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Characterizing the Needs of a Young Working Population: Making the Case for Total Worker Health in an Emerging Workforce

Rohlman, Diane S. PhD; Parish, Megan MPH; Elliot, Diane L. MD, FACSM; Montgomery, Dede MS, CIH; Hanson, Ginger PhD

Journal of Occupational and Environmental Medicine: December 2013 - Volume 55 - Issue - p S69–S72
doi: 10.1097/JOM.0000000000000039

Objective: Young workers are at increased risk for occupational injuries. Many lack appropriate skills to avoid workplace hazards. In addition, existing safety programs neither address total worker health principles nor align with the relatively high technological expectations of young workers. This article aimed to identify the content and process for an on-line total worker health training for young workers.

Methods: During the summer of 2012, an on-line survey (n = 187) assessed young workers' behavior, knowledge, and attitudes on total worker health topics and on-line training delivery methods.

Results: Forty-five percent of the workers indicated this was their first job; new workers demonstrated lower safety knowledge scores than returning workers. In addition, results demonstrated that workers would benefit from health behavior interventions delivered through technology-based means.

Conclusions: Findings characterize the work-related needs for this population and demonstrate the utility of using on-line training.

From the Center for Research on Occupational and Environmental Toxicology (Dr Rohlman, Ms Parish, and Ms Montgomery) and Health Promotion and Sports Medicine (Dr Elliot), Oregon Health & Science University, Portland; Occupational and Environmental Health (Dr Rohlman), University of Iowa, Iowa City; and Kaiser Permanente Northwest (Dr Hanson), Center for Health Research, Portland, Ore.

Address correspondence to: Diane S. Rohlman, PhD, Occupational and Environmental Health, University of Iowa, Iowa City, IA 52242 (

Funding for this project was through the Oregon Healthy Workforce Center (, a National Institute for Occupational Safety and Health Total Worker Health Center of Excellence (grant: U19OH010154).

The authors declare no conflicts of interest.

The work-related injury rate for workers younger than 25 years is approximately twice that of older workers.1 The primary method of reducing risk to young workers is through the provision of effective and relevant training. Although employers are required to provide basic safety training to these new and younger workers, few implement programs designed to address the special needs of this workforce; furthermore, they do not include training on health promotion topics.2

Young workers are at an increased risk for on-the-job injuries, because they lack valuable skills and experience.1,3 They are less likely to recognize hazards, speak up regarding safety concerns, or be aware of their legal rights as workers.1 Adolescents, in particular, may have little or no knowledge of their rights at work and may be hesitant to report injuries to their supervisors.3 Furthermore, the United States Occupational Safety and Health Act requires employers to provide health and safety information and instruction to all employees; however, a survey of young workers found that 84% of workers received little or no training related to health and safety in the workplace.4 Inadequate knowledge about their rights can lead to underreporting of injuries experienced at work and consequently, unintended social, health care, and financial burdens on workers and their families.

Injury and illness are not the only risks to younger workers. Although young workers have similar stressors as older workers, they also face unique cultural expectations. For example, this population frequently juggles a combination of school, homework, family responsibilities, and social activities along with the demands of their jobs. A recent study of working students found that working 20 hours or more a week during the school year was associated with higher levels of emotional distress, more substance abuse, and earlier onset of sexual activity than experienced by students working less than 20 hours a week or not at all.5

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Survey data provide evidence of technologically savvy adolescents and young adults.6 Adolescent and young adults typically own more gadgets (cell phones, mp3 players, computers, game consoles, and portable gaming devices) than adults, and they utilize these devices, in addition to computers, to allow them access to the Internet. By 2009, 93% of adolescents and young adults reported going on-line, and nearly two thirds report going on-line every day. While on-line, 82% of teens (14 to 17 years) report using social networking Web sites. The main motivation behind these activities seems to be for creative self-expression and to document and share personal experiences.7 Therefore, incorporating social media methods (viral videos, images, and memes) into on-line trainings and promoting training opportunities through social networks already frequented by the young workforce would provide a mechanism to capitalize on already established, normative methods of communication in this group.

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PUSH (Promoting U through Safety & Health) is a translational project, which blends existing programs into an on-line curriculum addressing both health promotion and occupational health protection. As part of the Oregon Healthy Workforce Center, PUSH addresses the National Occupational Research Agenda priority to “define the nature and magnitude of risks experienced by special populations,” specifically in this case, young workers. The paper-based, instructor facilitated NIOSH-developed training, Youth @ Work: Talking Safety, has been combined with evidence-based curriculum on lifestyle factors8 into an on-line, interactive training program.

The overall health of workers is impacted by both “work” and “nonwork” factors. A newer approach supported by the NIOSH Total Worker Health™ (TWH) initiative9 is to integrate workplace health protection and health promotion principles to improve the overall quality of life of workers. In this report, we provide preliminary data on young workers' general health, occupational history, and social media habits. This study is the first to assess the utility and acceptability of an on-line TWH training for young workers.

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Young workers, 14 through 24 years of age, employed as staff in the aquatics division of a city park and recreation program, were recruited during the summer of 2012. A letter describing the study was provided to the workers during the staff orientation meeting.

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Participants were e-mailed a Web address to a 133-item on-line survey administered through Survey Gizmo. On completion of the survey, participants received a $5 gift card. The Oregon Health & Science University institutional review board approved the study materials and procedures.

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Questionnaire items were used to collect demographic information, work history, lifestyle characteristics (sleep, diet, and substance use), risk-taking behavior, and social media use (Table 1). Specific measures were selected to complement data being collected in other projects in the Oregon Healthy Workforce Center to allow the development of a common database of information across industry, age ranges, and intervention methods.



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During the summer of 2012, 348 young workers from the aquatics division at a city park and recreation program were recruited during the orientation meeting held before the start of the summer work season. E-mail invitations, with a link to the Web address of the on-line survey, and periodic reminder e-mails were sent in June. Seventy-three were invalid e-mail addresses, leaving a total of 275 invitations sent to young workers. One hundred eighty-seven completed the survey for a response rate of 68%. Because of the developmental changes occurring during adolescence and young adulthood, participants were stratified by age (younger than 18 years, and 18 years and older).

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Work History

Most workers who completed the survey were female workers (65%), and the mean age of the participants was 17.9 (2.3) years. Those younger than 18 years, consisting primarily of high school students, were compared with workers aged 18 years and older, who may be entering college or their first full-time job. Participants aged 18 years and older had more work experience than workers younger than 18 years; this was the first job for 63% of workers younger than 18 years (Table 2). Older participants were also more likely to have a second job or to work during the school year. For those participants working during the school year, there was no difference by age on reported conflict from work, school, or family activities. The primary source for workplace safety information was employers (96%), followed by peers and coworkers (75%). For those who had worked previously, 34.7% reported receiving no safety training at work.



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Most participants were experiencing positive physical health; 35.6% reported their general health as good, 44.2% as very good, and 14.4% as excellent. Nevertheless, 20% reported “accomplishing less than they would like in their normal daily activities as a result of emotional problems, such as feeling depressed or anxious.” Body mass index ranged from 15.02 to 35.86 kg/m2, with a mean of 22.1 kg/m2 (Table 2). Physical activity decreased with age, although most workers younger than 18 years (86%) and 18 years and older (72.3%) met or exceeded the aerobic activity recommendations from the CDC for adults, exercising at least 2.5 hours per week. Seventy-three percent got 7 or more hours of sleep a night, and 11.7% reported daytime sleepiness.

A surprisingly small number of participants ate sugary snacks (23.5%) or drank sugar-sweetened drinks (17.1%) on a daily basis, and most reported eating a meal from home (66.9%), for example, packing a lunch for work. Although a small number reported ever smoking a cigarette (18.2%), approximately a third had smoked marijuana at least once (33%). Only 4.2% reported smoking cigarettes or marijuana (5.7%) on a weekly basis. Alcohol consumption was higher, 27.8% reported drinking to the point of getting drunk in the last 30 days, and of them, 69.2% were younger than 21 years.

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Social Media Use

Not surprisingly, all participants engaged in on-line activities, and 97% reported using the Internet at least once a day. Social networking sites were frequently used: 74.3% checked Facebook daily, 42.8% checked YouTube daily, 19.8% checked Twitter daily, and 13.9% checked Tumbler daily. These workers used the Internet to find information; most had gone on-line to find health-related information (71.7%), and a smaller number had also gone on-line to find safety-related information (18.2%). Approximately half of the workers were willing to receive workplace safety information delivered electronically, either by e-mail or text message (50.3%), presented on laptop, cell phone, iPod, or other portable device (52.4%), or to go on-line to find this information (52.4%).

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Workers were asked 35 multiple-choice questions related to health promotion and safety topics, such as rights, safety protocols, professional communication, nutrition, and sleep. Workers aged 18 years and older had significantly more correct responses to the knowledge questions than workers younger than 18 years (Table 2). Both younger and older workers (51% and 56% correct, respectively) had difficulty with general safety questions taken directly from the Talking Safety curriculum, addressing topics such as identifying and controlling hazards in the workplace. Workers younger than 18 years also had more incorrect responses on items related to workers' rights than older workers (63% compared with 77% correct, respectively). In addition, there were differences between the groups on questions addressing general health and other health promotion topics such as the impact of sleep, caffeine, and alcohol consumption on health (65% correct for younger and 72% correct for older workers).

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Young workers have unmet needs—many arrive to the workplace with no safety training or knowledge about their rights and responsibilities. Almost half were first-time workers, and of those who had worked previously, more than one third lacked safety training. Knowledge of workplace safety practices was low, particularly for the youngest workers; workers younger than 18 years were less familiar with their legal rights and lacked information about identifying and controlling hazards in the workplace.

Overall, general health in these workers was good; most exercised regularly, limited unhealthy food options, and got adequate sleep. Nevertheless, a subset of respondents reported poor mental health, inadequate exercise, and engagement in risky behaviors, including substance abuse. A subset of participants, including those underaged, report drinking to the point of getting drunk, indicating specific areas for improvement identified by this survey. Programs that promote healthy behaviors in adolescents have been shown to have durable positive outcomes that can lead to the development of habits that persist into adulthood.10–12

A limitation of the study is that the population consisted primarily of lifeguards and swim instructors with a narrow demographic background (mostly white with high grade point averages), who may be more active because of the nature of their work, and less representative of all young workers. Furthermore, the employer we partnered with to recruit participants includes both safety and health promotion as part of their training, potentially contributing to the high knowledge scores and overall trend toward health. One strength of this project is that it is the first study to look at the feasibility and utility of developing and disseminating an on-line health and safety training for young workers. This exploratory research project has given researchers useful data that will drive the development of the PUSH training curriculum.

Adolescents and young adults are major consumers of technology and three quarters of our population reported frequenting social networking sites daily. The Internet was a source of health-related information for most participants and for workplace safety information for some. Participants indicated that they would be willing to learn from a technologically delivered health and safety curriculum. Safety information is not being provided in the school setting but rather through the employer and peers. An on-line training would serve as an appropriate companion training to the job-specific safety training young workers should receive when beginning a new job. Using technology and social networking sites has been recognized as a way to deliver health protection and health promotion information to this at-risk group.13,14

The focus of the NIOSH TWH initiative is to integrate workplace health protection and health promotion principles to improve the overall quality of life of workers. PUSH utilizes an on-line curriculum for total young worker health that combines an existing safety curriculum with health promotion aspects relevant to young individuals. Establishing their needs allowed us to prioritize content; furthermore, findings confirmed that e-TWH is an appropriate delivery method for today's emerging adult workers.

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We thank Portland Parks and Recreation for their enthusiastic support of this project, particularly Barbara Aguon, Larissa Doty, and Nancy Roth. We also thank our summer interns, Eric Serres and Hannah White, for their contributions to the project.

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Copyright © 2013 by the American College of Occupational and Environmental Medicine