**1. Introduction**

The workplace is a social determinant of health, with employment and working conditions linked to a range of health, functioning, and quality-of-life outcomes [1,2]. Work-related injuries and illnesses are associated with morbidity and substantial financial and social costs, and health hazards from work can also impact people's personal lives and lifestyle [3,4]. Studies also show that lifestyle risk factors (e.g., being a smoker, stressful lives outside of work, being obese, and heavy alcohol use) can increase the likelihood of sustaining workplace injuries more so than among those without such risk factors [5,6]. North American employers are required to provide occupational health and safety (OHS) activities that minimize negative health effect due to worker exposures to job-related risks and hazards. In comparison, workplace health promotion or wellness activities are voluntarily provided by some employers to improve worker wellbeing through health behavior changes and are shown to have short and long-term health and productivity benefits [7,8].

There has been a shift in thinking about how workplaces can better integrate safety into the overall wellbeing of their workforce [9]. Wellness and OHS programs share the goal of protecting and improving worker health and given these overlaps it makes sense to integrate both. Integrating OHS and wellness activities is expected to have greater effects on health, safety, and wellbeing than if the activities operated separately from each other [10,11]. This approach, commonly referred to as Total Worker Health® in the US, is widely endorsed by international health and labor agencies [12–14] with the consensus that it will lead to improvements in the long-term well-being of workers and their families, and reduce pressures on healthcare and social security systems [13,14].

Several studies have demonstrated links between the characteristics of workplaces (workplace demographic factors) and the implementation and integration of OHS and wellness activities. For example, the manufacturing sector reports a higher number of OHS and wellness activities than other sectors [15,16], and smaller workplaces are likely to offer fewer OHS and wellness programs than larger organizations [15,17,18]. Examining workplaces in the US Midwest, McLellan et al. found leadership support and having an OHS committee to be important contributors to implementing integrated approaches [19]. Tremblay et al. examined Massachusetts employers and found a high degree of coordinated activities among unionized workplaces and in construction, healthcare, manufacturing, and entertainment industries [18]. These and other studies are limited in their focus on small workplaces [17,19] and sampled few larger workplaces [18]. A greater focus on medium to large in addition to smaller workplaces can further uncover factors enabling integrated activities as larger workplaces are likely to have more resources to support these activities [20]. Furthermore, much of the research examining relationships between workplace factors and the implementation of OHS and wellness have focused on US workplaces and little is known about the extent that these activities co-occur in Canadian workplaces. To inform research and policy recommendations towards the widespread adoption of integrated worker health approaches in Canada, research evidence is needed to understand the extent that OHS and wellness activities co-occur as a necessary first step towards identifying the current status quo and the workplace factors that can be amenable targets for integrated approaches in the future.

The objective of this study was to explore the workplace demographic factors associated with the concurrent implementation of OHS and wellness activities in Canadian workplaces. The study has two research questions (RQ): RQ1—"What is the extent that OHS and wellness activities co-occur in workplaces?" RQ2—"Are there associations between workplace demographic characteristics and the co-occurrence of OHS and wellness activities?" These questions were explored in a cross-section of a large, heterogenous sample of small, medium, and large workplaces in Ontario, Canada. Informed by evidence from US studies, we hypothesized that large and unionized workplaces in specific industry sectors have a higher co-occurrence of OHS and wellness activities than workplaces with other demographic characteristics.
