Center Projects

Center Projects

Research projects in the Healthier Workforce Center gather information to examine the impact of work organization and environment on safety, health, and well-being over time, as well as factors that impact the adoption by employers of programs, practices and policies designed to reduce these exposures.

Supervising Remote Work

Supervising the Future of Remote Work

Training for supervisors of remote workers is increasingly available, but lacks an evidence-base assessing the efficacy of these trainings, and fails to address the well-being of supervisors or employees. In this research project, the team will develop a training to address remote supervisor well-being and productivity and evaluate how this training will also affect employee well-being. Preliminary data from longitudinal employee well-being surveys conducted by the Center, indicates that remote supervisors are particularly affected by increased workload, more permeable work-family boundaries, and lack confidence in their remote management skills which leads to a burden for both workers and employers.

The team will adapt content previously developed for executive and professional education to address these additional areas of need in an intervention for supervisors of remote workers (Aim 1). The training will be implemented and evaluated in three large organizations using a multilevel randomized controlled trial (Aim 2). Contextual and organizational factors will be examined using both data collected during the trial and key informant interviews with an additional sample of Midwestern employers varying by industry and organizational size (Aim 3). Study outputs will include results of the trial showing effects of the intervention on the well-being of remote workers in the study population, and data from a broader group of employers that will guide future work to revise (if needed), translate, and disseminate the training intervention across job levels, categories, and occupations to positively impact the well-being of supervisors and remote workers.

Coming soon.

Livingston B. The Future of Work (and Life): Managing Boundaries for Yourself and Others. University of Iowa Nurse-Midwives Retreat. October 28, 2022. 

Livingston B. Best Practices, Tips, & Techniques for Different Work Modalities. Healthcare Information and Management Systems Society (HIMSS) Iowa Conference. November 3, 2022. 

Livingston B. Best Practices, Tips, & Techniques for Different Work Modalities. University of Iowa Staff Council Meeting. November 9, 2022.

Livingston B. Navigating Work-Life Boundaries. NIOSH Total Worker Health Webinar Series. November 10, 2022. 


Opioid Use Guidelines

Ann Marie Dale, PhD - Washington University-St. Louis

Construction workers continue to use prescription opioids and other substances for relief from pain caused by excessive physical and mental demands of work. Many construction factors including non-standard work arrangements, complex organization of work and narrow profit margins create challenges for employers to create effective opioid prevention programs and recovery friendly workplaces. Employers are becoming increasingly aware of worker’s opioid use and negative health outcomes of overdose and suicide. In spite of the burden on the workplace, most employers are not sure what to do to address the problem in their workforce and on their projects. Employers need help to recognize their role and how to address these issues through changes in their policies, programs, and health benefits. The research team is currently conducting a NIDA funded project (R34DA050044) focused on opioid misuse among construction workers. They conducted a series of stakeholder interviews with construction, healthcare, insurance, and legal experts on opioid related policies and programs. The interviews revealed common gaps in policies and programs that lead to opioid misuse, and potential strategies to overcome these barriers. Workplace Opioid Prevention Guidelines for the Construction Industry are currently drafted. There is a need to address the lack of knowledge, beliefs, and self-efficacy among construction stakeholders in order for them to be motivated to adopt evidence-based policies and programs. The CDC recommends using a social marketing approach to increase uptake and usability of products for complex interventions. The purpose of this project will be to refine the draft Guidelines using a social marketing process to translate and promote uptake by a broad range of construction stakeholders. Through this process, the research team will expand the target audience of users from the construction industry to go beyond early adopters. They will first assess manager’s attitudes, beliefs, self-efficacy, and barriers toward using the Guidelines and from results, identify the audience segment we will target for using the social marketing process (Aim 1). Next, they will create and follow a marketing plan and develop the revised intervention materials through an iterative process involving manager feedback from the target audience (Aim 2). The revised Guidelines will then be assessed by a broader range of stakeholders to assess relevance, understandability, likability, credibility and willingness to change policies and practices (Aim 3). The output of the research project will be Workplace Opioid Guidelines for the Construction Industry. Working with the Outreach Core, the Guidelines be disseminated to employers and union health funds to impact workplace opioid prevention policies, programs, and practices. 

Coming soon.

Dale AM, Keniston L, Kurtz S, Campo S. Social Marketing Targets Motivators for Participation in an Opioid Prevention Intervention. Total Worker Health Symposium, Bethesda, MD. October 13, 2022. 

Evanoff B, Rohlman DS, Dale AM, Anderson B, Dennerlein J. Preventing Suicide and Protecting Mental Health in the Construction Industry. Total Worker Health Symposium, Bethesda, MD. October 13, 2022. 

Kurtz S, Dale AM. Workplace Opioid and Substance Use Prevention Guidelines for the Construction Trades. Presented at 19th Annual Greater St. Louis Safety and Health Conference, St. Louis, MO, October 2022.

Dale AM. Opioid Guidelines and the Construction Industry. Presented at the National Occupational Research Agenda (NORA) Construction Sector Council, Washington, DC, November 16, 2022.  

Dale AM. Opioid Risk Reduction: How Employers Can Use Best Practices. Presented at Workplace Mental Health Action Summit 2.0: The Next Generation of Mental Health, Kansas City, MO, March 29, 2023.

Dale AM. Opioid Misuse and Overdose: Can health funds use their data to drive opioid prevention efforts for their members? Presented at Laborers International Union of North America (LIUNA) Midwest Region Tri Funds Conference, Osage Beach, MO, June 11, 2023.

Dale AM. Wrap up: Where do we go from here? Presented at Recovery Friendly Workplace Missouri Reimagining Today’s Workforce, Columbia, MO, August 10, 2023.


Implementation of Total Worker Health® in Nursing Homes

Jess Williams, PhD - Penn State University

The overall objective of this project is to determine the organizational factors that impact adoption and implementation of TWH interventions in nursing homes. This study has two aims. The first aim focuses on assessing the impact of key organizational factors, such as chain membership and community resources, on TWH adoption in nursing homes in Federal Region VII, using a survey linked with Medicare data. The second aim will utilize in-depth interviews with Directors of Nursing to investigate the decisional processes influencing TWH implementation. These interviews will focus on understanding how: current occupational safety and health strategies were developed and executed; competing priorities are balanced, and cultural factors that impact implementation of TWH interventions in nursing homes. Working with the Outreach Core, findings will be translated and disseminated through various mechanisms to address both academic audiences and nursing home management and workers.  

Coming soon.

Williams J. Data and Participant Feedback Supporting the Move from a Worksite Health Promotion Program to a Total Worker Health® Program within Long-term Care Settings. Total Worker Health Symposium, Bethesda, MD. October 13, 2022. 


Mental Health in Construction

Brad Evanoff, PhD - Washington University-St. Louis

While great strides have been taken to reduce traumatic injury and chemical exposures among construction workers, there is little awareness of or organized effort to understand and change work organization and environment issues that contribute to striking disparities in health and health behaviors that exist in this worker population. Since the majority of construction contractors are small businesses with limited financial resources, there is a need for low-cost interventions that can be readily incorporated into existing occupational safety and health programs (CPWR, 2013). To address this burden, there is a strong need for evidence-based interventions that can be implemented at multiple levels in the challenging culture and organization of construction. The Mental Health in Construction large research project will adapt and implement an existing, evidence-based, multicomponent mental health and suicide prevention program specific to construction that has been widely disseminated in Australia, “Mates in Construction” (“MATES”; Gullestrup et al., 2011; MATES in Construction, 2018; Martin et al., 2016). Interventions will include training at three organizational levels to change attitudes and culture around mental health stigma and help-seeking, and to improve help offering. In Aim 1 the research team will work with regional stakeholders, including leaders of contractor associations, contractors, and union health benefit plans to adapt MATES for the American construction industry. In Aim 2 the team will recruit regional contractors to implement the adapted intervention, which will include different levels of training and increased social and organizational support for suicide prevention and mental health promotion, including improved referral to existing mental health resources offered by employers and unions. In Aim 3, they will evaluate the implementation of the adapted intervention, and its efficacy in changing awareness of suicide and mental health, and changing attitudes around help-seeking and help-offering. The proposed intervention will be designed for dissemination, in coordination with the Outreach Core, through contractor associations and construction unions. This project builds on existing mental health and suicide prevention efforts successfully implemented with our regional construction partners through existing Healthier Workforce Center activities. The proposed study will address personal, cultural, and organizational factors that make construction a high-risk industry, and has a high potential impact to improving health by informing ongoing national efforts to improve mental health and to decrease suicide among this high-risk worker group. Project outputs and outcomes include a multi-level suicide prevention and mental health promotion intervention that can be implemented in US construction firms, leading to improved referral pathways for workers in need, and improved awareness, help-seeking, and help-offering among construction workers. 

Coming soon.

Evanoff B, Rohlman DS, Dale AM, Anderson B, Dennerlein J. Preventing Suicide and Protecting Mental Health in the Construction Industry. Total Worker Health Symposium, Bethesda, MD. October 13, 2022. 

Dale AM, Davis J, Rohlman DS, Evanoff BE. Implementing Multifaceted and Evidence-Based Approaches to Address Suicide Prevention in the Construction Industry. Construction Working Minds. February 29, 2024.

Previously Funded Center Projects

Apprentice Research Project

Impacting the Safety, Health, and Well-Being of Construction Apprentices: Using Intermediaries to Disseminate Change

The Construction Intermediary Research Project had two major components. First, we conducted a longitudinal survey among apprentice construction workers to identify relationships between work organization, environmental factors, health behaviors, and health outcomes. Second, we prioritized Total Worker Health (TWH) interventions among construction contractors and unions, and then used these key intermediary organizations to disseminate TWH interventions. Longitudinal surveys (over 900 apprentices each year for three years) identified the influence of work organization and environment (job strain, coworker safety behaviors, mandatory overtime, precarious work, supervisor support) on missed work, productivity, and use of pain medications among apprentices. Analysis of cross-sectional data found that health behaviors and both health and employment outcomes were related to multiple work organization factors, including job strain, mandatory overtime, precarious work, safety behaviors of coworkers, and supervisor support for safety. Most of these relationships persisted in our longitudinal analyses. In a separate analysis we found that these factors influenced binge drinking.

We also conducted focus groups and interviews with regional construction contractors, trade unions, and apprenticeship programs to identify current workplace programs, policies, and practices affecting worker health and well-being, and to prioritize areas for intervention. We found that few employers had formal programs addressing worker health and well-being beyond traditional workplace safety. While many felt that workplace policies should not address “personal behaviors” such as smoking, suicide prevention and opioid use were identified as high priorities for intervention by all groups. Our academic team provided content, logistical support, and consultation to these intermediaries (two regional contractor associations, two union health funds, and two union apprentice training programs) to develop and deploy new educational and awareness programs around suicide, mental health, and opioid use.

To date, Associated General Contractors of Missouri has implemented a week-long suicide prevention and awareness campaign. Two union health funds have created media plans and run stories in their newsletters about suicide and opioid use, reaching approximately 23,000 members. Two union apprenticeship programs will provide opioid use prevention training (developed with our team) for all new apprentices. Evaluation of these programs is ongoing, including the reach and uptake of awareness efforts and changes in knowledge and attitudes. This study established partnerships with trusted intermediary organizations, and showed that these can be an effective way to disseminate health information to high-risk worker groups. These materials were disseminated throughout the region.

Evanoff BA, Rohlman D, Strickland JR, Kelly KM, Dale AM. (2018, April-May). “Influence of work organization and environment on health
behaviors of construction apprentices.” Presented at the 32nd International Congress on Occupational Health, Dublin, Ireland.

Dale AM, Welch L, Evanoff BA. (2018, April-May). “Participatory ergonomic programs in commercial construction projects: Engagement
with multiple organizational levels to improve effectiveness.” Presented at the 32nd International Congress on Occupational Health,
Dublin, Ireland.

Dale AM, Rohlman DS, Strickland JR, Kelly KM, Evanoff BA. (2018, May). “Contrasting Prevalence of Health and Safety Risks and
Controls between Residential and Commercial Construction Apprentices.” Presented at the 2nd International Symposium to Advance
Total Worker Health, Bethesda, MD.

Evanoff BA, Rohlman, DS, Strickland JR, Kelly KM, Dale AM. (2018, May). “Influence of work organization and environment on health
behaviors of construction apprentices.” Presented at the 2nd International Symposium to Advance Total Worker Health, Bethesda, MD.

Evanoff BA, Rohlman DS, Strickland JR, Kelly KM, Dale AM. (2018, October). “Influence of work organization and environment on health
and productivity outcomes among construction apprentices: A Total Worker Health® approach.” Presented at the 7th National
Occupational Injury Research Symposium (NOIRS), Morgantown, WV.

Rohlman DS, Stickland J. (2018, October). “Influence of work organization and environment on health behaviors.” Presented at the 15th
Annual Greater St. Louis Safety & Health Conference, St. Louis, MO.

Dale AM, Rohlman DS, Strickland JR, Kelly KM, Evanoff BA. (2019, February). “Contrasting Prevalence of Health and Safety Risks and
Controls between Residential and Commercial Construction Apprentices.” Webinar presented with the Work Wellness Disability
Prevention Institute.

Rohlman DS. (2019, February). “Total Worker Health: An Example with Construction Apprentices.” Presented at the Department of
Occupational and Environmental Health Seminar, Iowa City, IA.

Evanoff BA, Rohlman DS, Strickland JR, Kelly KM, Dale AM. Influence of work organization and environment on health and productivity outcomes among construction apprentices: A Total Worker Health approach. 27th International Epidemiology in Occupational Health Conference (EPICOH), Aotearoa, New Zealand. 2019.

Rohlman DS, Evanoff, BA, Kelly KM, Strickland JM, Dale AM. The Impact of Work Organization and Work Environment on Health Behaviors of Construction Apprentices. 13th International Conference on Work, Stress and Health 2019, American Psychological Association, Philadelphia, PA. 2019.

Evanoff BA, Gage BF, Hayibor L, Colvin R, Strickland JR, Dale AM. Occupational factors are associated with opioid use among construction workers. American Public Health Association Annual Meeting & Expo (APHA) virtual meeting, 2020.

Evanoff BA, Strickland JR, Kinghorn AM, Rohlman D, Dale AM. Feasibility of using intermediary organizations to disseminate interventions to improve construction workers’ health and well-being: A Total Worker Health approach. American Public Health Association Annual Meeting & Expo (APHA), 2020.

Supplemental Projects

Opioid Prescription Use Among Union Construction Workers

Washington University in St. Louis, School of Medicine

A survey was conducted with union apprentices in 2018 and findings demonstrated high musculoskeletal symptoms and use of prescription pain medications. Opioids are commonly prescribed for treatment of musculoskeletal injuries and some data show these prescriptions are given for chronic musculoskeletal conditions as well. Construction workers have one of the highest rates of receiving prescriptions for opioid of any occupation and are at high risk of opioid overuse, dependency, and overdose fatalities. These concerns led to a request from the Carpenters’ Regional Council to extend the goals of the partnership by adding an opioid specific project to the ongoing apprentice project. The request is timely since opioid addiction and overdose have become a critical public health and workplace issue.

With supplemental funding from NIOSH to the Healthier Workforce Center of the Midwest coupled with funds from the Institute for Public Health at Washington University, Associate Professor Ann Marie Dale, PhD, OTR/L, is examining this issue more closely. The new project includes workers in Missouri, Kansas and Southern Illinois and use personal health insurance claims data collected between 2015 and 2018.

Dale’s team is exploring the relationships between opioid use and potentially preventable musculoskeletal disorders that have been associated with the physically demanding work activities of union construction workers. They are also testing the effectiveness of an intervention to decrease opioid use. The intervention includes a policy to restrict the initial prescribed quantity to one week followed by the provider’s reassessment of the member’s health status before additional prescriptions. In addition, members with new opioid prescriptions will be sent educational materials describing the risks of abuse soon after filling an opioid prescription.

Opioid Treatment and Work-Related Injuries in Iowa

University of Iowa

This project is using Iowa’s workers’ compensation data and data from Iowa’s Prescription Monitoring Program to examine how physically demanding jobs (e.g., healthcare and social assistance, manufacturing, retail trade, and educational services) impact opioid treatment and opioid related deaths.

The Role of Work Factors Influencing Health Behaviors, Health Interventions, and Health and Employment Outcomes

Washington University in St. Louis, School of Medicine

This small project is focused on the effects of work organization, workplace physical and psychosocial factors, and organizational health culture as predictors of changes in body weight and health behaviors including healthy eating and physical activity. Data from a large, multi-level group-randomized trial of
a workplace weight loss intervention in low-income health care workers (NIDDK R01 DK103760) will be used to examine the effects of work-related factors outside the scope of the original proposal. Initial analyses have described the associations of organizational health climate, supervisory support, and job satisfaction on the implementation success of a worker-driven participatory intervention, finding that results at one year showed statistically significant improvements in reported organizational health climate, supervisor support, and job satisfaction in workgroups with better-functioning participatory teams. Study findings will offer improved approaches to scalable workplace-based health behavior change that take into account organizational polices, programs, and practices as well as individual factors.

Evaluation & Planning Core-Funded Projects

Employee Well-Being Surveys

In response to the COVID-19 pandemic, there was considerable interest in learning about the impact of changes to work organization and well-being among clinical and non-clinical essential workers, remote workers, and supervisors. Faculty from Tippie collaborated on longitudinal surveys conducted at Washington University and the University of Iowa, who both have large regional hospitals as well as large and diverse employee populations outside of healthcare. Survey findings have been shared with leaders at both institutions and disseminated through local and regional webinars focusing on managing remote workers. Findings from the initial Washington University survey (first of 4 waves) included the negative impact of the pandemic on the well-being of clinical and non-clinical workers.