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.

The American Heart Association 2030 Impact Goal: A Presidential Advisory From the American Heart Association.

Each decade, the American Heart Association (AHA) develops an Impact Goal to guide its overall strategic direction and investments in its research, quality improvement, advocacy, and public health programs. Guided by the AHA's new Mission Statement, to be a relentless force for a world of longer, healthier lives, the 2030 Impact Goal is anchored in an understanding that to achieve cardiovascular health for all, the AHA must include a broader vision of health and well-being and emphasize health equity. In the next decade, by 2030, the AHA will strive to equitably increase healthy life expectancy beyond current projections, with global and local collaborators, from 66 years of age to at least 68 years of age across the United States and from 64 years of age to at least 67 years of age worldwide. The AHA commits to developing additional targets for equity and well-being to accompany this overarching Impact Goal. To attain the 2030 Impact Goal, we recommend a thoughtful evaluation of interventions available to the public, patients, providers, healthcare delivery systems, communities, policy makers, and legislators. This presidential advisory summarizes the task force's main considerations in determining the 2030 Impact Goal and the metrics to monitor progress. It describes the aspiration that these goals will be achieved by working with a diverse community of volunteers, patients, scientists, healthcare professionals, and partner organizations needed to ensure success.

Health risk factors as predictors of workers' compensation claim occurrence and cost.

OBJECTIVE: The objective of this study was to examine the predictive relationships between employee health risk factors (HRFs) and workers' compensation (WC) claim occurrence and costs. METHODS: Logistic regression and generalised linear models were used to estimate the predictive association between HRFs and claim occurrence and cost among a cohort of 16 926 employees from 314 large, medium and small businesses across multiple industries. First, unadjusted (HRFs only) models were estimated, and second, adjusted (HRFs plus demographic and work organisation variables) were estimated. RESULTS: Unadjusted models demonstrated that several HRFs were predictive of WC claim occurrence and cost. After adjusting for demographic and work organisation differences between employees, many of the relationships previously established did not achieve statistical significance. Stress was the only HRF to display a consistent relationship with claim occurrence, though the type of stress mattered. Stress at work was marginally predictive of a higher odds of incurring a WC claim (p<0.10). Stress at home and stress over finances were predictive of higher and lower costs of claims, respectively (p<0.05). CONCLUSIONS: The unadjusted model results indicate that HRFs are predictive of future WC claims. However, the disparate findings between unadjusted and adjusted models indicate that future research is needed to examine the multilevel relationship between employee demographics, organisational factors, HRFs and WC claims.

Reducing Medication Costs to Prevent Cardiovascular Disease: A Community Guide Systematic Review.

INTRODUCTION: Hypertension and hyperlipidemia are major cardiovascular disease risk factors. To modify them, patients often need to adopt healthier lifestyles and adhere to prescribed medications. However, patients' adherence to recommended treatments has been suboptimal. Reducing out-of-pocket costs (ROPC) to patients may improve medication adherence and consequently improve health outcomes. This Community Guide systematic review examined the effectiveness of ROPC for medications prescribed for patients with hypertension and hyperlipidemia. METHODS: We assessed effectiveness and economics of ROPC for medications to treat hypertension, hyperlipidemia, or both. Per Community Guide review methods, reviewers identified, evaluated, and summarized available evidence published from January 1980 through July 2015. RESULTS: Eighteen studies were included in the analysis. ROPC interventions resulted in increased medication adherence for patients taking blood pressure and cholesterol medications by a median of 3.0 percentage points; proportion achieving 80% adherence to medication increased by 5.1 percentage points. Blood pressure and cholesterol outcomes also improved. Nine studies were included in the economic review, with a median intervention cost of $172 per person per year and a median change in health care cost of -$127 per person per year. CONCLUSION: ROPC for medications to treat hypertension and hyperlipidemia is effective in increasing medication adherence, and, thus, improving blood pressure and cholesterol outcomes. Most ROPC interventions are implemented in combination with evidence-based health care interventions such as team-based care with medication counseling. An overall conclusion about the economics of the intervention could not be reached with the small body of inconsistent cost-benefit evidence.

Legislations and policies to expand mental health and substance abuse benefits in health insurance plans: a community guide systematic economic review.

BACKGROUND: Health insurance plans have historically limited the benefits for mental health and substance abuse (MH/SA) services compared to benefits for physical health services. In recent years, legislative and policy initiatives in the U.S. have been taken to expand MH/SA health insurance benefits and achieve parity with physical health benefits. The relevance of these legislations for international audiences is also explored, particularly for the European context. AIMS OF THE STUDY: This paper reviews the evidence of costs and economic benefits of legislative or policy interventions to expand MH/SA health insurance benefits in the U.S. The objectives are to assess the economic value of the interventions by comparing societal cost to societal benefits, and to determine impact on costs to insurance plans resulting from expansion of these benefits. METHODS: The search for economic evidence covered literature published from January 1950 to March 2011 and included evaluations of federal and state laws or rules that expanded MH/SA benefits as well as voluntary actions by large employers. Two economists screened and abstracted the economic evidence of MH/SA benefits legislation based on standard economic and actuarial concepts and methods. RESULTS: The economic review included 12 studies: eleven provided evidence on cost impact to health plans, and one estimated the effect on suicides. There was insufficient evidence to determine if the intervention was cost-effective or cost-saving. However, the evidence indicates that MH/SA benefits expansion did not lead to any substantial increase in costs to insurance plans, measured as a percentage of insurance premiums. DISCUSSION AND LIMITATIONS: This review is unable to determine the overall economic value of policies that expanded MH/SA insurance benefits due to lack of cost-effectiveness and cost-benefit studies, predominantly due to the lack of evaluations of morbidity and mortality outcomes. This may be remedied in time when long-term MH/SA patient-level data becomes available to researchers. A limitation of this review is that legislations considered here have been superseded by recent legislations that have stronger and broader impacts on MH/SA benefits within private and public insurance: Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) and the Patient Protection and Affordable Care Act of 2010 (ACA). IMPLICATIONS FOR FUTURE RESEARCH: Economic assessments over the long term such as cost per QALY saved and cost-benefit will be feasible as more data becomes available from plans that implemented recent expansions of MH/SA benefits. Results from these evaluations will allow a better estimate of the economic impact of the interventions from a societal perspective. Future research should also evaluate the more downstream effects on business decisions about labor, such as effects on hiring, retention, and the offer of health benefits as part of an employee compensation package. Finally, the economic effect of the far reaching ACA of 2010 on mental health and substance abuse prevalence and care is also a subject for future research.

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.

The Psychosocial, Organizational, and Environmental Stressors Experienced by Food Service Workers in a Hospital Setting During the COVID-19 Pandemic.

OBJECTIVE: To identify stressors faced by hospital food service workers amid the COVID-19 pandemic and effective interventions mitigating these stressors. Methods: In this cross-sectional study, we conducted surveys ( n = 305) and interviews ( n = 9) in the summer and fall of 2022 with employees in hospital settings to determine the psychosocial, organizational, and environmental stressors they faced during the COVID-19 pandemic and interventions that improved health and well-being. Findings: The main stressors reported were fear of infection, increased work demands and schedule unpredictability, and financial insecurity. Employee well-being was bolstered by regular, clear, bidirectional communication; a sense of community and purpose; benefits like paid sick leave and health insurance coverage; and organizational policies that included masking and vaccine requirements demonstrating commitment to protecting worker health. Conclusion: Organizations can play a critical role in guarding the health, well-being, and resilience of frontline workers.

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.

Promoting prevention through the affordable care act: workplace wellness.

Public health in the United States can be improved by building workplace "cultures of health" that support healthy lifestyles. The Affordable Care Act (ACA), which includes the Prevention and Public Health Fund, will support a new focus on prevention and wellness, offering opportunities to strengthen the public's health through workplace wellness initiatives. This article describes the opportunity the ACA provides to improve worker wellness.

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.

Preventing chronic disease in the workplace: a workshop report and recommendations.

Chronic disease is the leading cause of death in the United States. Risk factors and work conditions can be addressed through health promotion aimed at improving individual health behaviors; health protection, including occupational safety and health interventions; and efforts to support the work-family interface. Responding to the need to address chronic disease at worksites, the National Institutes of Health and the Centers for Disease Control and Prevention convened a workshop to identify research priorities to advance knowledge and implementation of effective strategies to reduce chronic disease risk. Workshop participants outlined a conceptual framework and corresponding research agenda to address chronic disease prevention by integrating health promotion and health protection in the workplace.

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.

Commentary on the Study: "What Do Workplace Wellness Programs Do? Evidence From the Illinois Workplace Wellness Study".

Recently, several high-profile randomized clinical trials conducted with employees at the University of Illinois and BJ's Wholesale Club have questioned the value of workplace health and well-being programs. This commentary focuses on the latest research published in The Quarterly Journal of Economics by authors Jones, Molitor, and Reif who evaluated the iThrive wellness program. The commentary challenges the study's main finding that wellness programs (in general) do not work. Several perspectives are explored including whether the evaluated programs are well-designed, sufficiently potent, and appropriate candidates for randomized trials. The article also asks what role employers can or should play in improving the health and well-being of Americans given recent troubling statistics showing a decline in life expectancy and an increase in health risks.

Ten Modifiable Health Risk Factors and Employees' Medical Costs-An Update.

PURPOSE: To estimate the relationship between employees' health risks and health-care costs to inform health promotion program design. DESIGN: An observational study of person-level health-care claims and health risk assessment (HRA) data that used regression models to estimate the relationship between 10 modifiable risk factors and subsequent year 1 health-care costs. SETTING: United States. PARTICIPANTS: The sample included active, full-time, adult employees continuously enrolled in employer-sponsored health insurance plans contributing to IBM MarketScan Research Databases who completed an HRA. Study criteria were met by 135 219 employees from 11 employers. MEASURES: Ten modifiable risk factors and individual sociodemographic and health characteristics were included in the models as independent variables. Five settings of health-care costs were outcomes in addition to total expenditures. ANALYSIS: After building the analytic file, we estimated generalized linear models and conducted postestimation bootstrapping. RESULTS: Health-care costs were significantly higher for employees at higher risk for blood glucose, obesity, stress, depression, and physical inactivity (all at P < .0001) than for those at lower risk. Similar cost differentials were found when specific health-care services were examined. CONCLUSION: Employers may achieve cost savings in the short run by implementing comprehensive health promotion programs that focus on decreasing multiple health risks.

Development of a community-wide cardiovascular risk reduction assessment tool for small rural employers in upstate New York.

Employers are implementing workplace health promotion programs that address modifiable health risk factors such as overweight and obesity, smoking, high blood pressure, high cholesterol, physical inactivity, poor diet, and high stress. Research with large employers has found that these programs can improve workers' health and decrease the costs associated with medical care, absenteeism, and presenteeism. Despite their promise, health promotion programs are not widely embraced by small businesses, especially those in rural communities. This article reviews the barriers encountered by small and rural businesses in implementing health promotion programs. We describe an approach developed in cooperation with the New York State Department of Health's Healthy Heart Program and the Cayuga Community Health Network to engage small businesses in health promotion. We review the development and implementation of an assessment tool created to evaluate current workplace health promotion programs, policies, and practices targeting cardiovascular disease among small, rural employers in upstate New York. Potential benefits of the assessment tool are discussed, and the instrument is made available for the public.

Framework for Evaluating Workplace Health Promotion in a Health Care Delivery Setting.

This case study describes a multistage approach applied to evaluation of an employee wellness program at Northwell Health. The paper describes a framework that other large employers may adopt in their wellness program evaluations. Evaluators worked with Northwell to develop, tailor, and apply a structure-process-outcome framework aligned with the organization's specific goals. Analyses of structural, process, and outcome variables will provide Northwell with valuable information about strengths and weaknesses of its wellness program. The measurement and evaluation framework can serve as a model for businesses aspiring to improve their workplace programs. This framework provides businesses with the opportunity to analyze key elements that need to be addressed collectively to gain a complete picture of program implementation processes and subsequent health and business outcomes.