The CDC Worksite Health ScoreCard: A Tool to Advance Workplace Health Promotion Programs and Practices.

INTRODUCTION: The CDC Worksite Health ScoreCard (ScoreCard) is a free, publicly available survey tool designed to help employers assess the extent to which they have implemented evidence-based interventions or strategies at their worksites to improve the health and well-being of employees. We examined how, how broadly, and to what effect the ScoreCard has been applied. METHODS: We analyzed peer-reviewed and grey literature along with the ScoreCard database of online submissions from January 2012 through January 2021. Our inclusion criteria were workplace settings, adult working populations, and explicit use of the ScoreCard. RESULTS: We found that the ScoreCard had been used in 1) surveillance efforts by states, 2) health promotion training and technical assistance, 3) research on workplace health promotion program effectiveness, and 4) employer efforts to improve program design, implementation, and evaluation. CONCLUSION: The ScoreCard has been used as intended to support the development, planning, monitoring, and continuous improvement of workplace health promotion programs. Our review revealed gaps in the tool and opportunities to improve it by 1) enhancing surveillance efforts, 2) engaging employers in low-wage industries, 3) adding new questions or topic areas, and 4) conducting quantitative studies on the relationship between improvements in the ScoreCard and employee health and well-being outcomes.

Scoping Review of Workplace Mental Health and Well-being Programs in Higher Education Institutions.

OBJECTIVE: The study aimed to conduct a scoping review of stressors in higher education institutions (HEIs), exacerbated by the COVID-19 pandemic, and to identify successful interventions. METHODS: We reviewed 79 studies published between January 2020 and January 2023. RESULTS: Stressors were organized into psychosocial, organizational, and environmental categories. They included high job demand/low control, work/personal life imbalance, pressure to publish, lack of resources, low perceived organizational support, and fear of infection. Interventions included providing back-up childcare, employee assistance programs, financial well-being resources, paid medical leave, flexible work arrangements, greater transparency in decision making, leadership development, and adaptive physical space design. CONCLUSIONS: Mental health and well-being interventions directed at faculty and staff in HEIs are needed given the many stressors faced by this workforce. Several interventions are highlighted in the literature, but most are speculative regarding their impact, given the limited number of outcome studies.

Proceedings from a National Summit on Workplace Mental Health and Well-Being: A Focus on the Graduate Academic Environment.

OBJECTIVE: To spotlight the challenges, gaps, and opportunities to improve workforce mental health and well-being in higher education institutions (HEIs). METHODS: We convened a full-day summit of subject matter experts from academia, business, government, and practice to share research and best practices on workplace mental health. RESULTS: Highlights from the summit are presented in this paper covering the importance of leadership and culture; the mental health costs associated with being a Black STEM scholar; the role of the environment; case studies of three university mental health and well-being programs; and the future of work. CONCLUSIONS: Establishing a culture of caring requires leadership commitment; strategic planning; accountability and shared responsibility; and measurement and evaluation. HEI leaders are called to lead by example; foster community partnerships; adopt a Total Worker Health framework; and regularly evaluate progress.

Addressing Psychosocial, Organizational, and Environmental Stressors Emerging From the COVID-19 Pandemic and Their Effect on Essential Workers' Mental Health and Well-being: A Literature Review.

OBJECTIVE: This study aimed to identify stressors faced by essential workers amid the coronavirus disease pandemic and effective interventions mitigating these stressors. METHODS: We reviewed literature on psychosocial, organizational, and environmental stressors faced by essential workers during the pandemic, the consequences of those stressors, and interventions to improve worker health and well-being. FINDINGS: Stressors included elevated risk of coronavirus disease 2019 exposure, fear of spreading the virus, lack of social and organizational supports, and financial insecurity. Negative outcomes included burnout, depression, and high turnover. Promising interventions included robust safety protocols, increased wages, childcare benefits, enhanced access to mental health services, and frequent leadership communications. CONCLUSION: Stress has taken a heavy toll on essential workers' physical and emotional health, productivity, and job satisfaction. To effectively protect Total Worker Health, employers should adopt evidence-based interventions promoting psychosocial, organizational, and environmental health and safety.

Reliability and Validity of the American Heart Association's Workplace Health Achievement Index.

OBJECTIVE: To test the validity and reliability of the American Heart Association's (AHA) updated Workplace Health Achievement Index (WHAI). METHODS: We piloted the updated WHAI with respondent pairs at 94 organizations, and examined the inter-rater reliability (percent agreement) for each item on the survey. To evaluate face and content validity, we conducted preliminary focus groups pre-survey, and follow-up cognitive interviews post-survey administration. RESULTS: Respondents found the updated WHAI to be comprehensive and useful in identifying gaps and opportunities for improving their health and wellbeing programs. The mean percent agreement on all items was 73.1%. Only 9% (or 14 items out of 146) had poor inter-rater reliability (below 61 percent agreement), but through follow-up cognitive interviews we determined that most were due to artifacts of the study design or were resolved through minor revisions to the survey question, instructions, and/or adding examples for clarity. Only 1 question was deleted due to lack of relevance. CONCLUSION: The updated WHAI is a valid and reliable tool for employers to assess how well they promote the health and wellbeing of their employees.

Why Should Businesses Support Public Health?

The COVID-19 pandemic presents a unique opportunity to gain support from the business community for rebuilding a more effective and resilient public health infrastructure in the U.S. This commentary provides the rationale for more engaged business involvement in efforts to promote public health during the time of COVID-19. Drawing on the current pandemic, the commentary highlights the implications of a fragmented public health system for businesses and the nation at large, the shortcomings of which are apparent as never before.

Organizational Best Practices Supporting Mental Health in the Workplace.

OBJECTIVE: To provide a narrative review of best and promising practices for achieving exemplary mental health in the workplace as the foundation for the inaugural Carolyn C. Mattingly Award for Mental Health in the Workplace. METHODS: Research was drawn from peer-reviewed articles using the search terms associated with workplace mental health. RESULTS: Eight categories of best practices were identified: (1) culture, (2) robust mental health benefits, (3) mental health resources, (4) workplace policies and practices, (5) healthy work environment, (6) leadership support, (7) outcomes measurement, and (8) innovation. CONCLUSION: The review provided the scientific backing to support criteria developed for the Carolyn C. Mattingly Award for Mental Health in the Workplace. By recognizing organizations that apply evidence-based practices in their health and well-being programs, the Mattingly Award may inspire employers to adopt best practices.

The Stock Performance of American Companies Investing in a Culture of Health.

PURPOSE: We investigated the relationship between companies' efforts to build internal (COH-INT) and external cultures of health (COH-EXT) and their stock performance. DESIGN: We administered 2 surveys, which measure companies' programs, policies, and supports for improving the health of their employees and communities. We then compared the companies' stock performance to the Standard and Poor's (S&P) 500 Index from January 2013 through August 2017. SETTING: United States. PARTICIPANTS: Representatives from 17 publicly traded companies who completed the COH-INT survey, of whom 14 also completed the COH-EXT. MEASURES: Culture of health scores were dichotomized into high versus low for both surveys. Stock price data for all companies were gathered from public sources. ANALYSIS: We constructed 5 stock portfolios: all 17 companies, high COH-INT, low COH-INT, high COH-EXT, and low COH-EXT companies. We examined total returns for each portfolio compared to the S&P 500. RESULTS: High COH-INT companies' stock price appreciated by 115% compared to the S&P benchmark (+69%), while low COH-INT companies appreciated only 43%. In contrast, high COH-EXT companies underperformed (+44%) when compared to the S&P 500 (+69%) and low COH-EXT companies (+89%). CONCLUSION: This study supports the view that employers' efforts to build an internal culture of health is a sound business strategy. More research is needed, however, to establish whether a link exists between supporting healthy community initiatives and company stock performance.

Improvements in an Organization's Culture of Health Reduces Workers' Health Risk Profile and Health Care Utilization.

OBJECTIVE: To examine changes in internal and external cultures of health scores and relate those changes to employees' health risks, health care utilization, and costs for 21 large employers (N = 641,901). METHODS: We measured the relationship between changes in internal and external culture of health scores and changes in employee health risks, health care utilization, and costs. RESULTS: Improvements in a company's internal culture of health predicted lower levels of obesity, poor diet, and tobacco use but higher stress for employees reporting high baseline risk. For those not at high baseline risk, health improved for depression, alcohol consumption, and diet. Improvements in internal culture of health also led to lower prescription drug utilization. CONCLUSION: Investments in internal culture of health predict improvements in some employee health risks and health care utilization.

Validity and Reliability of the Updated CDC Worksite Health ScoreCard.

OBJECTIVE: The aim of this study was to evaluate the reliability and validity of the updated 2019 CDC Worksite Health ScoreCard (CDC ScoreCard), which includes four new modules. METHODS: We pilot tested the updated instrument at 93 worksites, examining question response concurrence between two representatives from each worksite. We conducted cognitive interviews and site visits to evaluate face validity, and refined the instrument for public distribution. RESULTS: The mean question concurrence rate was 73.4%. Respondents reported the tool to be useful for assessing current workplace programs and planning future initiatives. On average, 43% of possible interventions included in the CDC ScoreCard were in place at the pilot sites. CONCLUSION: The updated CDC ScoreCard is a valid and reliable tool for assessing worksite health promotion policies, educational and lifestyle counseling programs, environmental supports, and health benefits.

Developing Two Culture of Health Measurement Tools: Examining Employers' Efforts to Influence Population Health Inside and Outside Company Walls.

OBJECTIVE: The aim of the study was to develop tools that quantify employers' investment in building cultures of health (COH)-inside and outside company walls. METHODS: Two COH instruments were developed through literature reviews and expert consultation. The first focused on internal culture of health (COH-INT), that is, programs, policies, and attributes of the physical and social environments that support employees' health and well-being. The second focused on external culture of health (COH-EXT), that is, programs, policies, and environmental supports that promote communities' health. We administered these tools to 32 employers and examined instrument reliability, distribution of scores, and correlation between the two instruments. RESULTS: Both tools demonstrated adequate reliability. COH-EXT scores changed minimally over the 3-year study timeframe. There was little correlation between the COH-INT and COH-EXT scores. CONCLUSIONS: More research is needed to further develop and validate COH-EXT instruments.

The predictive validity of the HERO Scorecard in determining future health care cost and risk trends.

OBJECTIVE: To determine the ability of the Health Enhancement Research Organization (HERO) Scorecard to predict changes in health care expenditures. METHODS: Individual employee health care insurance claims data for 33 organizations completing the HERO Scorecard from 2009 to 2011 were linked to employer responses to the Scorecard. Organizations were dichotomized into "high" versus "low" scoring groups and health care cost trends were compared. A secondary analysis examined the tool's ability to predict health risk trends. RESULTS: "High" scorers experienced significant reductions in inflation-adjusted health care costs (averaging an annual trend of -1.6% over 3 years) compared with "low" scorers whose cost trend remained stable. The risk analysis was inconclusive because of the small number of employers scoring "low." CONCLUSIONS: The HERO Scorecard predicts health care cost trends among employers. More research is needed to determine how well it predicts health risk trends for employees.

Reliability and validity testing of the CDC Worksite Health ScoreCard: an assessment tool to help employers prevent heart disease, stroke, and related health conditions.

OBJECTIVE: To develop, evaluate, and improve the reliability and validity of the CDC Worksite Health ScoreCard (HSC). METHODS: We tested interrater reliability by piloting the HSC at 93 worksites, examining question response concurrence between two representatives from each worksite. We conducted cognitive interviews and site visits to evaluate face validity of items and refined the instrument for general distribution. RESULTS: The mean question concurrence rate was 77%. Respondents reported the tool to be useful, and on average 49% of all possible interventions were in place at the surveyed worksites. The interviews highlighted issues undermining reliability and validity, which were addressed in the final version of the instrument. CONCLUSIONS: The revised HSC is a reasonably valid and reliable tool for assessing worksite health promotion programs, policies, and environmental supports directed at preventing cardiovascular disease.