Stress, burnout and diminished safety behaviors: An argument for Total Worker Health^® approaches in the fire service

Abstract

Introduction:

Firefighting is stressful work, which can result in burnout. Burnout is a safety concern as it can negatively impact safety outcomes. These impacts are not fully understood within the fire service. Further, the fire service needs support that safety strategies are needed to protect and promote the health and wellbeing of firefighters.

Methods:

Structural equation modeling was completed to examine a hypothesized model that linked stress and burnout to diminished safety behavior outcomes among a sample of career firefighters.

Results:

Findings support a full mediation model. Firefighter stress perceptions were positively associated with burnout and burnout was negatively associated with safety compliance behavior, personal protective equipment behavior, safe work practices, and safety citizenship behavior.

Conclusions:

These results illustrate the negative impact of health impairment on firefighter safety behaviors.

Practical Applications:

These outcomes suggest that interventions aimed at protecting and promotion firefighter health are needed. Total Worker Health^® (TWH) approaches may provide the framework for these interventions.

1. Introduction

Burnout is associated with long-term exposures to difficult and demanding work situations that have not been controlled. It is multi-faceted and is characterized by emotional exhaustion, depersonalization, and cynicism (ten Brummelhuis et al., 2011). These stress-related reactions may reduce safety outcomes (Shirom, 2011), which are already problematic in the fire service. Firefighter health outcomes are generally worse than many other occupational groups with respect to injuries, fatalities, and diminished health (Walton, Conrad, Furner, & Samo, 2003; Lee, Fleming, Gomez-Marin, & Leblanc, 2004; Marsh, Gwilliam, Konda, Tiesman, & Fahy, 2018).

Burnout has been linked to error, fatigue, cognitive weariness, reduced safety performance, and injury (Smith, DeJoy, Dyal, & Huang, 2019). Additionally, burnout has been linked to safety behavior deviations and violations such as personal protective equipment compliance, adherence to safe work practices, and safety reporting and communication (Smith, Hughes, DeJoy, & Dyal, 2018). Although research is beginning to shed light on these outcomes, more empirical research is needed to support these initial findings. For instance, Smith and colleagues (Smith et al., 2018), determined that burnout negatively impacted compliance-oriented behaviors such as compliance with the proper use of personal protective equipment and following standard operating procedures or practices. Additionally, it was determined that burnout negatively influenced communication outcomes, particularly in the context of safety. Although these findings are important, the authors suggested that additional studies should be conducted with a broader sample of firefighters. The present study addresses this by including firefighters from both the western United States and the eastern United States. Further, this study extends the prior work of Smith et al. as it focuses on incorporating firefighters from multiple large cities with more diverse operations (e.g., aircraft rescue and firefighting, high-rise firefighting, protection for major sport venues and facilities, protection for major universities) versus a small city fire department in the southern United States.

The present study also expands this line of research by looking at additional safety behavior outcomes that might be influenced by burnout. Particularly, this study includes safety citizenship as an outcome. This contextual behavior is important in the context of the fire service as participation in safety and performing extra-role behaviors may serve to protect other firefighters, thereby reducing overall injuries, illnesses, and fatalities.

The present study aims to test a hypothesized model using structural equation modeling (SEM). The posited model illustrating hypothesized relationships between model latent factors is presented in Fig. 1. The model posits stress will be positively associated with burnout and burnout will be negatively associated with safety citizenship behavior, safe work practices, personal protective equipment behavior, and safety compliance.

Fig 1.

Proposed model.

A full mediation model was proposed for multiple reasons. First, a full-mediation model is more parsimonious than a partial mediation model, which would include direct paths from stress to the behavior outcomes. Generally, more parsimonious models are preferred in model development and testing. Secondly, this model is consistent with existing theory ascribing stress as an antecedent to burnout. Paths from stress to the behavior outcomes were not included in the posited model as prior research suggests a full-mediation model in this context. Smith and colleagues (Smith, Hughes, DeJoy, & Dyal, 2018) did not find significant direct relationships between stress and firefighter safety behaviors in a smaller sample of firefighters, but found burnout was negatively associated with these behaviors supporting a full mediation model. Despite expanding the behavioral outcomes in the present study, model relationships similar to those found by Smith and colleagues are hypothesized.

The posited model and hypothesized relationships suggest that health impairment, in the context of stress and resultant burnout, negatively impacts safety. Traditional safety approaches, which are generally engineering-based first, may not counter or buffer the impact of health impairment on safety. These outcomes suggest that interventions aimed at protecting and promoting firefighter health are needed. Total Worker Health^® (TWH) approaches may provide the framework for these interventions.

Emerging from the need to incorporate health promotion and wellness into the traditional safety program model, based on growing evidence of the relationship between worker well-being and overall safety and health outcomes, Total Worker Health^® (TWH) is regarded as a modern holistic approach to meet the needs of the 21st-century workforce. TWH is defined as policies, programs, and practices that integrate protection from work-related safety and health hazards with promotion of injury and illness prevention efforts to advance worker well-being (NIOSH, 2018).

Methods

1.1. Participants

For the purposes of the present study, cross-sectional data (n = 742) were collected from firefighters and company officers via an online survey. The survey was accessed through the participating firefighter’s individualized department training portal. Prior to collecting data, consent was obtained from all participants. Institutional Review Board approvals were obtained from the researchers’ universities and the Department of Homeland Security Regulatory Compliance Office prior to the initiation of the study.

Firefighters from two city fire departments participated in the study, one in the western United States (Department 1) and the other in the eastern United States (Department 2). Department 1 has 33 stations; call volume is approximately 91,000 calls per year and the department employees approximately 700 firefighters. Department 2 has approximately 1,000 firefighters working across 35 stations, responding to approximately 100,000 calls per year. Both departments serve major metropolitan cities. Both also serve a major international airport.

Sixty-six percent of eligible members participated in the study (n = 464) at Department 1. Respondents ranged in age from 22 to 59, with a mean age of 41.11 (SD = 7.38). Fifty-three percent of available department members participated in the study (n = 530) at Department 2. Respondents ranged in age from 20 to 60, with a mean age of 39.87 (SD = 8.42).

Of those responding, most participants were male (97% for both departments) and most reported their race as White (Department 1 = 64%; Department 2 = 57%). At Department 1, 4% identified as Black or African American, 7% identified as Asian or Asian American, 2% identified as American Indian or Alaskan Native, 3% identified as Native Hawaiian or Pacific Islander, and 20% responded as Other. Twenty-two percent indicated their Ethnicity as Hispanic. At Department 2, 28% identified as Black or African American, 5% identified as Asian or Asian American, <1% identified as American Indian or Alaskan native, <1% identified as Native Hawaiian or Pacific Islander, and 9% responded as Other. Nine percent indicated their Ethnicity as Hispanic.

Most of the respondents had some schooling beyond high school. For Department 1, 29% reported completing some college or vocational/technical training, 34% reported earning an Associates degree, 32% reported a Bachelors degree, and 3% noted that they completed post graduate courses or earned a graduate degree. Less than 2% reported that their highest educational achievement was a high school diploma or GED. For Department 2, 35% reported completing some college or vocational/technical training, 25% reported earning an Associates degree, 28% reported earning a Bachelors degree, and 3% noted that they completed post graduate courses or earned a graduate degree.

Most participants were married or living with a partner (Department 1 = 76%, Department 2 = 73%) and several were single (Department 1 = 17%, Department 2 = 19%). Seven percent of participants at both departments reported they were divorced. With regard to tenure, 5% worked for Department 1 less than a year and 6% worked for Department 2 less than a year. Thirty-seven percent worked for Department 1 between 1 and 9 years and 39% worked for Department 2 between 1 and 9 years. Twenty-eight percent worked for Department 1 between 10 and 20 years and 31% worked for Department 2 between 10 and 20 years. Lastly, 30% of participants worked for Department 1 for more than 20 years and 24% of participants worked for Department 2 for more than 20 years.

1.2. Measures

Six measures were included in this analysis. Perceived work-related psychological stress was measured using a 6-item scale utilized previously in firefighter research (Smith, Hughes, DeJoy, & Dyal, 2018) and healthy work organization research (DeJoy, Wilson, Vandenberg, McGrath-Higgins, & Griffin-Blake, 2010). These measures were derived from the perceived stress scale by Cohen, Kamarck and Mermelstein (1983), which is considered a nonspecific appraisal of stress and an outcome measurement of experienced levels of stress. Each item was rated on a 5-point Likert-type scale ranging from almost never to almost always. Cronbach’s alpha was 0.91. Burnout was measured using a 10-item scale from Malach-Pines (2005), which was also previously used in research with firefighters (Smith et al., 2018). Response options for each of the items were rated on a 5-point Likert-type scale from almost never to almost always. Cronbach’s alpha was 0.92. Safety citizenship behavior used a 9-item scale adapted from Hofmann et al. (2003) and Turner, Chmiel, and Walls (2005). Response options for each of the nine items were rated on a 5-point Likert-type scale from almost never to almost always. Cronbach’s alpha was 0.93. The safe work practices scale was comprised of three items adapted from Smith et al. (2018). Response options for each of the items were rated on a 5-point Likert-type scale from almost never to almost always. Cronbach’s alpha was 0.68. The personal protective equipment behavior scale was comprised of three items adapted from Smith et al. (2018). Response options for each of the items were rated on a 5-point Likert-type scale from almost never to almost always. Cronbach’s alpha was 0.76. Lastly, safety compliance behavior was derived from prior measures used to examine safety compliance behaviors across various industries and the fire service (Neal & Griffin, 2006; Smith & DeJoy, 2014). Response options for each of the six items were rated on a 5-point Likert-type scale from almost never to almost always. Cronbach’s alpha was 0.91.

1.3. Analyses

Prior to completing the main analysis to examine the posited model and hypothesized relationships, data screening procedures were completed using SPSS v.25. Descriptive statistics and the correlation matrix for latent factors in the model are presented in Table 1. A general assessment of the correlation matrix illustrates that perceived work-related psychological stress and burnout were highly correlated in a positive direction. As expected, burnout is significantly negatively correlated with each of the behavior outcomes.

Table 1.

Descriptive statistics and correlation matrix.

	Number of Items	α	M	SD	Skewness	Kurtosis	Stress	Burnout	Safety Citizenship	Safe Work Practices	Personal Protective Equipment	Compliance
Stress	6	0.91	1.88	0.89	1.12	0.91	1.00
Burnout	10	0.92	1.84	0.76	1.52	2.50	0.76**	1.00
Safety Citizenship	9	0.93	3.65	0.67	−0.49	−0.38	−0.03	−0.08*	1.00
Safe Work Practices	3	0.68	4.41	0.60	−1.07	1.25	−0.30**	−0.27**	0.34**	1.00
Personal Protective Equipment	3	0.76	4.75	0.45	−2.12	4.66	−0.17**	−0.22**	0.27**	0.37**	1.00
Compliance	6	0.91	4.56	0.51	−1.08	0.82	−0.18**	−0.24**	0.43**	0.50**	0.53**	1.00

^*p < 0.05.

^**p < 0.01.

A structural equation modeling (SEM) analysis was completed using Mplus version 8.3 (Muthén & Muthén, 2017). Data from 742 firefighters and company officers were included; however, Mplus reports 54 missing data patterns. Mplus only used data available to estimate the model using full information maximum likelihood estimation.

Model fit was assessed against criterion presented by Hooper, Coughlan, and Mullen (2008). Comparative Fit Index (CFI), Root Mean Square Error of Approximation (RMSEA) and Standardized Root Mean Squared Residual (SRMSR) were examined as suggested by Kline (2005). A RMSEA ≤ 0.08, SRMSR ≤ 0.08 and a CFI ≥ 0.90 are commonly accepted values. Hypothesized relationships were assessed by examining statistics for each of the hypothesized pathways.

2. Results

The fit statistics for the posited model were: χ² = 3116.53, df = 618, p < 0.001, RMSEA = 0.07, SRMSR = 0.05 and CFI = 0.87. RMSEA and SRMSR were within prescribed guidelines, but CFI was slightly lower than preferred minimums. These results still suggest the overall fit of the model was satisfactory.

The hypothesized relationships were examined by evaluating unstandardized path coefficients, standard errors, and significance values. These outcomes are presented in Table 2. Results show that stress was positively, significantly associated with burnout and burnout was negatively, significantly associated with each of the behavior outcomes, including safety citizenship behavior, safe work practices, personal protective equipment behavior, and safety compliance. All hypothesized pathways were significant and in the posited direction. In addition, we were able to illustrate the adequacy of the measurement model. All items associated with the six latent factors significantly loaded onto their respective factors and were significant. These statistics are further presented in Table 2.

Table 2.

Hypothesized model statistics.

Path	Unstandardized Path Coefficient	SE	t	p
Stress
Sress1	1	0	–	–
Stress2	1.16	0.05	26.06	<0.001
Stress3	1.09	0.05	23.89	<0.001
Stress4	0.84	0.04	23.44	<0.001
Stress5	1.13	0.05	24.49	<0.001
Stress6	0.97	0.04	25.51	<0.001
Burnout
Burnout1	1	0	–	–
Burnout2	1.56	0.16	9.82	<0.001
Burnout3	2	0.19	10.82	<0.001
Burnout4	2.06	0.19	10.77	<0.001
Burnout5	1.93	0.18	10.82	<0.001
Burnout6	1.87	0.18	10.7	<0.001
Burnout7	1.24	0.12	10.17	<0.001
Burnout8	1.21	0.12	10.3	<0.001
Burnout9	1.43	0.16	9.06	<0.001
Burnout10	1.97	0.19	10.57	<0.001
Safety Citizenship (SC)
SC1	1	0	–	–
SC2	0.99	0.04	25.76	<0.001
SC3	1.05	0.04	26.59	<0.001
SC4	1.23	0.05	24.37	<0.001
SC5	1.26	0.05	24.89	<0.001
SC6	1.28	0.06	21.85	<0.001
SC7	0.85	0.05	18.63	<0.001
SC8	1.14	0.05	20.99	<0.001
SC9	1.06	0.05	19.7
Safety Work Practices (SWP)
SWP1	1	0	–	–
SWP2	0.88	0.07	12.15	<0.001
SWP3	0.78	0.07	11.31	<0.001
Personal Protective Equipment Behavior (PPE)
PPE1	1	0	–	–
PPE2	2.02	0.14	14.32	<0.001
PPE3	1.79	0.12	14.31	<0.001
Compliance
Compliance1	1	0	–	–
Compliance2	1.08	0.04	25.75	<0.001
Compliance3	1.13	0.04	26.93	<0.001
Compliance4	1.21	0.05	26.55	<0.001
Compliance5	1.25	0.07	18.24	<0.001
Compliance6	1	0.05	21.94	<0.001
Stress → Burnout	0.67	0.02	32.89	<0.001
Burnout → Safety Citizenship	−0.08	0.04	−2.21	<0.05
Burnout → Safe Work Practices	−0.21	0.03	−7.74	<0.001
Burnout → PPE	−0.12	0.02	−5.57	<0.001
Burnout → Compliance	−0.15	0.02	−6.25	<0.001

In addition to the posited model, an alternate partial-mediation model was tested. The fit statistics for the alternate model were: χ² = 3098.08, df = 614, p < 0.001, RMSEA = 0.07, SRMSR = 0.05 and CFI = 0.88. A χ² difference test suggests a significantly different model (χ^{2 diff} = 18.45, df ^diff = 4, p < 0.001), but the fit statistics nearly remained identical. As such, the more parsimonious model is preferred. Interestingly, hypothesized relationships were impacted in the alternate model. The measurement model was not impacted with regard to the significance of items loading onto respective factors, but burnout was no longer significantly related to compliance behaviors (p = 0.06) and safe work practices (p = 0.34). Burnout was just significantly related to safety citizenship behavior (p = 0.05) and personal protective equipment behavior (p = 0.05). Direct relationships between stress and behavior outcomes delineated that stress was significantly, negatively associated with compliance behaviors (p = 0.03) and safe work practices (p < 0.01). Stress was not significantly related to personal protective equipment behavior (p = 0.40) and safety citizenship behavior (p = 0.26). The statistics for the alternate model are presented in Table 3.

Table 3.

Alternate partial-mediation model statistics.

Path	Unstandardized Path Coefficient	SE	t	p
Stress
Sress1	1	0	–	–
Stress2	1.17	0.05	25.99	<0.001
Stress3	1.09	0.05	23.81	<0.001
Stress4	0.85	0.04	23.45	<0.001
Stress5	1.13	0.05	24.4	<0.001
Stress6	0.97	0.04	25.52	<0.001
Burnout
Burnout1	1	0	–	–
Burnout2	1.55	0.16	9.82	<0.001
Burnout3	2	0.18	10.82	<0.001
Burnout4	2.06	0.19	10.78	<0.001
Burnout5	1.93	0.18	10.83	<0.001
Burnout6	1.87	0.17	10.71	<0.001
Burnout7	1.24	0.12	10.17	<0.001
Burnout8	1.21	0.12	10.3	<0.001
Burnout9	1.42	0.16	9.06	<0.001
Burnout10	1.97	0.19	10.58	<0.001
Safety Citizenship (SC)
SC1	1	0	–	–
SC2	0.99	0.04	25.76	<0.001
SC3	1.05	0.04	26.61	<0.001
SC4	1.23	0.05	24.38	<0.001
SC5	1.26	0.05	24.9	<0.001
SC6	1.28	0.06	21.85	<0.001
SC7	0.85	0.05	18.63	<0.001
SC8	1.14	0.05	20.99	<0.001
SC9	1.06	0.05	19.7	<0.001
Safety Work Practices (SWP)
SWP1	1	0	–	–
SWP2	0.86	0.07	12.2	<0.001
SWP3	0.77	0.07	11.35	<0.001
Personal Protective Equipment Behavior (PPE)
PPE1	1	0	–	–
PPE2	2.02	0.14	14.31	<0.001
PPE3	1.79	0.12	14.31	<0.001
Compliance
Compliance1	1	0	–	–
Compliance2	1.08	0.04	25.76	<0.001
Compliance3	1.13	0.04	26.93	<0.001
Compliance4	1.21	0.05	26.56	<0.001
Compliance5	1.25	0.07	18.25	<0.001
Compliance6	1	0.05	21.93	<0.001
Stress → Burnout	0.45	0.05	10.05	<0.001
Burnout → Safety Citizenship	−0.23	0.11	−1.97	<0.05
Stress → Safety Citizenship	0.07	0.06	1.13	ns
Burnout → Safe Work Practices	−0.10	0.11	−0.95	ns
Stress → Safe Work Practices	−0.19	0.06	−3.18	<0.001
Burnout → PPE	−0.09	0.05	−1.96	0.05
Stress → PPE	−0.02	0.03	−0.84	ns
Burnout → Compliance	−0.14	0.08	−1.88	ns
Stress → Compliance	−0.09	0.04	−2.14	<0.05

ns = not significant.

3. Discussion

The present study shows that burnout, as a stress-related process, negatively impacts firefighter safety behavior outcomes, which have been linked to occupational injury and illness outcomes, including within the fire service (Smith & DeJoy, 2014). It was determined that burnout not only impacts compliance-oriented behaviors such as following standard operating procedures and properly using personal protective equipment, but also negatively influences safety citizenship behaviors. This is a novel finding that is disconcerting. Diminished safety citizenship behaviors will not only negatively impact the firefighter, but this lack of participation and engagement in extra-role behaviors will likely negatively impact his or her fellow firefighters. Given these results, proactive safety approaches that buffer or control health impairment are necessary to enhance safety and to protect the health and wellbeing of firefighters. A TWH approach, which integrates health promotion and health protection, is warranted and should be utilized to enhance firefighter safety, health and well-being, particularly since traditional safety solutions may be insufficient for addressing health impairment and safety-related behaviors.

Within the field of occupational safety and health, safety controls are applied to abate or control hazards through means such as hazard elimination, substitution, engineering controls, administrative controls, and personal protective equipment. This safety-focused traditional hierarchy of controls is generally applied with an initial focus on hazard elimination and generally is not focused on addressing work organization, psychosocial, or personal factors. These hazard control approaches therefore do not always abate or control the hazard, particularly when health impairment or diminished wellbeing may be the hazard, which places a person at risk for injury, illness, or death.

The National Institute for Occupational Safety and Health (NIOSH) established the Total Worker Health^® hierarchy of controls, similar to the traditional hierarchy of controls practiced by safety professionals, but tailored to incorporate considerations for protection and improvement of overall worker wellbeing (NIOSH, 2018). It appears the use of this modified hierarchy of controls may serve the fire service well, particularly given the results of the present study. A TWH approach using the modified hierarchy of controls would create the framework for a supportive culture within the fire service, which is generally associated with positive safety outcomes in the fire service (Smith, Eldridge, & DeJoy, 2016; Smith, DeJoy, Dyal, Pu, & Dickinson, 2019).

TWH approaches targeting long hours and shift work, making adequate resources available, such as psychological and family support, and providing continuous education and assistance could facilitate engagement, enhance motivation, and improve personal health and wellness (Basinska & Wiciak, 2012). This, in turn, would likely bolster safety behaviors resulting in increased compliance with safety norms, rules and standard operating procedures, effective and appropriate use of personal protective equipment and enhanced participation in safety activities, including extra-role or citizenship behaviors, whereby protecting not only themselves, but their fellow firefighters.

Further, TWH approaches may serve to reduce cognitive weariness, skill based errors and decision errors and violations on the fireground. This is significant because more than half of all firefighter injuries and fatalities have personnel related causal factors (Omodei, McLennan, & Reynolds, 2005; Owen, 2014; IAFC, 2016; Gough, 2019; Moore-Merrell et al., 2008). Any slip or change in mental, emotional, or physiological state or in attitude or perceived assessment of risk can lead to errors, in particular, decision and skill-based errors and violations (Shappell & Wiegmann, 2000), which could lead to devastating consequences.

The four original rationale for TWH^® approaches are centered on protecting high-risk workers. Firefighters are the embodiment of high-risk workers, facing extreme hazards that pose not only physical risk, but psychological and psychosocial risk (Smith, DeJoy & Dyal, 2019). Because personnel factors and diminished mental, emotional, and physiological states are a leading cause of incidents among firefighters (Omodei et al., 2005; Owen, 2014; IAFC, 2016; Gough, 2019; Moore-Merrell et al., 2008), it is apparent that interventions aimed at firefighter health and wellbeing are necessary to manage safety in the fire service. The ideal framework for these interventions should use TWH approaches that incorporate the modified TWH hierarchy of controls.

Although the findings of this study provide an argument for using TWH approaches to bolster firefighter safety, health, and wellbeing, there are some limitations that should be considered when assessing the implications of this research. Firefighter participants were recruited from two city fire departments. Although likely representative of career firefighters operating in larger metropolitan areas, they may not represent full-time firefighters from small towns or rural areas and may not represent the many volunteer firefighters that serve to protect the public in the fire service. The data collected for this study were cross-sectional, which limits causal inferences. And, only survey data were collected and analyzed for the present study, which could introduce bias, as multiple methods of data collection were not employed.

With regard to the constructs in the model, two constructs had Cronbach’s alphas less than 0.80 to include safe work practices (α = 0.68) and PPE (α = 0.76). Some researchers support the notion that lower values around 0.70 are acceptable (Cortina, 1993; Peterson, 1994). Although lower than preferred, the items related to these measures appropriately loaded onto their respective factors in the measurement model, were appropriately correlated with the other behavior outcomes and were significantly influenced by burnout. These measures appear to be valid, but are fairly new to the literature; thus, additional research should be explored to determine the reliability of each construct in additional studies. Additional research extending the scales may be beneficial as well since each of the two factors only includes three items. The fire service is in need of outcome measures that can be examined in research and use by practitioners within safety, public administration, or the fire service.

There are other opportunities for future research. It would be beneficial to conduct similar studies in a broader sample of firefighters, to particularly include volunteer firefighters. Given the differences in operations, organizational structure, and the like, stress and burnout perceptions may differ and their influence on safety behaviors may differ. Beyond this, it would be beneficial to conduct longitudinal studies that explored more distal outcomes. Specifically, researchers need to examine the influence of the more proximal behavior outcomes on distal outcomes including injury or occupational illness.

The findings in the present study specifically looked at the relationship between burnout and firefighter safety behaviors. Firefighters suffer from other health impairments such as anxiety, depression, and PTSD (Carey et al., 2011; Fullerton et al., 2004). Researchers should examine whether these health impairments similarly impact safety behaviors. Lastly, there is a need to implement and assess interventions that incorporate TWH approaches. We postulate that these approaches are warranted in order to promote health and wellbeing and protect firefighters from injury and illness. With so little research in this area, initial studies may need to propose and test interventions that would be delineated as TWH approaches. These interventions would likely emerge from programs that have been shown to reduce work-related stress and curtail health impairment. Social support, resilience building, mindfulness, safety climate, and other job resources that have been associated with buffering or controlling health impairment may be an aim for early interventions.

Biography

Todd D. Smith PhD, CSP, ARM, AIM is an Assistant Professor in the Department of Applied Health Science at the Indiana University School of Public Health – Bloomington. He completed his doctoral degree in Health Promotion and Behavior at the University of Georgia. Dr. Smith’s research is generally focused in safety management, healthy work design and occupational health psychology. He is a Certified Safety Professional, an Associate in Risk Management and an Associate in Management. Dr. Smith is on the editorial board of the Journal of Safety Research.

Charmaine Mullins-Jaime MS, CSP, CRSP, NCSO is a safety management faculty in the Department of Built Environment at Indiana State University. She was a safety professional in the oil & gas, industrial construction, healthcare, aerospace & defense, and manufacturing industries prior to joining Indiana State. Charmaine is completing a Safety Sciences PhD from Indiana University of Pennsylvania and is a member of the Central Indiana Chapter of the ASSP.

David M. DeJoy PhD is professor emeritus of Health Promotion and Behavior in the College of Public Health at the University of Georgia and founding director of the Workplace Health Group. He has been involved in workplace safety and health for over 35 years as a researcher, instructor, and consultant. His areas of research include: climate/culture, work organization, safe work practices, integrated programming, and theory-based intervention design/intervention effectiveness.

Mari-Amanda Dyal PhD earned her doctoral degree in Health Promotion and Behavior from the University of Georgia. Her research interests are rooted in workplace health promotion in the areas of job demands and job resources. Her health education and promotion background spans many specialties, settings and populations. She is currently an Assistant Professor at Kennesaw State University in the Public Health Education program.