The Healthy Worker Project: a work-site intervention for weight control and smoking cessation.

OBJECTIVES. A randomized trial was conducted to evaluate the effectiveness of a work-site health promotion program in reducing obesity and the prevalence of cigarette smoking. METHODS. Thirty-two work sites were randomized to treatment or no treatment for 2 years. Treatment consisted of health education classes combined with a payroll-based incentive system. Evaluation was based on cohort and cross-sectional surveys. RESULTS. Of 10,000 total employees in treatment work sites, 2041 and 270 participated in weight control and smoking cessation programs, respectively. Weight losses averaged 4.8 lbs, and 43% of smoking participants quit. Net 2-year reductions in smoking prevalence in treatment vs control work sites were 4.0% and 2.1% in cross-sectional and cohort surveys, respectively. No treatment effect was found for weight. Treatment effects for smoking prevalence and weight were both positively correlated with participation rates in the intervention programs (r = .45 for smoking and r = .55 for weight). CONCLUSIONS. This work-site health promotion program was effective in reducing smoking prevalence at a cost that is believed to make the investment worthwhile.     

The SUCCESS project: the effect of program format and incentives on participation and cessation in worksite smoking cessation programs

OBJECTIVES: This study examined the effect of program format and incentives on participation and cessation in worksite smoking cessation programs. METHODS: Twenty-four worksites were randomized to 6 conditions that differed in cessation program format and the use of incentives. Programs were offered for 18 months in each worksite. A total of 2402 cigarette smokers identified at baseline were surveyed 12 and 24 months later to assess participation in programs and cessation. RESULTS: A total of 407 (16.9%) of the smoker cohort registered for programs; on the 12- and 24-month surveys, 15.4% and 19.4% of the cohort, respectively, reported that they had not smoked in the previous 7 days. Registration for programs in incentive sites was almost double that of no-incentive sites (22.4% vs 11.9%), but increased registration did not translate into significantly greater cessation rates. Program type did not affect registration or cessation rates. CONCLUSIONS: Although incentives increase rates of registration in worksite smoking cessation programs, they do not appear to increase cessation rates. Phone counseling seems to be at least as effective as group programs for promoting smoking cessation in worksites.     

Factors influencing participation in worksite wellness programs among minority and underserved populations

In the United States, employers and employees are increasingly paying a larger portion of the nation's healthcare bill. Preventive measures are being employed by businesses in an effort to contain the escalating costs of employee healthcare. The work site is an ideal setting for health promotion because 130 million Americans are employed and spend one third of their time at work. However, unhealthy workers tend to be the least likely to participate in health promotion activities. Worksite Wellness Programs must be designed to engage segments of the work force with the greatest health needs. Culturally sensitive and appropriate programs must be developed to engage economically challenged minority and other underserved populations.     

The worksite component of variance: design effects and the Healthy Worker Project

Variance estimates in worksite health promotion studies depend partly on the intraclass correlation coefficient (ICC). ICC quantifies homogeneity of a variable within worksites. ICC would be zero for randomly formed worksites, but is generally positive because employees tend to share personal characteristics. The ratio comparing the variance estimated from worksite means with that estimated from individuals under simple random sampling is the design effect (DEFF). A DEFF of 1.0 indicates no excess variance due to worksite. The Healthy Worker Project (HWP) was a 32 worksite cross-sectional and longitudinal study of a weight and smoking intervention program. ICCs in cross-sectional surveys for health-related outcome variables ranged from 0.006 to 0.009, DEFFs from 2.0 to 2.6 ICCs/DEFF's in longitudinal analysis were smaller; ICCs ranged from -0.002 to 0.003, DEFFs from 0.7 to 1.5. Positive ICCs substantially increased variance estimates at a single measurement, yet variance of longitudinal analysis was less subject to worksite dependence. It is concluded the worksite component of variance is real and should not be ignored, although the worksite component of variance is small in these longitudinal analyses. This observation should be replicated before it is used in other worksite health promotion research.     

Organizational contraction and participation in worksite weight control programs: a pilot study

Abstract The hypothesis that overweight workers are more likely to participate in health promotion activities during times of organizational contraction than during other times was tested in a sample of 408 overweight employees selected from the total employee population at the headquarters facility of Control Data Corporation (CDC) in Minneapolis, Minnesota. Organizational contraction was defined as the average percentage loss of workers in the firm for the three months prior to a program offering. Organizational contraction levels were then compared with participation in weight control programs. The results of the logistic regression analysis support the hypothesis that participation in health promotion activities would be greater during periods of high levels of organizational contraction than during lower levels (1.34, p<.01).     

Impediment profiling for smoking cessation: application in the worksite

PURPOSE: To replicate results of a pilot smoking cessation study and demonstrate applicability to a worksite setting. METHODS: Smokers employed by a community hospital participated in an onsite smoking cessation program. Participants used an "impediment profiling" instrument to rate personal barriers to cessation and were assigned to between one and seven interventions. Cessation was defined as carbon monoxide concentration in expired air of < or = 10 ppm. RESULTS: Fifty-one employees participated. Subjects lost to follow-up were assumed to be smoking, resulting in a 39.2% 1-year quit rate; 47.5% of program completers (n = 40) were smoke-free at 1 year. Self-reported quit rate at 2.5 years was 25.5% (17 lost to attrition assumed to be smoking) with 38.2% of program completers smoke-free. DISCUSSION: This study suggests that impediment profiling holds promise far smoking cessation and demonstrates feasibility in a worksite setting. Further evaluation of this intervention in the context of randomized controlled trials is warranted.     

Incentives and competition in a worksite smoking cessation intervention.

We evaluated a worksite smoking cessation program that employed multicomponents including support groups, incentives, and competition. The combination of incentives and other components increased participation rates to over 80%. Forty-two percent of smokers were abstinent at six months, compared to 13 percent of a control group (difference 29 percent, 95% CI 9, 49).     

Payroll contracting for smoking cessation: a worksite pilot study

Twenty-one men and 38 women participated in a worksite smoking cessation/smoking reduction program that combined financial contracts, organized through payroll deduction, and biweekly group treatment sessions. At the end of the program the smoking cessation rate was 51%, validated by expired air carbon monoxide. Six months later the validated cessation rate was 12%. We conclude that payroll incentives may be effective in helping workers quit smoking and offer suggestions for ways to promote better maintenance of this important behavior change.     

Factors influencing the adoption and maintenance of Canadian, facility-based worksite health promotion programs

PURPOSE. The purpose of this study was to determine senior management's rationale for adopting and maintaining worksite health promotion programs and the congruence of this rationale with the program objectives of health professionals who manage the programs. DESIGN. A multiple case study design was used. SETTING. Nine major Canadian organizations which had adopted facility-based health promotion programs were the settings for this study. DATA COLLECTION. Semi-structured interviews (22 conducted) and two questionnaires (36 completed) were the methods used to collect data. RESPONDENTS. Senior managers involved in program adoption, senior managers responsible for program budgets, and senior health professionals responded to the interviews and questionnaires. RESULTS. Impetus for health promotion program adoption in the organizations we studied had more to do with tangential issues such as an organization moving to a new facility or having access to unused space than with employee health or organizational performance considerations. The most common program adoption rationale was related to employee recruitment/retention. Program continuance was based on process issues such as participation rates and the quality of activity offerings rather than on health or organizational outcomes. While health professionals and senior management both considered human relations and morale more important than cost savings outcomes, health professionals considered cost savings outcomes more important than did senior management. CONCLUSIONS. It is important for health promotion professionals to develop program objectives which are shared by organizational management. Future program adoptions and maintenance will be influenced by closer analyses of the effect of these programs on organizational performance.     

Occupational and worksite norms and attitudes about smoking cessation.

The relationship of worksite and occupational norms about smoking to workers' attitudes toward smoking cessation was studied in a defined population. From smokers identified in a self-administered questionnaire circulated to all employees of 10 worksites in suburban Minneapolis, 447 smokers were randomly selected and interviewed. Attitudes and social norms about smoking cessation were compared by occupation and worksite using analysis of covariance, controlling for age, sex, and education. Similarly, the relationships of social norms to attitudes were examined using multiple regression analysis. Interest in quitting smoking, confidence in the ability to quit, and coworker support of prior quit attempts were equally pervasive among workers from blue collar and white collar occupations. Yet substantial differences between worksites in attitudes and norms about smoking cessation suggest the importance of the unique social milieu of individual worksites. Of particular importance is the impact of coworker discouragement of prior quit attempts, which varied across worksites and was directly related to confidence in the ability to quit and the desire to seek formal help in future quit attempts. These findings point to the relevance of intervention programs aimed at changing worksite norms about smoking and smoking cessation.     

Four worksite weight loss programs with high-stress occupations using a meal replacement product

The objective was to evaluate the efficacy of worksite weight reduction programs at high-stress worksites. We employed a longitudinal study based on two meal replacements daily with subjects choosing a third 'sensible' meal. The subjects were 492 healthy, overweight men and women working in high-stress occupations (police, hospital health professionals, flight crew members, firefighters). The mean group ages ranged from 32.17 +/- 5.70 to 44.50 +/- 16.40 years; the mean group body mass indexes (BMIs) ranged from 27.40 +/- 2.54 to 32.90 +/- 3.39 kg/m(2). The completion rate for the 12 weeks was 79.8%. Reductions in mean weight and mean BMI were greater than in medically supervised clinical trials with non-worksite adults. Firefighters lost the most weight and medical personnel the least. Follow-up found considerable retention of weight loss. Men lost significantly more weight than women (p < 0.006). We conclude that employees in some high-stress settings may participate productively in worksite weight reduction and maintenance programs that use meal replacements.     

Psychosocial predictors of outcome in a worksite smoking cessation program

We examined the relationship of smoking history, motivation, social support, and stress to initial cessation and long-term abstinence in a sample of 402 smokers who participated in a worksite smoking cessation program. Compared to nonquitters, smokers who initially stopped smoking expected less difficulty quitting, had previously abstained for longer periods, and had a higher desire to quit. Long-term abstainers were lighter smokers and had more social support and less stress than relapsers. The differences in the predictors of initial cessation and long-term abstinence support the concept of a staged cessation process. The results suggest that intraindividual factors are particularly important early in the process, whereas environmental factors are more important during the later, maintenance stage. These findings are consistent with a biopsychosocial model of cessation and relapse and support multicomponent interventions.     

Competition/cooperation in worksite smoking cessation using nicotine gum

Worksite competitions have shown promise in facilitating smoking cessation among employees, but the effectiveness of the competition component itself has not been determined. A multicomponent behavioral treatment and maintenance program plus nicotine gum were provided to competition and no-competition conditions at two large worksites. At 1-year follow-up, 100% of subjects were contacted and measurement of expired carbon monoxide validated abstinence. Recruitment rates were significantly higher in the competition group (2% of smokers) than the no-competition group (0.6% of smokers, P less than 0.001). One-year abstinence rates were 50% for the competition group and 25% for the no-competition group. This difference was not statistically significant (P less than 0.25). However, survival analysis revealed a significant difference in number of weeks abstinent during the year after treatment. Mean weeks abstinent was 35 for competition and 22 for no-competition (P less than 0.05). At the 3-month follow-up, the number of boxes of nicotine gum used predicted abstinence (P less than 0.002). At the 1-year follow-up, rated supportiveness of one's "buddy" (P less than 0.01) and number of sick days prior to starting the program predicted abstinence (P less than 0.003). It is suggested that competition, nicotine gum, and social support may enhance worksite smoking cessation program rates.     

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.     

The Working Healthy Project: a worksite health-promotion trial targeting physical activity, diet, and smoking.

Worksites are a key channel for delivery of interventions designed to reduce chronic disease among adult populations. Although some evaluations of worksite physical-activity interventions have been conducted, to date very few randomized trials of worksite health promotion have included the goal of increasing physical-activity levels as part of a comprehensive multiple risk factor approach to worksite health promotion. This article presents the results regarding behavior change found among the cohort of 2055 individuals who completed three health-behavior assessments as part of their worksites' participation in The Working Healthy Project (WHP), a multiple risk factor intervention implemented in 26 manufacturing worksites. In this study, a randomized matched-pair design was used. Fifty-one percent (n = 2,761) of the employees who completed the baseline assessment also completed the interim survey. Eighty-three percent of those who completed the interim assessment also completed the final survey. The WHP intervention targeted smoking, nutrition, and physical activity. At baseline, 38% of the sample reported engaging in regular exercise, and subjects reported consuming an average of 2.7 servings of fruits and vegetables per day, 7.9 grams of fiber per 1000 kilocalories, and 35.4% calories from fat per day; 28% of the sample were smokers. By the time of both the interim (intervention midpoint) and final (end of intervention) assessments, participants in the intervention condition had significantly increased their exercise behavior, compared with the control condition. There was also increased consumption of fruits and vegetables and fiber in the intervention condition by the time of the final assessment, compared with the control condition. No differences by condition were found with regard to percentage of calories from fat consumed or smoking cessation. These results suggest that among a cohort of participants in a worksite health promotion study, there were significant health behavior changes across two risk factors over time. These data suggest that further investigation of multiple risk factor worksite health promotion is warranted, particularly with a focus on ways to increase participation in these programs and to diffuse intervention effects throughout the entire workforce.