conclusions The results show associations between WFH and the health of employees. There are indications that employees WFH are more health-conscious and thus pay more attention to their health. An improved target group orientation of WHPM, especially for employees WFH, may have positive effects on their health status and may contribute to fewer days of incapacity to work. Key messages • There are indications that employees working from home are more health-conscious and pay more attention to their health. • A further improvement of WHPM, especially for employees working from home, may have positive effects on their health status and may contribute to fewer days of incapacity to work.

Background Since 2015, workplace health promotion measures (WHPM) are implemented in the German Federal Armed Forces (GFAF). Here the aim was to evaluate associations between participation in WHPM and self-rated health, quality of life, social as well as health risk factors and days of incapacity to work (DIW) for main diseases reported. Methods A longitudinal observational study (T0: 06-09/2022; T1: 06-09/2023; T2: 06-09/2024) was conducted. Each survey invitation was addressed to about 220.000 employees of the GFAF. Employees who participated in at least two out of the three surveys were included in a longitudinal analysis. The odds were adjusted for relevant baseline characteristics in logistic regression models. Results In T0 23.568 (10.5%), T1 14.059 (6%), T2 13.551 (6%) employees participated. N = 7.183 participated in at least two surveys (military: 49%; women (w): 35.1%; mean age 43.42 ± SD 10.37 years). The chance to rate their general health status as good/very good was 20% higher for employees participating in WHPM [OR 1.20; 95%; CI [1.05, 1.37]) as well as the chance to rate their quality of life as very good/good [OR 1.48; 95%; CI [1.29, 1.69]. For employees participating in WHPM the chance was 12% lower to have high blood pressure (OR 0.88; 95% CI [0.75, 1.05]). No relevant difference was found regarding the ability to work (OR 1.05; 95% CI [0.92, 1.19]). Women participating showed a 13% lower chance to rate their job satisfaction as positive than men (OR 0.87; 95%; CI [0.71, 1.07]). There was a relative decrease of DIW for musculoskeletal diseases for employees participating (-2.6%; no WHPM: +28.9%). DIW for mental health issues showed the same trend (-14.9%; no WHPM: +7.5%). Conclusions Associations can be seen between WHPM and self-rated health, quality of life, health risk factors and DIW. Nevertheless, the study design is associated with limitations arising from the observational design, future studies should take randomized approaches into account. Key messages • There are associations between workplace health promotion measures and self-rated health, quality of life, health risk factors and days of incapacity to work. • There are sex/gender differences regarding job satisfaction. Future studies should take randomized approaches into account.

Background Due to social inequality and spatial segregation, people living in deprived neighborhoods tend to suffer from a lack of access to health care in general and occupational health services in particular, even though they are employed in occupations that are more likely to be detrimental to their health and well-being. We aim to assess the awareness and utilization of occupational health services in deprived French neighborhoods. Methods In a participatory project involving an association whose salaried members reside in these neighborhoods, we conducted an innovative survey based on a door-to-door campaign in three neighborhoods in greater Paris in 2024. Data were collected through face-to-face questionnaires. The three primary outcomes were being aware of occupational medicine, ever having had an occupational health visit, and knowing how to declare a workplace accident. We further investigated their determinants using multivariate logistic regressions. Results The survey included 462 individuals, 53% of whom were women. Among the working population sub-sample, 17,3% had never heard of occupational health (64/370), 18,9% never had an occupational health visit (64/338 currently in activity), and 33,7% did not know how to declare a workplace accident (124/368). Preliminary results for all three outcomes show that individuals without stable housing (a proxy for the precariousness of living conditions), those who lack a neighborhood social network, and immigrants who live in France for less than 10 years had lower odds of awareness and use. Moreover, women, younger individuals, and individuals with lower formal education had lower odds of having heard of occupational health. Individuals working part-time were less likely to know how to declare a workplace accident. Conclusions Our findings support the implementation of community-based occupational health promotion interventions at the neighborhood level to reduce occupational health-related disparities in France. Key messages • A survey based on a door-to-door campaign in deprived neighborhoods in Greater Paris revealed a significant lack of awareness and use of occupational health services. • Our analysis of the factors associated reveals the need and relevance of implementing a community-based neighborhood-level occupational health promotion intervention with local residents.

Preventive programs and health promotion strategies aim to identify and strengthen factors that reduce the onset and worsening of chronic diseases, combat addictions, and maintain good health. Rooted in the salutogenic approach, these strategies focus on promoting well-being and resilience. The new regional healthcare reform (L.r. 22/2021), along with national and regional health promotion documents (PNP 2020-2025; PRP 2021-2025), highlights intersectorality as a key strategy for implementing effective prevention actions. This principle is also reflected in local planning documents, particularly the Integrated Local Health Promotion Plan (PIL). Each year, the Health Ptotection Agency of Milan develops the PIL, which summarizes the vision, preventive programs, and health promotion activities carried out in the area, fostering collaboration between the health, social health, and social sectors. The plan is co-constructed through a joint process involving ATS departments, local ASSTs, external stakeholders (businesses, school offices, etc.), and other health promotion actors. To achieve sustainable results, it is essential to implement a system-wide strategy that engages all territorial stakeholders, local communities, and individuals. This engagement is integrated into both the planning and implementation stages. The plan is divided into five local health promotion programs focused on workplaces, schools, local communities, the first 1000 days of life, and socio-health integration. Within the PIL framework, health promotion is a global social and political process, aiming to strengthen individuals’ skills and participation while modifying social, environmental, and economic conditions that affect public health. This approach empowers individuals to exercise greater control over health determinants, leading to improved health outcomes. Key messages • The PIL is a co-constructed document with all active actors across the territory, addressing the population's health needs from an equity and sustainability perspective. • The integration of health promotion strategies in diverse settings fosters collaborative efforts that improve community well-being, contributing to achieving essential levels of care.