Workplace violence as a public health issue among environmental and occupational prevention technicians: a cross-sectional study in four Italian regions

Abstract

Background

Workplace violence is an increasing concern in the healthcare sector, affecting not only clinical health professionals but also non-clinical ones. Among these, Environmental and Occupational Prevention Technicians— who are responsible for public health surveillance and risk prevention —may frequently encounter high-conflict situations during their activities. However, evidence on their exposure to workplace violence remains limited. This study aims to assess the prevalence, characteristics, and associated risk factors of workplace violence among Prevention Technicians in Italy.

Methods

A cross-sectional survey was conducted between May and July 2024 among all registered Environmental and Occupational Prevention Technicians in four Italian regions (Piedmont, Campania, Sicily, and Aosta Valley). Data were collected through an anonymous online questionnaire covering sociodemographic characteristics, work setting, workplace violence, psychological impact, and organizational factors. Descriptive statistics, chi-square tests, and Poisson regression models with robust variance estimation were used to identify factors associated with workplace violence. Associations were reported as prevalence ratios (PRs) with 95% confidence intervals (95% CIs).

Results

Out of 2,380 eligible professionals, 566 completed the questionnaire (response rate: 23.8%). Among public-sector employees, 37.5% reported workplace violence compared with 29.1% among private-sector employees and self-employed professionals. In the public sector, a higher prevalence of workplace violence was associated with age 41–50 years (PR1.55; 95% CI 1.06–2.26; p = 0.023), age 61–67 years (PR2.02; 95% CI 1.42–2.86; p < 0.001) compared with participants aged 22–30 years, and high perceived risk of workplace violence (PR 2.76; 95% CI 1.63–4.66; p < 0.001). Registration with professional boards in Southern Italy and the presence of workplace procedures were associated with a lower prevalence of workplace violence (PR 0.57; 95% CI 0.47–0.70; p < 0.001 and 0.70; 95% CI 0.52–0.95; p = 0.022, respectively). Among private-sector employees and self-employed professionals, high perceived risk was associated with a higher prevalence of workplace violence (PR 8.84; 95% CI 1.22–63.95; p = 0.031), as was the presence of workplace procedures (PR 2.92; 95% CI 1.69–5.03; p < 0.001).

Conclusions

Workplace violence represents a relevant occupational issue also among Environmental and Occupational Prevention Technicians. The high prevalence observed and the associations identified with individual and organizational factors highlight the need for both further research to disentangle the causal relationship and potential preventive initiatives aimed at improving safety in non-clinical healthcare settings.

Supplementary Information

The online version contains supplementary material available at https://doi.org/10.1186/s12889-026-28609-1.

Introduction

The World Health Organization (WHO) defined violence in 1996 as “the intentional use of physical force or power, threatened or actual, against oneself, another person, or against a group or community, which results in or has a high likelihood of resulting in injury, death, psychological harm, developmental problems, or deprivation” [1]. In the same year, the National Institute for Occupational Safety and Health (NIOSH) described workplace violence as “any physical assault, threatening behaviour, or verbal abuse occurring in a work environment” [2]. In the healthcare sector, these definitions are particularly relevant. Healthcare workers (HCWs) are vulnerable to such incidents due to the nature of their work. In the United States, the Department of Labor has classified hospitals as among the most hazardous workplaces [3]. Workplace violence against HCWs is now recognized globally as a critical issue, with significant consequences for employee safety, mental health, and the overall quality of care. Recent studies have revealed high exposure rates to various forms of violence. A 2025 systematic review conducted in Ethiopia reported an overall prevalence of 56%, with similar rates for verbal abuse (57%), sexual harassment (56%), physical assault (55%), and bullying/mobbing (51%) [4]. Risk factors included being female, single, working in emergency departments, or on night shifts. Another recent review highlighted that non-physical violence, particularly verbal abuse and threats, are more frequent than physical violence, especially among women [5–7]. Other studies have shown that less experienced workers (under two years of tenure) are more likely to report verbal abuse, whereas individuals in the private sector or older professionals tend to report such incidents less frequently [8]. Regarding perpetrators, patients were responsible for 77% of physical violence cases, while colleagues were involved in 50% of non-physical violence [9]. Caregivers were more frequently targeted than non-clinical staff. Among clinical HCWs, frontline professionals—particularly nurses—were targeted more often than medical specialists. Additional evidence from regional studies supports these findings. International literature, including systematic reviews and meta-analyses, indicates that workplace violence against HCWs is a widespread phenomenon globally, with prevalence estimates widely varying depending on the type of violence, health contexts and professional categories considered. An umbrella review included over 30 systematic reviews and meta-analyses on the topic, documenting large levels of violence between HCWs in different countries [10].

In Italy, national literature is more limited and fragmented than international literature. A scoping review summarized, declaring the difficulty in comparing the data due to the methodological heterogeneity used, the available evidence on the prevalence rates of violence against HCWs by patients and visitors, including 32 studies conducted in the Italian context and documenting wide variations in prevalence depending on the contexts and professional roles considered [11]. For instance, a cross-sectional study involving 203 italian HCWs showed that women were 2.6 times more likely to experience violence, and nurses were nearly four times more likely than other roles [12]. The likelihood of violence also increased by 5% for each additional year of work experience. Another Italian study which involved 956 physicians showed that over 66% had experienced at least one incident of workplace violence during their career, with higher incidence among permanent employees and in public hospitals [13]. The existing literature on workplace violence in healthcare settings is predominantly focused on clinical health professionals, particularly physicians and nurses. On the other hand, non-clinical HCWs are rarely examined, despite their involvement in essential technical, organizational, and preventive activities within healthcare organizations. These roles include healthcare professionals responsible for environmental safety, workplace prevention, risk assessment, and regulatory compliance. These professionals, officially recognized by the Italian Ministerial Decree No. 58 of January 17, 1997, do not engage in direct clinical care but play a vital role in public health protection and workplace safety [14]. Environmental and Occupational Prevention Technicians, also named Prevention Technicians or Environmental Health Officers, have frequently extensive contact with citizens who interact with the Local Health Authority for non-clinical services, including regulatory oversight and administrative procedures. Their work in settings may become adversarial, exposing them to workplace violence risks like those experienced by clinical frontline HCWs. Despite this, the literature remains sparse regarding this professional group. This study aims to address this gap by assessing the prevalence and characteristics of workplace violence experienced by Prevention Technicians across four Italian regions. The primary objective of this study is to quantify the prevalence of workplace violence among these non-clinical HCWs. Secondary objectives include examining the individual and organizational variables associated with violence. The selection of sociodemographic and organizational variables was guided by previous literature on occupational violence, which suggests that workplace violence is a multifactorial phenomenon influenced not only by individual characteristics but also by structural and organizational conditions [15]. Sociodemographic variables (e.g., age, gender, marital status) were included as potential proxies of social support, occupational exposure patterns, and vulnerability to workplace stressors, rather than as direct causal determinants. Organizational factors, including recent organizational changes, on-call duties, and the availability of violence prevention procedures, were included as indicators of workplace structure, operational stability, and risk management practices, which have been hypothesized to influence both exposure to and reporting of workplace violence.

Materials and methods

This cross-sectional study was conducted between 13 May and 31 July 2024 in the regions of Piedmont, Campania, Sicily and Aosta Valley. This study was conducted in accordance with the Declaration of Helsinki and approved by the Bioethics Committee of the University of Perugia (protocol no. 2/2025). The primary objective was to assess the prevalence of workplace violence experienced by Prevention Technicians. The data were collected through an anonymous questionnaire, administered online through the Google Forms platform. The questionnaire was developed based on a literature review of the tools previously used in studies related to violence at work among health workers, with specific adaptations to the professional context of Prevention Technicians.

Questionnaire

The questionnaire (Supplement I), specifically developed and constructed for the purposes of this study, was structured into three main sections: the first, “Socio-demographic”, consisting of 12 questions (among these, age, gender, province of employment, educational qualifications, years of service); the second, “Public employees”, containing 6 questions (including professional role held, affiliated administration); and the third, “Freelancers/Private Sector Employees”, which included a single question regarding the classification of the occupation. For both the categories “Public Employees” and “Freelancers/Private Sector Employees”, subsections were included to deepen the following topics: violence suffered while on duty (6 questions); Types of violence suffered (4 questions); Psychological distress and its effects on health (10 questions); Consequences on work activities deriving from violence (4 questions); Potential violence against colleagues (4 questions). For public employees, a further question regarded the knowledge of the Italian Law 113/2020, which establishes the obligation for public officials and public service officers to report a crime if they become aware of it during the performance of their duties. Workplace violence was assessed through the question: “In carrying out your profession, and in the workplace, have you suffered acts attributable to violence?” No formal definition or examples were provided to respondents. Consequently, responses reflected participants’ own perceptions and interpretations of harassment, violence, and violence in the workplace. The question referred to experiences occurring at any time during the respondent’s professional activity and did not specify a reference period. Therefore, the outcome reflects broad self-reported lifetime exposure to workplace violence during professional practice and does not necessarily refer to events occurring in the respondent’s current workplace.

Study population

All the Prevention Technicians, registered in the professional registers of the Piedmont, Campania, Sicily and Aosta Valley regions, were reached out by e-mail. The involved provinces or area included are: Alessandria, Asti, Biella, Cuneo, Novara, Metropolitan City of Turin, Verbano-Cusio-Ossola, Vercelli, Avellino, Benevento, Caserta, Metropolitan City of Naples, Salerno, Agrigento, Caltanissetta, Metropolitan City of Catania, Enna, Metropolitan City of Messina, Metropolitan City of Palermo, Ragusa, Syracuse, Trapani and Aosta. The total number of registered professionals in May 2024 in these four regions was 2,380.

Procedure

Participation in the survey was voluntary and anonymous. The link to access the questionnaire was sent by e-mail from the Provincial Professional Registers of the Italian Federation of Orders of Medical Radiology Technicians and Technical, Rehabilitation and Prevention Healthcare Professions on May 13th, 2024. Two follow-up reminders were sent, on June 13th and July 13th, 2024, to promote a greater adherence. Informed consent was provided electronically prior to participation.

Data handling

All information collected through the online survey was anonymous and handled in accordance with the General Data Protection Regulation (GDPR). No personal identifiers were collected that could allow participants to be identified. Demographic information and all survey responses were analyzed only in aggregate form and used exclusively for the purposes of this study. Statistical analyses were performed using STATA 18 software.

Statistical analysis

Descriptive statistical analyses were performed for each questionnaire domain. Comparative analyses between participants reporting workplace violence and those not reporting violence were stratified by socio-demographic variables (gender, age, marital status), geographic macro-area, educational level, years of professional experience, employment sector, professional role, institutional setting, and organizational and occupational risk factors. The association between socio-demographic and professional variables (including gender, age, educational attainment, Judicial Police Officer status, type of employment relationship — public or private — and employment sector) and the experience of workplace violence was assessed using the chi-square test. When expected cell counts were less than 5, Fisher’s exact test was applied instead. The outcome variable was obtained by recoding the answers to the question “In carrying out your profession, and in the workplace, have you suffered acts attributable to violence?”, assigning the value 1 in case of affirmative answer (“Yes”) and 0 in case of negative answer (“No”) or uncertain (“I don’t know”). Variables associated with the outcome at univariate analysis (p < 0.25) were entered into a multivariable Poisson regression model with robust variance estimation (full model). Subsequently, a reduced model was obtained by removing non-significant covariates. The full and reduced models were compared to assess model parsimony and stability. Association estimates were reported as Prevalence ratios (PRs) with their corresponding 95% confidence intervals (95% CIs). Given the binary nature of the outcome and its relatively high prevalence, Poisson regression with robust variance estimation was chosen because it provides direct estimates of prevalence ratios and avoids the overestimation that may occur when odds ratios are used for common outcomes. Statistical significance was set at p < 0.05. Some variables have been recoded to allow a more functional analysis. The age was divided into five age groups (22–30, 31–40, 41–50, 51–60, 61–67 years). The region of birth has been grouped by geographical macro-area (North = 0, Centre = 1, South = 2, Foreign = 3), as well as registration in the professional register (North = 0, South = 1) and the macro-area in which the work activity is carried out (North = 0, South = 1, Other = 2). Years of professional experience were coded into three groups: less than one year to five years (0), six to fifteen years (1), and over sixteen years (2). The scales 0 to 10 used in the questionnaire were recoded into three levels: 0–3 (low, code 0), 4–6 (medium, code 1), and 7–10 (high, code 2). The level of education has also been recategorized, distinguishing between high school diploma (code 0), first-level university qualifications (bachelor’s degree or first-level master’s degree, code 1), and second-level qualifications (master’s degree, second-level master’s degree or doctorate, code 2). For public employees, professional role was recoded as a binary variable distinguishing between non-managerial roles (code 0) and managerial roles (code 1).

Results

Out of a total of 2,380 Prevention Technicians registered in the records of the Italian Federation of Orders of Medical Radiology Technicians and Technical, Rehabilitation and Prevention Healthcare Professions across the regions involved in the study, 566 completed the questionnaire, resulting in an overall response rate of 23.8%. Response rates by region were 21.6% in Piedmont and Aosta Valley (155/719), 28.1% in Campania (183/652), and 22.6% in Sicily (228/1,009).

Socio-demographic section

As described in Table 1 , most of the survey respondents (58%) were male. The majority of respondents were aged between 31 and 40 years (33.2%), followed by the age groups 22 to 30 years (26%) and 51 to 60 years (19.6%). 43.4% of participants reported being married, while 37.8% were single. 13.2% indicated they were cohabiting and 5.5% were classified as previously married (including divorced, separated, and widowed individuals). Most respondents (98.6%) were from the European Union, while non-EU categories were aggregated into an “Other / Not reported” category due to small cell counts (< 5) to ensure data confidentiality. Only 3 participants did not disclose their nationality, while 99.5% confirmed being Italian. Regarding region of birth, the highest percentage of participants were born in Southern Italy (74.2%), around a quarter in Northern Italy (24.1%), 0.8% in Central Italy, and less than 1% were born abroad. Most respondents (72.6%) were registered with professional registers in Southern regions, while 27.4% in Northern regions. 60.8% carried out their professional activities in the Southern provinces and islands, while 35.5% worked in Northern provinces. More than half of the respondents (50.9%) held a Bachelor’s degree, followed by 21.9% with a Master’s degree. 17.3% held a Level I Master’s degree, and 4.4% a Level II Master’s degree and Ph.D. 37.4% of respondents had less than 5 years of experience in the profession, 26.8% between 6 and 15 years, and 35.7% over 16 years of experience. The overwhelming majority of participants (87.6%) worked in the public sector, while 5.8% work in the private sector. Another 5.1% were freelancers, and 1.5% were unemployed. When asked about their perception of the risk of being exposed to acts of violence while performing their job, more than half (56.7%) of respondents reported perceiving a high risk, 29.4% reported a medium risk, and 13.9% perceived a low risk. The descriptive results of the other sociodemographic and Professional Positioning or Organizational Structure sections are contained in Supplement II.

Table 1.

Sociodemographic characteristics

Variable	Frequency (N)	Percentage (%)
Gender (566)
Female	229	40.4
Male	328	58
I prefer not to answer	9	1.6
Age groups
22–30	147	26
31–40	188	33.2
41–50	67	11.8
51–60	111	19.6
61–67	53	9.4
Marital status
Single	214	37.8.
Cohabiting	75	13.2
Married	246	43.5
Previously married (Divorced/Separated/Widowed)	31	5.5
Ethnicity
Europe	558	98.6
Other/Not reported	8	1.4
Nationality
Italian	563	99.5
I prefer not to answer	3	0.5
What is your region of birth by Macro-area?
North	136	24.1
Center	5	0.8
South	420	74.2
Foreign	5	0.9
Are you registered in the Professional Register of which Macro-area?
North	155	27.4
South	411	72.6
In which Province, by Macro-area, do you carry out the activity?
North	201	35.5
South and islands	344	60.8
Other	21	3.7
What is the highest degree acquired?
High school diploma	31	5.5
Bachelor’s degree	288	50.9
Level I Master’s Degree	98	17.3
Degree	124	21.9
Master’s Degree II level and PhD	25	4.4
Years of professional experience
< 5 years	212	37.4
6–15 years	152	26.8
> 16 years	202	35.7
Current employment status as a Prevention Technician was classified as:
Public sector employee	496	87.6
Employee in the private sector	33	5.8
Freelancer	29	5.1
Unemployed	8	1.5
To what extent do you believe, on a scale from 0 to 10 (where “0” represents low risk and “10” high risk), that your professional activity can expose you to acts of violence?
Low risk (0–3)	79	13.9
Medium risk (4–6)	166	29.4
High risk (7–10)	321	56.7

() Number of respondents

Overall prevalence of workplace violence and differences across work contexts

As shown in Table 2, the overall prevalence of self-reported workplace violence among study participants was 36.6% (95% CI 32.6–40.6%). Among public employees, 37.5% (95% CI 33.1%–41.9%) reported having experienced workplace violence, compared with 29.1% (95% CI 18.1%–41.9%) among private employees and self-employed professionals.

Table 2.

Prevalence of violence in different work contexts

	Yes N (%)	CI 95%
		Lower	Upper
In carrying out your profession, and in the workplace, have you suffered acts attributable to violence?
Public employees	186 (37.5)	33.1%		41.9%
Private employees / self-employed professionals	18 (29.1)	18.1%		41.9%
Total	204 (36.6)	32.6%		40.6%

Workplace violence among public employees

To better understand the potential determinants of violence, sociodemographic, professionals and organizational variables were compared with the reported experience. As shown in Table 3, significantly higher rates of violence were reported among older professionals, particularly those aged 61–67 years (p = 0.001). A higher prevalence of violence was also observed among participants born in Northern Italy (p < 0.001), those practicing in the North (p = 0.003), and those registered with professional boards in Northern Italy, compared with colleagues from Southern Italy (p < 0.001). Violence was more frequently reported by professionals with longer seniority (16–40 years of service; p = 0.014) and by those perceiving a high occupational risk of violence (p < 0.001). Regarding professional positioning, Prevention Technicians who held the qualification of Judicial Police Officer reported a significantly higher prevalence of workplace violence than those who did not (39.7% vs. 26.8%; p = 0.023). Furthermore, among qualified officers, those appointed by the Prefecture showed a significantly higher prevalence of reported violence compared with appointments issued by other authorities, e.g. Local Health Authorities (p = 0.049). Similarly, a significantly higher prevalence of violence was observed among HCWs who were required to be on call (i.e., formally available outside regular working hours) compared with those who did not have on-call duties (p = 0.010). Among organizational factors, professionals reporting recent changes in their operational organization, such as staff reallocation or modifications in work processes, showed a significantly higher prevalence of violence compared with those who did not experience such changes in the previous two years (p = 0.025). Higher rates of violence were also reported by professionals working in settings without specific procedures for the prevention and management of violence (p = 0.033) and by those who were not aware of violence prevention techniques (p = 0.024).

Table 3.

Frequency of violence among public employees by socio-demographic variables, professional positioning and organizational structure

Variables	No violence N (%)	Violence N (%)	p-value
Socio-demographic
Gender (496)
Female	126 (64.6)	69 (35.4)	0.425
Male	177 (60.6)	115 (39.4)
I prefer not to answer	7 (77.8)	2 (22.2)
Age groups
22–30	82 (73.2)	30 (26.8)	0.001
31–40	106 (65.1)	57 (34.9)
41–50	29 (50)	29 (50)
51–60	70 (63.6)	40 (36.4)
61–67	23 (43.4)	30 (56.6)
Marital status
Single	120(68.2)	56 (31.8)	0.197
Cohabiting	40 (63.5)	23 (36.5)
Married	131 (57.7)	96 (42.3)
Previously married (Divorced/Separated/Widowed)	19 (63.3)	11 (36.7)
Ethnicity
Europe	305 (62.5)	183 (37.5)	1.000 (Fisher’s exact)
Other/Not reported*	5 (62.5)	3 (37.5)
Nationality
Italian	307 (62.3)	186 (37.7)	0.178
I prefer not to answer	3 (100)	0
Region of birth by Macro-area
North	55 (45.1)	67 (54.9)	< 0.001
Center	3 (60)	2 (40)
South	251 (68.7)	114 (31.3)
Foreign	1 (25)	3 (75)
Province. by Macro-area. in which he carries out the profession
Other	6 (40)	9 (60)	0.003
North	100 (54.9)	82 (45.1)
South and islands	204 (68.2)	95 (31.8)
Registration in the Professional Register by Macro-area
North	63 (45.6)	75 (54.4)	< 0.001
South	247 (68.9)	111 (31.1)
What is the highest degree acquired?
High school diploma	18 (62.1)	11 (37.9)	0.457
Level I Education (bachelor’s degree - Level I Master’s Degree)	208 (64.4)	115 (35.6)
Level II Education (master’s degree - Level II Master’s Degree. PhD)	84 (58.3)	60 (41.7)
Years of professional experience
< 5 years	122 (70.5)	51 (29.5)	0.014
6–15 years	78 (61.9)	48 (38.1)
16–40 years	110 (55.9)	87 (44.1)
To what extent do you believe. on a scale from 0 to 10 (where “0” represents low risk and “10” high risk). that your professional activity can expose you to acts of violence?
Low risk (0–3)	47 (81.1)	11 (18.9)	< 0.001
Medium risk (4–6)	113 (81.2)	26 (18.8)
High risk (7–10)	150 (50.1)	149 (49.9)
Professional Positioning
What professional role do you hold?
Non managerial role	286 (62.4)	172 (37.6)	0.931
Managerial role (including organizational positions)	24 (63.2)	14 (36.8)
In which institution do you work?
Local Health Authority	296 (62.8)	175 (37.2)	0.510
Ministry/Agency	7 (50)	7 (50)
University Hospital	4 (80)	1 (20)
Other regional Authorities	2 (40)	3 (60)
Other	1 (100)	0
In which Service of the Local Health Authority are you assigned? (477)
Food Hygiene and Nutrition Service	72 (61)	46 (39)	0.476
Safety and Prevention in the Workplace Service	101 (57.7)	74 (42.3)
Hygiene and Public Health Service	57 (68.7)	26 (31.3)
Veterinary Area A (Animal Health)	15 (75)	5 (25)
Veterinary Area B (Hygiene of food of animal origin)	14 (70)	6 (30)
Veterinary Area C (Livestock and Livestock Production)	6 (66.6)	3 (33.4)
Transversal Veterinary (Area A, B, C)	8 (50)	8 (50)
Prevention and Protection Service	13 (72.2)	5 (27.8)
Other	13 (72.2)	5 (27.8)
Do you hold the position of Judicial Police Officer? (496)
No	63 (73.2)	23 (26.8)	0.023
Yes	247 (60.2)	163 (39.7)
Who issued it to you? (410)
General Manager of the Local Health Authority	133 (63.4)	76 (36.6)	0.049
Ministry	5 (100)	0
Prefecture	102 (54.5)	85 (45.5)
Region	7 (77.8)	2 (22.2)
Carries out on-call activities (496)
No	73 (73.7)	26 (26.3)	0.010
Yes	237 (59.7)	160 (40.3)
Organizational Structure
Have you been affected in the last 2 years by an organizational change? (496)
No	195 (66.5)	98 (33.5)	0.025
Yes	115 (56.6)	88 (43.4)
On behalf of the Institution/Local Health Authority to which you belong have you ever attended a training course on risk factors and management of violence against HCWs?
No	229 (62.4)	138 (37.6)	0.937
Yes	81 (62.8)	48 (37.2)
Is there a procedure/plan within the Institution/Local Health Authority where you work for the prevention and management of acts of violence against HCWs?
No	53 (51.4)	50 (48.6)	0.033
I don’t know	173 (65.1)	93 (34.9)
Yes	84 (66.1)	43 (33.9)
Are you aware of techniques to prevent the risk of violence? (407)
No	228 (63.9)	129 (36.1)	0.024
Yes	40 (80)	10 (20)
Do you think that your Professional Order should invest in training courses on risk factors and management of violence against HCWs? (496)
No. I am not interested in issues of this type as I do not believe that I will encounter violence while working	13 (61.9)	8 (38.1)	0.252
I don’t know	42 (72.4)	16 (27.6)
Yes, it would be interesting to deepen this topic through a targeted training course	255 (61.1)	162 (38.9)

() Number of respondents

Workplace violence among private employees and self-employed professionals

For Prevention Technicians working in the private sector, as shown in Table 4, significant differences were observed regarding gender. The results clearly show that female professionals were more frequently assaulted than their male colleagues. Another significant difference concerned the risk perception: professionals with a high perception of the risk of assaults were more likely to experience violence compared to those with a lower risk perception. Regarding professional classification, it emerged that professionals classified as employees reported more violence episodes compared to colleagues working in self-employed status, but this difference was not significant.

Table 4.

Frequency of violence among private employees by socio-demographic variables, professional positioning and organizational structure

Variables	No violence N (%)	Violence N (%)	p-value
Socio-demographic
Gender (62)
Male	29 (80.5)	7 (19.5)	0.050
Female	15 (57.7)	11 (42.3)
Age groups
22–30	22 (75.9)	7 (24.1)	0.721
31–40	16 (64)	9 (36)
41–50	5 (71.4)	2 (28.6)
Other	1 (100)	0 (0)
Marital status
Single	25 (71.4)	10 (28.6)	0.812
Cohabiting	7 (63.6)	4 (36.4)
Married	12 (75)	4 (25)
Region of birth by Macro-area
North	11 (84.6)	2 (15.4)	0.365
South	32 (66.7)	16 (33.3)
Other	1 (100)	0
Province, by Macro-area in which you carry out the profession
Other	3 (75)	1 (25)	0.925
North	14 (73.7)	5 (26.3)
South and islands	27 (69.2)	12 (30.8)
Registration in the Professional Register by Macro-area
North	13 (81.2)	3 (18.8)	0.293
South	31 (67.3)	15 (32.7)
What is the highest degree acquired?
Other	2 (100)	0	0.574
Level I Education (bachelor’s degree - Level I Master’s Degree)	38 (69.1)	17 (30.9)
Level II Education (master’s degree - Level II Master’s Degree, PhD)	4 (80)	1 (20)
Years of professional experience?
< 5 years	23 (71.9)	9 (28.1)	0.266
6–15 years	16 (64)	9 (36)
16–40 years	5 (100)	0
On a scale from 0 to 10 (where “0” represents low risk and “10” high risk) your professional activity can expose you to acts of violence?
Low risk (0–3)	19 (94.9)	1 (5.1)	0.008
Medium risk (4–6)	16 (66.6)	8 (33.4)
High risk (7–10)	9 (50)	9 (50)
Professional Positioning
What is your job classification?
Dependent	19 (65.5)	10 (34.5)	0.207
Self-employed	22 (81.4)	5 (18.6)
Other	3 (50)	3 (50)
Organizational Structure
Have you been affected in the last 2 years by an organizational change?
No	29 (80.5)	7 (19.5)	0.050
Yes	15 (57.7)	11 (42.3)
On behalf of the Institution / Local Health Authority you are working for, have you ever attended a training course on risk factors and management of violence against HCWs?
No	40 (72.7)	15 (27.3)	0.392
Yes	4 (57.1)	3 (42.9)
Is there a procedure/plan within the Institution / Local Health Authority where you work for the prevention and management of acts of violence by health workers?
No	26 (74.2)	9 (25.8)	0.048
I don’t know	8 (88.9)	1 (11.1)
Yes	1 (20)	4 (80)
Not applicable	9 (69.2)	4 (30.8)
Are you aware of techniques to prevent the risk of violence?
No	27 (69.2)	12 (30.8)	0.695
Yes	17 (73.9)	6 (26.1)
Do you think that the Professional Order should invest in specific training courses on risk factors and management of violence against HCWs?
No, I am not interested in issues of this type, as I do not believe that I will encounter violence while working	5 (83.3)	1 (16.7)	0.491
Yes, it would be interesting to deepen this topic through a targeted course	37 (68.5)	17 (31.5)
I don’t know	2 (100)	0

() Number of respondents

In respect to organizational structure, significant more Prevention Technician among those who have undergone an organizational change in the last two years reported being assaulted, compared to colleagues who did not experience any changes. Additionally, as shown in Table 4, the presence of a procedure for preventing violence does not appear to act as a deterrent for assaults. In fact, in workplaces benefiting from the procedure the prevalence of violence is 80%, while in workplaces without such a procedure, the assault percentage is 25.8% (p-value = 0.048).

Factors associated to workplace violence among public and private professionals

According to the Poisson regression model (Table 5), a high perceived risk of workplace violence was associated with a significantly higher prevalence of workplace violence among public employees (PR 2.76; 95% CI 1.63–4.66; p < 0.001). Regarding age, participants aged 41–50 years (PR 1.55; 95% CI 1.06–2.26; p = 0.023) and 61–67 years (PR 2.02; 95% CI 1.42–2.86; p < 0.001) showed a significantly higher prevalence of workplace violence compared with those aged 22–30 years. Conversely, registration with a professional board located in Southern Italy was associated with a lower prevalence of workplace violence compared with Northern Italy (PR 0.57; 95% CI 0.47–0.70; p < 0.001). The presence of workplace procedures for the management or prevention of violence was also associated with a lower prevalence of workplace violence (PR 0.70; 95% CI 0.52–0.95; p = 0.022). Among private employees and self-employed professionals, the Poisson regression model showed that a high perceived risk of workplace violence was associated with a higher prevalence of workplace violence (PR 8.84; 95% CI 1.22–63.95; p = 0.031). The presence of company procedures was also positively associated with workplace violence (PR 2.92; 95% CI 1.69–5.03; p < 0.001).

Table 5.

Predictors of violence among public and private employees

	PR (95% CI)	p - value
Public employees
Perception of risk group
Ref: Low risk perception High risk perception	2.76 (1.63–4.66)	< 0.001
Medium risk perception	1.05 (0.56–1.93)	0.879
Registration in the Macro-area Professional Register
Ref: North South	0.57 (0.47–0.70)	< 0.001
Presence of Risk Management Procedures
Ref: No Yes	0.70 (0.52–0.95)	0.022
Age
Ref: 22–30 years 31–40 years 41–50 years 51–60 years 61–67 years	1.19 (0.84–1.69) 1.55 (1.06–2.26) 1.22 (0.85–1.77) 2.02 (1.42–2.86)	0.314 0.023 0.278 < 0.001
Private employees
Perception of risk group
Ref: Low risk perception High risk perception	8.84 (1.22–63.95)	0.031
Medium risk perception	5.44 (0.72–40.19)	0.099
Presence of Risk Management Procedures
Ref: No Yes	2.92 (1.69–5.03)	< 0.001

Discussion

The study revealed that the frequency of workplace violence among Environmental and Occupational Prevention Technicians is relevant, with prevalence rates comparable to those already documented among clinical HCWs [10]. Notably, approximately one-third of respondents reported experiencing at least one episode of violence, with a higher prevalence observed among public sector employees compared to private sector workers and freelancers. Among the individual factors associated with a higher prevalence of workplace violence, age (41–50 and above all 61–67 years) emerged as a significant determinant. This finding may reflect cumulative occupational exposure over time, as well as the greater likelihood that senior professionals are involved in activities characterized by higher levels of conflict, such as inspections, enforcement actions, or regulatory decision-making, rather than an intrinsic vulnerability associated with age itself [16]. However, other studies [17–19] have reported that younger professionals are at greater risk, particularly with respect to sexual harassment. Since the present study assessed violence as an overall phenomenon without differentiating between its specific forms, direct comparisons with studies focusing on individual types of violence should be made with caution. Importantly, the outcome investigated in the present study was a composite measure of workplace violence and did not distinguish between physical violence, verbal violence, threats, harassment, or other forms of hostile behaviour. These manifestations may arise from different underlying mechanisms and may require different targeted prevention strategies, as interventions effective against one form of violence may not be equally effective against others. Furthermore, it limits direct comparisons with studies focusing on particular categories of workplace violence. In univariate analyses, longer service duration—particularly among public sector employees—and holding the qualification of Judicial Police Officer were associated with increased exposure to violence. However, these associations did not retain statistical significance in the multivariable Poisson regression model, suggesting that their effects may be partly explained by other individual or organizational factors. The association observed for Judicial Police Officer status, which entails broader control and sanctioning authority, is scarcely addressed in the existing literature and may reflect the specific legal and operational characteristics of this professional role. In contrast, in the adjusted analysis, high perceived occupational risk was independently associated with a higher prevalence of workplace violence. However, this association should be interpreted cautiously, as the cross-sectional design does not allow us to determine whether higher perceived risk is a true predictor of violence or, conversely, a result of previous exposure to aggressive events. It is likely that perceived risk serves as a proxy for cumulative exposure, increased situational awareness, or sensitization following past incidents rather than acting as an independent causal factor. Although the relationship between perceived risk and reported violence is not consistently supported by previous studies on HCWs, this finding highlights the potential role of risk perception in shaping both exposure and reporting behaviours and warrants further investigation. Registration with a professional board in Southern Italy and the presence of institutional risk management procedures were independently associated with a lower prevalence of workplace violence. The lower risk observed in Southern Italy could also reflect a lower propensity to report incidents in this region. Conversely, having experienced organizational changes within the previous two years was associated with increased violence in univariate analyses, but this association did not persist after adjustment, suggesting that organizational instability may act indirectly by exacerbating stress, deteriorating workplace climate, and weakening existing prevention mechanisms [20, 21]. To the contrary, within private organizations and among freelancers, high perceived risk and the presence of preventive procedures were associated with a higher prevalence of workplace violence. This finding should not be interpreted as evidence that preventive procedures increase violence. Rather, it may reflect reverse causation, whereby organizations that have experienced previous episodes of violence are more likely to introduce formal prevention procedures. This apparently paradoxical association should therefore be interpreted with particular caution, given the study design. In fact, it is plausible that preventive procedures are introduced reactively following critical incidents, or that their presence reflects previously problematic organizational contexts rather than effective preventive capacity.

Overall, the results indicate that violence against Environmental and Occupational Prevention Technicians is not an isolated phenomenon, but rather a systemic issue influenced by a complex interplay of individual, professional, and organizational factors. This underscores the need for integrated and context-specific strategies aimed at both prevention and the psychological and legal protection of affected personnel.

Limitations of the study

Despite the relatively large sample size and the relevance of the phenomenon investigated, this study has several limitations that should be taken into account when interpreting the findings. Firstly, the cross-sectional design of the study prevents exploring causal relationships between the variables examined and the experience of workplace violence. The associations identified indicate statistical associations but should not be interpreted as cause-and-effect links. Secondly, the use of a self-administered questionnaire, although anonymous, may have introduced self-reporting and social desirability biases, particularly given the sensitivity of topics such as violence and the psychological responses associated with it. In addition, participants’ subjective perception of risk may have influenced their responses, potentially exaggerating or underestimating actual exposure to violence. Another limitation concerns the response rate, which was relatively low (23.8%), possibly introducing selection bias. It is plausible that individuals with previous experiences of violence or a heightened sensitivity to the topic were more likely to participate, potentially leading to an overestimation of prevalence. A further limitation concerns the measurement of the outcome. The questionnaire assessed workplace violence as a broad self-reported experience and did not distinguish between physical violence, verbal violence, threats, harassment, sexual harassment, or other specific forms of aggressive behaviour. Moreover, no formal definitions or illustrative examples were provided. As a result, respondents may have interpreted these concepts differently, leading to potential outcome misclassification. This limitation reduces the possibility of identifying risk factors specific to different forms of violence and limits comparability with studies adopting other workplace violence classifications. An additional limitation concerns the temporal framework of the outcome measure. Participants were asked whether they had ever experienced acts attributable to violence during their professional activity, without a specified reference period. Consequently, some reported events may have occurred in previous workplaces or organizational settings. This may have introduced temporal misclassification when examining associations with current organizational characteristics, such as workplace procedures or recent organizational changes. In addition it should be acknowledged that differences in reported prevalence of workplace violence may also reflect variations in reporting behaviour across subgroups. Individuals with higher awareness of occupational risks or prior exposure to violence may be more likely to recognise and report episodes of violence, whereas others may underreport similar experiences due to normalization or differences in perception of what constitutes workplace violence. Therefore, observed associations may partly reflect reporting heterogeneity in addition to true differences in exposure. Although the study included HCWs from four Italian regions, its geographical representativeness remains limited with respect to the whole national context. Therefore, the findings may not be generalizable to all Prevention Technicians in Italy, particularly in light of the organizational, cultural, and socio-economic differences among regions. Furthermore, the subgroup of private-sector employees and self-employed professionals was relatively small, resulting in wide confidence intervals for several estimates. Consequently, associations observed in this subgroup should be interpreted cautiously and require confirmation in larger studies. Finally, the lack of comparable studies focusing on Prevention Technicians specifically limited the ability to contextualize and benchmark the findings against existing literature, which is primarily focused on clinical HCWs. Nonetheless, despite these limitations, the study provides a valuable empirical contribution to the underexplored issue of violence against occupational and environmental health prevention professionals. The findings offer a foundation for future research and underscore the need for further investigation at the national level.

Conclusions

Workplace violence represents a concrete and under-recognized occupational issue for Environmental and Occupational Prevention Technicians, a group for whom limited sector-specific evidence is available, compared to other HCWs [22, 23]. The high prevalence of reported violence, together with the identification of factors associated with a higher or lower prevalence of workplace violence, highlights the need for structured and multidimensional prevention strategies. The prevention of workplace violence in this area cannot be separated from organizational, educational and cultural interventions. It is essential that public administrations and private-sector employers acknowledge their responsibility in implementing effective violence prevention protocols, providing adequate training, psychological support, and continuous monitoring systems. Although the cross-sectional design does not allow conclusions regarding causality, the findings suggest that organizational factors may play an important role in shaping the occurrence and reporting of workplace violence. The introduction of standardised procedures, accompanied by a safety culture based on primary prevention, can make a substantial contribution to mitigating the phenomenon. However, further longitudinal studies are needed to better understand the temporal relationship between organizational measures and workplace violence and to identify the most effective prevention strategies. Finally, it is hoped that the current investigation can provide a foundation for further research aimed at exploring in greater depth the dynamics and characteristics of work-related violence in non-clinical public health services, such as prevention and community-based settings. A deeper understanding of these factors is essential to inform the development of effective and sustainable long-term strategies.

Authors’ contributions

Conceptualization, V.C., M.S. and V.M.; formal analysis, V.C.; investigation, M.S., L.F., C.D.P., G.D., E.C., D.F. and F.N.; data curation, V.C.; writing—original draft preparation, V.C., V.M., M.S., L.F., C.D.P., G.D., E.C., D.F., F.N., A.F. and M.L.R.; writing—review and editing, V.C., V.M., C.N., T.S., C.D.V. and C.d.W.; supervision, T.S., C.D.V., C.d.W. and C.N.; project administration, V.C., M.S. and V.M. All authors reviewed the manuscript.

Funding

No funding was received to conduct this study.

Data availability

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

Declarations

Ethics approval and consent to participate

The study protocol has been approved by the Bioethics Committee of the University of Perugia (protocol no. 2/2025). Informed consent was provided electronically from all of the participants before joining the survey.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.