**5. Conclusions**

The ARM program had a positive impact at the individual level on the worksites that implemented the program. The trial saw improved ergonomics practices, as well as, reduction in new pain and injury, and improved diet and physical activity, as reported by the workers. A number of obstacles were encountered which made integrating a health promotion and injury prevention intervention into the multi-employer, outcome-driven, dynamic work environment challenging. Process tracking suggested that our intervention had less impact at the systems/organizational level in terms of changing organizational programs and practices, due to the complex organizational structures on site. For the longer term, more organizations in the multiple employer environment should be involved in the implementation to facilitate more upstream changes.

**Author Contributions:** Conceptualization, J.T.D., C.A.O. and M.P.G.; Methodology, J.T.D., C.A.O. and M.P.G.; Formal Analysis, S.E.P., J.M., J.R.; Investigation, J.T.D., M.P.G. and C.A.O.; Resources, J.T.D.; Data Curation, M.P.G.; Writing—Original Draft Preparation, S.E.P.; Writing—Review & Editing, S.E.P., J.T.D., M.P.G., J.R., J.M. and C.A.O.; Visualization, S.E.P. and J.T.D.; Project Administration, J.T.D.; Funding Acquisition, J.T.D., C.A.O. and J.M.

**Funding:** This research was funded by a grant from the National Institute for Occupational Safety and Health (NIOSH) for the Center for Work, Health and Well-being at the Harvard T.H. Chan School of Public Health, grant number U19 OH008861. Additional funding was provided by the NIOSH Education and Research Center at the Harvard Chan School, grant number T42OH008416.

**Acknowledgments:** The authors thank Glorian Sorensen, Greg Wagner, Jeffrey Katz, Emily Sparer, Kristin Ironside, Andrea Sheldon, Kincaid Lowe, and Mia Goldwasser from the Harvard T.H. Chan School of Public Health Center for Work, Health, and Wellbeing. The authors also provide a special and extra thank you to all of our construction company partners in the Boston metropolitan area.

**Conflicts of Interest:** The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results.
