A Nationally-Representative Employer Survey on Total Worker Health®

June 2017

Contributed by Rashaun Roberts, Ph.D. & Paula Grubb, Ph.D., National Institute for Occupational Safety and Health (NIOSH)

Traditionally, there have been two main approaches that employers have taken to prevent or reduce work-related injuries and illnesses that collectively cost billions of dollars, including medical, administrative, productivity, and wage losses.1One approach is based on the occupational health and safety (OHS) movement and focuses on minimizing or eliminating workplace hazards that may be physical, biological, chemical, ergonomic, or psychosocial in nature. The second approach is worksite health promotion (WHP), which focuses on individual lifestyle factors and seeks to encourage healthy behaviors in workers, such as smoking cessation, weight management, exercise, health risk assessments, and better management once an injury or illness has occurred.
Current estimates indicate that 50% to 80% of all organizations, depending on size, have some type of OHS or WHP program in place.2 However, there is a lack of information on how employers design, implement, and integrate these programs, on the characteristics of these programs, and on their potential impact.3 OHS and WHP programs can both be effective in reducing illness and injury, but how employers design and implement OHS and WHP programs matters. While programs that are well-designed, effectively executed, and properly evaluated work, programs that are poorly designed, executed in a haphazard fashion, inadequately resourced, and are not culturally supported do not.4
To shed more light on how employers administer OHS and WHP programs, a Core Team of NIOSH intramural researchers is developing a national employer survey in collaboration with a group of academic, labor, and industry partners. Planned for administration in 2018, this survey will collect information from a nationally representative sample of U.S. employers across industrial sectors on: the availability and utilization of occupational health and safety and worksite health promotion programs, design and implementation of the programs, the barriers and drivers to offering and utilizing these programs, and a full range of health and safety outcomes. The survey will also gather information on how employers evaluate the quality, impact, and effectiveness of these programs, and the nature and extent that the programs are integrated, which is a foundational concept of the National Institute for Occupational Safety and Health Total Worker Health® Program. Finally, the survey will include measures that will, for the first time, enable the U.S. to obtain national-level data on occupational health and safety and worksite health promotion from employers that will be comparable to existing domestic data and to data routinely collected from employers in European and other countries. The development of new survey items that are essential to OHS and WHP assessment has been a cornerstone of the Total Worker Health (TWH) Program.5
A representative sample of organizations in the U.S. will be surveyed. The sample will consist of approximately 500 public and private businesses or organizations. Organizations in all industrial sectors will be captured in the sample, including the largest industrial sectors (i.e. services, wholesale/retail trade, and manufacturing), to reflect the occupational profiles of businesses in the U.S. Roughly one-half of the sample will be comprised of small businesses (10-49 employees), one-fourth of mid-sized businesses (50-249 employees), and one-fourth of large businesses (250 or more employees). Within these organizations, the survey will be administered to one or more organizational key informants (e.g., human resource manager, occupational health and safety, worksite health promotion manager, or owner) per organization by professional interviewers via Computer Assisted Telephone Interviewing. Each interview will be in-depth and take approximately 45-55 minutes to complete.
The Core Team will use the survey data to assess the prevalence of occupational health and safety and worksite health promotion programs, the effect of organizational characteristics (size, industry, etc.) on program offerings and rates of utilization, degree of integration of programs, and barriers/drivers. These findings will be compared to relevant national and international findings. Analyses will also be conducted to characterize the relationship between the availability and utilization of occupational health and safety and worksite health promotion programs and health and safety outcomes at the organizational level.
The Core Team will share survey findings with other NIOSH researchers, U.S. and international research communities, and to the larger public through manuscripts, presentations, and other outputs. A website will be created to make survey findings and the dataset publicly available in 2019. These outputs will assist other researchers, labor, and industry partners to target and develop future hypothesis-driven research, assess occupational health and safety and worksite health promotion programs, develop program guidelines, and otherwise improve their respective capacities for supporting employers in their program efforts. The results of this project will also provide a framework for defining and measuring the concept of “integration” of occupational health and safety and worksite health promotion programs, and can be used to promote the relevance of TWH to a broader audience.


  1. Sorensen, G., Landsbergis, P., Hammer, L., Amick, B., Linnan, L., Yancey, A., Welch, L., Goetzel, R., Flannery, K., Pratt, C., & the Workshop Working Group on Worksite Chronic Disease Prevention. (2011). Preventing chronic disease in the workplace: A workshop report and recommendations. American Journal of Public Health, 101(S1), S196-S207. doi: 10.2105/ajph.2010.300075
  2. Mattke, S., Hangsheng, L., Caloyeras, J., Huang, C., Van Busum, K., Khodyakov, D., and Shier, V. (2013). Workplace wellness programs study: Final report. Santa Monica, CA: RAND Corporation.
  3. Tremblay, P.A., Nobrega, S., Davis, L, Erck, E. & Punnett, L. (2013). Healthy workplaces? A survey of Massachusetts employers. American Journal of Health Promotion 27(6): 390-400. http://ajhpcontents.org/doi/abs/10.4278/ajhp.110216-QUAN-72
  4. Goetzel, R., Ozminkowski, R., Bowen, J., & Tabrizi, M. (2008). Employer integration of health promotion and health protection programs. International Journal of Workplace Health Management, 1(2), 109-122.
  5. Zweber SM, Henning RA, Magley VJ, Faghri P. Considering the Differential Impact of Three Facets of Organizational Health Climate on Employees’ Well-Being (2015). Sci World J: Volume 2015 Article ID 407232, 10 pages.  
Rashaun Roberts and Paula Grubb are research psychologists with NIOSH, Work Organization andStress Research Team, where they direct or co-direct projects on a wide variety of topics ranging from occupational health disparities and workplace violence to Total Worker Health®.


CPH-NEW is a Center for Excellence to Promote a Healthier Workforce of the National Institute for Occupational Safety and Health. CPH-News & Views is a semi-monthly column written by Center researchers on emerging topics related to healthy workplaces. These comments reflect thoughts of the individual researchers and do not represent conclusive research summaries, nor do they necessarily reflect a consensus among all Center personnel.
We welcome your responses and discussion. Please send all questions and comments to CPHNEW@uml.edu.