Vivian Rueskov Poulsen

Aim: Adolescence is a critical period during which health behaviors and school participation intersect, influencing long-term health outcomes. This study examines the associations between health behaviors, mental well-being, health outcomes, and reading and writing difficulties (RWDs) among Danish adolescents. Subject and methods: This cross-sectional study analyzed data from the 2017 Future Occupation of Children and Adolescents (FOCA) cohort, including 13,100 ninth-grade students across Denmark. All data except sex were self-reported. Logistic regression models estimated odds ratios (ORs), adjusted for socioeconomic status and sex. Results: Poorer self-rated health (OR = 1.50; 99% confidence interval [CI] 1.25–1.80), poor mental health (OR = 1.99; 99% CI 1.57–2.52), increased smoking (OR = 1.14; 99% CI 1.02–1.28), lower life satisfaction (OR = 1.15; 99% CI 1.10–1.19), lower self-efficacy (OR = 1.08; 99% CI 1.05–1.12), higher body mass index (BMI) (OR = 1.06; 99% CI 1.04–1.08), and lower levels of leisure-time physical activity (OR = 1.05; 99% CI 1.03–1.08) were all associated with higher odds of reporting having RWDs. No associations with alcohol use were found. Socioeconomic status and sex did not substantially confound the results, except for regular drug and hash use. Conclusion: RWDs and health-related outcomes appear to be associated among adolescents. Prospective studies are needed to determine whether the associations imply a causal relation that could inform the development of targeted interventions addressing both educational challenges and health risks.

Introduction: Work-related diseases and injuries represent a rising global health challenge, with 2.9 million deaths attributed to work-related causes in 2019. Work-related risk factors and diseases are unequally distributed across occupational groups, with cleaners identified as a vulnerable occupational group. Integrated approaches combining the prevention of disease and promotion of health in work health interventions have been developed. This process evaluation aims to assess the implementation of the Integrated Approach to Health, Wellbeing, and Productivity at Work (ITASPA) intervention. Methods: The ITASPA intervention was implemented at two workplaces among cleaners in Denmark. At each workplace, a committee of employees and line managers was formed to develop initiatives to prevent work-related injuries and diseases and promote workers’ health, safety, and well-being. Using the British Medical Research Council’s framework, this process evaluation assessed the implementation through reach, dose, fidelity, adaptations, mechanisms of impact, and contextual factors. Data from focus group interviews and field notes were utilized to evaluate the implementation. Results: A total of 91 cleaners provided data, and three workshops were held at each workplace. Lack of information about the intervention and motivation challenged the implementation. Furthermore, unwanted power dynamics were unintended consequences of the intervention. Contextual factors, such as many replacements, time pressure, and the absence of managers, challenged the implementation and fidelity. Conclusion: Integrated approaches to work health interventions among employees with short or no education can positively impact employees’ health, well-being, and safety if comprehensively implemented. However, attention should be given to unintended power dynamics arising from participatory approaches and the importance of management during implementation. Future interventions may benefit from increased attention to such factors to enhance long-term sustainability as well as realist evaluation approaches for more comprehensive evaluations of contextual factors. Trial registration: ITASPA was retrospectively registered at Clinicaltrials.gov on the 19 May 2023 (NCT05866978).

Background: School-based health literacy interventions have the potential to significantly impact the health of disadvantaged youth. However, the effectiveness of such interventions varies. The aim of the ‘health literacy among youth’-intervention was to improve the health literacy of disadvantaged youth in two school settings in Denmark. Methods: The intervention began with identifying the health literacy needs of 128 students. Groups of teachers from each school participated in workshops facilitated by the research team to develop activities to address the specific needs of the students. Over the course of one school year (August 2023 to May 2024), these activities were implemented. Questionnaires were administered to students before, during, and after the intervention, and semi-structured interviews were conducted among teachers and students. Results: Teachers at each school created activities aligned with the organizational structure and the needs of the students, focusing on occupational diseases and injuries, and physical activity and mental well-being, respectively. However, contextual factors such as time constraints, students’ characteristics, and teachers’ professional backgrounds and varying levels of motivation, influenced the implementation. Conclusions: The intervention design offered flexibility in tailoring health literacy activities and their implementation to suit the unique contexts of the two schools. While the participatory approach facilitated targeted and organizationally aligned health interventions, its feasibility varied across contexts. Our findings highlight the importance of involving participants in developing health interventions to ensure relevance and alignment with specific needs of the target group. Key messages: • Despite contextual similarities, the outcome of participatory intervention approaches may vary across contexts. • Co-creation contribute to health literacy interventions that are tailored the needs of the target group.

Purpose: The physical activity paradox states occupational physical activity (OPA) to be hazardous and leisure time physical activity (LTPA) to be beneficial for health. Yet, the acute effects of OPA and LTPA on cardiovascular risk factors are sparsely investigated. The aim of this study was to investigate the acute effects on ambulatory blood pressure (ABP) from steps/hour during work and leisure time among cleaners. Methods: Data were obtained from a cluster randomized worksite intervention among 91 cleaners in Denmark and included a questionnaire, objective physical measurements, ABP (measured across 24 h), and steps/hour (measured during work and leisure time). A preliminary linear regression analysis was conducted as a mixed model including random intercept and slope, allowing for both within- and between-participant variability. We adjusted for sex, age, job seniority, medication use, smoking, self-reported fitness and BMI. Changes in ABP (mmHg) were estimated per 100 steps/hour. Results: The number of steps taken was not associated with ABP during either work or leisure. Moreover, the ABP did not seem to differ between exposure to steps taken during work (systolic − 0.42 mmHg, 95% Confidence Interval (CI): − 1.10–0.25, diastolic − 0.03 mmHg, 95% CI, − 0.45–0.39) and leisure time (systolic -0.47 mmHg, 95% CI, − 1.66–0.72, diastolic 0.25 mmHg, 95% CI, − 0.46–0.97). Conclusion: Our findings show no significant association between steps/hour and ABP and no contrasting effects between work and leisure time. These mechanisms fostering the divergent results need to be further investigated to improve the understanding of the physical activity paradox.

Aim: Evidence suggests low-grade inflammation (LGI) to be associated with multimorbidity. Furthermore, there are links between inflammation markers, physical activity (PA), and labour market participation. The aims of this study were to examine the association between PA and LGI in people with multimorbidity and if this association was moderated by self-reported labour market attachment. Methods: Cross-sectional data were collected in the Lolland-Falster Health Study (LOFUS) from 2016–2020. We included 1,106 participants with multimorbidity and valid accelerometer data. PA was measured as the average counts per minute (CPM) per day during wake time and split in time spent in moderate to vigorous intensity (MVPA) and light intensity (LPA). Degree of inflammation was determined by high sensitive C-reactive protein (hsCRP) level. Associations were investigated using multiple logistic regression analyses, stratified by labour market attachment. Results: The odds of having LGI was higher with lower amount of daily LPA. The highest odds of LGI was observed for CPM < 200 per day (odds ratio (OR) 2.55; 95% confidence interval (CI) 1.46–4.43), MVPA < 15 minutes per day (OR 2.97; 95 % CI 1.56–5.62), and LPA < 90 (OR 2.89; 95 % CI 1.43–5.81) with the reference groups being CPM ≥ 400 per day, MVPA ≥ 30, and LPA ≥ 180 min per day, respectively. We could not preclude an interaction between LPA and labour market attachment ( p = 0.109). Conclusion: PA recommendations should be developed with attention to people with chronic diseases, who may experience barriers to reach PA at high intensities. People with no labour market attachment may benefit from primary and secondary prevention of multimorbidity.

Background: Despite an intensive focus on workers’ health during recent decades, the prevalence of work-related diseases remains unchanged in Denmark and internationally. Therefore, USA and Australian researchers have initiated new paradigms for integration of health promotion, prevention of work-related disease, and organization of work. Inspired by the Australian WorkHealth Improvement Network program (WIN), this paper describes the background, design, intervention methodologies, and evaluation methods of an Integrated Approach to Health, Wellbeing, and Productivity at Work (ITASPA) intervention aiming to prevent work-related injuries and diseases and promote the health, safety, and wellbeing of the worker. Methods: Using a stepped wedge design, worksites will be enrolled at baseline and offered the intervention starting at different times. Data will be collected at baseline, before the off-set of the intervention, and after each implementation period. The effect evaluation will be based on a mixed-methods approach. The qualitative data are based on semi-structured interviews and focus groups. The quantitative data consists of questionnaires, anthropometrics, and resting blood pressure and will be analyzed based on the intention-to-treat principle in linear mixed models with random slope and intercept. Discussion: Integrated interventions are shown to increase overall health and safety at worksites more effectively and rapidly than more narrowly focused programs. Still, previous integrated interventions are lacking successful implementation. In ITASPA, the effects of the intervention is tested in a strong scientific mixed-methods design. Thus, the ITASPA project contributes to the knowledge about what characterizes a best practice for the implementation of integrated worksite interventions. Trial registration: ITASPA is retrospectively registered in Clinicaltrials.gov on May 19, 2023 (NCT05866978).

Background: Despite an intensive focus on worker health over the last three decades, the prevalence of work-related diseases remain largely unchanged in Denmark and internationally. In recent years, American and Australian researchers have developed new approaches to integrate health promotion, prevention of work-related disease and organization of work. The aim of this study was to examine whether an Integrated Approach to Health, Wellbeing and Productivity at Work (ITASPA) intervention would promote the mental health and wellbeing of workers. Methods: Two worksites were recruited and offered the intervention and 76 cleaners agreed to participate in the scientific evaluation. At each worksite, employees developed initiatives to improve the psychosocial work environment, building on top of existing work environment programs, practices and procedures. The developed initiatives did not hold any physical activity components. The intervention was planned to run for 12 months, and this analysis presents data from the first of four follow-ups. Data on mental health and wellbeing were obtained using the SF12 and Orebro questionnaires. Using a stepped wedge design, participants functioned as their own controls. Data were analysed using a linear mixed model with random slope and intercept. Intercorrelation of repeated measurements was included in the models as random effect. Results: The results showed significant decrease in sleeping problems (-4.04, 95% CI, -5,32- -2.75) after the intervention. Moreover, there was a non-significant increase in the amount of time participants had felt relaxed and calm (0.33, 95% CI, -0.10-0.96) and a small non-significant decrease in the amount of time participants had felt sad (-0.004, 95% CI, -0.42-0.41). Finally, results showed a small non-significant increase in how much physical pain had challenged the daily work (0.04, 95% CI, -0.21-0.30). Conclusion: The findings show that ITASPA intervention led to significantly reduced sleep problems. There was a tendency of improved self-ratings of feeling relaxed and calm as well as reduced feeling sadness. The intervention did not decrease ratings of whether physical pain challenged the daily work, however, the worksites decided to focus on the psychosocial work environment and thus changes in mental health are expected to show greatest effects.

The physical activity health paradox, describing contrasting long-term effects of domain-specific physical activity on health, states occupational physical activity (OPA) to be hazardous and leisure time physical activity (LTPA) to be beneficial for health. Yet, the acute effects of OPA and LTPA on cardiovascular risk factors are sparsely investigated. The aim of this study was to investigate the acute effects on ambulatory blood pressure (ABP) from steps per hour during work and leisure time among cleaners in Denmark. Data were obtained from a cluster randomized worksite intervention among 91 cleaners in Denmark. Data included a questionnaire, objective physical measurements of weight, height, BMI, ABP and steps per hour. The latter was measured during work and leisure time within a maximum of four continuous days. A preliminary linear regression analysis was conducted as a mixed model including random intercept and slope, allowing for both within- and between-participant variability. The analysis was adjusted for sex, age, job seniority, medication use, smoking, self-reported fitness and BMI. Changes in ABP (mmHg) were estimated per 100 steps/hour. Mean steps/hour were 1333.4 (SD ± 404.1) during work and 530.8 (SD ± 234.1) during leisure time. The resting ABP was systolic 122.4 mmHg (SD ± 20.5) and diastolic 80.7 mmHg (SD ± 12.8). In total, 15.4% of the population were hypertensive (≥140/90 mmHg, or using anti-hypertensives). The ABP did not seem to differ from exposure to steps taken during work (systolic -0.44 mmHg, 95% CI: -1.07-0.20, diastolic 0.04 mmHg, 95% CI, -0.43-0.36) and leisure (systolic -0.42 mmHg, 95% CI, -1.54-0.70, diastolic 0.30 mmHg, 95% CI, -0.49-1.08). Either did the amount of steps taken seem to affect the ABP during work or leisure. Our findings show no significant association between steps per hour and ABP, and no contrasting effects between work and leisure time. These acute mechanisms fostering the divergent results need to be further investigated to improve the understanding of the physical activity health paradox.