Worksite health promotion: its evolution and the Johnson & Johnson experience.

Worksite health promotion, a rapidly growing form of preventive health service, may include health risk appraisal with communication of findings to the individuals tested. It may also assist in achieving and maintaining physical and mental fitness, controlling alcohol use, avoiding or quitting tobacco and other drugs, and otherwise maintaining health protective habits, while providing opportunities to control high blood pressure, and reduce elevated blood cholesterol, obesity, and other health hazards. This article presents a synopsis of the evolution of that movement and reviews the experience of one industrial firm that has endeavored to document and evaluate its effort. Such a review may be helpful in consolidating the various findings to date and in indicating the complexity of assessing the health and economic consequences of such an endeavor in private companies.

Effect of the Johnson & Johnson Live for Life program on employee smoking.

Smoking-cessation programs at the worksite hold the potential to reduce the national prevalence of smoking. This article presents the 2-year results of a broad-spectrum smoking-cessation initiative that was part of the comprehensive Johnson & Johnson LIVE FOR LIFE wellness program. In a quasi-experimental design, four companies offered the complete LIVE FOR LIFE program to their employees, and three comparison companies offered only annual health screen assessments. Smoking status was assessed by self-report and serum thiocyanate at baseline and at a 2-year follow-up. At the LIVE FOR LIFE companies, 22.6% of all smokers quit versus 17.4% of smokers at the health screen only companies. The LIVE FOR LIFE program was particularly effective with smokers at high risk for coronary heart disease: 32% of all high-risk smokers quit at the LIVE FOR LIFE companies versus 12.9% at the health screen only companies. These results demonstrate that a company-wide smoking-cessation initiative can produce significant changes in smoking behavior.

A public health intervention model for work-site health promotion. Impact on exercise and physical fitness in a health promotion plan after 24 months.

We need effective ways of getting adults to exercise if we are to meet the Surgeon General's 1990 health goals for the nation. This study reports a comprehensive effort to evaluate the sustained effect of a public health intervention model to achieve these health goals. Employees at four companies (N = 2,600) were exposed to a health promotion program, while employees at three comparison companies (N = 1,700) were offered an annual health screen. Daily energy expenditure in vigorous activity increased 104% among employees at companies offering the health promotion program, compared with a 33% increase among employees at comparison companies. Changes in exercise habits were corroborated by estimates of maximal oxygen uptake. Exercise and physical fitness improvements were distributed throughout the work force. Meaningful population changes in exercise and physical fitness can be produced at the work site and are of a magnitude that makes it possible to meet the 1990 goals for exercise and physical fitness.

The Johnson & Johnson program.

Health promotion in industry should be linked to a "cost containment" strategy and managed like any other business endeavor. Health promotion is best thought of as a marketing process which produces widespread and sustained employee participation in healthful activities. For individual employees, participation improves lifestyle and awareness of personal responsibility for health. The end result of the marketing process is a workplace culture that selectively rewards more healthful lifestyles.

Comparison of respondents and nonrespondents to a worksite health screen.

As part of an evaluation of the voluntary health promotion program offered by Johnson & Johnson to its employees, comparisons were made between nonrespondents and respondents (75% of all employees) in the baseline health screen. A survey of randomly selected nonrespondents was conducted in 1979-1980 to collect health and life-style information. Comparisons between respondents and nonrespondents on a multitude of characteristics indicated that the nonrespondents reported life-styles as healthful as those of the respondents with the exception that significantly more nonrespondents reported ever having smoked cigarettes and significantly more female nonrespondents currently smoke. These results suggest that the systematic biases found among nonrespondents in general population health surveys do not exist among this more homogeneous employed population and imply that the participants in the program provide a good estimate of the health status and life-style of the entire workforce.

Influence of ecologic events on cafeteria food selections: understanding food habits.

Our data confirm that, in terms of eating, people are creatures of habit. Most food selections in an employee cafeteria showed remarkable stability across time, appearing relatively immune to such naturalistic changes as seasons, outdoor temperature, and day of the week. A rew seasonal variations were observed, but these resulted largely from changes in food availability. A tendency for lower calorie food selection was observed during late spring and the summer months. This finding should caution researchers, when evaluating any public health intervention program designed to reduce caloric consumption which is conducted during the spring-summer time period. An inventory control cash register system provides a promising methodology for conducting public health field experiments on food selection. Daily information on food purchases allows food selections of large population groups to be intensively scrutinized. This methodology can be readily applied to improve our understanding of the process of food selection in public and to evaluate ways of promoting healthy eating habits.

A new direction for public health care: changing cafeteria eating habits.

A "Food for Thought" game, an eight-week, media-based nutrition program designed to influence food choices in a cafeteria setting, was conducted in a National Institutes of Health employee cafeteria. Its purpose was to encourage customers to select lower-caloric food during lunch. The effects of the program on food choices and total calories of food purchased each day were measured by time series analyses. During the eight-week intervention period, skim milk purchases increased, and dessert and bread sales, as well as average number of calories purchased per day per person, declined significantly. Some evidence for a maintenance effect over a ten-week follow-up period was obtained. The "Food for Thought" game delivered nutrition education in an upbeat but unobtrusive way. Although people patronize cafeterias to eat, socialize, and relax and not to be educated, this program had only minimal requirements for participation. The result was a high level of interest and involvement. People can "learn while they eat," if careful attention is paid to customer needs and principles of effective communication.

A psychological perspective for double-blind trials.

Blind breaking is likely to occur in a long-term clinical trial involving subjects at risk. Double-blind conditions require subjects to live with ambiguity regarding their health status. It is unrealistic to expect them to tolerate this ambiguity over an extended period of time. A logical step for a subject is to break the blind and surreptitiously seek the best medical care available. Moreover, the staff assigned to monitor protocol adherence may further contribute to blind breaking because of ambiguity regarding their proper clinical role. Several steps are recommended to manage blind breaking within a trial, including improving the quality of medical care, more rigorous screening procedures, and maintaining a clinical environment that promotes accurate disclosure of blind breaking.