Perceived Workplace Health and Safety Climates: Associations With Worker Outcomes and Productivity.

INTRODUCTION: This study investigates the associations between perceived workplace health and safety climates and a variety of worker and employer outcomes. METHODS: Self-reported data were collected from an employee health assessment offered at 3 companies (n=959) in 2014. Independent variables included 2 climate variables: perceived safety climate and perceived health and well-being climate. Logistic regression models, performed in 2016-2017, explored the associations between the 2 climate variables and 3 sets of outcomes: worker outcomes, worker health behaviors, and employer outcomes. RESULTS: Perceived workplace safety climate was positively associated with physical activity and optimal sleep. Stronger perceived workplace health and well-being and safety climates were related to less depression, higher job and life satisfaction, less back pain, and higher general health. Stronger perceived climates of workplace safety and health and well-being were associated with less productivity loss. CONCLUSIONS: Conditions of work, such as perceived climate, are associated with improved worker behaviors (physical activity and sleep), worker outcomes (depression, job and life satisfaction, back pain, and general health), and employer (productivity) outcomes.

State of the art conference on weight management in VA: Policy and research recommendations for advancing behavioral interventions.

This article summarizes outcomes of the behavioral interventions work group for the Veterans Health Administration (VHA) State of the Art Conference (SOTA) for Weight Management. Sixteen VHA and non-VHA subject matter experts, representing clinical care delivery, research, and policy arenas, participated. The work group reviewed current evidence of efficacy, effectiveness, and implementation of behavioral interventions for weight management, participated in phone- and online-based consensus processes, generated key questions to address gaps, and attended an in-person conference in March 2016. The work group agreed that there is strong evidence for efficacy and effectiveness of core behavioral intervention components and processes, but insufficient evidence to determine the comparative effectiveness of multiple clinician-delivered weight management modalities, as well as technologies that may or may not supplement clinician-delivered treatments. Effective strategies for implementation of weight management services in VHA were identified. The SOTA work group's foremost policy recommendations are to establish a system-wide culture for weight management and to identify a population-level health metric to measure the impact of weight management interventions that can be tracked and clearly communicated throughout VHA. The work group's top research recommendation is to determine how to deploy and scale the most effective behavioral weight management interventions for Veterans.

Effectiveness of phone and e-mail lifestyle counseling for long term weight control among overweight employees.

OBJECTIVES: To determine the effectiveness of a weight-management program with personal counseling by phone or e-mail. METHODS: A randomized controlled trial of a 6-month program comparing two modes of intervention delivery (phone, n = 462; Internet, n = 464) with self-directed materials (control, n = 460), among overweight employees. Change in body weight after 2 years was the main outcome. RESULTS: Among complete cases, weight loss in the Internet group was 1.2 kg (95% confidence interval [CI], -1.9 to -0.4) and in the phone group 0.8 kg (95% CI, -1.5 to 0.03), compared with the control group. Multiple imputation of missing body weight resulted in comparative weight losses of -0.9 kg (95% CI, -2.0 to 0.3) and -0.4 kg (95% CI, -1.4 to 0.7). CONCLUSIONS: Among complete cases, the Internet intervention showed modest long-term weight loss, but among all participants neither program version was more effective than self-help.

Comparative effectiveness of lifestyle interventions on cardiovascular risk factors among a Dutch overweight working population: a randomized controlled trial.

BACKGROUND: Overweight (Body Mass Index [BMI] ≥ 25 kg/m²) and obesity (BMI ≥ 30 kg/m²) are associated with increased cardiovascular risk, posing a considerable burden to public health. The main aim of this study was to investigate lifestyle intervention effects on cardiovascular risk factors in healthy overweight employees. METHODS: Participants were 276 healthy overweight employees (69.2% male; mean age 44.0 years [SD 9.2]; mean BMI 29.7 kg/m² [SD 3.1]). They were randomized to one of two intervention groups receiving a six month lifestyle intervention with behavior counseling by phone (phone group) or e-mail (Internet group), or to a control group receiving usual care. Body weight, height, waist circumference, sum of skinfolds, blood pressure, total cholesterol level and predicted aerobic fitness were measured at baseline, at 6 and at 24 months. Regression analyses included the 141 participants with complete data. RESULTS: At 6 months a significant favorable effect on total cholesterol level (-0.2 mmol/l, 95%CI -0.5 to -0.0) was observed in the phone group and a trend for improved aerobic fitness (1.9 ml/kg/min, 95%CI -0.2 to 3.9) in the Internet group. At two years, favorable trends for body weight (-2.1 kg, 95%CI -4.4 to 0.2) and aerobic fitness (2.3 ml/kg/min, 95%CI -0.2 to 4.8) were observed in the Internet group. CONCLUSIONS: The intervention effects were independent of the used communication mode. However short-term results were in favor of the phone group and long-term results in favor of the internet group. Thus, we found limited evidence for our lifestyle intervention to be effective in reducing cardiovascular risk in a group of apparently healthy overweight workers. TRIAL REGISTRATION: ISRCTN04265725.

Maintaining physical activity among older adults: 24-month outcomes of the Keep Active Minnesota randomized controlled trial.

OBJECTIVE: To evaluate the efficacy at 6-, 12-, and 24-month follow-up of Keep Active Minnesota (KAM), a telephone and mail-based intervention designed to promote physical activity (PA) maintenance among currently active adults age 50 to 70. METHOD: Participants who reported having recently increased their MVPA to a minimum of 2d/wk, 30 min/bout, (N=1049) were recruited in 2004 and 2005 from one large managed care organization in Minnesota, and randomly assigned to either treatment (KAM; N=523), or Usual Care (UC; N=526) with PA assessed using the CHAMPS questionnaire, and expressed as kcal/wk energy expenditure. RESULTS: We find a sustained, significant benefit of the intervention at 6, 12 and 24 months. kcal/wk expenditure in moderate or vigorous activities was higher at 6 (p<.03, Cohen's d(6m)=.16), 12 (p<.04, d(12 m)=.13) and 24 months (p<.01, d(24 m)=.16) for KAM participants, compared to UC participants. CONCLUSIONS: The KAM telephone- and mail-based PA maintenance intervention was effective at maintaining PA in both the short-term (6 months) and longer-term (12 and 24 months) relative to usual care.

Assessment and outcomes of HealthPartners 10,000 Steps program in an academic work site.

The authors examined the feasibility, acceptability, and potential for physical activity behavior change of a 21-week, 10,000 Steps program in an academic work site. In a pre-post, noncontrolled study design, participants were supplied a pedometer, online resource, and health promotional activities. Means, medians, ranges, and frequencies of self-reported average daily steps (ADS) described physical activity behavior change. An online exit survey assessed the acceptability of the intervention. Of 1,322 eligible participants, 619 (47%) registered; 74% of participants tracked step counts at least once, and 57 (9%) tracked them all 21 weeks. The proportion of cohort participants with < 7,499 ADS tracking all 21 weeks was significantly less than that same cohort tracking only at baseline (p < .02). Survey results showed that 85% of the participants reported general satisfaction with content and navigation of the program Web site. Results suggest elements of feasibility and acceptability but limited potential for physical activity behavior change. Future studies should assess pre-enrollment ADS and barriers to retaining participants.

Maintaining physical activity among older adults: six-month outcomes of the Keep Active Minnesota randomized controlled trial.

OBJECTIVE: We evaluate the 6-month efficacy of Keep Active Minnesota, a phone- and mail-based physical activity maintenance intervention designed for use with adults age 50 to 70 years who have increased their physical activity within the past year. METHOD: Participants (N=1049) recruited in 2004 and 2005 from one large managed-care organization in Minnesota were randomly assigned to either treatment (N=523) or usual care (N=526) with physical activity assessed using the Community Healthy Activities Model Program for Seniors questionnaire, and expressed as kcal/week expenditures. RESULTS: Total physical activity at baseline was similar for treatment and usual care participants (p<0.44) as was moderate/vigorous physical activity (p<0.21). Maintenance of physical activity was higher among treatment participants whose mean 6-month change in total kcal/week energy expenditure was -91, compared to -683 for usual care participants (p<0.002). Mean 6-month change in kcal/week expenditure in moderate or vigorous activities was -49 for treatment participants, compared to -612 for usual care participants (p<0.001). CONCLUSIONS: This phone- and mail-based physical activity maintenance intervention is efficacious at maintaining physical activity at 6 months.

The future of health promotion/disease prevention programs: the incentives and barriers faced by stakeholders.

According to Healthy People 2010, 95% of employers with more than 50 employees reported that they offered at least one health promotion activity by 1999. Employment-based health promotion/disease prevention (hp/dp) programs have significantly increased in frequency and scope since 1985. Yet, 20 years later, the reported results for employee health lag behind the literature documenting the impact of lifestyle-related health risks on morbidity, healthcare utilization, and costs. In this article, we consider the key stakeholders involved-employers, health plans, and employees-and explore their legitimate and feasible roles in employment-based hp/dp programs, including the incentives and barriers they face to program participation. We argue for the integration of hp/dp programs into the traditional health protection mission of occupational health and safety professionals.

ALIFE@Work: a randomised controlled trial of a distance counselling lifestyle programme for weight control among an overweight working population [ISRCTN04265725].

BACKGROUND: The prevalence of overweight is increasing and its consequences will cause a major public health burden in the near future. Cost-effective interventions for weight control among the general population are therefore needed. The ALIFE@Work study is investigating a novel lifestyle intervention, aimed at the working population, with individual counselling through either phone or e-mail. This article describes the design of the study and the participant flow up to and including randomisation. METHODS/DESIGN: ALIFE@Work is a controlled trial, with randomisation to three arms: a control group, a phone based intervention group and an internet based intervention group. The intervention takes six months and is based on a cognitive behavioural approach, addressing physical activity and diet. It consists of 10 lessons with feedback from a personal counsellor, either by phone or e-mail, between each lesson. Lessons contain educational content combined with behaviour change strategies. Assignments in each lesson teach the participant to apply these strategies to every day life. The study population consists of employees from seven Dutch companies. The most important inclusion criteria are having a body mass index (BMI) > or = 25 kg/m2 and being an employed adult. Primary outcomes of the study are body weight and BMI, diet and physical activity. Other outcomes are: perceived health; empowerment; stage of change and self-efficacy concerning weight control, physical activity and eating habits; work performance/productivity; waist circumference, sum of skin folds, blood pressure, total blood cholesterol level and aerobic fitness. A cost-utility- and a cost-effectiveness analysis will be performed as well. Physiological outcomes are measured at baseline and after six and 24 months. Other outcomes are measured by questionnaire at baseline and after six, 12, 18 and 24 months. Statistical analyses for short term (six month) results are performed with multiple linear regression. Analyses for long term (two year) results are performed with multiple longitudinal regression. Analyses for cost-effectiveness and cost-utility are done at one and two years, using bootstrapping techniques. DISCUSSION: ALIFE@Work will make a substantial contribution to the development of cost-effective weight control- and lifestyle interventions that are applicable to and attractive for the large population at risk.