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.

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.