Behavioral-diagnostic analysis of compliance with universal precautions among nurses.

This study used the PRECEDE model (L.W. Green, M.W. Kreuter, S.G. Deeds, & K.B. Partridge, 1980) to examine individual, job-task, and environmental-organizational factors related to compliance with universal precautions (UP) among nurses. Structural equation modeling showed that the hypothesized model did a better job predicting general compliance (R2 = .41) than compliance with personal protective equipment (PPE; R2 = .18). All 3 categories of diagnostic factors (predisposing, enabling, and reinforcing) influenced general compliance, but predisposing factors were relatively unimportant for compliance with PPE. With a set of nested models, the greatest improvement in model fit occurred when the indirect effects of reinforcing factors were added. A positive safety climate may increase the likelihood that the work environment will contain features that enable workers to comply with safe work practices.

Health promotion programs in small worksites: results of a national survey.

PURPOSE: This study documents the prevalence of workplace health promotion activities at small worksites with 15 to 99 employees. DESIGN: A random sample of U.S. worksites stratified by size and industry (n = 3628) was drawn using American Business Lists. MEASURES: Each worksite was surveyed using a computer-assisted telephone interview system to document activities related to health promotion and related programs, worksite policies regarding health and safety, health insurance, and philanthropic activities. SUBJECTS: Participation varied by industry and size, with an overall response rate for eligible worksites of 78% for a total sample of 2680 worksites. DATA ANALYSIS: Data were analyzed using SUDAAN statistical software. RESULTS: Approximately 25% of worksites with 15 to 99 employees offered health promotion programs to their employees, compared with 44% of worksites with 100+ employees. As with the larger worksites, the most common programs for worksites with 15 to 99 employees were those related to occupational safety and health, back injury prevention, and CPR. The majority of worksites in both size categories had alcohol, illegal drug, smoking, and occupant protection policies. The majority of both small and large worksites also offered group health insurance to their employees (92% and 98%, respectively), with many of the worksites also extending benefits to family members and dependents (approximately 80% for both business sizes). CONCLUSIONS: The results indicated that small worksites are providing programs to their employees, with a primary focus on job-related hazards. Small worksites also have formal policies regarding alcohol, drug use, smoking, and seatbelt use and offer health insurance to their employees at a rate only slightly lower than that of large worksites.

A work-systems analysis of compliance with universal precautions among health care workers.

Universal precautions are work practices designed to protect health care workers from occupational exposure to HIV and other bloodborne pathogens. However, despite aggressive dissemination efforts by CDC and regulatory action by OSHA, compliance remains less than satisfactory. This article argues that the minimization of risk from bloodborne pathogens requires a multilevel or work-systems perspective that considers individual, job/task, and environmental/organizational factors. The available literature on universal precautions suggests the potential of such an approach and provides insight into the limited success of current worker-focused mitigation efforts. In particular, specific opportunities exist to develop and apply engineering controls, to improve the design and organization of jobs and tasks, and to create organizations that facilitate and reinforce safe behavior.

An integrative perspective on work-site health promotion.

The present paper argues that health promotion efforts, particularly those directed to resistant and high-risk workers, should be integrated into a corporate health strategy in which equal concern is expressed for individual lifestyle modification and the provision of safe and healthful working conditions. The current popularity of work-site health promotion is discussed, and the health promotion and occupational safety and health movements are compared and contrasted. Following this, ecologic models of health promotion are examined as a vehicle for addressing environmental and organizational influences, and this line of thinking is expanded into an integrative model of worker health. The proposed model features three interactive systems: (1) job demands and worker characteristics, (2) work environment, and (3) extraorganizational influences, and assigns an expanded role to environmental factors in promoting and protecting worker health. The principal goal of integrative programming is to devise complementary behavioral and environmental interventions that will have mutually reinforcing effects on workplace health problems. The remainder of the paper outlines the three phases of implementing such a program.

Development of a work behavior taxonomy for the safety function in industry.

A safety job activity questionnaire incorporating 24 job tasks was developed for describing the safety function within industry. This instrument was mailed to a stratified-proportionate sample of 1,190 working safety professionals representing 10 major industrial categories. Respondents rated the relative importance and amount of time spent on each of the 24 job activities. The overall response rate was 40%, producing 465 usable questionnaires. Factor analytic techniques were applied to each set of ratings to derive the principal dimensions of the safety position. Similar five-factor solutions emerged for both importance and time spent, accounting for 56% and 52% of the variance, respectively. The five job dimensions were: (i) serving as safety consultant and advisor, (ii) coordinating compliance and control activities, (iii) assessing the effectiveness of controls, (iv) analyzing hazards and losses, and (v) conducting specialized studies and reviews. Respondents, classified by industrial group and size of operation, were then compared using the job dimensions from the factor analyses. There were very few differences in the safety function across different industries or sizes of operations.

An examination of gender differences in traffic accident risk perception.

Excessively optimistic judgements of driving competency and accident risk have often been implicated in the disproportionate involvement of young males in traffic crashes. In this study, young male and female drivers (ages 18-24) were asked to judge their relative driving safety, skill, and accident likelihood. Comparisons were made using both peers and the average motorist as referent groups. Subjects then rated 15 risky driving behaviors on four dimensions: frequency in everyday driving, seriousness, accident potential, and apprehension likelihood. Self-report driving experience/history data were also collected. Substantial optimism was evident in both sexes, but males tended to be more optimistic, particularly when judging their driving skill. Males were equally optimistic with respect to the two referent groups; females tended to be less optimistic when making comparisons to the average motorist. Males and females held similar perceptions concerning the frequency and accident likelihood of the risky behaviors, but males perceived the behaviors as generally less serious and less likely to results in accidents. Regression analyses showed that considerably more variance in optimism could be explained for males than females. Driving record was the single best predictor of perceived safety; its role, however, was diminished for perceived skill and subjectively estimated accident likelihood.

Cost effectiveness of work-site cholesterol screening and intervention programs.

A study was conducted to evaluate the costs and cost effectiveness of behavioral interventions designed to reduce high serum cholesterol levels in a manufacturing population. A sample of 3202 employees participating in a screening was separated into four intervention groups and a control group. All four intervention groups received an educational program of varying length (1 or 3 months). Two of these groups also received incentives. A second screening was conducted after the interventions to determine effectiveness. The 1-month educational intervention with incentive and the 3-month educational intervention had the lowest costs per participant ($46.28 and $53.09, respectively) and costs per borderline high or high risk participant reducing cholesterol greater than 10% ($285.89 and $351.56) and the greatest effectiveness per dollar spent (0.60 and 0.62). The cost-effectiveness analyses were affected by the impact of the intervention and participation rate. Sensitivity analyses showed that increasing participation had a greater impact on the less cost-effective interventions.

The optimism bias and traffic accident risk perception.

Research suggests that people are excessively and unrealistically optimistic when judging their driving competency and accident risk. In this study, college-age drivers compared their risk of being involved in a variety of described traffic accidents relative to their peers. They also rated each of the accidents along a number of dimensions hypothesized as being related to optimism. In addition, subjects provided global estimates of their driving safety, skill, and accident likelihood. Significant optimism was evident for both the accidents and the global ratings. Optimism increased with driving experience and marginally with age. Those with more driving experience considered human factors to be more important in accident causation; those assigning more importance to human factors also rated themselves as more skillful drivers. For the specific accidents, perceived controllability was a strong predictor of optimism. The findings for controllability are interpreted in terms of other recent data and hypothesized explanations of the optimism bias. In general, it appears that optimism arises because people persistently overestimate the degree of control that they have over events.

An attribution theory perspective on alcohol-impaired driving.

Attribution theory is offered as a theoretical framework for generating and testing hypotheses about how people perceive and respond to the behavior of impaired driving. Recent work on the attribution of responsibility for alcohol-impaired driving indicates that the perceived seriousness of this behavior varies with the consequences and circumstances associated with it. In some instances, impaired driving is not considered to be particularly blameworthy, while in other instances, relatively minor variations in the event sequence have pronounced effects on the assignment of responsibility and punishment. In general, the seriousness of impaired driving is related to the consequences produced. Impaired driving is not perceived as being particularly negligent as long as it does not result in harm to others. Other findings suggest that people are likely to deny the personal relevancy of situations involving impaired driving. The final section of the article discusses the program implications of this research. Specific attention is given to sources of attributional "error" and to how these inaccuracies might be identified and corrected within a prevention/intervention program context.

The nonauditory effects of noise: review and perspectives for research.

This review considered 118 references classified according to nonauditory physiological effects, performance and behavioral effects, sleep disturbance, and communication interference. For each separate category of effect a brief summary was presented of relevant current research, the consequences of noise exposure were sketched, and research needs were suggested in experimental design, in stimulus control and specification, in experimental techniques, and as to appropriate subpopulations to be taken into account. Much was shown to have been accomplished in the past decade, but to date only sparse quantitative data have been reported to express the effects of noise as a dose-response function on physiological processes or on behavior. In almost all studies only a very modest fraction of variance was explainable. It seems especially important to consider other factors along with the physical characteristics of the noise, particularly the interactions of the noise with other toxic agents and with situational and personality factors.