Evaluating health promotion programs in the workplace: behavioral models versus financial models

This paper suggests that the future of occupational health promotionevaluation lies in the creative utilization of behavioral sciencemodels in an integrated manner with financial models of programevaluation. Evaluators must simultaneously ask ‘Does theprogram work?’ and ‘At what cost?’ Economicconditions may well dictate that both of these questions beanswered. Further, it seems clear that researchers need notbe bound to the impracticalities of true experimental designin order to evaluate program effectiveness. In addition, giventhe numerous potential tangible and intangible benefits to firmssponsoring occupational health promotion programs, evaluatorsshould be equally concerned with controlling beta errors asthey are with controlling alpha errors in test design; otherwise,they run the risk of prematurely cancelling potentially profitableinvestments before they come to fruition.     

ERRATUM

The title of the editorial in the Journal of the Society forOccupational Medicine, 25, p. 1 should have been ‘ A HopefulProspect ’. Page 34, line 6 in the paragraph ‘ ScientificMeetings ’ should have read ‘ The Provincial Meetingwas held in York ’.     

Testing a conceptual model related to weight perceptions, physical activity and smoking in adolescents

The purpose of this study was to test a conceptual model basedon theoretical and empirically supported relationships relatedto the influences of weight perceptions, weight concerns, desiresto change weight, friends, age and location in relation to physicalactivity (PA) and smoking in adolescents. A total of 1242 malesand 1446 females (mean age = 15.6 ± 1.3) were recruitedfrom rural and urban Canadian schools. Study respondents providedself-reports of PA, ‘smoking’, ‘perceivedbody weight’, ‘desire to change weight’, ‘concernabout weight gain’ and ‘friends' smoking and PAbehaviors’. Results revealed an acceptable fitting model² (40) = 155.63, P < 0.05, root mean square error of approximation= 0.047 and comparative fit index = 0.98. Large effect sizesfor both genders were observed between friends' and adolescents'smoking behavior, and between perceived body weight and desireto change weight. Further, significant differences were identifiedbetween the male and female models [² difference (24) = 65.28,P < 0.05]. Several findings of this study point to the needto design programs to motivate adolescent females to adopt healthyweight-control practices and to target young peoples' socialnetworks to promote health behaviors, especially with regardto smoking. Received on December 22, 2005; accepted on June 15, 2006     

erratum

JOURNAL OF THE SOCIETY OF OCCUPATIONAL MEDICINE, 24, 87 and88. Table I and Table II were transposed. 81, the first sentenceunder Treatment with.Calcium Gel should have read: ‘Klauderet al. (1955) reported the successful treatment of a late hydrofluoricacid burn by topical 5 per cent calcium gluconate in wool fatcombined with calcium gluconate intravenously’. 84, column1, line 8, ‘articles’ should have read article.     

Evaluating the progress of the health promoting hospitals initiative? A WHO perspective. Commentary on: Whitehead, D. (2004) The European Health Promoting Hospitals (HPH) project: how far on? Health Promotion International, 19, 259-267

We have read with interest the contribution of Dean Whiteheadon ‘The European Health Promoting Hospitals (HPH) project:how far on?’ in a recent issue of Health Promotion International(Whitehead, 2004). He points out some of the issues the HPHmovement has faced over the years that are linked to the inherentdifficulties in changing the behaviour of organizations. However,we would like to clarify a number of points. Dean Whitehead's article aims ‘to investigate the natureand progress of the European HPH movement’ and he concludesthat ‘the majority of the available literature demonstratesa more limited impact than perhaps the World Health Organization(WHO) might have     

The impact of the COSHH regulations on workers with occupational asthma

In the UK, the COSHH Regulations give specific guidance thatemployers have duties to inform, instruct and train their employeesabout occupational risks and provide them with suitable healthsurveillance. The aim of the study was to evaluate the impactof the Regulations on employees with occupational asthma. Onehundred consecutive patients attending an occupational lungdisease clinic completed a questionnaire assessing the implementationof the COSHH Regulations in their workplace. Twenty-eight percent had a pre-employment inquiry about asthma, 31% had regularhealth surveillance by questionnaires and 19% had regular lungfunction assessment at work. Pre-employment spirometry was carriedout in 44% of the workers who were exposed to one of the originalseven prescribed agents, significantly more than those who wereexposed to other agents (19%) (p < 0.05). Moreover, figuresfor spirometry during employment were 31% and 8% respectively(p < 0.05). The patients who worked after ‘COSHH’but before ‘MS25’ had a tendency to be providedwith health surveillance more than those who worked after both‘COSHH’ and ‘MS25’. Ninety-one per centof the patients had never been informed about the risks of gettingasthma at work and 73% had never seen the safety data sheets.The workers who (1) worked after ‘COSHH’ introduction;(2) worked in larger firms and (3) were exposed to one of theoriginal seven prescribed agents, had a tendency to be informed,instructed and trained more than the rest. However, there wereonly significant statistical differences (p<0.05) in termsof the safety data sheet provision between the cases who workedbefore the time of the legislation and those employed afterwards.     

ERRATUM

In the article by A. L. Morgan ‘Cholinesterase Problemsarising in a Plant Manufacturing Tri-aryl Phosphates’(Journal of the Society of Occupational Medicine 31, 119–122)on p. 120, the first sentence of Case 1 should read ‘Thisindividual had three split blood samples examined.’     

ERRATUM

The Journal of the Society of Occupational Medicine, 27, 53,second column, contains eight lines of text which should haveappeared on 70–71. 53, second column. The section Complaints in General shouldhave ended (second paragraph, lines 8–9) with the sentence:‘This pattern is present in the experiences of both "old"and "new" employees.’ The text should then continue withthe section Complaints about Slow Work, appearing on 55. 70–71. The final paragraph of the section Finance on 70(bottomof second column) should have been completed by matter appearingat the end of the section Complaints in General on 53 (secondparagraph, lines 9–12) so as to read: ‘Staff salariesare related to the appropriate scales recommended by the BritishMedical Association and the Royal College of Nursing. Despitethe distances involved, transport costs are not unduly high(total of 5.5 per cent)’. The Finance section should befollowed by the section The Future, the heading and first paragraphof which appear at the bottom of 53, second column; this sectioncontinues on 71, first column, paragraph beginning: Furtheremphasis is given by the actions of government and by decisionsin court and settlements out of it'.The headline on 71 shouldread: ‘East of Scotland OHS’. The publishers much regret these errors, which have been correctedon the reprints of the articles concerned.     

Stewardship, Paternalism and Public Health: Further Thoughts

In November 2007, the Nuffield Council on Bioethics publishedthe report Public Health: Ethical Issues. While the report hasbeen welcomed by a wide range of stakeholders, there has alsobeen some criticism. First, it has been suggested that it isnot clear why, in developing its ‘stewardship model’,the Council felt the need to go beyond the liberal positiondeveloped by John Stuart Mill—what is it that the stewardshipmodel adds? Second, it is suggested that the Report is confusedabout the concept of paternalism. Third, it is argued that thediscussion of the concept of stewardship is lacking in detailand substance. We clarify the Working Party's thinking regardingthese three areas, which demonstrates the robustness of theframework set out in the report.     

CORRIGENDUM

O. A. Forsander and J. D. Sinclair. Alcohol elimination andthe regulation of alcohol consumption in AA and ANA rats. Alcoholand Alcoholism 27, 411–416 (1992). On page 414 of the above article, paragraph 3, lines 11–13should read: ‘An earlier study (Koivula et al., 1975)found the AAs to have lower ADH activity than the ANAs’,not ‘higher ADH activity’ as printed in the article.This error does not affect the authors' conclusions.     

The Impact of Discussion of Non-Medical Problems in the Physician's Office

Martin FJ, Bass MJ. The impact of discussion of non-medicalproblems in the physician's office. Family Practice 1989; 6:254–258. To determine the impact of discussion of non-medical problemswith the physician, patients with at least one chronic illnesswho were taking medication were interviewed in their familydoctor's office. Of 149 patients interviewed, 90.6% reportedat least one non-medical problem. Half (51%) of those patientswith a problem had discussed it with their doctor. More thanhalf (55%) of those patients discussing a problem reported thatthe discussion was helpful. Patient compliance and satisfactionwere positively associated with ‘helpful’ discussion,but not with discussion per Se. In particular, the two aspectsof doctor-patient communication which were significantly associatedwith feeling helped were: ‘Doctor tells me all I wantto know about my illness’ and ‘Doctor gives me achance to say what is really on my mind’. Both factorsreflect care which is oriented to patient concerns. The studyresults provide support for a patient-centred approach to care.     

Developments in the darkroom: a cross-sectional study of sickness absence, work-related symptoms and environmental monitoring of darkroom technicians in a hospital in Glasgow

Nine female technicians using both manual and automatic processingmethods were matched by age, sex and smoking habits with controlsfrom the occupational therapy department. All were interviewedusing a questionnaire about symptoms experienced during theday in question and the preceding month. Sickness absence informationfor 1987 was obtained, and the working environment was assessedby standard occupational hygiene methods. The technicians andcontrols had similar numbers of episodes of sickness absence(23 versus 24, respectively) but aggregated substantially moredays absence attributed to sickness (204 versus 41). The totalnumber of ‘monthly’ symptoms experienced by thetechnicians was greater than the controls (44 versus 30) aswas the number of ‘daily’ complaints (26 versus6). In all cases, respiratory symptoms were responsible forabout one-third of problems, but statistical analysis (Wilcoxonmatched pairs signed ranks tests) showed that the differenceswere not statistically significant. Occupational hygiene resultswere all within normal limits.     

Milestones or furlongstones?

Nisar M (College of Family Medicine, Bazar e Kalan, Peshawar,Pakistan). Milestones or furlongstones? Family Practice 1985;2: 173–174. A study was carried out over five years of 15000 children agedbetween one day and three months. It was observed that manyinfants passed their important ‘milestones’ muchearlier than is suggested in present textbooks. A plea is made for discarding the traditional ages for the variouslandmarks in the development of a child. The changes of mentaldevelopment are very important in the first three months andduring the three to six months period the baby seems to be merelyconsolidating more methodically what he was doing less convenientlyduring the first three months.     

Resistance to peer group pressure: an inadequate basis for alcohol education

saper explores the notion of ‘peer group pressure’as it has been deployed in educational interventions on alcoholfor adolescents. It is argued that ‘peer group pressure’is an inadequate explanation for youthful alcohol use and thatinterventions formulated around the inculcation of resistanceto peer group norms must inevitably be at variance with theeveryday experience of those at whom such interventions areaimed. The paper argues that a reformulation of the conceptof ‘peer group pressure’ opens up its positive featuresand that these offer a strong base for a new range of educationalinitiatives.     

PERCEPTIONS OF DRINKERS AND ABSTAINERS IN A SAMPLE OF SCOTTISH ADULTS

Following Davies and Stacey's investigation (1972, Teenagersand Alcohol, HMSO, London) into perceptions of drinking andabstaining among Scottish teenagers, this study extended theirgeneral method to an investigation of the perceptions of 239Scottish adults. Results showed that the stereotypes of theheavy drinker as ‘tough and rebellious’ and theabstainer as ‘weak and cissy’ persist into adulthood.Heavy drinkers were seen as low on ‘sociability’and ‘sexual attractiveness’ and abstainers wereseen as less ‘sociable’ than moderate drinkers.There was also some evidence of a ‘double standard’in perceptions of male and female drinking roles. Other findingsconcerning the effects on perceptions of subjects sex and drinkingbehaviour are compared to those reported in the earlier studyand implications for the treatment of alcohol problems are discussed.It is concluded that the dimensions described by Davies andStacey represent a relatively stable structure within futureresearch where fresh initiatives in alcohol education may belocated.     

Response to Hayden: Comment on 'ethnic cleansing' and 'genocide'

Note: This paper refers to a Commentary by Robert Hayden thatappeared in issue 17(6) of this journal of pages 546–547. Dictionaries describe ‘ethnic cleansing’ as genocide.¹A comparison of the accepted UN definition of genocide witha suggested definition for ‘ethnic cleansing’ leadsus to ask: what are the real differences in the outcomes? (SeeTable 1.) Proof of genocide does not depend on the     

ERRATUM

The Journal of the Society of Occupational Medicine, 25, page75, line 3 should have read, ‘...whether it is in theemployee's interest’.     

Supply and demand-oriented measures of alcohol policy in Switzerland--current trends and drawbacks

Following a presentation of the national context and the basicprinciples of alcohol policy in Switzerland the paper focusesupon two main questions:

1. What political, economic and socialresistance is met with whenimplementing alcohol policy measures?and
2. To what extent have signs of changing health-related valuesbecome visible which can be taken up and supported by the ‘alcoholpolicy maker’?

In answer to the first question, the paper will deal with thelimits of price policy, the effects of international interdependenceand the influence of societal interest groups on alcohol legislation.Furthermore, the relative significance of alcohol problems inpublic opinion will be discussed. The second question intendsto examine to what extent evidence can be found in Switzerlandfor the slogan ‘the new sobriety’.     

The imperative of control

When we are researching and teaching health promotion, inevitablythere is one student who dares ask the question: ‘If youtake that definition of yours seriously, everything is healthpromotion. I find that hard to handle. Wouldn't it be better,if only for my own sanity, to limit our understanding of whathealth promotion is?’ I am always tempted to first blame myself for the insecurityI have installed in such students; I am a bit of a traditionalist,and therefore stick to the