More than 770 participants from 39 countries gathered in Los Angeles to discuss the latest research on ways to improve worker health at the 10th International Conference on Occupational Stress and Health, May 16-19. Over the past decade, the conference co-organizers — APA, the National Institute for Occupational Safety and Health (NIOSH) and the Society for Occupational Health Psychology — have worked together to shape this young but burgeoning field.

In its first few years, the conference dealt mostly with academic issues, such as risk factors for workplace stress and methodology for studying it, said Steven Sauter, PhD, a consultant to NIOSH who has co-chaired the conference since its inception in 1990. While those have continued to be important research topics, today's gatherings are much broader in scope.

"We're looking at a whole range of factors that relate to reducing the effects of stress in the workplace," he said. In addition to exploring health protection, the conference participants are examining health promotion, the design of health services in the workplace, the economic cost of job stress and ways to diffuse this knowledge to employers.

This year's conference theme — "Promoting and Protecting Total Worker Health" — illustrated this broader view of occupational health. In fact, NIOSH coined the term "Total Worker Health" to advance the idea that factors both inside and outside the workplace contribute to the health and safety of today's workforce.

"Work and health, because they're such important components of our lives, cannot be separated," said L. Casey Chosewood, MD, senior medical officer at NIOSH, who chaired a session on Total Worker HealthTM. "What happens at work doesn't stay at work, and what happens at home doesn't stay at home."

Traditionally, workplace health and safety measures haven't been well integrated with general health-promotion programs. That's finally changing, Chosewood said. Today's companies aren't just working to make their physical spaces safe for workers, he said. They're also encouraging employees to make healthy choices when they're off the clock, by providing opportunities for health education or medical screenings, for example.

"The workplace is an ideal venue for advancing health," Chosewood added. "People come to work with an understanding that they are going to follow directions, take instruction, be part of a team and learn new skills. It's really a perfect place for health interventions."

While Total Worker Health was the theme of this year's conference, presenters discussed a wide range of topics at the event. Following are just a few of the many highlights.

Promoting mental health in the workplace

In the opening session plenary presentation, Anthony LaMontagne, ScD, of the University of Melbourne's School of Population and Global Health, discussed an integrated intervention approach to work and mental health. Anxiety, depression and other mental health problems are prevalent in working populations, he said, and some of those problems are attributable to working conditions. Any intervention to improve mental health in the workplace needs to combine three components, he argues.

First, he said, mental health interventions should reduce work-related risk factors for mental health problems, such as bullying, job insecurity, long working hours or poor social support at work.

Second, interventions should promote the positive elements of work. "Most people derive some meaning or satisfaction from work," LaMontagne said. While those elements may be more obvious in some jobs than in others, people in all sorts of jobs can draw self-esteem and self-efficacy from their work. "We don't do a good enough job trying to build up the positives," he said.

Finally, LaMontagne said, employers must address mental health problems among working people, regardless of their underlying cause. In the end it doesn't matter whether a person is depressed because of factors at work or at home, he notes. Either way, employers must address the issue in the workplace. Assisting affected employees to seek professional help will benefit the organization as well as the individual worker.

LaMontagne said that employers have been fairly accepting of workplace mental health promotion programs, driven mostly by concerns about absenteeism and productivity. But they've been less successful addressing job stress issues. "Employers are basically saying, ‘Come in and fix the workers,' but aren't making sure the workplace is optimal," he said. While that's frustrating for people concerned about mental health, he adds, it's also an opportunity. "To some extent, this is an opportunity to ride on the coattails of mental health promotion, to get job-stress prevention into the mainstream."

Job insecurity and accident under-reporting

Tahira Probst, PhD, from Washington State University, studies both job insecurity and the safety climate of organizations. She presented results of a recent study investigating the intersection of those two interests. Three million work-related injuries and illnesses are reported in the United States each year, Probst said, but some studies have found more than three-quarters of workplace injuries go unreported. She hypothesized that when workers feel their jobs are insecure, they are less likely to report accidents and injuries.

She surveyed 1,265 workers in 27 organizations from a variety of sectors, such as hospitality, manufacturing, construction and health care. She confirmed that as job security went down, the number of unreported injuries climbed. On the other hand, organizations with a positive safety climate — those that reward safe behaviors, enact good safety training systems and make employees feel comfortable raising issues to managers, for instance — had lower rates of under-reporting. Encouragingly, a positive safety climate could overcome the effect of high job insecurity on under-reporting.

Job security can't always be improved, Probst said, but organizations can protect workers by taking steps to improve the company's overall commitment to safety. "What goes unreported goes unfixed," she said. "The issue of under-reporting is extremely critical to the health and safety of employees."

The gap between policy and practice

When it comes to formal policies and management standards, organizations may say one thing but do another. Companies may espouse excellent safety practices, for example, but cut corners in reality if those procedures undermine the bottom line. Unsurprisingly, employees are quick to pick up on this "decoupling" of policy and practice.

Dov Zohar, PhD, at Technion Institute of Technology in Haifa, Israel, discussed an intervention designed to reduce this discrepancy and improve the safety climate. He tested the intervention in a heavy-industry manufacturing company in which he randomly divided the company's 28 departments into control and experimental groups. He asked workers in both groups to take surveys measuring safety climate, safety behavior and teamwork.

During the 12-week intervention phase, supervisors in the experimental group were given feedback about the ratings they received from employees who completed the surveys. Graduate students who acted as facilitators helped the supervisors interpret the survey feedback and set informal goals for communicating with employees. At the end of the intervention, Zohar found that safety measures had significantly improved in the departments that received the feedback, as measured by employee reports and independent audits. Meanwhile, safety in control departments continued to lag.

Zohar said this study demonstrates the importance of frequent communication between supervisors and their workers. Such interventions could be used to improve the safety climate in any number of organizations, for very little cost, he adds — and the findings aren't limited to safety. Similar feedback interventions could also be used to improve a company's climate for ethics, diversity or even creativity, he said.

Effectiveness of job-search interventions

As unemployment has risen in recent years, job-search training programs have flourished. But studies have found large variations in these programs' effectiveness, and few researchers have taken a big-picture view of the literature, said Songqi Liu, PhD, of Pennsylvania State University. He examined 47 studies of various job-search interventions to draw broad conclusions about the ingredients of a successful program.

Overall, Liu found, the interventions were helpful: The odds of landing a job were 2.67 times higher for job seekers who participated in these programs. The most successful programs used a combination of skill development (emphasizing such techniques as creating a resume, networking for job leads or presenting yourself well in an interview) and motivation enhancement (such as setting realistic goals, sharing job-search information with peers and converting negative self-talk into positive statements). "If you have a blend of those techniques in your training program, you're likely to see the maximum benefits," he said.

On the other hand, job seekers are a diverse bunch. Older workers may benefit more from programs that teach skills such as using the Internet effectively. Younger workers, who are more likely to have honed their technical skills, might get more out of programs that teach networking or interviewing tips, for instance. "You should choose the training program that's best for you," he said.

The results, said Liu, aren't applicable only to job hunters and career counselors. He found that governments fund a number of job-search training programs — and of those, many weren't very effective. He hopes his study and others like it will help governments and other groups design more effective unemployment programs for people looking for work.

Kirsten Weir is a science writer in Minneapolis.