Reducing risk for chronic disease: evaluation of a collective community approach to sustainable evidence-based health programming.

BACKGROUND: Community initiatives can shape health behaviors, such as physical activity and dietary habits, across a population and help reduce the risk of developing chronic disease. To achieve this goal and impact health outcomes, Pasadena Vibrant Community aimed to engage communities in an ongoing dialogue about the importance of healthy behaviors, implement and advance community-based strategies to promote health, and improve diet and physical activity behaviors. The initiative was centered around a collaboration between a backbone organization, steering committee, and 7 collaborating organizations funded to implement multicomponent, evidence-based programs.. The common agenda was detailed in a community action plan, which included 19 interventions targeting healthy eating and active living among adults and youth in Pasadena, Texas. METHODS: A mixed methods evaluation of the initiative was conducted over 4 years. Data sources included document reviews of quarterly progress reports (n = 86) and supplemental data reports (n = 16) provided by collaborating organizations, annual Steering Committee surveys (n = 4), and interviews conducted with staff from a subset of Collaborating Organizations (n = 4). RESULTS: The initiative reached over 50,000 community members per year through 19 evidence-based interventions and impacted health outcomes, including knowledge and adoption of healthy eating practices and increased physical activity. Thirty-one systems-level changes were implemented during the initiative, including 16 environmental changes. Steering Committee meetings and shared goals enabled connections, communication, and cooperation, which allowed Collaborating Organizations to address challenges and combine resources to deliver their programs. CONCLUSIONS: Community initiatives can effectively permeate the community by reaching individuals, improving physical activity and dietary habits, and ensuring sustainability. Based on the experience reported here, the success of a community initiative can be facilitated if collaborating organizations come together to implement evidence-based interventions and tailor them to the community, and if they are empowered by significant leadership and supportive collaboration and aligned by a common agenda.

Expanding the Focus of Occupational Safety and Health: Lessons from a Series of Linked Scientific Meetings.

There is widespread recognition that the world of work is changing, and agreement is growing that the occupational safety and health (OSH) field must change to contribute to the protection of workers now and in the future. Discourse on the evolution of OSH has been active for many decades, but formalized support of an expanded focus for OSH has greatly increased over the past 20 years. Development of approaches such as the National Institute for Occupational Safety and Health (NIOSH)'s Total Worker Health® concept and the World Health Organization (WHO)'s Healthy Workplace Framework are concrete examples of how OSH can incorporate a new focus with a wider view. In 2019, NIOSH initiated a multi-year effort to explore an expanded focus for OSH. This paper is a report on the outputs of a three-year cooperative agreement between NIOSH and The University of Texas School of Public Health, which led to subject matter expert workshops in 2020 and an international conference of global interest groups in 2021. This article traces the background of these meetings and identifies and assesses the lessons learned. It also reviews ten thematic topics that emerged from the meetings: worker health inequalities; training new OSH professionals; future OSH research and practice; tools to measure well-being of workers; psychosocial hazards and adverse mental health effects; skilling, upskilling and improving job quality; socioeconomic influences; climate change; COVID-19 pandemic influences; and strategic foresight. Cross-cutting these themes is the need for systems and transdisciplinary thinking and operationalization of the concept of well-being to prepare the OSH field for the work of the future.

Fitness-for-Duty Assessments of Industrial Firefighters: Guidance for Occupational Medicine Physicians.

: Industrial firefighters share many characteristics with municipal firefighters; however, employers frequently have not addressed or characterized the unique job duties, hazards, and specific physical/mental demands associated with industrial firefighting. In addition, gaps exist in the medical literature with regard to industrial firefighter demographics, behavioral risk factors, and chronic diseases. Finally, the proper methodologies for fitness-for-duty assessment of employees acting in this capacity are lacking. To address these gaps, the American College of Occupational and Environmental Medicine (ACOEM) convened a Task Force in 2014, to develop fitness-for-duty guidance for industrial firefighters. This document highlights these gaps and suggests research opportunities to enhance the health and safety of this population. While an extensive literature review found a lack of studies for this population-thus excluding the development of an evidence-based document-sufficient materials were available from which to draw preliminary conclusions, considerations for best practices, and recommendations for future studies.

Simulating the impact of changing trends in smoking and obesity on productivity of an industrial population: an observational study.

OBJECTIVE: To estimate the impact of trends in smoking and obesity prevalence on productivity loss among petrochemical employees from 1980 to 2009. METHODS: Smoking and obesity informations were collected during company physical examinations. Productivity loss was calculated as differential workdays lost between smokers and non-smokers, and obese and normal-weight employees. RESULTS: During 1980-2009, smoking prevalence decreased from 32% to 17%, while obesity prevalence increased from 14% to 42%. In 1982, lost productivity from obesity was an estimated 43 days/100 employees, and for smoking, 65 days/100 employees, but by 1987, workdays lost due to obesity exceeded that attributable to smoking. In 2007, workdays lost from obesity were 3.7 times higher than for smoking. CONCLUSIONS: Owing to the increasing trend in obesity, the productivity impact on employers from obesity will continue to rise without effective measures supporting employee efforts to achieve healthy weight through sustainable lifestyle changes.

Risk factors for illness absence due to musculoskeletal disorders in a 4-year prospective study of a petroleum-manufacturing population.

OBJECTIVES: To quantify risk factors for nonoccupational absence from musculoskeletal disorders (MSD) among petroleum-manufacturing employees. METHODS: We conducted a 4-year follow-up study including 860 employees with an MSD illness absence of 4 days or longer and 5691 employees with no MSD absence. Odds ratios were calculated using logistic regression. RESULTS: Risk of MSD absence from low back and non-low back disorders was significantly associated with physically demanding job, overweight/obesity, prior absence from MSD, and absence from cardiovascular, respiratory, or mental illness, or accidents during the study period. Smoking also increased risk of low back disorders. CONCLUSIONS: Results suggest it is possible to reduce the impact of MSD through integrated safety prevention and health promotion programs including traditional elements of job factor evaluation, training, and ergonomics, but also health counseling and support for weight reduction, smoking cessation, and personal fitness programs.

The Shell Disability Management Program: a five-year evaluation of the impact on absenteeism and return-on-investment.

OBJECTIVE: To evaluate the impact of the Shell Disability Management Program (DMP) on U.S. manufacturing employee absenteeism. METHODS: We estimated absence episodes and days lost per employee from 2004 to 2008 compared to pre-program values in 2002, and productivity gains from transitional duty (TD). RESULTS: Between 2002 and 2008, absence episodes/100 employees decreased from 37.4 to 25.7 among hourly workers but increased from 9.7 to 13.1 among staff employees. Days lost per employee decreased from 7.4 to 5.2 for hourly employees and were virtually unchanged for staff employees. TD resulted in 6042 days saved in 2006 and 11,438 days in 2008, with direct cost savings of more than $4.1 million from 2006 to 2008. CONCLUSIONS: The Shell DMP emphasizes absence tracking, timely return-to-work, and facilitation of TD. Absenteeism decreased significantly after DMP implementation, particularly among hourly employees, with an estimated 2.4:1 return-on-investment.

Combined impact of health risk factors on mortality of a petroleum industry population.

OBJECTIVE: To assess the combined impact of health risk factors on mortality. METHODS: A 21-year mortality follow-up of 12,896 Shell Oil Company employees was conducted. Relative risks of mortality, expressed as hazard ratios, in relation to the six risk factors, including cigarette smoking, obesity, high blood pressure, total cholesterol, serum glucose, and triglycerides, were calculated using a Cox proportional hazards model. RESULTS: Employees with health risk factors had higher mortality rates for all-causes combined and for cardiovascular diseases compared to employees without such risk factors. Smoking, obesity, hypercholesterolemia, and hyperglycemia independently and significantly predicted cardiovascular disease mortality. Mortality risks from all causes and from cardiovascular disease increased with the number of risk factors present. CONCLUSIONS: This study found a positive association between several health risk factors and mortality. A greater number of risk factors corresponded to a higher rate of death. Reductions of employee health risk factors may be an effective means of improving employees' long-term health.

Refinery firefighters: assessing fitness for duty.

Firefighting is a hazardous and physically demanding activity. The demanding nature of the tasks involved in firefighting requires a high level of fitness both for the safety of the firefighting personnel as well as for the adequate performance of their tasks. Here, the characteristics (body weight, lung function, etc.) of a small group of refinery firefighters were investigated using exploratory factor analysis and discriminant analysis. The results indicated that there is a group of factors that characterize those individuals meeting minimum fitness requirements as described previously in the literature. The factors that were identified included those related to anthropometry (such as body composition and weight) and those related to physical capabilities (such as push-ups). Since these data are collected relatively easily in most occupational settings, they may offer an efficient surrogate method to determine fitness for duty among firefighters.

Reliability and validity of an occupational health history questionnaire.

This study determined the reliability and validity of a self-administered occupational health history questionnaire. Reliability was evaluated using a test-retest study design based on 123 volunteers (56% participation rate) who were administered the questionnaire approximately 1 month apart. Validity and general acceptability was evaluated in a clinical setting through in-depth clinician interviews of 25 patients. The interviews assessed patients' understanding of and sensitivities to questions and degree of adherence to initial responses after discussing questions with clinicians. All but one question related to repetitive motion exposures showed 84% or higher agreement. Clinician interviews of patients indicated that most questions were well understood, although some patients misinterpreted questions regarding pregnancy history, repetitive motion, and immunization history. Overall, our results suggest that the questionnaire is highly reliable, valid, and acceptable to both clinicians and employees.