Liliana Tenney

Health promotion in small business: a systematic review of factors influencing adoption and effectiveness of worksite wellness programs.

Objective: To assess the evidence regarding the adoption and efficacy of worksite health promotion programs (WHPPs) in small businesses. Methods: Peer-reviewed research articles were identified from a database search. Included articles were published before July 2013, described a study that used an experimental or quasiexperimental design and either assessed adoption of WHPPs or conducted interventions in businesses with fewer than 500 employees. A review team scored the studys rigor using the WHO-adapted GRADEprofiler “quality of evidence” criteria. Results: Of the 84 retrieved articles, 19 met study inclusion criteria. Of these, only two met criteria for high rigor. Conclusions: Fewer small businesses adopt WHPPs compared with large businesses. Two high-rigor studies found that employees were healthier postintervention. Higher quality research is needed to better understand why small businesses rarely adopt wellness programs and to demonstrate the value of such programs.

Occupational exposures in the oil and gas extraction industry: State of the science and research recommendations

The oil and gas extraction industry is rapidly growing due to horizontal drilling and high volume hydraulic fracturing (HVHF). This growth has provided new jobs and economic stimulus. The industry occupational fatality rate is 2.5 times higher than the construction industry and 7 times higher than general industry; however injury rates are lower than the construction industry, suggesting injuries are not being reported. Some workers are exposed to crystalline silica at hazardous levels, above occupational health standards. Other hazards (particulate, benzene, noise, radiation) exist. In this article, we review occupational fatality and injury rate data; discuss research looking at root causes of fatal injuries and hazardous exposures; review interventions aimed at improving occupational health and safety; and discuss information gaps and areas of needed research. We also describe Wyoming efforts to improve occupational safety in this industry, as a case example.

The Center for Human Development in Guatemala: An Innovative Model for Global Population Health

Edwin J. Asturias, MD, Gretchen Heinrichs, MD, DTMH, Gretchen Domek, MD, MPhil, John Brett, PhD, Elizabeth Shick, DDS, MPH, Maureen Cunningham, MD, MPH, Sheana Bull, PhD, Marco Celada, MD, Lee S. Newman, MD, MA, Liliana Tenney, MPH, Lyndsay Krisher, MPH, Claudia Luna-Asturias, MSW, Kelly McConnell, MD, Stephen Berman, MD* Center for Global Health, Colorado School of Public Health Partners with Children’s Hospital Colorado, 13199 E. Montview Boulevard, Campus Box A090, Aurora, CO 80045, USA; Department of Pediatrics, University of Colorado School of Medicine, 13123 E. 16th Avenue, Campus Box B065, Aurora, CO 80045, USA; Department of Obstetrics and Gynecology, University of Colorado School of Medicine, 13001 E. 17th Place, Campus Box C290, Aurora, CO 80045, USA; Department of Anthropology, College of Liberal Arts and Sciences, University of Colorado-Denver, PO Box 173364, Campus Box 103, Denver, CO 80217, USA; School of Dental Medicine, University of Colorado Anschutz Medical Campus, 13065 E. 17th Avenue, Campus Box F833, Aurora, CO 80045, USA; Center for Health, Work & Environment, Colorado School of Public Health, 13001 E. 17th Place, Campus Box B186, Aurora, CO 80045, USA

Small Business Total Worker Health: a Conceptual and Methodological Approach to Facilitating Organizational Change

Nearly half of Americans are employed by small businesses, and future projections suggest that the number of those employed by small businesses will rise. Despite this, there is relatively little small business intervention research on the integration of health protection and health promotion, known as Total Worker Health® (TWH). We first discuss the importance of studying small businesses in TWH research and practice. Second, we describe an example of a small business TWH intervention, Health Links™ plus TWH owner/senior manager leadership training, that we are evaluating via the Small+Safe+Well (SSWell) study. Key features of the intervention and the SSWell study include attention to multi-level influences on worker health, safety and well-being; organizational change; and dissemination and implementation science strategies via the RE-AIM model. We offer several considerations for future small business TWH research and practice both in terms of the small business context as well as intervention development and evaluation. Our goal is to provide TWH researchers and practitioners with a framework and an example of how to approach small business TWH interventions. Ultimately, through the SSWell study, we aim to provide small businesses with strong evidence to support the use of TWH strategies that are practical, effective and sustainable.

Integrated approach to health screening of former department of energy workers detects both occupational and non-occupational illness.

BACKGROUND The National Supplemental Screening Program (NSSP) uses a Total Worker Health(TM) approach to address U.S. Department of Energy (DOE) former worker health. This article provides the design of the integrated occupational health screening and promotion program. METHODS The NSSP implemented a web-based relational health records system to process demographic, exposure, and clinical data. We present medical findings for 12,000 DOE former workers that completed an initial NSSP medical screening between October 1, 2005 and October 4, 2013. We discuss the DOE former worker participant population and the exposure-based and non-occupational medical screening tests used. RESULTS The NSSP identified potential occupationally related health conditions in 40.5% of those screened. Notably, we identified 85.8% of participants with addressable non-occupational health conditions, many of which were previously undiagnosed. CONCLUSION The NSSP demonstrates that the identification of potential occupational health issues in conjunction with addressable non-occupational health conditions provides former workers with information to more effectively manage health.

Unadjusted point of care creatinine results overestimate acute kidney injury incidence during field testing in Guatemala

Objective Acute kidney injury (AKI) occurs at high rates among agricultural workers (12–33%) in tropical environments. Because of the remote locations affected, traditional laboratory services are often unavailable. In this study we compare point of care (POC) creatinine values to standardized laboratory values, and examine the effect of POC testing on the interpretation of AKI rates under tropical field conditions. Methods Blood samples were collected from 104 sugarcane workers from two time points in January 2018 as a derivation cohort, and from 105 workers from February to April 2017 as a validation cohort. Finger stick and venipuncture samples were drawn at the end of a worker’s shift to measure creatinine. Laboratory samples were tested in Guatemala City, Guatemala, in duplicate using the Jaffe Generation 2 method. An adjustment factor to improve agreement with serum creatinine was statistically derived and validated, and then used to determine impact on observed rates of acute kidney injury based on across shift changes in creatinine. Results POC creatinine and serum creatinine measures showed that POC consistently overestimated the creatinine by an average of 22% (95% CI: 19.8%, 24.7%) and the disagreement appeared greater at higher values of serum creatinine. An adjustment factor of 0.7775 was applied, which led to significantly greater agreement between the two measures. Rates of AKI in the two combined groups fell from 72% before adjustment to 57% afterwards. Conclusions POC testing under tropical field conditions routinely overestimates creatinine compared to laboratory testing, which leads to overestimation of rates of acute kidney injury. The application of an adjustment factor significantly improved the accuracy of the POC value.

The impact of heat and impaired kidney function on productivity of Guatemalan sugarcane workers

Background Climate change has implications for human health and productivity. Models suggest that heat extremes affect worker health, reduce labor capacity, and commodity supply. Chronic health conditions are on the rise internationally. However there is a paucity of direct empirical evidence relating increasing temperatures to both agricultural worker health and productivity. Methods and findings We evaluated the relationship between temperature exposure, kidney function, and two measures of productivity—tons of commodity produced and job attrition, of 4,095 Guatemalan sugarcane cutters over a 6-month harvest. We used distributed lag non-linear models to evaluate associations between wet bulb globe temperature (WBGT) and productivity of workers with normal or impaired kidney function. The cumulative effect of exposure to a max WBGT of 34°C was 1.16 tons (95% CI: -2.87, 0.54) less sugarcane cut over the next five days by workers with impaired kidney function, compared to exposure to 29°C. Impaired kidney function was associated with premature workforce attrition. Workers starting the harvest season with impaired kidney function were more than twice as likely to leave employment (HR: 2.92, 95% CI: 1.88, 4.32). Conclusions Heat extremes may be associated with loss of agricultural worker productivity and employment, especially among those with impaired kidney function. Agricultural workers who develop health conditions, such as kidney disease, are particularly vulnerable in the face of climate change and increasing heat extremes. The resultant loss of employment and productivity has significant implications for global commodity supplies.

1003 Small + safe + well: understanding the relationship between programs, organisational climate, and outcomes for health, safety and wellbeing among small business

Introduction The majority of workers are employed by small enterprises; however, small enterprises face many barriers to building and maintaining cultures of health and safety. This presentation will describe preliminary data from the evaluation of an existing community-based Total Worker Health (TWH) intervention – Health Links plus senior-level TWH leadership training – which aims to build small business capacity around health, safety and wellbeing policies and programs as well as strengthenorganisational climates. Methods We are recruiting small businesses with fewer than 500 employees in a variety of high and low hazard industries in Colorado USA. Upon enrolment, businesses are randomised into one of two doses: Health Links plus senior–level TWH leadership training and Health Links. Annual business- and employee-level assessments are collected. Results Data collection began in April 2017 and we will have baseline data to share from about 100 businesses and 3500 employees. We will present a cross-sectional assessment of (1) organizational-level adoption of TWH policies and programs (2) organisational safety and health climates, and (3) worker-level health and safety outcomes. Preliminary data from businesses enrolled in Health Links prior to the start of the study (n=145) indicates variation in level of policies and programs by business. Thus, we hypothesise that small businesses that have more TWH policies and programs have (1) more positive organisational safety and health climates, and (2) safer and healthier workers. Discussion Little is known about small business capacity for delivering health, safety and wellbeing. Even less is known about how TWH interventions impact employee safety, health and well-being in small enterprises. This information is needed to understand how to creategeneralizable TWH interventions that can have a broad public health impact.

Reoccurring Injury, Chronic Health Conditions, and Behavioral Health: Gender Differences in the Causes of Workers’ Compensation Claims

Objective: The aim of this study was o examine how work and nonwork health-related factors contribute to workers’ compensation (WC) claims by gender. Methods: Workers (N = 16,926) were enrolled in the Pinnacol Assurance Health Risk Management study, a multiyear, longitudinal research program assessing small and medium-sized enterprises in Colorado. Hypotheses were tested using gender-stratified logistic regression models. Results: For both women and men, having incurred a prior WC claim increased the odds of a future claim. The combination of incurring a prior claim and having metabolic health conditions resulted in lower odds of a future claim. Behavioral health risk factors increased the odds of having a claim more so among women than among men. Conclusion: This study provides data to support multifactorial injury theories, and the need for injury prevention efforts that consider workplace conditions as well as worker health.

The Impact of Worksite Wellness Programs by Size of Business: A 3-Year Longitudinal Study of Participation, Health Benefits, Absenteeism, and Presenteeism

Objective Worksite wellness programs (WWP) may positively impact employee health, medical expenditures, absenteeism, and presenteeism. However, there has been little research to assess the benefits of WWP in small businesses. The purpose of this study is to prospectively evaluate changes in health, absenteeism, and presenteeism for employees who participated in a WWP. Methods We conducted an observational, 3-year cohort study of 5766 employees from 314 businesses of differing sizes. We followed two cohorts of employees, who completed at least two annual health risk assessments (HRA) between May 2010 and December 2014. Changes from baseline to the first and second follow-up periods were assessed for chronic and non-chronic health conditions, absenteeism, and presenteeism. Results Small business employees were more likely to participate in the WWP than were employees from large businesses. Changes in chronic and non-chronic health conditions varied by size of business, with small business employees showing improvements in stress, overall health, depression, smoking status, vegetable and fruit consumption, and physical activity, and in their perceptions of job health culture. In contrast, large business employees experienced improvements in stress, vegetable consumption, and alcohol use. No changes in absenteeism or presenteeism were observed. Conclusions Small businesses achieve higher employee participation rates and more health improvements when compared to employees from large employers. Findings suggest that small businesses may gain the most from a WWP.