Health and Wealth: The Importance for Lifestyle Medicine.

Many people spend years dreaming about their retirement. Unfortunately, today's workers will likely work longer, suffer greater economic uncertainty, and might have poorer health status compared with retirees in previous generations. Preserving good health during the working years is associated with a more consistent employment record, greater financial resources, and reduced risk of disease. Making smart financial decisions as a younger adult also translates to improved finances in retirement. While many people are aware of these relationships, many continue to make poor health choices. Employers and lifestyle medicine professionals can both work to improve financial well-being in retirement. Employers can offer effective worksite financial wellness programs and promote participation in retirement savings programs. Physicians and other health providers can foster healthy behaviors, encourage preventive services compliance, and help adults foster overall financial and health well-being. Adopting a healthy lifestyle as early as possible would increase the likelihood that today's workers will enjoy financial security in retirement.

Lifestyle Medicine and Worker Productivity.

The issue of employee productivity has become a major concern for companies. Inefficiency can occur at every stage of production either as poor design, worker limitation, or other factors. It is generally assumed that a healthy worker is more productive than an unhealthy worker. As early as 1776 Adam Smith observed and published in The Wealth of Nations that poor worker health was a detriment to industrial productivity. The objective of this article is to review the literature documenting the gain or loss of productivity related to the health of workers, as well as any lifestyle management strategies that can be used to improve employee health and productivity. The impact of employee obesity, smoking, physical activity, sleep, and behavioral health on productivity will be explored. By identifying and addressing health risks that impair worker performance, lifestyle medicine professionals can demonstrate a significant return on investment by creating a healthier and more productive work force.

Health and Economics of Lifestyle Medicine Strategies.

The cost of medical care in the United States is increasing at an unsustainable rate. The lifestyle medicine (LM) approach is essential to influence the root causes of the growing chronic disease burden. LM addresses health risk factors in primary, secondary, and tertiary prevention of developing disease rather than limiting resources and medical expenditures on acute care and reacting to illness, injury, and disease. Employers have much to gain financially from such an approach due to their status as the payer of health care costs for their employees, and as the recipient of productivity gains among their employees. This article discusses LM programs delivered at the worksite, including important findings from the University of Michigan Health Management Research Center. Examples of evidenced-based population LM interventions are summarized for physical activity, weight management, and nutrition programs that address chronic diseases such as cardiovascular disease, cancer, and diabetes mellitus. These approaches have the potential to reduce health care cost trends, increase employee performance/productivity, and improve patient health outcomes.

The Future of Health Promotion in the 21st Century: A Focus on the Working Population.

The purpose of this article is to synthesize developments from various disciplines including the medical, wellness, psychology, and sociology fields to shed light on where health promotion is headed in the next 25 years. Lifestyle medicine practitioners will continue to play a large role in helping people achieve the highest levels of wellness, which does not simply mean the absence of disease. New research identifies the important roles of many diverse factors such as relationships, lifestyle behaviors, emotional outlook, positive environment, mind-body connection, use of technology, and work styles, which can help each person achieve the fullness of life, vitality, and flourishing that characterizes a high level of well-being.

Development and validity of a scale to measure workplace culture of health.

OBJECTIVE: To describe the development of and test the validity and reliability of the Workplace Culture of Health (COH) scale. METHODS: Exploratory factor analysis and confirmatory factor analysis were performed on data from a health care organization (N = 627). To verify the factor structure, confirmatory factor analysis was performed on a second data set from a medical equipment manufacturer (N = 226). RESULTS: The COH scale included a structure of five orthogonal factors: senior leadership and polices, programs and rewards, quality assurance, supervisor support, and coworker support. With regard to construct validity (convergent and discriminant) and reliability, two different US companies showed the same factorial structure, satisfactory fit statistics, and suitable internal and external consistency. CONCLUSIONS: The COH scale represents a reliable and valid scale to assess the workplace environment and culture for supporting health.

Evaluation of a comprehensive employee wellness program at an organization with a consumer-directed health plan.

OBJECTIVE: Consumer-directed health plans (CDHPs) are popular among employers in the United States. This study examined an employee wellness program and its association with employee health in an organization that recently initiated a CDHP. METHODS: This retrospective observational analysis compared the health risks, employer-paid health care costs, and short-term disability absences of employees of a large financial services corporation from 2009 to 2010. RESULTS: The two-time health risk appraisal participants had a significant improvement in the percentage of employees in the overall low-risk category. The average annual employer-paid medical and pharmacy costs did not significantly change. For employees who improved their health risk category, there was a commensurate change in costs and absences. CONCLUSIONS: In a difficult economic climate, this organization began a health promotion program for employees as well as a new CDHP benefit structure. No short-term reduction in health care usage or overall health status was observed.

Impact of compliance to oral hypoglycemic agents on short-term disability costs in an employer population.

This study evaluated the relationships between compliance with oral hypoglycemic agents and health care/short-term disability costs in a large manufacturing company. The retrospective analysis used an observational cohort drawn from active employees of Ford Motor Company. The study population consisted of 4978 individuals who were continuously eligible for 3 years (between 2001-2007) and who received a prescription for an oral hypoglycemic agent during that time. Medical, pharmacy, and short-term disability claims data were obtained from the University of Michigan Health Management Research Center data warehouse. Pharmacy claims/refill data were used to calculate the proportion of days covered (PDC); an individual was classified as compliant if his/her PDC was ≥80%. Model covariates included age, sex, work type, and Charlson comorbidity scores. The impact of compliance on disability and health care costs was measured by comparing the costs of the compliant with those of the noncompliant during a 1-year follow-up. Among these employees, compliant patients had lower medical, higher pharmacy, and lower short-term disability costs than did the noncompliant. After adjusting for demographics and comorbidity, noncompliance was associated with statistically higher short-term disability costs ($1840 vs. $1161, P<0.0001), longer short-term disability duration, and an increase in short-term disability incidence (21.5% of the noncompliant had a claim compared to 16.0% of the compliant, P<0.0001). These results suggest that medication compliance may be important in curtailing the rise of health care/disability costs in the workplace. Employers concerned with the total costs associated with diabetes should not overlook the impact of compliance on short-term disability.

Reduction in health risks and disparities with participation in an employer-sponsored health promotion program.

There is an increasing awareness among employers and health care providers that health care needs to be tailored to address the diversity of the workforce. Population-based data have shown significant differences in health behaviors and health risks among different racial/ethnic groups in the United States. The purpose of this study was to examine health risks and changes in health risks over time in an employed population at a financial services corporation. This large financial services corporation is naturally concerned about any disparities in health among employees. The study population consists of employees who participated in the organization's medical plan and also the annual health risk appraisal questionnaire in both 2009 and 2010. Significant demographic differences exist among the four ethnic groups studied: whites, African Americans, Hispanics, and Asians. At baseline, African American employees had a significantly higher average number of health risks measured by the health risk appraisal, but they also experienced the greatest improvement in health risks by time 2. There were differences in the health risk profiles of the ethnic groups, with certain risk factors being more prevalent among some ethnicities than among others. The health care costs were not significantly different among the groups studied here. It is likely that other large employers may also find health risk differences among employees belonging to various ethnicities. Future research in this field should seek to understand the reasons behind differences in health among ethnic groups and how best to address them so that all employees can achieve a high level of health and wellness.

Predictors of behavior change intention using health risk appraisal data.

OBJECTIVES: To investigate predictors of behavior change intention and discuss potential implications for practitioners. METHODS: Health risk appraisal (HRA) data from 2 organizations were used to develop and confirm a path analysis model for predictors of intention to change behavior. RESULTS: Lower self-rated health perception and higher ratings of stress corresponded to higher behavior-change intention scores. Stress was associated with poorer health perception. CONCLUSIONS: Higher stress and lower perception of health status were directly associated with intention to change behavior. Incorporating stress management and awareness of health perception into health promotion strategies could enhance wellness programs by aligning programs with motivating factors.

Examining individual factors according to health risk appraisal data as determinants of absenteeism among US utility employees.

OBJECTIVES: To investigate predictors of absenteeism and discuss potential implications for policy/program design. METHODS: Health Risk Appraisal (HRA) data and self-reported and objective absenteeism (personnel records) were used to develop a structural equation model, controlling for age, sex, and job classification. A Medical Condition Burden Index (MCBI) was created by summing the number of self-reported medical conditions. RESULTS: Higher MCBI and stress were direct predictors of absenteeism. Physical activity was not associated with absenteeism but mediated both stress and MCBI. CONCLUSIONS: Because stress impacted both absenteeism and MCBI, organizations may benefit by placing stress management as a priority for wellness program and policy focus. Physical activity was not directly associated with absenteeism but was a mediating variable for stress and MCBI. Measures of stress and physical health may be more meaningful as outcome measures for physical activity programs than absenteeism.

Advancing workplace health protection and promotion for an aging workforce.

OBJECTIVE: To explore issues related to the aging workforce, including barriers to integrating health protection and promotion programs, and provide recommendations for best practices to maximize contributions by aging workers. METHODS: Workgroups reviewed literature and case studies to develop consensus statements and recommendations for a national approach to issues related to older workers. RESULTS: Consensus statements and actions steps were identified for each of the Summit goals and call-to-action statements were developed. CONCLUSIONS: A national dialogue to build awareness of integrated health protection and promotion for the aging workforce is needed. Workers will benefit from improved health and performance; employers will realize a more engaged and productive workforce; and the nation will gain a vital, competitive workforce.

Work environment and psychosocial factors affecting physical activity among Taiwanese information technology professionals: a structural equation modeling approach.

OBJECTIVE: To examine the relationships among work environment, psychosocial factors, and physical activity (PA) among information technology (IT) professionals. METHODS: This was a cross-sectional survey of 576 IT professionals from three IT companies in Taiwan. Structural equation modeling was used to test a theoretically supported model using social cognitive theory, incorporating variables from the demand-control model. RESULTS: Higher levels of PA were positively associated with supportive workplace environments, positive outcome expectations, and self-efficacy for PA. Self-efficacy partially mediated the effects of supportive workplace environments on PA. Job strain had an indirect effect on PA through self-efficacy. The final model accounted for 31% of the variance in PA. CONCLUSIONS: Work environment and psychosocial factors are both important. Workplace PA interventions directed toward individuals' self-efficacy and outcome expectations in the context of supportive environments may be useful.

Translation and psychometric properties of the Chinese version of the perceived workplace environment scale in Taiwanese information technology professionals.

BACKGROUND: The six-item Perceived Workplace Environment Scale (PWES) is a self-report instrument designed to measure employees' perceptions of the extent to which their workplace environment supports employee physical activity. A Chinese version is needed to facilitate workplace physical activity research in Chinese speaking countries. OBJECTIVES: This paper describes the translation process and the psychometric properties of the newly translated Chinese version of the PWES (PWES-C). METHODS: The PWES in English was translated into Chinese using a modified committee approach with the consideration of cross-cultural equivalence. Psychometric properties were examined by a cross-sectional survey of 466 male and 109 female Taiwanese information technology (IT) professionals from three IT companies in northern Taiwan. RESULTS: Content validity of the newly translated PWES-C was supported by a panel of experts. Internal consistency reliability was high (Cronbach's alpha=0.88), and no significant ceiling and floor effects were observed for the PWES-C. Construct validity was supported by examining the factor structure of the PWES-C using a confirmatory factor analysis, and the results suggest a single-factor structure. CONCLUSIONS: The PWES-C is a reliable and valid measure of perceived workplace physical activity environments in Taiwanese IT professionals. The scale could be used by employers to document employees' perception of the workplace environment.

The burden and management of dyslipidemia: practical issues.

The objective of this study is to describe briefly the burden of dyslipidemia, and to discuss and present strategies for health professionals to improve dyslipidemia management, based on a review of selected literature focusing on interventions for dyslipidemia treatment adherence. Despite the availability of effective lifestyle and pharmaceutical therapies for dyslipidemias, they continue to present a significant economic burden in the United States. Adherence to evidence-based guidelines for the treatment of dyslipidemias is unsatisfactory. The reasons for medication nonadherence are complex and specific to each patient. The lack of progress in achieving optimal lipid targets is caused by many factors: patient (medication adherence, cost of medication, literacy), medication (adverse effects, complexity of regimen), provider (lack of adherence to evidence-based practice guidelines, poor communication), and the US healthcare system (being focused on acute care rather than prevention, lack of continuity of care, general lack of use of an electronic health record). Combined interventions that target each part of the system have been effective in improving treatment adherence and achieving lipid goals. Patients, providers, pharmacists, and employers all play a role in management of dyslipidemia. No single approach will solve the complex issue of improving dyslipidemia management. The required lifestyle changes are known and effective medications are available. The challenge is for all interested parties-including nurses, nurse practitioners, doctors, pharmacists, other health care professionals, employers, and health plans-to help patients achieve behavioral changes.

Multilevel analysis of the physical health perception of employees: community and individual factors.

PURPOSE: To investigate whether the communities where employees reside are associated with employee perception of overall physical health after adjusting for individual factors. DESIGN: Retrospective cross-sectional. SETTING: Active employees from a large manufacturing company representing 157 zip code tabulation areas (ZCTAs) in Michigan. PARTICIPANTS: 22,012 active employees who completed at least one voluntary health risk appraisal (HRA) during 1999-2001. METHOD: Community deprivation and racial segregation at the ZCTA level were obtained using indices created from 2000 U.S. Census data. Demographics and HRA-related data (health-related behaviors, medical history, and quality of life indicators) at the individual level were used as independent variables. A two-level logistic regression model (employees nested in ZCTA) was used to model the probability of better self-rated health perception (SRH) (better health: 89.1% versus poor health: 10.9%). RESULTS: Relative to those living in highly deprived communities, employees residing in less-deprived communities showed 2.06 (95% confidence interval [CI], 1.57-2.72) and those living in moderately deprived communities showed 1.83 (95% CI, 1.42-2.35) increased odds of better SRH. After adjusting for individual-level variables, employees living in less-deprived communities had increased odds (1.31 [95% CI, 1.07-1.60]) and those living in moderately deprived communities had increased odds (1.33 [95% CI, 1.11-1.59]) of better SRH compared with individuals from highly deprived communities. The association of racial segregation with employees' SRH was mediated after adjusting for other variables. Individual-level variables showed significant statistical associations with SRH. CONCLUSION: Communities do have a modest association with SRH of the employees living there. After adjusting for individual-level and demographic variables, employees living in less/moderately deprived communities are more likely to perceive better physical health relative to those who live in highly deprived communities.

Presenteeism: critical issues.

OBJECTIVE: The objective of this commentary is to discuss the issues surrounding the concept of presenteeism, including the measurement of lost work time per individual, the conversion of the scores attained by the instruments into expressions of productivity loss, and the translation of productivity losses into economic outcomes. METHODS: Literature searches using PubMed and MEDLINE were conducted using "presenteeism" and "productivity" as keywords and combined with other studies known to the authors. Publications on presenteeism instruments and their applications were included. RESULTS: Substantive questions remain about the measurement of presenteeism, its conversion into lost productivity, and the translation of presenteeism into financial equivalents. CONCLUSIONS: Many aspects of presenteeism still warrant caution, especially when using presenteeism measurements to quantify economic outcomes. Focusing on productivity at the population level, rather than the individual level, may be more appropriate.

An observational study of an employer intervention for children's healthy weight behaviors.

OBJECTIVE: This observational study was undertaken to assess whether changes in healthy weight behaviors could be advanced in a short-term intervention involving parents and children at IBM. METHODS: IBM's Children's Health Rebate offered a cash incentive for parents to complete a 12-week program of self-selected activities in family food planning and meals, family physical activity, and sedentary time related to electronic entertainment ("screen time"). A preprogram/postprogram comparison of self-reported activities was used to assess behavior change. RESULTS: A total of 22,265 (52.3%) employees elected to participate, 11,631 (52.2%) of whom completed all program requirements and earned a $150 cash rebate. Families completing the program reported significant changes in levels of physical activity, amount of entertainment screen time, and proportion of healthy meals. For example, family physical activity >3 times per week increased by 17.1 percentage points (from 23.2% to 40.3%), eating healthy dinners ≥ 5 days/week increased by 11.8 percentage points (from 74.9% to 86.7%), and entertainment screen time <1 hour/day increased by 8.3 percentage points for children (from 22.4% to 30.7%) and by 6.1 percentage points for adults (from 18.1% to 24.2%). CONCLUSIONS: The results of this short-term observational study suggest that healthy weight behaviors in children, adolescents, and parents can be improved by using a Web-based intervention linked with a cash incentive. The results also show that employers can activate parents and support a role for employers in community-based strategies for obesity prevention in children. Experimental designs with biometric data would strengthen the suggestion of positive impact.

Impact of the prevention plan on employee health risk reduction.

This study evaluated the impact of The Prevention Plan™ on employee health risks after 1 year of integrated primary prevention (wellness and health promotion) and secondary prevention (biometric and lab screening as well as early detection) interventions. The Prevention Plan is an innovative prevention benefit that provides members with the high-tech/high-touch support and encouragement they need to adopt healthy behaviors. Support services include 24/7 nurse hotlines, one-on-one health coaching, contests, group events, and employer incentives. Specifically, we analyzed changes in 15 health risk measures among a cohort of 2606 employees from multiple employer groups who completed a baseline health risk appraisal, blood tests, and biometric screening in 2008 and who were reassessed in 2009. We then compared the data to the Edington Natural Flow of risks. The cohort showed significant reduction in 10 of the health risks measured (9 at P≤ 0.01 and 1 at P≤0.05). The most noticeable changes in health risks were a reduction in the proportion of employees with high-risk blood pressure (42.78%), high-risk fasting blood sugar (31.13%), and high-risk stress (24.94%). There was an overall health risk transition among the cohort with net movement from higher risk levels to lower risk levels (P<0.01). There was a net increase of 9.40% of people in the low-risk category, a decrease of 3.61% in the moderate-risk category, and a 5.79% decrease in the high-risk category. Compared to Edington's Natural Flow model, 48.70% of individuals in the high-risk category moved from high risk to moderate risk (Natural Flow 31%), 46.35% moved from moderate risk to low risk (Natural Flow 35%), 15.65% moved from high risk to low risk (Natural Flow 6%), and 87.33% remained in the low-risk category (Natural Flow 70%) (P<0.001).