Candace C. Nelson

Physical Activity and Body Mass Index: The Contribution of Age and Workplace Characteristics

BACKGROUND The workplace is an important domain for adults, and many effective interventions targeting physical activity and weight reduction have been implemented in the workplace. However, the U.S. workforce is aging, and few studies have examined the relationship of BMI, physical activity, and age as they relate to workplace characteristics. PURPOSE This paper reports on the distribution of physical activity and BMI by age in a population of hospital-based healthcare workers and investigates the relationships among workplace characteristics, physical activity, and BMI. METHODS Data from a survey of patient care workers in two large academic hospitals in the Boston area were collected in late 2009 and analyzed in early 2013. RESULTS In multivariate models, workers reporting greater decision latitude (OR=1.02, 95% CI=1.01, 1.03) and job flexibility (OR=1.05, 95% CI=1.01, 1.10) reported greater physical activity. Overweight and obesity increased with age (p<0.01), even after adjusting for workplace characteristics. Sleep deficiency (OR=1.56, 95% CI=1.15, 2.12) and workplace harassment (OR=1.62, 95% CI=1.20, 2.18) were also associated with obesity. CONCLUSIONS These findings underscore the persistent impact of the work environment for workers of all ages. Based on these results, programs or policies aimed at improving the work environment, especially decision latitude, job flexibility, and workplace harassment should be included in the design of worksite-based health promotion interventions targeting physical activity or obesity.

Occupational injury among hospital patient-care workers: what is the association with workplace verbal abuse?

OBJECTIVE To test the association between workplace abuse exposure and injury risk among hospital workers. We hypothesized that exposed workers would have higher injury rates than unexposed workers. METHODS Survey of direct-care workers (n = 1,497) in two hospitals. Exposure to workplace abuse was assessed through self-report; occupational injury reports were extracted from employee records. We tested associations between non-physical workplace violence and injury using log-binomial regression and multilevel modeling. RESULTS Adjusted prevalence ratio (PR) for injury associated with being yelled at was 1.52 (95% CI 1.19, 1.95); for experiencing hostile/offensive gestures 1.43 (1.11, 1.82); and for being sworn at 1.41 (1.09, 1.81). In analyses by injury subtypes, musculoskeletal injuries were more strongly associated with abuse than were acute traumatic injuries. Associations operated on group and individual levels and were most consistently associated with abuse perpetrated by patients. CONCLUSION Exposure to workplace abuse may be a risk factor for injuries among hospital workers.

Assessing the relationship between work-family conflict and smoking.

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.

Effects of workplace, family and cultural influences on low back pain: What opportunities exist to address social factors in general consultations?

Social factors are widely acknowledged in behavioural models of pain and pain management, but incorporating these factors into general medical consultations for low back pain (LBP) can be challenging. While there is no compelling evidence that social factors contribute to LBP onset, these factors have been shown to influence functional limitation and disability, especially the effects of organisational support in the workplace, spousal support, family conflict and social disadvantage. A number of barriers exist to address such social factors in routine medical encounters for LBP, but there is emerging evidence that improving social and organisational support may be an effective strategy to reduce the negative lifestyle consequences of LBP. For clinicians to address these factors in LBP treatment requires a clearer psychosocial framework in assessment and screening, more individualised problem-solving efforts, more patient-centred interventions involving family, peers and workplace supports and a less biomechanical and diagnostic approach.

Supervisors' support for nurses' meal breaks and mental health

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.

Implementing an Integrated Health Protection/Health Promotion Intervention in the Hospital Setting: Lessons Learned from the Be Well, Work Well Study

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.

Organizational Characteristics Influence Implementation of Worksite Health Protection and Promotion Programs: Evidence From Smaller Businesses.

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.

Integrating health promotion and occupational safety and health in manufacturing worksites: Perspectives of leaders in small-to-medium sized businesses

BACKGROUND Accumulating evidence suggests that worksite interventions integrating worksite health promotion (WHP) and occupational safety and health (OSH) may be more efficacious and have higher participation rates than health promotion programs offered alone. However, dissemination of integrated programs is complicated by lack of tools for implementation - particularly for small and medium-sized businesses (SMBs). OBJECTIVE The goal of this study is to describe perceptions of acceptability and feasibility of implementing an integrated approach to worker health that coordinates WHP and OSH in SMBs. METHODS In September to November 2012, decision-makers for employee health programming within SMBs (< 750 employees) in greater Minneapolis were identified. Fourteen semi-structured interviews were conducted and analyzed to develop an understanding of perceived benefits and barriers, awareness, and capacity for implementing an integrated approach. RESULTS Worker health was widely valued by participants. They reported strong management support for improving employee health and safety. Most participants indicated that their company was open to making changes in their approach to worker health; however, cost and staffing considerations were frequently perceived as barriers. CONCLUSIONS There are opportunities for implementing integrated worksite health programs in SMBs with existing resources and values. However, challenges to implementation exist, as these worksites may lack the appropriate resources.

Validation of a New Metric for Assessing the Integration of Health Protection and Health Promotion in a Sample of Small- and Medium-Sized Employer Groups.

Objective: To conduct validation analyses for a new measure of the integration of worksite health protection and health promotion approaches developed in earlier research. Methods: A survey of small- to medium-sized employers located in the United States was conducted between October 2013 and March 2014 (n = 111). Cronbach &agr; coefficient was used to assess reliability, and Pearson correlation coefficients were used to assess convergent validity. Results: The integration score was positively associated with the measures of occupational safety and health and health promotion activities/policies—supporting its convergent validity (Pearson correlation coefficients of 0.32 to 0.47). Cronbach &agr; coefficient was 0.94, indicating excellent reliability. Conclusions: The integration score seems to be a promising tool for assessing integration of health promotion and health protection. Further work is needed to test its dimensionality and validate its use in other samples.

Allocation of household responsibilities influences change in dietary behavior

This study was undertaken to understand dietary behavior as situated within the household, an important social context that serves to either inhibit or promote a healthy diet. Data were collected as part of a worksite-based health behavior intervention trial that took place between 1999 and 2003 in small manufacturing businesses in New England, U.S.A. The subjects were a cohort of 790 male and female workers who participated in the intervention trial and responded to both the baseline and the 18-month follow-up surveys. Regression models were built to determine whether proportion of household responsibility predicted daily fruit and vegetable consumption and weekly red meat consumption at 18-months. The results indicate that participants who were responsible for earning most or all of the money to support the household ate more servings of fruits and vegetables per day at 18-month follow-up than those without this responsibility. Further, those responsible for earning about half ate fewer servings of red meat than those responsible for earning most or all of the money to support the household. The results for red meat consumption differed by sex, such that responsibility for more than half or less than half of the money to support the household had different effects for men and women. The results of this study demonstrate that the distribution of household responsibilities can be an important factor in determining the effectiveness of a worksite-based health behavior intervention and that these effects can be different for women versus men.