Cynthia Feltner, MD, MPH; Kristina Peterson, PhD; Rachel Palmieri Weber, PhD; Laurie Cluff, PhD; Emmanuel Coker-Schwimmer, MPH; Meera Viswanathan, PhD; Kathleen N. Lohr, PhD
Disclaimer: The authors of this manuscript are responsible for its content. Statements in the manuscript should not be construed as endorsement by the AHRQ or the U.S. Department of Health and Human Services. The AHRQ retains a license to display, reproduce, and distribute the data and the report from which this manuscript was derived under the terms of the Agency's contract with the author.
Acknowledgment: The authors thank Carol Woodell of RTI International for her project management expertise; Loraine Monroe of RTI International for formatting the technical report; and Kim Wittenberg, MA, AHRQ Task Order Officer, for her support, commitment, and contributions.
Financial Support: This project was funded under contract 290-2012-00008-I_HHSA 29032009T from AHRQ, U.S. Department of Health and Human Services.
Disclosures: Dr. Cluff reports funding from the Centers for Disease Control and Prevention outside the submitted work. Dr. Viswanathan reports a contract with RTI International during the conduct of the study. Dr. Lohr reports contracts with the Agency for Healthcare Research and Quality outside the submitted work. Authors not named here have disclosed no conflicts of interest. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M16-0626.
Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that she has no financial relationships or interests to disclose. Darren B. Taichman, MD, PhD, Executive Deputy Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Deborah Cotton, MD, MPH, Deputy Editor, reports that she has no financial relationships or interest to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Catharine B. Stack, PhD, MS, Deputy Editor for Statistics, reports that she has stock holdings in Pfizer and Johnson & Johnson.
Reproducible Research Statement:Study protocol: Available in the Supplement or at https://effectivehealthcare.ahrq.gov/ehc/products/611/2085/worker-health-protocol-150526.pdf. Statistical code: Not applicable. Data set: Available at http://srdr.ahrq.gov/projects/620.
Requests for Single Reprints: Cynthia Feltner, MD, MPH, Department of Medicine, University of North Carolina at Chapel Hill, 5034 Old Clinic Building, CB 7110, PO Box 12194, Chapel Hill, NC 27599; e-mail, firstname.lastname@example.org.
Current Author Addresses: Dr. Feltner: Department of Medicine, University of North Carolina at Chapel Hill, 5034 Old Clinic Building, CB 7110, PO Box 12194, Chapel Hill, NC 27599.
Drs. Peterson, Cluff, Viswanathan, and Lohr: Workplace Health and Safety, RTI International, 3040 Cornwallis Road, PO Box 12194, Research Triangle Park, NC 27709-2194.
Dr. Palmieri Weber and Mr. Coker-Schwimmer: RTI-UNC Evidence-based Practice Center, Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, 725 Martin Luther King Jr. Boulevard, CB 7590, Chapel Hill, NC 27599.
Author Contributions: Conception and design: C. Feltner, K. Peterson, R. Palmieri Weber, M. Viswanathan.
Analysis and interpretation of the data: C. Feltner, K. Peterson, R. Palmieri Weber, L. Cluff, M. Viswanathan, K.N. Lohr.
Drafting of the article: C. Feltner, K. Peterson, R. Palmieri Weber, E. Coker-Schwimmer, K.N. Lohr.
Critical revision of the article for important intellectual content: C. Feltner, K. Peterson, R. Palmieri Weber, E. Coker-Schwimmer, M. Viswanathan, K.N. Lohr.
Final approval of the article: C. Feltner, K. Peterson, R. Palmieri Weber, L. Cluff, E. Coker-Schwimmer, M. Viswanathan, K.N. Lohr.
Provision of study materials or patients: R. Palmieri Weber.
Statistical expertise: C. Feltner, R. Palmieri Weber.
Obtaining of funding: C. Feltner, M. Viswanathan.
Administrative, technical, or logistic support: C. Feltner, R. Palmieri Weber, E. Coker-Schwimmer, M. Viswanathan.
Collection and assembly of data: C. Feltner, K. Peterson, R. Palmieri Weber, L. Cluff, E. Coker-Schwimmer.
The Total Worker Health (TWH) program of the National Institute for Occupational Safety and Health aims to advance worker well-being by integrating injury and illness prevention efforts with work-related safety and health hazard efforts.
To evaluate evidence on the benefits and harms of integrated TWH interventions.
MEDLINE, Cochrane Library, and PsycINFO (January 1990 through September 2015); clinical trial registries; and reference lists.
English-language studies that enrolled employed adults and compared integrated interventions with usual work practice, no intervention, or another intervention.
Dual abstraction and risk-of-bias (ROB) assessment.
Ten of the 15 included studies had high ROB, primarily because of selection and attrition bias. Findings graded as having low strength of evidence (SOE) supported the effectiveness of TWH interventions for improving smoking cessation, as measured by self-reported 7-day abstinence over 22 to 26 weeks (2 randomized, controlled trials [RCTs]; n = 737), and increasing consumption of fruits and vegetables over 26 to 104 weeks (3 RCTs; n = 6056); results apply to populations of blue-collar manufacturing and construction workers. Findings graded as having low SOE supported the effectiveness of TWH interventions for reducing sedentary work behavior in office workers over 16 to 52 weeks (2 RCTs; n = 262). Evidence was insufficient or lacking for other outcomes of interest, such as rates of work injuries, quality of life, and harms.
Small, diverse body of evidence with many methodological limitations; possible publication bias.
Integrated TWH interventions might improve health behaviors (for example, reduce tobacco use and sedentary behavior and improve diet) of workers, but effects of these interventions on injuries and overall quality of life are not known.
Agency for Healthcare Research and Quality.
Table. Summary of Key Findings and Strength of Evidence for Total Worker Health Interventions
Appendix Table 1. Inclusion/Exclusion Criteria for Studies of TWH Interventions
Appendix Table 2. Characteristics of and Outcomes From Total Worker Health Interventions
Disposition of articles for systematic evidence review of Total Worker Health interventions.
NIOSH = National Institute for Occupational Safety and Health; PICOTS = population, intervention, comparator, outcomes, timing of outcomes measurement, and setting.
* ClinicalTrials.gov and Academic Search Premier.
Appendix Table 3. Characteristics of Work Settings and Populations
Appendix Table 4. Results for Intermediate and Final Health Outcomes From Studies of Total Worker Health Interventions
Appendix Table 5. Definitions of the Grades of Overall Strength of Evidence*
Appendix Table 6. Strength of Evidence: Smoking Cessation
Appendix Table 7. Strength of Evidence: Healthy Eating Behavior (Increased Consumption of Fruits and Vegetables)
Appendix Table 8. Strength of Evidence: Healthy Eating Behavior (Decreased Consumption of Red Meat)
Appendix Table 9. Strength of Evidence: Increased Levels of Physical Activity
Appendix Table 10. Strength of Evidence: Work Stress
Appendix Table 11. Strength of Evidence: Quality of Life (SF-12)
Appendix Table 12. Strength of Evidence: Safety Compliance and Safety Behaviors
Appendix Table 13. Strength of Evidence: Blood Pressure
Appendix Table 14. Strength of Evidence: Weight
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Feltner C, Peterson K, Palmieri Weber R, Cluff L, Coker-Schwimmer E, Viswanathan M, et al. The Effectiveness of Total Worker Health Interventions: A Systematic Review for a National Institutes of Health Pathways to Prevention Workshop. Ann Intern Med. 2016;165:262–269. doi: 10.7326/M16-0626
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Published: Ann Intern Med. 2016;165(4):262-269.
Published at www.annals.org on 31 May 2016
Cardiology, Coronary Risk Factors, Smoking, Tobacco, Alcohol, and Other Substance Abuse.
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