A comprehensive review of the effects of worksite health promotion on health-related outcomes

PURPOSE: This article provides the foundation for a series of literature reviews that critically examine the effectiveness of worksite health promotion programs. This issue reviews the exercise, health risk appraisal, nutrition and cholesterol, and weight control literatures; a future issue will review the alcohol, HIV/AIDS, multicomponent program, seat belt, smoking, and stress management literatures. METHODS: The literature search used a four-step process that included a computerized database search, a reference search, a manual search of relevant health promotion journals, and the writing of the review by a recognized expert in the area being searched. The databases were searched from 1968 through 1994 and included Medline, Aidsline, Psychological Abstracts, Combined Health Information Database, Employee Benefits Infosource, National Prevention Evaluation Research Collection, National Resource Center on Worksite Health Promotion, National Technical Information Service, and the Substance Abuse Information database. A total of 288 articles were identified by the search, not including the 37 articles in the hypertension literature. Authors of each review were requested to incorporate additional studies not identified by the search, provide a research rating for each individual article, and a rating for the overall literature for their respective area. The authors reviewed 316 studies. FINDINGS: The overall ratings for the reviews reported in this issue were suggestive for exercise, weak for health risk appraisals, suggestive/indicative for both nutrition and cholesterol, and indicative for weight control. The ratings for the other reviews will be reported in the subsequent issue. CONCLUSIONS: Research reported in these reviews suggests the effectiveness of worksite health promotion programs, however, additional research is required to provide conclusive evidence of their impact.     

A psychosocial-approached health promotion program at a Japanese worksite

This study examined trends of sickness absence before and after a psychosocial-approached health promotion program (HPP) at a Japanese worksite. The subjects were 1029 male employees working at a manufacturing company from April 1991 to March 1999. The HPP was performed from April 1995 to decrease sickness absence through helping to improve all employees' lifestyles according to a psychosocial approach incorporating six characteristics: 1) concept based on the population strategy, 2) use of a health risk appraisal (HRA), 3) setting easy lifestyle targets, 4) praising the employees' personal lifestyle initiatives, 5) supported (sponsored) by the management, 6) award of subsidiary payments. Sickness absence was considered to be consecutive days calculated by medical certification and company records. Absences due to musculoskeletal diseases and total diseases decreased, when comparing four-year periods before and after the program's introduction. In this report we show that trends of sickness absence changed after the introduction of the psychosocial-approached health promotion program.     

Examination of risk status transitions among active employees in a comprehensive worksite health promotion program.

Most worksite health promotion programs are designed to effect risk reduction. Net changes in the prevalence of health behaviors are a combination of individuals who reduce to low-risk and those who become high-risk. It is the purpose of this study to examine overall risk status transitions, between low-risk (0-2 risks); medium-risk (3-4 risks); and high-risk (5 or more risks), within a comprehensive worksite health promotion program over the first year of the program (short-term) and after 5 years (long-term). Significant increases were demonstrated in the numbers of individuals who transitioned to lower risk status. Nearly half (0 percentage points) of the net reduction to low-risk status (+10.4 percentage points) occurred during the first year of the program. The design of health promotion programs may need to be adjusted from risk reduction in the short-term to programs that maximize retention of individuals within low-risk categories over the long-term. This program design would maximize the opportunity to obtain initial risk reduction during the first years of the program and then maximize the opportunity to maintain low-risk status in the long-term.     

The cardiovascular health impact of an incentive worksite health promotion program

PURPOSE: We examined the cardiovascular health profiles of benefit-eligible hospital employees who participated in an incentive screen program for 4 years. We also determined if cardiovascular health changes differed between participants (CHAP) who enrolled in structured follow-up risk reduction programs (CHAPplus) compared with those who chose less formal options (CHAPonly). METHODS: CHAP consisted of cardiovascular screens, results counseling, and encouragement to participate in education and behavioral support programs. After adjusting for gender, medication use, and baseline levels of adiposity and physical activity, cardiovascular health changes were tested with repeated-measures analysis of covariance (ANCOVA) among CHAP participants and by CHAP type. RESULTS: CHAP 4-year members (n = 278) were generally healthy and mostly women (87%) with an average age of 40.6 +/- .5 years at baseline. Despite increases in overall (p = .034) and central adiposity (p = .001), cardiovascular health improvements were found for the total cholesterol/high-density lipoprotein ratio (TCHOL/HDL; p = .007), low-density lipoprotein (p = .009), and blood glucose (p = .018) among 4-year CHAP members. CHAPonly employees showed greater improvements in most cardiovascular health indicators than CHAPplus participants, although these differences did not achieve statistical significance. DISCUSSION: Cardiovascular health improvements were associated with long-term participation in a hospital worksite incentive screen program. The cardiovascular health benefits tended to be greatest for CHAP employees who chose informal follow-up risk reduction options (CHAPonly) than those who enrolled in structured programs (CHAPplus).     

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.     

The impact of a worksite health promotion program on short-term disability usage

This study examined the impact of a worksite health promotion program on short-term disability (STD) days in a large telecommunications company. The evaluation used a quasi-experimental, multiple time-series design with between-group comparison of workdays lost due to STD to determine impact. The study period was 3 years and included 1628 employees on STD leave. Self-selected program participants were compared with non-participants on net days lost at three assessment points: the year before the launch of the program, and each of 2 years post-launch. A comprehensive health promotion program was developed to reduce health care costs, improve employee satisfaction, and enhance the employer's image. Key features of the program included reimbursement for employees participating in the Health Risk Assessment and in wellness or fitness activities. Other features included occupational health services, targeted interventions for high-risk employees, self-care materials, and a nurse advice line. Results revealed no significant differences at baseline between participants and non-participants for net days lost while on STD leave. At the post-program launch, non-participants' net days lost significantly increased from 33.2 to 38.1 when controlled for age, gender, job type, tenure, and STD category, whereas the participant group average net days lost decreased from 29.2 to 27.8. After adjusting for baseline differences, we found a 6-day difference between groups, which represented a 20% program impact. This study found that participation in a health promotion reimbursement program had a significant impact on average net days lost for employee STD absence. These findings represented potential savings in excess of $1,371,600 over a 2-year period. Future program evaluation efforts will address the impact on medical care costs related to program participation.     

Effect of health risk appraisal on health outcomes in a university worksite health promotion trial

Data from a 1-year worksite health promotion trial were examinedto assess the effect of a health promotion intervention andhealth risk appraisal (HRA) on health behavior and health statusindicators among university employees. Forty-one departments(N = 2198) were randomly assigned to receive: (1) a health promotionintervention and a HRA, (2) the intervention only, (3) the riskappraisal only or (4) neither. After controlling for age, race,gender, job category and the appropriate baseline measure, groupassignment was used to predict total cholesterol level, systolicand diastolic blood pressure, exercise frequency, and body massindex (BMI) among 801 employees who completed both baselineand follow-up assessment. Receipt of the combination of theintervention and the risk appraisal or each component separatelyresulted in significantly lower systolic blood pressure andBMI.     

Cost-benefit analysis of a worksite oral-health promotion program

This study was conducted to examine whether oral-health promotion programs provided as an occupational health service for employees were cost-beneficial for employers. The subjects were composed of 357 male workers (20-59 yr of age) who participated in oral-health promotion programs conducted at their workplaces between 1992 and 1997. The design of this study was a quasi-experimental study design in which the three programs (light: 1 visit; medium: 2-4 visits; and heavy: 5-6 visits) were compared through cost-benefit analysis conducted from the viewpoint of the employers. The programs consisted of oral-health checkups by dentists and oral-health education, including that on the proper brushing method, by dental hygienists. The costs of the program included direct costs for the payment of oral-health-care staff and for teaching materials, and indirect costs for the time for employee participation in the program (20 min/employee per visit). The accumulated dental expenses for the seven years were used to calculate benefits, which were determined, based on the differences between 0 visits and each program. The benefit/cost ratios of the three programs were -2.45, 1.46, and 0.73, respectively. These results suggest that a worksite oral-health promotion program of medium frequency is cost-beneficial for employers.     

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.     

The effectiveness of a telephone-based tobacco cessation program offered as part of a worksite health promotion program

Extensive research on tobacco cessation affirms the effectiveness of interventions, although the literature is more limited concerning the impact of programs designed specifically for the workplace. The present study examines the effectiveness of a telephone-based health coaching tobacco cessation program that was provided as part of worksite health promotion programs by 10 large employers. The participants were recruited based on their health risks as identified by health assessments, and the program was personalized to meet their individual needs and stages of change. The results indicate that at 12 months, health coaching program participants achieved a 32% quit rate, compared to 18% for nonparticipants. The quit rate was highest (44%) among program completers who were ready to change at baseline. These results suggest that a tobacco cessation program offered as part of a worksite health promotion program can be highly effective, especially for those who are ready to change. However, the relatively low annual participation rate may indicate that tobacco users remain among the most difficult to engage and to support in their efforts to complete programs. Therefore, implementing a variety of engagement strategies, such as policy changes, as well as social and financial incentives and penalties will most likely have a positive effect at the population level.     

Tailoring and targeting a worksite health promotion program to address multiple health behaviors among blue-collar women

PURPOSE: This study examined the relationship between health risks, health behaviors, stages-of-change, and behavior change priorities among blue-collar women participating in a worksite health promotion study. DESIGN: Cross-sectional. SETTING: Rural manufacturing worksites in North Carolina. SUBJECTS: Participants were 859 women aged 18 and over. MEASURES: The self-administered questionnaire assessed smoking, exercise, nutrition (fat, fruits, and vegetables), and breast and cervical cancer screening behaviors. In addition, demographics, body weight, perceived health, stages-of-change, and priority for behavior change were measured. Chi-square tests and regression analysis were used to assess statistical significance. RESULTS: Overall, 28% of women smoked, 37% were completely sedentary, 82% consumed less than five daily servings of fruits and vegetables, and the majority were overweight. The dominant stage of change for each of the lifestyle behaviors was contemplation, whereas most women were in the action stage for cancer screening. When asked to prioritize the behavior they most wanted to change, the majority of women chose healthy eating and/or exercise. CONCLUSIONS: The findings suggest that blue-collar women in this study had multiple health risks and were interested in changing multiple health behaviors. Allowing women to choose the behavior(s) on which they are ready to focus may be a promising approach to tailoring interventions for this population.     

The effects of a worksite health promotion program on the wives of fire fighters

One method of increasing the cost-effectiveness of worksite health promotion programs is to develop programs that also have an impact on risk factors of family members and friends of the employees. In this study, 41 wives of fire fighters were interviewed concerning changes the fire fighters and they had made in their health habits--exercise, weight, and consumption of fats, fruits/vegetables, and cereal/whole grain breads--in the previous year. Thirty-two were wives of fire fighters who had received a worksite health promotion program and nine were wives of fire fighters who had not yet received the program. Findings of our exploratory study strongly suggest that wives of fire fighters who received information were more aware of the program (93% vs 56%), had greater exposure to the written diet plan (72% vs 11%) and guide to high fat foods (72% vs 0%) than controls. Furthermore, the intervention led to changes in the fire fighters' health habits that were reported by the wives. No significant changes in the wives' health habits occurred as a result of the intervention, although the changes were in the predicted direction in every category; changes by the wives were, however, related to changes by fire fighters. Involvement of the fire fighters in the preparation of meals and sharing of information from the intervention program by the participant with the wife, were related to change in health habits of the wives.(ABSTRACT TRUNCATED AT 250 WORDS)     

Financial impact of a comprehensive multisite workplace health promotion program

INTRODUCTION: The purpose of this study is to determine if the Washoe County School District Wellness Program impacted employee health care costs and rates of absenteeism over a 2-year period. METHODS: Outcome variables included health care costs and absenteeism during 2001-2002. Data were collected on 6246 employees over a 6-year period from 1997-2002. Baseline health claims costs and absenteeism from 1997-2000, age, gender, job classification, and years worked at the school district were treated as covariates. Logistic regression was used to compare 2-year costs and absenteeism rates between nonparticipants and employees who participated for 1 and 2 years. RESULTS: No significant differences in health care costs were found between those who participated in any of the wellness programs and those who did not participate. There was a significant negative association between participation and absenteeism; program participants averaged three fewer missed workdays than those who did not participate in any wellness programs. The decrease in absenteeism translated into a cost savings of 15.60 US dollars for every dollar spent on the program. CONCLUSIONS: After controlling for several confounding variables, wellness program participation was associated with large reductions in employee absenteeism.