Work stress and health risk behavior

This contribution discusses current knowledge of associations between psychosocial stress at work and health risk behavior, in particular cigarette smoking, alcohol consumption and overweight, by reviewing findings from major studies in the field published between 1989 and 2006. Psychosocial stress at work is measured by the demand-control model and the effort-reward imbalance model. Health risk behavior was analyzed in the broader context of a health-related Western lifestyle with socially and economically patterned practices of consumption. Overall, the review, based on 46 studies, only modestly supports the hypothesis of a consistent association between work stress and health risk behavior. The relatively strongest relationships have been found with regard to heavy alcohol consumption among men, overweight, and the co-manifestation of several risks. Suggestions for further research are given, and the need to reduce stressful experience in the framework of worksite health promotion programs is emphasized.     

Assessing the effects of health promotion in worksites: a review of the stress program evaluations

In a recent issue of Health Education Quarterly, Chen(1) reviewed the evaluations of worksite health promotion programs published in health education journals from 1980 through June 1983. He found few evaluations in the literature that used either quasi-experimental or experimental designs. This paper reviews the evaluations of stress reduction programs in the worksite, most of which were either published outside of health education journals or unpublished. Over one-half of the studies used either experimental or quasi-experimental designs in the evaluations. This suggests that reviews of worksite health promotion program evaluations must encompass journals from a variety of disciplines. Recommendations for improving the evaluations of stress reduction programs in the worksite are included.     

A review of health-related outcomes of multi-component worksite health promotion programs

PURPOSE: The purpose of this article is to critically review evaluation studies of the health-related effects (i.e., health risk modification and reduction in worker absenteeism) of multicomponent worksite health promotion programs. SEARCH METHOD: A comprehensive literature search conducted under the auspices of the Centers for Disease Control and Prevention identified 36 articles that examined health-related outcomes of multi-component programs. The authors identified 11 additional articles through manual searches of recent journal issues and through personal contacts with worksite health promotion researchers. Forty-seven studies describing the results of 35 worksite health promotion programs were reviewed. IMPORTANT FINDINGS: The worksite health promotion programs reviewed for this article varied tremendously in the comprehensiveness, intensity, and duration of the intervention activities. All of the programs provided health education to employees. In a majority of the programs, opportunities to learn and practice new skills were also offered. A smaller number of programs incorporated modifications in organizational policy or the physical work environment. Results from well-conducted randomized trials suggest that providing opportunities for individual risk reduction counseling for high risk employees within the context of comprehensive programming may be the critical component of an effective worksite health promotion program. Just offering low intensity, short duration programs aimed at increasing awareness of health issues for the entire employee population may not be sufficient to achieve desired outcomes. MAJOR CONCLUSIONS: The results of the studies reviewed provide both cautious optimism about the effectiveness of these worksite programs and some general guidance as to the critical components and characteristics of successful programs. Overall, the evidence suggests that a rating of indicative/acceptable may best characterize this literature.     

Mental health issues in the workplace: a case for a new managerial approach.

Anger, stress, and depression in the workplace are growing concerns among management. Traditionally, health outcomes have functioned under the realm of workplace health professionals. This study assessed whether a traditional worksite health promotion program had an impact on mental health factors. The results suggested that worksite health promotion programs play a limited role in ameliorating work-related mental health outcomes. Rather, management must play a greater role in addressing workplace stress, anger, and depression.     

A participatory approach to worksite health promotion

A review of literature suggests that individual, social, and organizational factors are important to consider in the development of worksite health promotion programs. This article describes a conceptual framework that integrates these factors. The implications of this framework for the development, implementation, and evaluation of worksite health promotion programs and the results of an intervention based on this approach are presented. The results from this study highlight the importance of active employee involvement in all stages of worksite health promotion programs. The findings also indicate that programs need to address the causes, not just the symptoms, of stressful working conditions.     

Using organization theory to understand the determinants of effective implementation of worksite health promotion programs

The field of worksite health promotion has moved toward the development and testing of comprehensive programs that target health behaviors with interventions operating at multiple levels of influence. Yet, observational and process evaluation studies indicate that such programs are challenging for worksites to implement effectively. Research has identified several organizational factors that promote or inhibit effective implementation of comprehensive worksite health promotion programs. However, no integrated theory of implementation has emerged from this research. This article describes a theory of the organizational determinants of effective implementation of comprehensive worksite health promotion programs. The model is adapted from theory and research on the implementation of complex innovations in manufacturing, education and health care settings. The article uses the Working Well Trial to illustrate the model's theoretical constructs. Although the article focuses on comprehensive worksite health promotion programs, the conceptual model may also apply to other types of complex health promotion programs. An organization-level theory of the determinants of effective implementation of worksite health promotion programs.     

Comparison of participation in federal worksite and community health promotion programs

The extent to which employees rely on the worksite exclusively for health promotion programs was examined in a cross-sectional study of 10 federal worksites. Responses were received from 3,403 of the 5,757 employees surveyed (59%). Fewer than 10% of employees exclusively used agency programs for physical fitness, nutrition, substance abuse, smoking cessation, and support group meetings. A higher percentage participated in health risk assessment (27%), health and disease risk education activities (17%), medical care services (23%), personal safety and first aid training 26%, and stress management programs (17%) only at the worksite. Men were more likely than women to participate exclusively in workplace programs.     

Incidence and reasons for medical referral in a worksite health promotion program

Abstract The purpose of this study was to examine incidence and reasons for medical referral as a result of screening performed in a worksite health promotion program. Screening consisted of a medical history questionnaire, blood lipid profile, a submaximal treadmill stress test to 85% of age-predicted maximal heart rate, and other fitness measures. Overall, 11.5% of participants were referred to their personal physician for medical reasons following testing. Males (rate = 23.3%) were significantly more likely to be referred than females (rate = 8.8%). No significant difference was found in the percent of male (89.3%) or female (78.5%) referrals who were subsequently cleared to actively participate in the worksite program by their personal physician. These findings have important practical applications for worksite health promotion programs that conduct health screening.     

Stress prevention and supervisor training]

This article surveys available literature addressing the role of supervisors (corporate administrators) in stress prevention activities within the workplace and describes some desirable training courses. In most successful stress management programs or programs that promote mental health, the provision of training for supervisors has been an important strategy. Several reports have asserted that proper training is an effective method of reducing worksite stress and improving job satisfaction in workers, but few prospective intervention studies investigating the truth of these reports have been made. Additional research is necessary to assess the validity of various training programs. The structure of organizations and employment systems has recently begun to change, and the traditional employee-supervisor relationship is slowly disappearing in some enterprises, so that the role of supervisors with regard to stress management may need to be revised.     

Factors influencing participation in worksite smoking cessation and weight loss programs: the Healthy Worker Project

Worksite intervention for health behavior change has attracted much recent interest as a potentially cost-effective way to promote healthier behaviors in the general population. In evaluating the impact of health promotion activities, it is essential to consider the entire work force rather than just self-selected participants. Overall, recruitment results reported to date have varied widely. There are a large number of factors pertaining to both employee and worksite characteristics that could contribute to variability in how well worksite health promotion programs attract employees. A critical issue that has received little research attention is the dynamics of participation in employee health promotion programs as they are offered repeatedly over time. The present study examined participation rates and contributing factors in worksite health promotion programs for weight loss and smoking cessation in the Healthy Worker Project, a randomized trial of worksite intervention conducted among 16 intervention and 16 control worksites in the Minneapolis/St. Paul metropolitan area between 1987 and 1990. Data analyses focused on characterizing individuals enrolling in worksite health promotion programs in comparison to those in the worksite population as a whole who would be considered in need of such programs.     

A short history of occupational fitness and health promotion

The suggestion of a linkage between adequate exercise and occupational health dates back to Ramazzini's classical observations on cobblers and tailors. However, excessive hours of work at too high an intensity were of greater concern than increase of fitness or health promotion in the early phases of the industrial revolution. Loss of physical condition is a more recent phenomenon, and it can be traced to automation in industry and the home, progressive urbanization, and widespread use of the automobile. The Canadian government has seen worksite fitness and health promotion programs as convenient tactics to reverse this trend. Exercise programs apparently yield a healthier and more effective labor force, and major corporations have thus followed the government's lead in developing fitness and health promotional facilities as a part of personnel or occupational health departments. Some health economists have suggested a substantial return upon such investment, but most corporations still regard the promotion of fitness and a healthy lifestyle as an expression of good citizenship. Currently, unifocal fitness programs are being replaced by modular health programs that address a wide range of lifestyle issues, including nutrition, stress relaxation, cigarette addiction, and drug abuse. The purpose of the present brief review is to trace from a personal perspective the development of an interest in employee fitness as an important component of occupational health programs over the past 300 years. The linkage of this phenomenon to the changing human demands of the worksite will also be explored.     

Building program participation: strategies for recruitment and retention in worksite health promotion programs

Building program participation is vital for all health promotion programs. There are a large variety of strategies that have been used to enhance recruitment and retention in worksite health promotion programs. Many of these strategies are examined and their significance in the design and operation of health promotion programs in worksite settings is reviewed.     

Physical activity promotion as a strategic corporate priority to improve worker health and business performance

BackgroundThe increasingly sedentary nature of work and its impact on health and productivity indicators demands the promotion of physical activity at the worksite.PurposeThis paper aims to present considerations for broad-scale application of corporate strategies designed to promote physical activity among employees and their families through employer-sponsored initiatives.ApproachThe benefits of physical activity are multifold, including health and wellbeing and productivity related outcomes. The workplace setting may be leveraged to promote physical activity levels through frequent and sustained exposures to effective interventions that reach employees and, indirectly, their families. Furthermore, employers represent a powerful stakeholder group that should leverage its influence on health policy initiatives designed to create supportive environments inside the workplace as well as the broader community. Specific principles, recommendations for action, and considerations for the prioritization of initiatives are provided based on essential elements for comprehensive programs and health policy initiatives and in the context of a social–ecological model and supportive research.ConclusionsPhysical activity promotion at the worksite should be an integrated initiative that measurably improves worker health and enhances business performance.     

Worksite health promotion programs in the U.S.: factors associated with availability and participation

PURPOSE: To examine how the availability of and participation in worksite health promotion programs varies as a function of individual (e.g., age), organizational (e.g., occupation), and health (e.g., high blood pressure) characteristics. Availability of worksite programs was also compared to that reported in two previous national surveys of private companies. DESIGN: Data analyzed were from the 1994 National Health Interview Survey (NHIS), a national cross-sectional probability sample of the U.S. civilian population. SUBJECTS: Five thousand two hundred nineteen NHIS respondents met the inclusion criteria of (1) being currently employed in a company of at least 50 employees, and (2) completing the NHIS section on worksite health promotion. MEASURES: Employees indicated the availability of, and their participation in, 33 different types of worksite programs. National Health Interview Survey data were also available regarding general health, blood pressure, body mass index, and medical conditions. RESULTS: Smoking cessation programs had the highest mean availability (43%), followed by health education programs (31%) and screening tests (31%). Overall, availability of worksite programs appeared comparable to that reported in a recent national survey. Participation ranged from 32% for health education programs to 5% for smoking cessation programs. Compared to availability, participation depended less on individual and organizational characteristics. Healthy employees were not consistently more likely to participate in worksite health promotion programs than nonhealthy employees. CONCLUSIONS: Although availability of worksite health promotion programs remains high, participation by employees in specific types of programs can vary widely. Attempts to increase participation should look beyond individual, health, and organizational variables, to specific features of the work environment that encourage involvement in health promotion activities.     

Responses to Food Insecurity in the Changing Canadian Welfare State

In the post-Depression era, Canada developed as a welfare state. However, the past 15 years have been characterized by high levels of poverty and unemployment. With the gradual erosion of social programs, a variety of ad hoc, community-based programs have emerged in response to problems of poverty. These include food assistance programs and self-help and community development initiatives designed to improve the food situations of the poor. Current economic, social, and political trends suggest increasing hardship for low-income groups and highlight the need for a critical appraisal of food and nutrition programs within this broader context.     

Worksite Health Promotion

Although the significant majority of employers offer health promotion programs, for most companies the size and impact of existing programs is minor. Recent research has yielded substantial data in support of worksite health promotion activities, from both medical and economic perspectives. Yet despite this compelling information, corporations have been slow to incorporate more substantial health promotion activities.Employers must come to see that an investment in employee health promotion programs is an investment in their workforce, likely their greatest asset. The impact of health promotion programs needs to be viewed not simply in the context of a business operations cost. In the face of rapidly escalating healthcare costs, successful health promotion programs have the potential to reduce those expenditures as well as enhance employee performance, resulting in improved business productivity.To be effective, worksite health promotion programs must be implemented in a systematic manner. To gain senior management support, education regarding the principles of health and productivity is critical. Program selection and implementation must be carefully planned, reflecting the health promotion interests, needs, culture and resources of the organization. Objective, easily measurable parameters of program quality and outcome must be identified prior to program implementation, in order to assess program effectiveness, from both employee health and business productivity perspectives. Collaborative data review through regular reporting can identify program strengths and weaknesses, leading to corrective modifications.     

Health promotion and industry. Where interdisciplinary research meets reality.

Health promotion and disease prevention programs are now a common part of worksite life. Their acceptance has been based more on faith than scientific evidence of their effectiveness or benefit to either the companies or the participants. Evaluation research in worksite health promotion offers an opportunity to test the effectiveness of the programs and should be done using the methods of several disciplines: organizational psychology, industrial hygiene, and health education. Because of the inherent difficulties in planning, developing goals and objectives, and measuring outputs in worksite health promotion programs, any effective evaluation will have to combine methods and approaches from each of these perspectives.     

Corporate characteristics and worksite health promotion programs: survey findings from Fortune 500 companies

A study was carried out to assess the nature and extent of worksite health promotion programs in Fortune 500 companies. Growth and interest in worksite health promotion continues at a remarkable rate. Fortune 500 firms are a good barometer of the state of the art of programs in work settings because these companies have large numbers of employees, an interest in cost savings, and expertise to invest in innovative efforts. Data collection consisted of questionnaires sent to the medical officer or Chief Executive Officer of all companies appearing on the 1984 Fortune 500 list. The following issues were addressed: whether companies offered worksite programs; what health promotion activities were provided in their programs; whether organizations had plans to start up or expand programs; what organizational support existed for programs (i.e. who pays, on whose time employees participate, when activities are offered, and what types of personnel are hired to staff programs); and whether these companies applied needs assessments, evaluation and cost analysis in their programs. Differences in these characteristics were examined in relation to the organizational variables of size (number of employees), Fortune 500 rank and type of industry (low-technology versus high-technology). The response rate for the survey was 49.4% (n = 247). Results of the study indicate a high level of health promotion activity in Fortune 500 firms. Out of the total group of respondents, two-thirds (n = 164) report having worksite programs and two-thirds of organizations with programs have plans to expand their health promotion offerings. One-third of responding organizations without programs planned to initiate them. The health promotion activities provided are numerous and varied, and within units that have programs rates of employee eligibility are reported to be high. However, the participation rates reported are appreciably lower. It is of special interest that, in general, the higher ranked, larger and high-technology companies are more likely to have programs; offer more activities in programs; have plans for program expansion; use a model of sharing costs of, and time to participate in program activities; make greater use of health professionals; and utilize more often needs assessment, evaluation and cost analysis techniques. The results of this study underscore the importance of examining a broad constellation of factors surrounding worksite programs. Given the organizational literature reviewed, it is likely that the characteristics of Fortune 500 programs documented here will serve as models for programs in midsize and smaller companies.     

Stress reduction at the worksite: an evaluation of two methods

Abstract Stress is estimated to cost industry between 75 and 100 billion dollars annually as a result of absenteeism, medical claims and diminished productivity. Two types of stress management programs were studied to evaluate their effectiveness at the worksite. The Time-Life Stress Management Program and a Myers-Briggs Personality Type approach were used. The Time-Life program was given to 113 participants, and 35 participated in the Myers-Briggs program. Baseline stress (strain) scores were obtained using a standardized strain survey instrument. Follow-up strain scores were obtained six to eight months after baseline for 62 percent of the individuals. Both groups showed significant reductions in follow-up strain scores when compared to baseline. Reductions in strain were greater in the group with higher baseline strain scores (Time-Life). Worksite stress management programs have the potential to reduce strain among employees for at least six to eight months.