"Harvard Center of Excellence to Promote a Healthier Workforce": Project A - "Integrated approaches to improving the health and safety of health care workers: Proposed Revision to incorporate objective physiologic markers of health" (Competitive Revision). The goal of this sub-study is to augment the existing study design with objective health biomarkers. Currently, this study exploring the relationships between work-related exposures and health outcomes uses two methods to assess worker health outcomes: self reported measures of health (e.g., constructs such as low back pain disability and chronic conditions) and employee record data (e.g., workers compensation claims, injury reports). In this competitive revision, we propose to add objective measures of health that are clinical markers for disease risk. The addition of objective health measures substantially strengthens the overall conceptual framework developed using subjective measures and administrative workplace data. The current study proposes to evaluate the relationships among the mediating mechanisms (e.g., physical and psychosocial exposures on the job, social norms and social support), modifying conditions (e.g., socioeconomic position, race/ethnicity, gender, managerial attitudes), proximal outcomes (e.g., fatigue, job satisfaction), and self-reported worker health outcomes (e.g., low back pain disability, health behaviors) through a survey of a random sub-sample (n=1200) of patient care workers. Furthermore, the relationships of organizational policies and programs and selected worker health outcomes will be investigated. We now propose to evaluate objective worker health outcomes, including blood-based biomarkers (CHD risk, and including diabetes risk, chronic inflammation, and stress-mediated immunosuppression), vital signs, height/weight/girth in a subset of the surveyed workers. The proposed competing revision adds important objective measures of worker health outcomes, which are not a part of the current study. The collection of these objective measures would additionally allow us to compare findings with related NIOSH/NIH-funded research through the Work, Family, and Health Network.