Total Worker Health

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Total Worker Health is a trademarked strategy defined as policies, programs, and practices that integrate protection from work-related safety and health hazards with promotion of injury and illness prevention efforts to advance worker well-being. It was conceived and is funded by the National Institute for Occupational Safety and Health (NIOSH). Total Worker Health is tested and developed in six Centers of Excellence for Total Worker Health in the United States. [1]

Contents

Definition

Total Worker Health (TWH) is defined as policies, programs, and practices that integrate protection from work-related safety and health hazards with promotion of injury and illness prevention efforts to advance worker well-being. [1] [2]

Traditional occupational safety and health protection programs have primarily focused on ensuring that work is safe and that workers are protected from the harms that arise from work itself. [1] TWH builds on this approach through the recognition that work is a social determinant of health. [3] Job-related factors such as wages, hours of work, workload and stress levels, interactions with coworkers, and access to leave and healthful workplaces all can have an important impact on the well-being of workers, their families, and their communities. TWH explores opportunities to not only protect workers, but also advance their health and well-being by targeting the conditions of work. Scientific evidence now supports what many safety and health professionals, as well as workers themselves, have long suspected—that risk factors in the workplace can contribute to health problems previously considered unrelated to work. For example, there are work-related risk factors for abnormal weight fluctuations, [4] [5] sleep disorders, [6] cardiovascular disease, [7] depression, [8] [9] [10] and other health conditions. In recognition of these emerging relationships, the TWH approach focuses on how environmental, workplace factors can both mitigate and enhance overall worker health beyond traditional occupational safety and health concerns. [1]

The five Defining Elements of TWH are: [11] [12]

Hierarchy of controls applied to Total Worker Health

Hierarchy of Controls Applied to Total Worker Health developed by the National Institute for Occupational Safety and Health Hierarchy of Controls Applied to Total Worker Health.jpg
Hierarchy of Controls Applied to Total Worker Health developed by the National Institute for Occupational Safety and Health

The Hierarchy of Controls Applied to NIOSH Total Worker Health is a conceptual model for prioritizing efforts to advance the safety, health, and well-being of all workers. This model applies the framework of Total Worker Health approaches to the traditional Hierarchy of Controls used in occupational safety and health. Like the traditional Hierarchy of Controls, strategies are presented in order of expected effectiveness, from top to bottom. [13]

  1. The first strategy is "Eliminate workplace conditions that threaten worker safety, health, and well-being."
  2. The second strategy is "Substitute health-enhancing policies, programs, and practices." This suggests replacing unsafe, unhealthy working conditions with policies, programs, and management practices that improve the culture of safety and health in the workplace.
  3. The third strategy is "Redesign the work environment for safety, health, and well-being."
  4. The fourth strategy is "Educate for safety and health." This suggests providing safety and health education and resources to enhance individual knowledge for all workers.
  5. The fifth strategy is "Encourage personal change." [13]

The hierarchy suggests that eliminating or reducing recognized hazards in the workplace is the most effective means of prevention. However, hazards that are difficult or impossible to eliminate can be managed through engineering, administrative, or individual-level interventions. Based on this hierarchy, workplace programs using a TWH approach may emphasize elimination or control of workplace safety and health hazards as the primary goal. [13]

Issues

Issues Relevant to Advancing Worker Well-Being Through Total Worker Health Issues Relevant to Advancing Worker Well-Being Using Total Worker Health Approaches.png
Issues Relevant to Advancing Worker Well-Being Through Total Worker Health

The accompanying graphic, “Issues Relevant to Advancing Worker Well-Being Using Total Worker Health Approaches” illustrates a wide-ranging list of issues that are relevant to advancing worker safety, health, and well-being. Revised in January 2020, this list reflects an expanded focus for TWH that recognizes workplace and work issues such as innovative technologies, working conditions, and emerging forms of employment that present new risks for today’s and tomorrow’s workforce. Additionally, this expanded focus recognizes that there are linkages between health conditions that may not arise from work but that can be adversely affected by work. Understanding, preventing, and reducing these risks are important elements of TWH. A TWH approach advocates for the integration of all organizational policies, programs, and practices that contribute to worker safety, health and well-being, including those relevant to the prevention and control of hazards and exposures, built environment supports, community supports, compensation and benefits, healthy leadership, organization of work, policies, technology, work arrangements, and workforce demographics.

History

Background

Total Worker Health originated from the Steps to a Healthier US Workforce symposium in October 2004, which sought to bring together knowledge and experience of health protection and health promotion, in order to stimulate action for the development of programs. The symposium developed around themes of research, practice and policy related to the integration of health protection and health promotion. [14]

By 2005, the initiative was redeveloped from the Steps to a Healthier US Workforce Symposium and renamed the NIOSH WorkLife Initiative. The WorkLife Initiative supported addressing worker health and well-being in a novel way, by addressing the physical and organizational work environment concurrently with personal health decisions and behaviors of individuals. In September 2007, NIOSH and 35 other sponsors conducted the "WorkLife 2007: Protecting and Promoting Worker Health" symposium. Collaborators at the symposium, which included leaders from labor, business and academic communities provided evidence of work and health benefits from integrated approaches, case studies, and anecdotal reports. The overall consensus was that such integrated work-based programs, if executed and sustained properly, can be good for worker health and business. [14]

In 2008, collaborators at NIOSH and the Centers of Excellence developed 10 recommendations, grouped in practice, research and policy, as a long-range strategy for advancing the WorkLife Initiative. These recommendations were based on evidence-based practice and research-to-practice initiatives. [15] In 2011, a collaborative symposium with other federal agencies culminated in the "Healthier Federal Workers 2011 Symposium", which applied the integrated work health approaches to federal employees. [14]

Expansion

In 2011, NIOSH WorkLife became "Total Worker Health" to better convey the more comprehensive approach to workplace prevention. [16] The year 2012 marked the publication of The Research Compendium: The NIOSH Total Worker Health Program: Seminal Research Papers 2012 [17] presenting the rationale for the TWH approach. These papers noted that a small, but growing body of evidence suggests that integrating occupational safety and health protection program activities with other workplace policies, programs, and practices is more effective for safeguarding worker safety, health, and well-being than either of these programmatic activities on their own. In 2014, NIOSH created the Office for TWH Coordination and Research Support (Office for TWH) to coordinate and advance these extramural and intramural efforts.

The 1st International Symposium to Advance Total Worker Health was first held October 6–8, 2014 at the National Institutes of Health Natcher Center. [18] The year 2015 marked developments for the program and Office, including the U.S. Patent and Trademark Office’s granting of the mark “Total Worker Health” as an official registered trademark of the U.S. Department of Health and Human Services; the launch of the first Center within TWH, the National Center for Productive Aging and Work; and a NIH-cohosted Pathways to Prevention Workshop [19] titled: “Total Worker Health—What’s Work Got to Do with It?”.

In 2016, the NIOSH Office for Total Worker Health released a National Occupational Research Agenda (NORA) National Total Worker Health Agenda [20] to define and prioritize activities for 2016–2026, and published Fundamentals of Total Worker Health Approaches: Essential Elements for Advancing Worker Safety, Health, and Well-being. [11] That same year, NIOSH funded six Centers of Excellence to conduct research on the concepts of Total Worker Health. [21] In 2017, three universities launched certificate programs for TWH. [22] In 2018, the National Institute for Occupational Safety and Health hosted the 2nd International Symposium to Advance Total Worker Health. [23] The year 2019 marked the first TWH publication, Edited Volume on Total Worker Health. [24]

NIOSH programs

NIOSH has funded ten Centers of Excellence for Total Worker Health in the United States to explore and research concepts of TWH, such as pilot testing policies and programs, building a scientific evidence base developing new solutions, developing and disseminating best practices and tool kits, developing strategies for overcoming barriers to organizational adoption, and applying physiological and biological markers of stress, sleep, and depression. [21] The ten NIOSH Centers of Excellence for Total Worker Health are at the University of California San Francisco, University of Colorado School of Public Health, University of Massachusetts Lowell and University of Connecticut jointly, Harvard-T.H. Chan School of Public Health, University of Iowa, Johns Hopkins University, Oregon Institute of Occupational Health Science, University of Illinois-Chicago, University of North Carolina at Chapel Hill, and University of Utah School of Medicine.

NIOSH also runs the Total Worker Health Affiliate Program to foster an integrated approach to protecting and promoting worker well-being through collaborations with academic, labor, nonprofit, and government organizations. [25]

Research

National Total Worker Health Agenda

National Total Worker Health Agenda National Total Worker Health Agenda.png
National Total Worker Health Agenda

In 2016, the NIOSH Office for Total Worker Health released a National Occupational Research Agenda (NORA) National Total Worker Health Agenda [20] to define and prioritize occupational safety and health research, practice, and prevention activities for 2016–2026. The Agenda, representing the first time a TWH-specific NORA has been created, builds on an earlier draft released in September 2014.

NIOSH invited stakeholders to provide comment on this draft agenda. In 2015, in response to stakeholder input received, the TWH definition was expanded and the TWH approach was more finely focused in the final Agenda. The refined description better reflects the priorities of the program, and helps to overcome the equating of TWH with traditional workplace wellness programs that do not integrate worker protection elements. TWH continues to place priority upon a hazard-free work environment that protects the safety and health of all workers. [26]

Sit-stand workstations

Pilot studies of sit-stand workstations have shown reductions in sedentary time and possible indications of improved health outcomes. Treadmill workstation view 2.jpg
Pilot studies of sit-stand workstations have shown reductions in sedentary time and possible indications of improved health outcomes.

Concerns over the increasingly sedentary lifestyle of individuals and the associated health risks lead to this development. A study from a large sample of Australian adults found that prolonged sitting was a risk factor for all-cause mortality, independent of physical activity. [27] Sit-stand workstations are custom-built computer workstations, allowing the user to adjust the height of the workplace envelope and to work while standing. With the implementation of sit-stand workstations, individuals will be able to reduce sedentary time while at work, thereby improving health outcomes, and possibly improving work productivity.

Published research in 2012 on the benefits from implementing sit-stand workstations in the workplace has resulted in the development of some pilot studies for Total Worker Health. While the individual results of the studies varied, the researchers found that sit-stand workstations resulted in an overall improvement in health outcomes of workers who switched to these workstations, in addition to the reduced sitting time. Such health benefits from these pilot studies include increased HDL cholesterol, improved mood outcomes, reduced eye strain, and reduced upper back, neck and shoulder pain. [28] [29] [30] Robertson et al. found that the sit-stand workstation users, who were trained to vary their postures at work, exhibited increased productivity at work, compared to those who were not trained so. [30] Further, the study by Pronk et al. showed decreased fatigue and increased vigor among participants. [29] With these findings, NIOSH has begun a pilot program among employees for the Total Worker Health initiative. [31]

Health care workers

Several studies out of the Harvard Center for Work, Health and Wellbeing have focused on the relationships between work context and quality of life measures for health care workers. A survey of over 1500 hospital patient care workers examined the relationships between health outcomes (lower back pain, inadequate physical activity, and sleep deprivation) and work context measures. [32] Inadequate physical activity and sleep deficiency were associated, while lower back pain was not significantly related to either stressor. [32] Work context measures, such as low supervisor support, harassment at work, job title, and job culture were found to be associated with the quality of life and health outcomes for the hospital care workers. [32]

Aging workforce

Seventy-year-old miner emerging from his coal mine in eastern Pennsylvania. 70 yr old miner.jpg
Seventy-year-old miner emerging from his coal mine in eastern Pennsylvania.

Aging in the American workforce, the rapidly increasing numbers of older workers (ages 55 and above) comprising the workforce in the United States, could have significant impacts to the economy, social security benefits, occupational safety and health, health care, and American society as a whole. Researchers from the American College of Occupational and Environmental Medicine (ACOEM) and NIOSH convened a national Invitational Summit on ‘’Advancing Workplace Health Protection and Promotion in the Context of an Aging Workforce’’ to address several questions and to develop consensus statements and recommendations for a national approach to tackle these issues. [33] These issues included why employers should care about aging in the workplace, how to establish best practices to maximize health and productivity of aging workers, how organizational structures can better approach aging in the workplace, what are the barriers to integrating health protection and promotion programs for aging workers, and what tools, programs, and resources exist to overcome the barriers. [33] Some of the consensus statements conceived during this summit include creating a “culture of health” throughout the workplace, creating “age-friendly” programs and policies, increasing the use of incentives to impact change, integrating workforce health as a standard business measures, conducting new research and models to analyze data, and creating a new culture of “shared accountability.” [33]

Implementation

Various companies have implemented integrated health protection and health promotion management programs successfully, with documented health improvements and cost savings. [34] Each integrated program varies a bit in focus areas and in implementation, but follow the components of Total Worker Health. Examples of companies that have yielded successful results from their programs include Caterpillar, FedEx, Dow Chemical and Perdue Farms. [34]

See also

Related Research Articles

<span class="mw-page-title-main">Personal protective equipment</span> Equipment designed to help protect an individual from hazards

Personal protective equipment (PPE) is protective clothing, helmets, goggles, or other garments or equipment designed to protect the wearer's body from injury or infection. The hazards addressed by protective equipment include physical, electrical, heat, chemicals, biohazards, and airborne particulate matter. Protective equipment may be worn for job-related occupational safety and health purposes, as well as for sports and other recreational activities. Protective clothing is applied to traditional categories of clothing, and protective gear applies to items such as pads, guards, shields, or masks, and others. PPE suits can be similar in appearance to a cleanroom suit.

<span class="mw-page-title-main">National Institute for Occupational Safety and Health</span> US federal government agency for work-related health and safety

The National Institute for Occupational Safety and Health is the United States federal agency responsible for conducting research and making recommendations for the prevention of work-related injury and illness. NIOSH is part of the Centers for Disease Control and Prevention (CDC) within the U.S. Department of Health and Human Services. Despite its name, it is not part of either the National Institutes of Health nor OSHA. Its current director is John Howard.

Occupational noise is the amount of acoustic energy received by an employee's auditory system when they are working in the industry. Occupational noise, or industrial noise, is often a term used in occupational safety and health, as sustained exposure can cause permanent hearing damage. Occupational noise is considered an occupational hazard traditionally linked to loud industries such as ship-building, mining, railroad work, welding, and construction, but can be present in any workplace where hazardous noise is present.

<span class="mw-page-title-main">Occupational hygiene</span> Management of workplace health hazards

Occupational hygiene is the anticipation, recognition, evaluation, control, and confirmation (ARECC) of protection from risks associated with exposures to hazards in, or arising from, the workplace that may result in injury, illness, impairment, or affect the well-being of workers and members of the community. These hazards or stressors are typically divided into the categories biological, chemical, physical, ergonomic and psychosocial. The risk of a health effect from a given stressor is a function of the hazard multiplied by the exposure to the individual or group. For chemicals, the hazard can be understood by the dose response profile most often based on toxicological studies or models. Occupational hygienists work closely with toxicologists for understanding chemical hazards, physicists for physical hazards, and physicians and microbiologists for biological hazards. Environmental and occupational hygienists are considered experts in exposure science and exposure risk management. Depending on an individual's type of job, a hygienist will apply their exposure science expertise for the protection of workers, consumers and/or communities.

<span class="mw-page-title-main">Occupational hazard</span> Hazard experienced in the workplace

An occupational hazard is a hazard experienced in the workplace. This encompasses many types of hazards, including chemical hazards, biological hazards (biohazards), psychosocial hazards, and physical hazards. In the United States, the National Institute for Occupational Safety and Health (NIOSH) conduct workplace investigations and research addressing workplace health and safety hazards resulting in guidelines. The Occupational Safety and Health Administration (OSHA) establishes enforceable standards to prevent workplace injuries and illnesses. In the EU, a similar role is taken by EU-OSHA.

<span class="mw-page-title-main">Musculoskeletal disorder</span> Medical condition

Musculoskeletal disorders (MSDs) are injuries or pain in the human musculoskeletal system, including the joints, ligaments, muscles, nerves, tendons, and structures that support limbs, neck and back. MSDs can arise from a sudden exertion, or they can arise from making the same motions repeatedly repetitive strain, or from repeated exposure to force, vibration, or awkward posture. Injuries and pain in the musculoskeletal system caused by acute traumatic events like a car accident or fall are not considered musculoskeletal disorders. MSDs can affect many different parts of the body including upper and lower back, neck, shoulders and extremities. Examples of MSDs include carpal tunnel syndrome, epicondylitis, tendinitis, back pain, tension neck syndrome, and hand-arm vibration syndrome.

<span class="mw-page-title-main">Health Hazard Evaluation Program</span>

The Health Hazard Evaluation (HHE) program is a workplace health program administered by the National Institute for Occupational Safety and Health (NIOSH). NIOSH developed the HHE program to comply with a mandate in the Occupational Safety and Health Act of 1970 to investigate workplace health hazards reported by employers and employees. According to Section 20(a)(6) of the Act, the Secretary of Health and Human Services is authorized "following a written request by any employer or authorized representative of employees, to determine whether any substance normally found in the place of employment has potentially toxic effects in such concentrations as used or found."

Workplace health surveillance or occupational health surveillance (U.S.) is the ongoing systematic collection, analysis, and dissemination of exposure and health data on groups of workers. The Joint ILO/WHO Committee on Occupational Health at its 12th Session in 1995 defined an occupational health surveillance system as "a system which includes a functional capacity for data collection, analysis and dissemination linked to occupational health programmes".

The National Occupational Research Agenda (NORA) is a partnership program developed by the National Institute for Occupational Safety and Health (NIOSH). The program was founded in 1996 to provide a framework for research collaborations among universities, large and small businesses, professional societies, government agencies, and worker organizations. Together these parties identify issues in the field of workplace safety and health that require immediate attention based on the number of workers affected, the seriousness of the hazard, and the likelihood that new safety information and approaches can effect a change.

Prevention through design (PtD), also called safety by design usually in Europe, is the concept of applying methods to minimize occupational hazards early in the design process, with an emphasis on optimizing employee health and safety throughout the life cycle of materials and processes. It is a concept and movement that encourages construction or product designers to "design out" health and safety risks during design development. The process also encourages the various stakeholders within a construction project to be collaborative and share the responsibilities of workers' safety evenly. The concept supports the view that along with quality, programme and cost; safety is determined during the design stage. It increases the cost-effectiveness of enhancements to occupational safety and health.

An occupational fatality is a death that occurs while a person is at work or performing work related tasks. Occupational fatalities are also commonly called "occupational deaths" or "work-related deaths/fatalities" and can occur in any industry or occupation.

<span class="mw-page-title-main">Physical hazard</span> Hazard due to a physical agent

A physical hazard is an agent, factor or circumstance that can cause harm with contact. They can be classified as type of occupational hazard or environmental hazard. Physical hazards include ergonomic hazards, radiation, heat and cold stress, vibration hazards, and noise hazards. Engineering controls are often used to mitigate physical hazards.

<span class="mw-page-title-main">Buy Quiet</span>

Buy Quiet is an American health and safety initiative to select and purchase the lowest noise emitting power tools and machinery in order to reduce occupational and community noise exposure. Buy Quiet Programs are examples of noise control strategies. Buy Quiet is part of the larger Hearing Loss Prevention Program, and is an example of Prevention Through Design, which seeks to reduce occupational injury through prevention considerations in designs that impact workers.

Occupational health nursing is a specialty nursing practice that provides for and delivers health and safety programs and services to workers, worker populations, and community groups. The practice focuses on promotion, maintenance and restoration of health, prevention of illness and injury, and protection from work‐related and environmental hazards. Occupational health nurses (OHNs) aim to combine knowledge of health and business to balance safe and healthful work environments and a "healthy" bottom line.

<span class="mw-page-title-main">Occupational safety and health</span> Field concerned with the safety, health and welfare of people at work

Occupational safety and health (OSH) or occupational health and safety (OHS), also known simply as occupational health or occupational safety, is a multidisciplinary field concerned with the safety, health, and welfare of people at work. These terms also refer to the goals of this field, so their use in the sense of this article was originally an abbreviation of occupational safety and health program/department etc. OSH is related to the fields of occupational medicine and occupational hygiene.

<span class="mw-page-title-main">Hierarchy of hazard controls</span> System used in industry to eliminate or minimize exposure to hazards

Hierarchy of hazard control is a system used in industry to prioritize possible interventions to minimize or eliminate exposure to hazards. It is a widely accepted system promoted by numerous safety organizations. This concept is taught to managers in industry, to be promoted as standard practice in the workplace. It has also been used to inform public policy, in fields such as road safety. Various illustrations are used to depict this system, most commonly a triangle.

<span class="mw-page-title-main">Safe-in-Sound Award</span>

The Safe-in-Sound Excellence in Hearing Loss Prevention Award is an occupational health and safety award that was established in 2007 through a partnership between the National Institute for Occupational Safety and Health (NIOSH) and the National Hearing Conservation Association (NHCA). In 2018, the partnership was extended to include the Council for Accreditation in Occupational Hearing Conservation (CAOHC).

<span class="mw-page-title-main">Occupational hearing loss</span> Form of hearing loss

Occupational hearing loss (OHL) is hearing loss that occurs as a result of occupational hazards, such as excessive noise and ototoxic chemicals. Noise is a common workplace hazard, and recognized as the risk factor for noise-induced hearing loss and tinnitus but it is not the only risk factor that can result in a work-related hearing loss. Also, noise-induced hearing loss can result from exposures that are not restricted to the occupational setting.

Occupational heat stress is the net load to which a worker is exposed from the combined contributions of metabolic heat, environmental factors, and clothing worn which results in an increase in heat storage in the body. Heat stress can result in heat-related illnesses, such as heat stroke, hyperthermia, heat exhaustion, heat cramps, heat rashes and chronic kidney disease. Although heat exhaustion is less severe, heat stroke is a medical emergency and requires emergency treatment, which if not provided can even lead to death.

Engineering controls are strategies designed to protect workers from hazardous conditions by placing a barrier between the worker and the hazard or by removing a hazardous substance through air ventilation. Engineering controls involve a physical change to the workplace itself, rather than relying on workers' behavior or requiring workers to wear protective clothing.

References

  1. 1 2 3 4 "Total Worker Health: Frequently Asked Questions". Centers for Disease Control. Retrieved 2017-01-31.PD-icon.svg This article incorporates text from this source, which is in the public domain .
  2. ↑ "CDC – NIOSH Total Worker Health". www.cdc.gov. Retrieved 2017-01-30.
  3. ↑ "WHO | What are social determinants of health?". www.who.int. Retrieved 2017-01-30.
  4. ↑ Luckhaupt, Sara E.; Cohen, Martha A.; Li, Jia; Calvert, Geoffrey M. (2014-03-01). "Prevalence of Obesity Among U.S. Workers and Associations with Occupational Factors". American Journal of Preventive Medicine. 46 (3): 237–248. doi: 10.1016/j.amepre.2013.11.002 . PMID   24512862.
  5. ↑ "NIOSHTIC-2 Search Results – Full View". www2a.cdc.gov. Retrieved 2017-01-30.
  6. ↑ "NIOSHTIC-2 Search Results – Full View". www2a.cdc.gov. Retrieved 2017-01-30.
  7. ↑ "NIOSHTIC-2 Search Results – Full View". www2a.cdc.gov. Retrieved 2017-01-30.
  8. ↑ "NIOSHTIC-2 Search Results – Full View". www2a.cdc.gov. Retrieved 2017-01-30.
  9. ↑ "NIOSHTIC-2 Search Results – Full View". www2a.cdc.gov. Retrieved 2017-01-30.
  10. ↑ "NIOSHTIC-2 Search Results – Full View". www2a.cdc.gov. Retrieved 2017-01-30.
  11. 1 2 "Fundamentals of TWH Approaches Workbook PDF" (PDF). NIOSH.
  12. ↑ "NIOSH Publication Page for Fundamentals of TWH Approaches". NIOSH. 2016. doi: 10.26616/NIOSHPUB2017112 .PD-icon.svg This article incorporates text from this source, which is in the public domain .
  13. 1 2 3 "Hierarchy of Controls Applied to NIOSH Total Worker Health | NIOSH | CDC". www.cdc.gov. 2021-08-02. Retrieved 2022-03-22.PD-icon.svg This article incorporates text from this source, which is in the public domain .
  14. 1 2 3 "CDC – Total Worker Health History of Total Worker Health – NIOSH Workplace Safety and Health Program". NIOSH. Retrieved 23 October 2012.
  15. ↑ Cherniack, Martin; Henning, Rob; Merchant, James A.; Punnett, Laura; Sorensen, Laura R.; Wagner, Gregory (2011). "Statement on National WorkLife Priorities". American Journal of Industrial Medicine. 54 (1): 10–20. doi:10.1002/ajim.20900. PMC   5860803 . PMID   20949545.
  16. ↑ "CDC – Total Worker Health WorkLife Transitions to Total Worker Health – NIOSH Workplace Safety and Health Program". NIOSH. Retrieved 23 October 2012.
  17. ↑ "CDC – NIOSH Publications and Products – The Research Compendium: The NIOSH Total Worker Health Program: Seminal Research Papers 2012 (2012–146)". www.cdc.gov. 2012. doi: 10.26616/NIOSHPUB2012146 . Retrieved 2017-01-30.
  18. ↑ "TWH Symposium on NIOSH TWH Website". September 14, 2017. Retrieved September 14, 2017.
  19. ↑ Bradley, Cathy J.; Grossman, David C.; Hubbard, Rebecca A.; Ortega, Alexander N.; Curry, Susan J. (2016-08-16). "Integrated Interventions for Improving Total Worker Health: A Panel Report From the National Institutes of Health Pathways to Prevention Workshop: Total Worker Health—What's Work Got to Do With It?". Annals of Internal Medicine. 165 (4): 279–83. doi: 10.7326/m16-0740 . ISSN   0003-4819. PMID   27240228.
  20. 1 2 "CDC – Research Program Development & Collaboration – NIOSH Office for Total Worker Health". www.cdc.gov. Retrieved 2017-02-01.
  21. 1 2 "CDC – NIOSH Centers of Excellence for Total Worker Health". NIOSH. Retrieved 14 March 2022.
  22. ↑ "Graduate Training, Certification Programs & Degree Programs | NIOSH | CDC". www.cdc.gov. 2019-10-25. Retrieved 2019-12-11.
  23. ↑ "A Total Worker Health Symposium" . Retrieved 2019-12-11.
  24. ↑ "Edited Volume on Total Worker Health". www.cdc.gov. 2019-09-17. Retrieved 2019-12-11.
  25. ↑ "CDC – Total Worker Health Topics – NIOSH Total Worker Health". www.cdc.gov. Retrieved 2017-02-01.
  26. ↑ "NIOSH Response to Summarized Stakeholders' Comments on Proposed National Total Worker Health Agenda" (PDF).
  27. ↑ van der Ploeg, HP; Chey, T; Korda, RJ; Banks, E; Bauman, A (2012). "Sitting time and all-cause mortality in 222497 Australian adults". Arch Intern Med. 172 (6): 494–500. doi:10.1001/archinternmed.2011.2174. PMID   22450936.
  28. ↑ Alkhajah, TA; Reeves, MM; Eakin, EG; Winkler, EA; Owen, N; Healy, GN (2012). "Sit-stand workstations: a pilot intervention to reduce office sitting time" (PDF). Am J Prev Med. 43 (3): 298–303. doi:10.1016/j.amepre.2012.05.027. PMID   22898123.
  29. 1 2 Pronk, NP; Katz, AS; Lowry, M; Payfer, JR (2012). "Reducing occupational sitting time and improving worker health: The Take-a-Stand Project, 2011". Prev Chronic Dis. 9 (110323): E154. doi:10.5888/pcd9.110323. PMC   3477898 . PMID   23057991.
  30. 1 2 Robertson, MM; Ciriello, VM; Garabet, AM (2012). "Office ergonomics training and a sit-stand workstation: effects on musculoskeletal and visual symptoms and performance of office workers". Appl Ergon. 44 (1): 73–85. doi:10.1016/j.apergo.2012.05.001. PMID   22727324.
  31. ↑ "CDC – NIOSH Science Blog – NIOSH Takes a Stand". NIOSH. Retrieved 11 December 2012.
  32. 1 2 3 Sorensen, G; Stoddard, AM; Stoffel, S; Buxton, O; Sembajwe, G; Hashimoto, D; Dennerlein, JT; Hopcia, K (2011). "The Role of the Work Context in Multiple Wellness Outcomes for Hospital Patient Care Workers". Journal of Occupational and Environmental Medicine. 53 (8): 899–910. doi:10.1097/JOM.0b013e318226a74a. PMC   3693572 . PMID   21775897.
  33. 1 2 3 Loeppke, Ronald R.; Schill, Anita L.; Chosewood, L. Casey; Grosch, James W.; Allweiss, Pamela; Burton, Wayne T.; Barnes-Farrell, Janet L.; Goetzel, Ron Z.; Heinen, LuAnn; Hudson, T. Warner; Hymel, Pamela; Merchant, James; Edington, Dee W.; Konicki, Doris L.; Larson, Paul W. (2013). "Advancing Workplace Health Protection and Promotion for an Aging Workforce". Journal of Occupational and Environmental Medicine. 55 (5): 500–506. doi: 10.1097/jom.0b013e31829613a4 . PMID   23657074. S2CID   5396115.
  34. 1 2 Goetzel, Ron Z. (2005). "Examining the Value of Integrating Occupational Health and Safety and Health Promotion Programs in the Workplace" (PDF). NIOSH Report. Retrieved 23 October 2012.
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