**4. Discussion**

Approaches focusing on education and training have shown improvement in workplace safety [8,11]. As a result of completing the PUSH training, knowledge increased significantly from baseline to post-training for both groups. Although knowledge decreased at follow-up, it still remained elevated compared to baseline. The training was received positively by an overwhelming majority of participants in both groups, with most of the participants reporting the training to be interactive and informative and compared it with other training programs:

"*Yes, because it provided me with lots of insightful information that I did not learn on my job. I was able to know how to quickly respond to emergencies on the job after using the training program.*" [MTurk, Cashier].

Several participants in the Park and Rec group mentioned that the PUSH training was repetitive. This is likely due to the fact that participants in the Park and Rec group receive mandatory safety training before starting their job and have regular safety meetings throughout the season. These meetings address many of the topics presented in the PUSH training and could be the reason for these negative responses. On the other hand, MTurk participants were from diverse workplaces including restaurants and retail stores. Few of these participants reported receiving safety training. The majority of the MTurk participants liked the training and felt the training prepared them for workplace hazards.

The questions evaluating participants' reaction to the training included multiple choice on a Likert scale with items as well as open-ended questions. All the participants entered a response to the question on likeability, and many gave specific reasons why they liked/did not like the training. The majority of participants answered the questions about preparedness and several (21%) provided specific examples. These responses stated that the training prepared them to handle workplace hazards by increasing awareness and led to specific changes in their behavior. One participant in the Park and Rec group indicated, "*I felt empowered to take action in my workplace environment when I saw something that violated my workplace rights or somebody else's.*" [Park and Rec]. Raising awareness about working rights and building confidence in young workers to "speak up" about hazards is extremely important in promoting health and safety. It is not uncommon for participants to leave open-ended questions unanswered [31]. However, everyone in the study at follow-up provided their response to the open-ended question on how the PUSH training prepared them for behavior change with majority providing specific examples.

The goal of the current study was to assess the generalizability of the online training among different groups of young workers. The current study included young workers in a range of occupations, including cashiers, accountants, service managers, counselors, and lifeguards. The changes in knowledge in the current study replicated previous findings reported in parks and recreation workers [12]. This study provided additional feedback about the training including a generally positive response about the format of the training and the need for training for young workers. In addition, many participants provided examples in the open-ended questions describing situations where they felt empowered to speak up about safety hazards or specific changes to their behavior they made in their workplace.

One of the study's strengths is that it is the first study to include two groups of young workers that were diverse in terms of their work experience. Young workers hired as summer employees at a city parks and recreation center were recruited along with a diverse group of workers selected via an announcement placed on Amazon Mechanical Turk. However, participants in both groups reported the need for training on health and safety. They liked the training and reported that the PUSH training prepared them to handle health and safety hazards at the workplace. The prospective nature of the study provides information on retention of information among young workers. Although knowledge scores at the three-month follow-up showed a decline from the immediate post-test, the scores were still greater than baseline for both groups with non-seasonal workers getting better scores compared to the seasonal workers. The decline in scores can indicate a need for frequent reminders or trainings on safety and health. Another strength of the PUSH training is the online format and interactive content. Young workers are familiar and comfortable with technology [11], which makes the online format of the training an appropriate dissemination technique for younger adults [16].

Studies have reported the need for training workers on the identification and control of workplace hazards [5,11,30]. A survey of Latino youths under the age of 21 working in construction found that the majority of participants reported that the training they received did not include information on controlling workplace hazards [13]. The results from the current study also emphasize the need to include topics on hazard identification and control selection as part of training for young workers, as evidenced by a higher number of hazard identification and control selection questions missed at each time point by participants in both groups.

One limitation of the study is that several participants were lost to follow up. Only participants who completed all three surveys were included in the analysis. However, the participants who were lost to follow-up had similar knowledge scores compared to the participants in the study at baseline and post-training. Another potential limitation of the study might be its generalizability outside of the US. Hence, there is a need for additional research to identify if the training can be utilized and to understand how young workers outside the US will receive it.
