Occupational Occupational Health Health

PsychologyPsychology

Psychology of Health Psychology of Health and Safetyand Safety

Fernand Léger, 1950, Builders with Rope

Occupational Health Psychology

• OHP concerns the application of psychology to improving the quality of work life, and to protecting and promoting the safety, health and well-being of workers” NIOSH

OHP Issues

• Accidents/injuries

• Health promotion

• Musculoskeletal disorders

• Physical illness

• Psychological well-being

• Stress

• Violence

• Work-family

StressorIllness

Violence Work/Family

MSD

Accident

StrainIllness

Violence Work/Family

MSD

Accident

OHP Field• Next major area of psychology• Interdisciplinary

– Within psychology– Public health, medicine, nursing, safety

• Society for OHP (SOHP)– www.sohp-online.org

• European Academy of OHP (EA-OHP)– www.ea-ohp.org

• Journal of OHP• Work & Stress

History of SOHP

• 2001 USF Meeting– Established OHP Forum– Representatives from 11 schools who got

APA/NIOSH training grants.– About 35 attended– Set goals to promote OHP

• 2003 Portland State U meeting– Continued discussion– Serious talk about starting SOHP

SOHP Membership

• 2005– 31 Founding members donated $100 to start

society

• 2006– 95 Charter members joined.

• 2012

SOHP Activities

• Members receive Journal of Occupational Health Psychology

• Joint sponsor of Work, Stress & Health conference

• Newsletter

• Promote OHP

• Website– Clearinghouse for OHP information

OHP Training

• 11 schools in US got APA/NIOSH grants– USF 2001

• Most associated with I/O Psychology

• Specialization attached to core discipline

• PhD level training

• Prepares for academic-research and practice

• Supported by NIOSH– Colorado State, Portland State, U Conn, USF

OHP At USF• Specialization for I/O and other students• Interdisciplinary with public health and nursing• Coursework and research collaboration• Sunshine Education and Research Center (ERC)• NIOSH-funded OHP training grant for I/O students

– Stipends

– Conference travel funds

• Ten OHP trainees from psychology

National Institute for Occupational Safety and Health (NIOSH)

• Promote health and safety– Training– Research– Outreach

• Internal research on health & safety• External funding for research and training • ERCs• Program grants• National Occupational Research Agenda

NORA

NIOSH ERCs

• 17 throughout US

• Sunshine ERC at USF

• Promote workplace health safety– Graduate training programs– Research– Continuing education/outreach

• Supported through NIOSH center grants

Sunshine ERC

• Began 1998

• Four Colleges– Public Health (EOH)– Nursing– Medicine– Arts and Sciences (Psychology)

• Director: Tom Bernard (EOH)

• Deputy Director: Candace Burns (Nursing)

Sunshine ERC Programs• Five training programs

– Industrial Hygiene– Occupational Health Medicine– Occupational Health Nursing– Occupational Health Psychology– Occupational Safety

• Continuing Education– Occupational safety– Hazardous materials

Program Focus• Industrial hygiene

– Effects of hazardous substances

• Occupational health medicine & nursing– Treatment of occupational disease/injury

• OHP– Psychological factors in health/safety/well-being

• Occupational safety– Safety policies and practices

• Occupational Ergonomics– Design of the physical environment

Exposures

• Acute: Incident leading to outcome– Risk behavior Accidents/injury– Posttraumatic stress

• Chronic: Degenerative disease/disorder– Stressors Cardiovascular disease– Physical activity Musculoskeletal disorders

MSD

Concepts

• Prevention and health promotion

• Healthy organization—for whom?

• Positive health—not just absence of disease

• Public health model– Primary prevention—change job for everyone– Secondary prevention—help those at risk– Tertiary prevention—intervene after

sick/injured

Week 3Occupational Stress

Concepts• Stressor: Environmental condition requiring

adaptation– Environmental versus perceived

• Appraisal: Cognitive processing of stressor• Strain: Response to stressor

– Psychological– Physical– Behavioral

• Coping: Way of dealing with stressors– Emotion vs. Problem

• Social support

Basic Stress Model

Stressor AppraisalStrain

ModeratorsControlCopingPersonalitySocial Support

Stressors

• Objective vs. psychosocial

• Task-based vs. social

• Challenge vs. hindrance

• Acute vs. chronic

• Exposure

Methodology

• Human reports– Self-report– Other-report

• Quantitative vs. qualitative

• Too subjective?

• Physical measures– Stressors– Strains

Confounds

• Personality

• Demographics

• Confounded stressors– Workhours confounded with work-family conflict– Role ambiguity confounded with poor

management

• Establish relationship and rule out alternatives

Design Issues

• Alternative measures (to self-report)– Lack precision

• Longitudinal designs– Arbitrary points in time

Week 4:Control and Buffering

Factors that Buffer Effects of Stressors

• Control

• Social-Support

• Coping

• Reverse Buffering

Control-Demand Model

Stressor

Low High

Strain

Low

High Low Control

High Control

Control

• Control relates to stressors

• Control relates to strains

• Buffering effect inconsistent– Methodological issues

• Small samples

• General control

Types of Control

• Primary: Control the environment

• Secondary: Control reaction to the environment

Social Support

• Thought to buffer like control

• Reverse buffering– Demands of social support

• Instrumental support

• Emotional support

Coping

• How people deal with stressors

• Problem-focused coping

• Emotion-focused coping

• Style vs. situational

Control, Coping, and Support

• Focus on stressor– Primary control– Instrumental support– Problem focused coping

• Focus on reaction to stressor– Secondary control– Emotional support– Emotion focused coping

Week 5: Schedules & Work-Family

Schedules: Time Demands

• Number of hours– Daily, Weekly

• Scheduling of hours– Shift work– Night work– Flex time

• Conflicting hours – Work-family conflict (WFC)

Hours/Day

• 5 days/8 hour standard• 4 days/10 hour• Longer work days inconsistent results

– More fatigue?– More days off– Preferred by employees– More satisfaction

Hours/Week

• Magic number 48/week

• Little relation to psychological strain

• Relates to heart disease

• European Union 48 hour rule– 48 hours/week– 11 hours off/24 hours

Shifts

• Rotating Shifts and night work• Physical issues

– Sleep disturbance– Stomach distress– More accidents/injuries

• Social issues– Interference with nonwork activities– Higher divorce rate

Work-Family Conflict

• Work & Nonwork interference– Work to family: WIF– Family to work: FIW

• Types– Time-based– Strain-based– Behavior-based– Energy-based

WFC as Stressor

• Job dissatisfaction

• Family dissatisfaction

• Psychological strain

• Physical strain– Symptoms– Cortisol elevation

Interventions

• Flextime

• Family-friendly benefits

• Family supportive organization climate

Week 6: Cross-National Issues CC/CN

Basic Question

• How do cultural and national differences relate to job stress?

Why Is This Important

• Psychology the study of humans not just Americans

• Explore principles in the context of different cultural/national conditions

• We’re curious scientists

• The field is interested, i.e. it’s publishable

Types of CC-CN studies

• International replication in a single country

• Comparison of two countries

• Comparison of multiple countries

• Country-level analysis of culture-national variable with other variables

International Replication

• Many examples of job stress and other studies outside of North America

• Jia Lin Xie 1996: Test of Karasek’s demand-control model in PRC– Anxiety, depression, and job satisfaction– Support for interactive effects in sample of

1200 Chinese

Comparison of Two Countries

• Narayanan, Menon, Spector (1999) International Journal of Stress Management

• Comparison of India and U.S.

• Open-ended Stress Incident Record

• Stress incident in prior 30 days

• Content analyzed

• University clerks: 130 India, 133 U.S.

Most Frequent Stressors By Country

Stressor India U.S.

Lack of control 0% 23%

Work overload 0% 26%

Lack of clarity/ structure

27% 0%

Constraints 15% 0%

Conflict 12% 17%

Reactions By Country

Reaction India U.S.

Anger 0% 18%

Resignation 20% 0%

Talk to boss 5% 60%

Talk to family 35% 17%

Comparison of Multiple Countries

• Peterson, Smith et al. 1995

• Spector, Cooper, Sanchez, Sparks, O’Driscoll, et al. 2002

Methodological Issues

• Measurement equivalence– Can measures be transported?

• Sample equivalence– Are working populations similar

Approaches to Sample Equivalence

• Choose similar working groups

• Not always possible due to economic differences

Approaches To Scale Equivalence

• Translation—Back Translation

• Analysis of equivalence– Comparison of factor structure with SEM– Comparison of item response with IRT

• Create cross-national scales– Parallel development in more than one place

Parallel Scale Development

• Spector, Sanchez, Siu, Salgado, Ma, 2004, Applied Psychology: An International Review

• Development of scales for new constructs• Avoid ethnocentrism with multi-national team

– American, Chinese, and Spanish colleagues

• Sample equivalence with similar samples

Background

• Asians score much lower than Americans on locus of control

• View of passive Asian• Primary vs. Secondary control

– Primary: Direct control of environment– Secondary: Control of reaction to environment

• Socioinstrumental control: Control through development of social networks

Background 2

• Individualists focus on primary control

• Collectivists focus on secondary and socioinstrumental control

Hypotheses/Purpose

• Americans will score higher than Chinese on locus of control

• Chinese will score higher than Americans on secondary and socioinstrumental control

• Scale exists for LOC

• Need to develop scales for other forms of control

Scale Development

1. Spector-Sanchez developed definitions of primary-secondary and socioinstrumental

2. Each partner wrote items to tap constructs3. Large item pool administered to 126 employed

students4. Item analysis reduced to 11 items (Secondary)

and 24 items (Socio)5. Administered as part of larger questionnaire in

PRC, Hong Kong, and U.S.

Items

• I take pride in the accomplishments of my superiors at work (vicarious control)

• I sometimes consider failure as payment for future success (interpretative control)

• It is important to cultivate relationships with superiors at work to be effective (socio)

• You can get your own way if you learn how to get along with others (socio)

Coefficient Alphas

Country Secondary Socioinstrumental

Job Satisfaction

Hong Kong .87 .91 .82

PRC .70 .88 .65

U.S. .76 .91 .89

Comparison of Means

Variable Hong Kong

PRC U.S R2

Secondary 43.8A 46.0B 45.6B .01

Socio 93.4A 97.1B 91.9A .02

Work LOC

51.0B 57.0C 40.2A .38

Results/Conclusions

• Scale internal consistency did not degrade when used in China

• Chinese as high or higher than Americans on new control scales

• Differences on new scales small• Differences on Work LOC huge• View of passive Asians incorrect based on

American view of control

Concluding Thoughts

• CC-CN research in its infancy

• Evolving from descriptive to theory testing studies

• Challenging methodological issues

• International colleagues eager to collaborate

• Lots to be done

Week 7: Negative Affectivity

Affect Central Role in Stress

• Emotional response– Psychological Strain– Immediate response to stressor

• State vs. Trait

Negative Affectivity

• Watson & Clark• Noted high correlations among measures of

affect– Trait anxiety– Neuroticism– Depression

• Concluded they are all manifestations of NA– Tendency to experience negative emotion across

situations and time

Nature of NA

• NA mainly anxiety and related states/traits

• Other emotions distinct– Anger– Depression– Boredom

The Great Debate about NA

• What is the role of NA trait in stress research?

Watson, Pennebaker, Folger 1986

• NA is a confounder

• Questions validity of survey research

• If correct, reshapes entire field

Brief, Burke, George, Robinson, Webster, 1988

• Test of Watson et al.

• Conclude they are correct

• Recommend partialling NA routinely

Chen & Spector, 1991

• Another test of Watson et al.

• Conclude general confounding does not occur

• Amount of overlap variable across measures

• Criticized Brief et al. for item overlap and affect-laden measures

Burke, Brief George, 1993

• Reanalyzed data from Frese and Spector

• Concluded confounding a problem

• Agrees with Watson et al. and Brief et al.

Spector, Zapf, Chen, & Frese, 2000

• Reanalyzed Burke et al reanalysis & came to different conclusions

• Summarized evidence for confounding

• Discusses several NA mechanisms

• Argues against routine partialling of NA

Week 8: Interventions

Level of Intervention

• Primary: Sound management– Positive impact on performance

• Secondary: Stress management training– Quick fix

• Tertiary: EAPs– Failure?

Primary• Selection/placement• Training• Leadership• Reward systems

– Justice

• Climate– Safety, civility, violence

• Empowerment• Petterson study

Secondary

• Skills at handling stressors/strains

• Bruning– Exercise, relaxation, management skills

(primary?)

• Ganster– Stress management

Tertiary: EAPs

• Popular among large organizations

• Employee benefit

• Multiple purposes– Stress– Alcohol/drug problems– Psychological problems

• Self vs. supervisor referral

• Research inconsistent on effectiveness

Semmer Chapter Comments

• More attention to task than social stressors

• Concludes interventions effective– Intervention-stressor/strain match unclear

• Health Circle

• Job satisfaction general well-being indicator

• Strains persist after stressor removed– “I’ll remove the cause but not the symptom”

• Tim Currey to Brad and Janet in Rocky Horror

Week 9: Spring BreakWeek 10: Appraisal Vs.

Environment Debate

Week 11: Cardiovascular disease, Immune Functioning, and Post-

traumatic Stress

Psychological Factors Important

• Stress

• Exposures through behavior– Over-eating– Smoking

• Diseases– Cardiovascular– Cancer– Diabetes

Points from Landisbergis

• No hypertension in hunter-gatherers, herders, or family farmers

• SES and stress risk factors

• Job control important work factor

• Threat-avoidance vigilant work

• Econeurocardiology—Social environment and CNS

• Work and family stressors compound

Relative Weight

• Parkes

• Obesity important risk factor– Heart disease– Cancer– Diabetes

• RW = W/H2 (W in kg, H is M)

• I am 21.3

Model of Physical Illness

Stressors

Emotion

Physiology Catecholamines Cortisol

PhysicalSymptoms

Disease

Job Stressors & Cardio ResponseFox, Dwyer & Ganster

• 198 hospital nurses

• Workload– Patient load & Contact

• Perceived control

• Blood pressure

• Cortisol

HighLow

Workload

BPSy

Work

Low

High

Low control

High control

HighLow

Workload

CortisolHome

Low

HighLow control

High control

Stressor-Physical Symptom Meta-Analysis

Ashley Nixon and Joe Mazzola

k Mean wr

Workhours 5 .14

Workload 28 .31

Role ambiguity

16 .27

Role conflict 16 .38

Abuse 4 .30

Week 12: Accidents and Safety

Not So Fun Facts• US 2005

– 5702 workplace fatalities– Rate declining recent years: 4/100,000– 4.2 million illnesses/injuries

• Least safe occupations– Agriculture/fishing/forestry/hunting– Mining

• Safest– Education/health service– Services

Gender and Safety

• Men– 54% of workforce– 93% of fatalities

• Reasons– Men in more dangerous jobs– Less safe behavior?

Accident causes

• Unsafe conditions

• Unsafe behavior

• How do we get management to make conditions safer?

• How do we get employees to engage in safer behavior?

Areas of Concern

• Physical conditions– Equipment– Lighting

• Psychological factors– Job skill– Personality– Stress

• Organizational factors– Leadership– Safety climate

Psychological Factors• Personality

– People high on openness to experience

– Low on conscientiousness

– Low on agreeableness

– Grumpy, lazy, sensation seekers

• Job Dissatisfaction• Job stress

– Divorce

– Heavy workload

– Unclear expectations

– Conflicting job demands

Organizational Factors

• Balance between production and safety– Higher accident rates with incentive system

(piece rate) vs. hourly

• Workplace norms– Rickett et al. Hoist usage in hospitals

• Beliefs about reactions of others related to use

• Safety climate– Shared perception that safety is important

Safety Climate

• Shared perception that safety is important• Reflected

– Policies– Practices

• Supervisor main source of climate– Actions (model safe working)– Words (talks about safety)

• Related to– Safe behavior– Accidents/injuries

Focus of Intervention• Recruitment/selection: Hire safe people• Training

– Safe procedures– Skills– Attitudes

• Control stress• Goal setting

– Careful to affect behavior and not just reporting

• Leadership– Mentoring– Modeling– Support

Scale Development Project

Scale Development Steps

• Define Construct

• Write items

• Administer

• Item-analysis

• Validity evidence

Item Analysis

• Goal: Internally consistent scale

• Items are intercorrelated

• Reflect single construct

• Coefficient alpha: Measure of internal consistency

• Item-remainder: Correlation of item with sum of other items in scale

Internal Consistency• Coefficient alpha

– Standard at least .70– Looks like correlation

• Item-remainder– Take items with highest values– Typically .30 or more

• Alpha with item removed– Indicates if item contributes to internal

consistency– Delete if alpha is larger without item

Data Analysis Steps

• Enter data• First variable is ID• Reverse score oppositely worded items• Subtract item from difference between high and

low value– Subtract item from 7 for 1 to 6 scale– Subtract item from 5 for 1 to 4 scale

• Run item analysis• Refine measure• Relate measure with other variables

Refining the Scale

• Delete items that reduce alpha• Delete one at a time iteratively• Sum final items into scale score• Relate scale with other variables

– T-test or correlation for 2 group differences (e.g., gender)

– Correlation with continuous variables (e.g., job satisfaction)

– ANOVA for multi-group differences (e.g., race)

Item Analysis Example

• Violence Climate Scale: VCS• Three subscales

– Policies– Practices– Pressure for unsafe performance

• Example– Practices (First 4 items)– Pressure (Last item)

3. Management in this organization quickly responds to episodes of violence.

4. Management in this organization requires each manager to help reduce violence in his/her department.

18. Management encourages employees to report physical violence.

19. Management encourages employees to report verbal violence.

36. In my unit in order to get the work done, one must ignore some violence prevention policies.

Variables Alpha

ƒƒƒƒƒƒƒƒƒƒƒƒƒƒƒƒƒƒƒƒƒƒƒƒƒƒƒƒ Raw 0.753049  Deleted Correlation

Variable with Total Alpha

ƒƒƒƒƒƒƒƒƒƒƒƒƒƒƒƒƒƒƒƒƒƒƒƒƒƒƒƒƒƒƒƒƒƒƒƒƒƒƒƒƒ x3 0.622879 0.673323 x4 0.627735 0.670671 x18 0.679266 0.650681 x19 0.719180 0.632802 x36 0.091843 0.865910

Variables Alpha

ƒƒƒƒƒƒƒƒƒƒƒƒƒƒƒƒƒƒƒƒƒƒƒƒƒƒƒƒ Raw 0.865702  Deleted Correlation

Variable with Total Alpha

ƒƒƒƒƒƒƒƒƒƒƒƒƒƒƒƒƒƒƒƒƒƒƒƒƒƒƒƒƒƒƒƒƒƒƒƒƒƒƒƒƒ x3 0.672844 0.845290 x4 0.665091 0.848473 x18 0.751180 0.813753 x19 0.774005 0.803730

What To Report

• Item-remainder statistics for each item

• Alpha if item removed for each item

• Overall coefficient alpha

• Mean, standard deviation and range of total scale and other variables in study

• Relationships with other variables

• Factor analysis of scale (optional)

Week 13: SIOPWeek 14: Aggression and

Violence

Thomas McIlvane

• Postal Employee• Royal Oak, Michigan• November 14, 1991• Killed 5• Wounded 4• Harassed and bullied

by supervisors• Fired for

insubordination

What Are the Homicide Risks?

• 5.6% of homicides at work (2000)– 677 out of 12,000 in US

• 8% by coworkers– 54 cases in 2000

• 84% male victims• Female deaths rare

– 2000 151 homicide plus suicide at work

• Workplace much safer than home and street

Workplace Nonfatal Violence

Common in many jobs

Workplace Verbal Aggression

Common in all jobs

Helen Green

• Successfully sued Deutsche Bank in the UK

• Secretary• Hospitalized for stress-

related disorder• Abused and bullied at work• Awarded $1,575,000

Types of Violence/Aggression

• Type 1: Strangers committing a crime– Cab driver, Convenience store clerk

• Type 2: Clients, customers, patients– Health care workers, nurses

• Type 3: Coworkers, supervisors– Any job

• Type 4: Relationship– Any job

How Prevalent

• 2 million violent episodes/year in U.S.– NIOSH Report

• 16 million verbal aggression incidents/year in U.S.– Northwestern National Life Insurance

Company

Type 1 & 2 Factors

Physical control over others

Handle weapons

Physical care of others

Contact with drug takers

Contact with alcohol drinkers

Decisions over others

Exercise security functions

Work alone

Go to client’s home

Interacted with frustrated

Emotional care of others

Guard valuables

LeBlanc & Kelloway, 2002

StressConflictConstraintsInjusticeWorkload

PersonalGenderHostile attributionLocus of controlTrait AngerTrait Anxiety

EmotionAngerAnxietyDepressionFrustration

AggressionViolence

Type 2 and 3 Aggression & Violence: Emotion-related

Control a Vital Element

• Low control leads to aggression/violence to deal with stressful incidents

• High control leads to constructive acts to deal with stressful incidents

Relations With Predictors

Variable Behavior

(Employee)

Behavior

(Coworker)

Conflict .36 .25

Constraints .25 .12

Justice -.20 -.29

Job satisfaction -.14 -.18

The Relationship of Physical and

Psychological Violence With Safety Climate

Paul E. Spector, Psychology, USF

Martha L. Coulter, Public Health, USF

Heather G. Stockwell, Public Health, USF

Mary Matz, VA Patient Safety Research Center

Work & Stress, 2007

Current Study• Survey of Nurses in a VHA hospital• Incidence of physical and verbal assault• Relationship of violence climate with assault• Relationship of assault with physical and

psychological well-being

Participants

• 198 Nurses

• Variety of departments– Medical, surgical, mental health, emergency

• All shifts– Day, evening, night

Measures• How often assaulted and who assaulted

– Physical and verbal– Prior year

• Violence climate• Physical symptoms

– Digestive problems, Sleep disturbance• Emotional well-being (Brief Symptom Inventory)

Abuse Scale• Been yelled or sworn at• Been insulted or made fun of• Been hit or slapped• Been kicked, bit or punched with a

fist

Safety Climate Items

• Violence prevention training.• Violence prevention policies and procedures.• Procedures for reporting violence.• Encourage reporting physical violence.• Encourage reporting verbal violence.• Violence reports taken seriously by management.

Incidence

Source n % n %

Coworker/

Supervisor

5 9% 38 33%

Patient 53 95% 98 85%

Patient family 5 9% 23 20%

Total 56 115

Physical Verbal

CorrelationsPhysical assault

Verbal assault

Abuse Physical symptoms

Emotional Well-being

Climate -.28 -.32 -.57 -.22 -.26

Physical assault

.34 .63 .31 .31

Verbal assault

.35 .30 .30

Abuse .34 .41

Conclusions• Physical common: ¼ of nurses

– Missing data suggests underreporting

• Injuries occurred tended to be minor– Most serious broken bone done by patient

• Verbal more common: over ½ of nurses• Patients biggest source for both forms• Verbal climate relates to assault/abuse

Week 15: Musculoskeletal Disorders (MSDs)

MSD

• Acute– Sudden injury– Back injury– Nurse lifting a patient

• Chronic– Repetitive strain injury through overuse– Carpal tunnel– Employee typing

Common Injury Areas

• Upper extremities– Fingers, hand/wrist, elbow, shoulder, neck

• Lower extremities– Toes, foot/ankle, knee, hip

• Back

Symptoms

• Numbness

• Pain– Muscle– Tendon– Joint

• Weakness

• Inflammation

• Fracture

Psychological Factors

• Neuroticism and pain

• Soft tissue– No obvious physical injury

• Malingering– Form of CWB– Relates to injustice?

Physical Solutions

• Hardware to minimize physical strain

• Lifting device for acute

• Keyboard design for chronic

Patient Lifting Device

Split Keyboard

Psychological Factors

• Heavy workload

• Low control

• High work pace

• Monotonous work

• Low social support

• Job dissatisfaction

• Negative mood

Week 16: Future - Healthy Work Organization

What is a HWO?

• Organization that maximizes– Effectiveness/productivity– Employee health, safety, and well-being

• Joint Optimization– Socio-technical systems theory

• Social and technical systems in balance

– Health and Performance systems in balance

Sauter HWO Characteristics

• Quality• Career development• Strategic planning• HR planning• Justice• Innovation• Cooperation• Diversity• Technology

Health Climates

• Safety

• Civility

• Violence

• Health

Management of Stress• Empowerment/control• Social support• Workload management

– Priorities

• Schedule flexibility• Clear expectations• Justice• KSAO – Job fit

– Selection/Placement– Training– Task assignment

Six OHP Topics Linked

• As Stressors

• As Strains

Stressors

• Accidents

• Illness

• MSD

• Violence

• Work-Family Conflict

Strains

• Response to stressor

• By-product of behavioral strain

• Accidents

• Illness

• MSD

• Violence

StressorIllness

Violence Work/Family

MSD

Accident

StrainIllness

Violence Work/Family

MSD

Accident

Employee Health, Safety, and Well-Being Is a Psychological Problem As Well As a Physical

Problem