There have been over 507 million cases of COVID-19, the disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), resulting in 6 million deaths globally. Wastewater surveillance has emerged as a valuable tool in understanding SARS-CoV-2 burden in communities. The National Wastewater Surveillance System (NWSS) partnered with the United States Geological Survey (USGS) to implement a high-frequency sampling program. This report describes basic surveillance and sampling statistics as well as a comparison of SARS-CoV-2 trends between high-frequency sampling 3-5 times per week, referred to as USGS samples, and routine sampling 1-2 times per week, referred to as NWSS samples. USGS samples provided a more nuanced impression of the changes in wastewater trends, which could be important in emergency response situations. Despite the rapid implementation time frame, USGS samples had similar data quality and testing turnaround times as NWSS samples. Ensuring there is a reliable sample collection and testing plan before an emergency arises will aid in the rapid implementation of a high-frequency sampling approach. High-frequency sampling requires a constant flow of information and supplies throughout sample collection, testing, analysis, and data sharing. High-frequency sampling may be a useful approach for increased resolution of disease trends in emergency response. © 2022 American Chemical Society. All rights reserved.

Understanding of how Total Worker Health® (TWH) guidelines are implemented in employment organizations in the USA is not well understood. The purpose of this study is to explore how the principles of the Hierarchy of Controls Applied to NIOSH Total Worker Health (TWH HoC), have been implemented among organizations featured as Promising Practices for TWH between 2012-2019, with special focus on the work-related issues of fatigue, stress, sedentary work, and tobacco control. We also sought to identify benefits, obstacles, and lessons learned in the implementation of the TWH HoC. Eighteen organizations were identified to be included in the study. Using a qualitative cross-sectional design and purposive sampling, seven in-depth interviews were conducted with thirteen key informants. The Consolidated Framework for Implementation Research was used to guide the thematic analysis and interpretation of qualitative data. Four themes identified include recognition of the TWH approach and TWH HoC, implementation of the TWH HoC, barriers and facilitators in addressing specific work-related issues, and implementation climate primes benefits, obstacles, and lessons learned. The inner setting (i.e., culture, implementation climate, readiness for implementation) of organizations was a prominent determinant of the implementation of integrated worker safety, health, and well-being interventions.

Work has become increasingly technologically driven and fast paced, with long work hours, new/emerging hazards, and rising health care costs. Threats to worker safety, health, and well-being including non-traditional work arrangements and practices, precarious work, uncertain hazardous exposures, and work organization issues, such as heavy workloads, design of work, uneven work hours, and difficult interpersonal relationships among workers and managers are apparent. Furthermore, the relationship between personal health risk factors and workplace risks and exposures has drawn increased attention and concern. As employer economic pressures continue to build, it is anticipated that ethical dilemmas for practitioners will become increasingly complex. A review of relevant Total Worker Health (TWH) literature, related ethical constructs and competencies, an examination of codes of ethics for occupational safety and health and health promotion/education disciplines was conducted. A case study for TWH utilizing an ethical decision-making model for the analysis of key ethical issues and solutions was completed. TWH approaches to protecting safety, promoting health, and advancing well-being are increasingly being adopted. These approaches can reveal ethical dilemmas, and ethical constructs are needed to guide decision-making. A core set of proposed ethical competencies for TWH professionals are identified as a transdisciplinary framework to support workplace ethical culture. © 2021 by the authors. Licensee MDPI, Basel, Switzerland.

OBJECTIVE: There is growing interest in the NIOSH Total Worker Health program, specifically in the process of designing and implementing safer, health-promoting work and workplaces. A Total Worker Health (TWH) Research Methodology Workshop was convened to discuss research methods and future needs. METHODS: Twenty-six experts in occupational safety and health and related fields reviewed and discussed current methodological and measurement issues and those showing promise. RESULTS: TWH intervention studies face the same challenges as other workplace intervention studies and some unique ones. Examples are provided of different approaches and their applications to TWH intervention studies, and desired developments in the TWH literature. CONCLUSIONS: This report discusses and outlines principles important to building the TWH intervention research base. Rigorous, valid methodologic, and measurement approaches are needed for TWH intervention as well as for basic/etiologic, translational, and surveillance research.

OBJECTIVE: This article describes the National Institute for Occupational Safety and Health's (NIOSH) development of a conceptual framework for worker well-being. While well-being research is growing, there is a need to translate theoretical concepts into practical models for measurement and action. METHODS: Multidisciplinary literature reviews informed development of the worker well-being framework and major domains and subdomains. An expert panel helped prioritize constructs for measurement. RESULTS: The framework includes five domains and twenty subdomains and conceptualizes worker well-being as a subjective and objective phenomenon inclusive of experiences both within and beyond work contexts. CONCLUSIONS: Well-being is a positive and unifying concept that captures multiple factors that contribute to workers' health and quality of life. This work lays the foundation for larger well-being measurement efforts and will provide tools for NIOSH partners to help workers flourish.

OBJECTIVE: To declare a call to action to improve mental health in the workplace. METHODS: We convened a public health summit and assembled an Advisory Council consisting of experts in the field of occupational health and safety, workplace wellness, and public policy to offer recommendations for action steps to improve health and well-being of workers. RESULTS: The Advisory Council narrowed the list of ideas to four priority projects. CONCLUSIONS: The recommendations for action include developing a Mental Health in the Workplace 1) "How to" Guide, 2) Scorecard, 3) Recognition Program, and 4) Executive Training.

The true burden (morbidity, mortality, disability, cost, pain, distress) of occupational and work-related diseases and injuries is unknown, and what is reported as burden is significantly underestimated. This underestimation affects the way decision-makers view investments in research and worker protection, which in turn has a substantial impact on national welfare and public health. To better describe the societal and individual burdens of occupational and work-related diseases and injuries, we propose an approach to gauge what is known about burden and where new assessments may be made. This approach consists of 4 elements to consider in burden assessments: (1) utilizing multiple domains, including the individual worker, the worker's family, the community in which the workplace is located, the employer, and society as a whole; (2) taking a broader view of the work-relatedness of disease and injury; (3) assessing the impact of the entire working-life continuum; and (4) applying the comprehensive concept of "well-being" as an indicator in addressing contemporary changes in the nature of work, the workplace, and the workforce. Further research on burden and enhanced surveillance is needed to develop these elements. (Am J Public Health. Published online ahead of print May 18, 2017: e1-e7. doi:10.2105/AJPH.2017.303765).

Total Worker Health(R) (TWH) is a paradigm-shifting approach to safety, health, and well-being in the workplace. It is defined as policies, programs, and practices that integrate protection from work-related safety and health hazards with promotion of injury and illness prevention efforts to advance worker well-being. The most current TWH concepts are presented, including a description of issues relevant to TWH and introduction of a hierarchy of controls applied to TWH. Total Worker Health advocates for a foundation of safety and health through which work can contribute to higher levels of well-being.

The National Institute for Occupational Safety and Health (NIOSH) appreciates the recommendations of the independent panel of the National Institutes of Health (NIH) Pathways to Prevention workshop, “Total Worker Health—What's Work Got to Do With It?” (1). The workshop speakers, audience contributors, and panelists provided useful insights (2). | The Total Worker Health (TWH) program is defined as policies, programs, and practices that integrate protection from work-related safety and health hazards with promotion of injury and illness prevention efforts to advance worker well-being. The definition for TWH was updated in 2015 to emphasize that integration from a TWH perspective focuses on the ways work-related and nonwork risk factors interact to cause worker injury and illness. This represents an evolution from an earlier TWH definition when the evidence report was first commissioned. The current definition emphasizes the primacy of health protection and prioritizes work organizational factors over individual behaviors in advancing worker well-being. NIOSH is taking the following actions and looks forward to moving quickly to implement the panel's 8 recommendations.

As co-managers of the National Institute for Occupational Safety and Health (NIOSH) Total Worker Health® (TWH) Program, we read the Campbell and Burns article titled “Total Worker Health Implications for the Occupational Health Nurse” published in the July issue with great interest. We are delighted that TWH resonates so strongly with many of our stakeholders, especially occupational health nurses, who, we believe, play a critically important role in the health of working Americans. Therefore, we take this opportunity to more fully describe TWH concepts and expand upon four points to more fully inform all Journal readers about TWH efforts at NIOSH. | First, TWH is not synonymous with wellness programs. This misunderstanding has been so common that recently (July 2015) the definition of TWH was revised to more clearly distinguish the TWH approach from that of wellness programs that focus primarily on worker health-related behaviors. The revised definition is, | A Total Worker Health® (TWH) approach is defined as policies, programs, and practices that integrate protection from work-related safety and health hazards with promotion of injury and illness prevention efforts to advance worker well-being. | Simply put, the TWH approach integrates workplace interventions that protect workers’ safety and health with activities that advance their overall well-being. The TWH approach always prioritizes a hazard-free work environment that protects the safety and health of all workers. Simultaneously, the approach advocates integration of all organizational policies, programs, and practices that contribute to worker safety, health, and well-being, including those relevant to the control of hazards and exposures, the organization of work, compensation and benefits, work–life management, a health-supporting built environment, and well-being supports.

The rat lungworm (Angiostrongylus cantonensis) is a parasitic nematode that causes rat lungworm disease. It is the leading cause of eosinophilic meningitis and is a zoonotic health risk. We confirmed the presence of A. cantonensis using species-specific, quantitative PCR in 18 of 50 (36%) giant African land snails (Lissachatina fulica) collected from Miami, Florida, US in May 2013. These snails were collected from seven of 21 core areas that the Florida Department of Agriculture and Consumer Services monitor weekly. Rat lungworms have not previously been identified in these areas. Duplicate DNA extractions of foot muscle tissue from each snail were tested. Of the seven core areas we examined, six were positive for A. cantonensis and prevalence of infection ranged from 27% to 100%. Of the 18 positive snails, only five were positive in both extractions. Our results confirm an increase in the range and prevalence of rat lungworm infection in Miami. We also emphasize the importance of extracting sufficient host tissue to minimize false negatives.

Action to address workforce functioning and productivity requires a broader approach than the traditional scope of occupational safety and health. Focus on "well-being" may be one way to develop a more encompassing objective. Well-being is widely cited in public policy pronouncements, but often as ". . . and well-being" (e.g., health and well-being). It is generally not defined in policy and rarely operationalized for functional use. Many definitions of well-being exist in the occupational realm. Generally, it is a synonym for health and a summative term to describe a flourishing worker who benefits from a safe, supportive workplace, engages in satisfying work, and enjoys a fulfilling work life. We identified issues for considering well-being in public policy related to workers and the workplace.

The workplace is recognized as a setting that can profoundly influence workers’ health and well-being (1,2). The Centers for Disease Control and Prevention (CDC) workplace health promotion efforts address cancer prevention by focusing on cancer screening programs, community–clinical linkages, and cancer risk factors (eg, tobacco use, physical inactivity) that also influence risk for other chronic diseases (http://www.cdc.gov/workplacehealthpromotion/). Some efforts focus specifically on cancer; some focus on general chronic disease prevention. Additionally, the National Institute for Occupational Safety and Health (NIOSH), part of CDC, provides research and recommendations to address workplace hazards posed by chemicals that may increase cancer risk (http://www.cdc.gov/niosh/topics/cancer/policy.html). | Existing resources can be leveraged to expand the scope of workplace initiatives to address additional cancer risk factors and disparities. Changes to the physical and social characteristics of work environments are likely to have greater impact than health education alone (3). Given the aging US population (which is expected to result in a marked increase in the number of cancer diagnoses over the coming decades) and the prevalence of numerous risk factors among working-aged adults (4,5), a multifaceted approach to cancer prevention in the workplace is timely and needed. In addition, community-based prevention efforts may offer unrealized opportunities to reach vulnerable working populations who are not served by workplace health promotion programs. In this essay, we draw attention to a wide variety of available CDC resources and provide ideas for new efforts to advance primary cancer prevention among working adults.

OBJECTIVE: The objective of this article was to provide an overview of the National Institute for Occupational Safety and Health (NIOSH) Total Worker Health (TWH) Program that was launched by the institute in 2011. METHODS: This article describes the TWH concept, relevant issues, and the NIOSH Program. Examples of the concept are provided. RESULTS: Total Worker Health is a strategy integrating occupational safety and health protection with health promotion to prevent worker injury and illness and to advance health and well-being. CONCLUSIONS: The NIOSH TWH Program responds to demands for information and practical solutions to the health, safety, and well-being challenges that workers and their employers face. It also addresses issues related to the nation's need to sustain a globally competitive workforce.

OBJECTIVE: To explore issues related to the aging workforce, including barriers to integrating health protection and promotion programs, and provide recommendations for best practices to maximize contributions by aging workers. METHODS: Workgroups reviewed literature and case studies to develop consensus statements and recommendations for a national approach to issues related to older workers. RESULTS: Consensus statements and actions steps were identified for each of the Summit goals and call-to-action statements were developed. CONCLUSIONS: A national dialogue to build awareness of integrated health protection and promotion for the aging workforce is needed. Workers will benefit from improved health and performance; employers will realize a more engaged and productive workforce; and the nation will gain a vital, competitive workforce.