In This Issue
Tool Time: Toolbox Talk
The Center for Construction Research and Training (CPWR) publishes toolbox talks on topics related to the safety of construction workers. Toolbox talks are one-page documents that raise awareness on the control and reduction of safety hazards in the workplace. The talks incorporate case studies, discussion questions and site-specific actions to better understand the hazards. Additionally, stories and illustrative pictures provide visual aids to increase awareness of hazards.

The Toolbox Talks are short and informal resources that aim at discussing specific safety issues on the worksite. They can also be used to improve departmental safety culture and to enable health and safety discussions.
This tool is available (in English and Spanish) for free on the
CPWR website.
Healthier Workforce Center
2018 Year in Review
Improving Health and Safety of Construction Apprentices
Construction is clearly dangerous. In addition to traditional hazards for workplace injury and illness, other threats to health and well-being of construction workers occur from work organization and work environment factors, including irregular employment, working at multiple job sites, long commutes, long work hours, and employer policies regarding health and safety. These non-traditional hazards are associated with injury and illness, as well as health behaviors and outcomes including poor diet, smoking, and stress. Diane Rohlman, PhD and Brad Evanoff, MD, of the Healthier Workforce Center of the Midwest, have led a team of researchers and focused attention on the young and vulnerable construction apprentices, to instill safety and health practices at the start of workers’ careers. In 2018, a survey was conducted with a cohort of apprentice construction workers to identify relationships between work organization, environmental factors, health behaviors, and health outcomes. Nearly 1000 completed surveys were returned. Preliminary analyses show that respondents report high levels of job satisfaction, job security, and social support, but also report high rates of musculoskeletal symptoms and various work organizational factors that can potentially impact overall health and health behaviors. On average, apprentices reported commutes of over 35 miles to work, and 63% reported no limits on daily working hours. Despite high smoking rates (28% are current smokers), only 55% reported any restrictions on smoking at their worksites. Only 10% reported regularly using sunscreen, and very few worksites (4) made sunscreen available. These results highlight non-traditional worksite health risks. As the study progresses, investigators plan to evaluate the impact of work organization on health and health behaviors in three construction trades; identify workplace programs, policies, and practices affecting worker health and well-being; and determine readiness for adoption of integrated interventions to improve worker health. Early study results were shared in May at the 2nd International Symposium on Total Worker Health in Bethesda, MD.

The Use of Digital Human Modeling to Prevent Injury
The Virtual Soldier Research Program developed digital human modeling software to predict posture, motion, and other functions in a three-dimensional, real-time environment. The technology considers real-world constraints such as muscle fatigue and strength, carrying needs, body size, and clothing restrictions to determine soldiers’ performance in varying conditions. With funding from the Healthier Workforce Center, Nate Fethke, PhD and Mark Schall, PhD examined the feasibility of this technology to reduce workplace injuries in manufacturing environments through the identification of physical hazards and the evaluation of potential engineering solutions. In a newly accepted publication in IISE Transactions on Occupational Ergonomics and Human Factors, Schall and Fethke describe the implementation of digital human modeling software as a component of an occupational safety and health process in a manufacturing environment over the course of one year. Success stories, challenges, and practical recommendations are described in the publication. Strengths of the software include the ability to evaluate design alternatives without prototypes and with different sized individuals, improved communication and awareness of ergonomic issues among stakeholders, and the identification of potential costs. Despite strengths, there are challenges including developing software expertise, the availability of facility and software data for use in simulations, and organizational challenges such as turnover.

Healthier Workforce Center Showcases their Efforts
Members of the Healthier Workforce Center (HWC) from three Midwest states packed their bags in May 2018 and traveled to Bethesda, MD for the 2nd International Symposium on Total Worker Health (TWH). This diverse team includes practitioners, researchers with a wide range of academic training, including safety and health, ergonomics, engineering, occupational medicine, anthropology, occupational therapy, communication, psychology, and public health. HWC presenters led workshops and symposia, disseminated recent research findings from core and pilot research projects, participated in poster sessions, and hosted a table display showcasing Center outreach materials. More than 20 presentations from members addressed safety and health topics, populations, and research and dissemination methods. One poster presented by Kevin Kelly, PhD, Deputy Director, represented the history of precarious work from the stone age to the gig economy. Approaches to translating research findings into the workplace were described by Heather Vanover, PMPCHCM, Director of Workplace Services at the Nebraska Safety Council/WorkWell. Pilot grantee, Lauren Remspecher, MPH, from the St. Louis Business Health Coalition shared their TWH resource guide for employers.

Opioid Use Among Construction Workers
The Healthier Workforce Center of the Midwest has had funding to examine the health and safety of construction apprentices. 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, will be examining this issue more closely. The new project will include 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 will also test the effectiveness of an intervention to decrease opioid use. The intervention will include 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.

Using Hazard Mapping to Assess Safety and Health in Workplaces
Hazard mapping is commonly used to identify workplace safety hazards. It begins with an exercise that asks participants to draw their workplace and identify safety hazards. Diane Rohlman, PhD, Director of the Healthier Workforce Center of the Midwest, traveled with the University of Iowa College of Public Health’s Business Leadership Network to Oelwein, IA as part of an outreach activity with local employers. Rohlman and her team designed an expanded hazard mapping activity asking participants to create a hazard map that includes both safety and health hazards. Participants were given a list of potential hazards and asked to include relevant hazards on their map. Maps included hazards such as workplace violence, slips, trips and falls, machinery, and working with difficult customers. Solutions to address the identified hazards including changes to the work environment, adoption of policies, and individual behaviors were discussed. Participants were also encouraged to partner with other local organizations to address the identified concerns.

Return to Work Among Breast Cancer Survivors
Early detection and treatment of breast cancer has led many women to be able to return to work, particularly those with early-stage cancer. While medical advances have been great, disparities for African American women remain. A pilot project funded by the Healthier Workforce Center of the Midwest to Christine Ekenga, PhD, a faculty member at Washington University at St. Louis, is examining factors that influence return to work as well as the quality of life for early-stage breast cancer survivors. Dr. Ekenga and her colleagues have already found that African American women, women with more fatigue, and uninsured or publicly insured women were less likely to have returned to work two years after initial diagnosis. Early results from this study were presented at the 2nd International Symposium to Advance Total Worker Health in May 2018 and were also published in Cancer in May 2018.

Event Planner

January 10 · Young Worker Curriculum Intervention Webinar
January 10-11 · Opioids and the Workplace (MO)
February 8 · CBJ Health Care Summit (IA)
February 20-21 · Workplace Fatigue Conference
March 28-29 · Occupational Health Symposium (IA)
Visit our calendar for a full listing of trainings, conferences, and other events
Please send questions, comments or ideas for future newsletters to
Healthier Workforce Center Update
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The Healthier Workforce Center of the Midwest (HWCMW) is one of six Total Worker Health® Centers of Excellence funded by the National Institute for Occupational Safety and Health (NIOSH).  Our mission is to improve the health of workers in Iowa, Missouri, Nebraska and Kansas, as well as nationally, through integrated health promotion and health protection research, collaboration, and dissemination of successful interventions.

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