Completing a worksite health risk assessment correlates with continuing employment, lower health care costs and utilization.

OBJECTIVES: Companies that understand the collective health risks of their employees, as well as worker productivity as it relates to health risks can provide more effective and necessary interventions. Health Risk Assessments (HRAs) are an important source of information for understanding overall health risks of a company's employees. However, HRA data tend to represent only a subset of employees, thereby providing employers an incomplete picture of employee health risks. The current study identifies the representativeness of those completing a worksite HRA by selected demographics, health care costs, and health risks in a large US company. MATERIAL AND METHODS: A retrospective analysis of employees in a large US company during 2017-2019, with statistically significant results reported, adjusted for sex, age, and year. RESULTS: The percentage of employees completing the HRA increased from 23.9% in 2017 to 28.4% in 2018 to 32.3% in 2019. These employees were more likely women, middle aged, have lower health care costs, remain employed from year to year, and have better health behaviors and biometric scores. If all employees looked like employees completing the HRA, total medical costs would be 17% lower. If all employees looked like employees completing the HRA who had a health perception rating (1-10 [excellent]) of 7-8 (57.4%) or 9-10 (25.2%) vs. 1-6, total medical costs would be 21.9% and 25.6% lower, respectively. CONCLUSIONS: A minority of employees completed the worksite HRA. Basing overall employee health risks on the HRA underestimates health risks and can result in a poorly representative health intervention program. Int J Occup Med Environ Health. 2022;35(4):449-57.

Lowering employee health care costs through the Healthy Lifestyle Incentive Program.

OBJECTIVE: To evaluate the impact of the Healthy Lifestyle Incentive Program (HLIP), a worksite health program, on lowering prescription drug and medical costs. DESIGN: Health care cost data for Salt Lake County employees during 2004 through 2008 were linked with HLIP enrollment status. Additional program information was obtained from a cross-sectional survey administered in 2008. INTERVENTION: The program includes free annual screenings, tailored feedback on screening results, financial incentives for maintaining and modifying certain behaviors, and periodic educational programs and promotions to raise awareness of health topics. MAIN OUTCOME MEASURES: Frequency and cost of prescription drug and medical claims. RESULTS: Participation increased from 16% to 23% in men and 34% to 45% in women over the 5-year study period and was associated with a significantly greater level of physical activity and improved general health. Participants were generally satisfied with the HLIP (43% were very satisfied, 51% satisfied, 5% dissatisfied, and 1% very dissatisfied). The primary factors contributing to participation were financial incentives (more so among younger employees), followed by a desire to improve health (more so among older employees). Over the study period, the cost savings in lower prescription drug and medical costs was $3,568,837. For every dollar spent on the HLIP the county saved $3.85. CONCLUSION: Financial incentives and then a desire for better health were the primary reasons for participation. The HLIP resulted in substantial health care cost savings for Salt Lake County Government.

The Coronary Health Improvement Project (CHIP) for lowering weight and improving psychosocial health.

This study extends previous research evaluating the association between the CHIP intervention, change in body weight, and change in psychological health. A randomized controlled health intervention study lasting 4 wk. was used with 348 participants from metropolitan Rockford, Illinois; ages ranged from 24 to 81 yr. Participants were assessed at baseline, 6 wk., and 6 mo. The Beck Depression Inventory (BDI) and three selected psychosocial measures from the SF-36 Health Survey were used. Significantly greater decreases in Body Mass Index (BMI) occurred after 6 wk. and 6 mo. follow-up for the intervention group compared with the control group, with greater decreases for participants in the overweight and obese categories. Significantly greater improvements were observed in BDI scores, role-emotional and social functioning, and mental health throughout follow-up for the intervention group. The greater the decrease in BMI through 6 wk., the better the chance of improved BDI score, role-emotional score, social functioning score, and mental health score, with odds ratios of 1.3 to 1.9. Similar results occurred through 6 mo., except the mental health variable became nonsignificant. These results indicate that the CHIP intervention significantly improved psychological health for at least six months afterwards, in part through its influence on lowering BMI.

Participation in the Healthy Rewards Program Predicts Staying Employed, Medical Costs, and Utilization.

OBJECTIVE: To identify who is participating in the healthy rewards program (HRP), how participation corresponds with employment, and to compare health care costs and utilization between partial and full participants with non-participants. METHODS: A retrospective analysis of employees in a large US company during 2016 to 2019, with statistically significant results reported, adjusted for sex, age, and year. RESULTS: Women, ages 30 to 59, and those employed in more recent years correspond with higher HRP participation. Participants were 15.7% more likely to remain employed from year to year. Compared with non-participants, partial and full participants experienced $740.43 and $884.07 lower annual costs. If all employees experienced the same health care costs as non-participants, partial participants, and full participants, there would be an 8% increase, 13% decrease, and 17% decrease in costs, respectively. CONCLUSIONS: HRP participation is a marker of interest in healthier living.

Improving overall health status through the CHIP intervention.

OBJECTIVE: To evaluate the efficacy of a coronary heart disease prevention program at improving selected health indicators. METHODS: A randomized controlled health intervention study was used, with 348 participants from metropolitan Rockford, Illinois, followed for 6 months; ages ranged from 24 to 81 years. Health indicators were based on the SF-36v2. RESULTS: Those in the intervention group showed significantly greater increases in scale scores for physical functioning, role-physical, bodily pain, general health perceptions, vitality, social functioning, role-emotional, and mental health. CONCLUSION: The prevention program improved functional health and well-being scores as well as psychometrically based physical and mental health summary measures.

Coronary Health Improvement Project (CHIP) is associated with improved nutrient intake and decreased depression.

OBJECTIVE: We evaluated the efficacy of the Coronary Health Improvement Project (CHIP) at lowering depression by modifying selected daily nutrients from food. METHODS: A randomized controlled trial was used, with 348 participants 24 to 81 y of age from metropolitan Rockford, Illinois. Participants were assessed at baseline and at 6 wk and 6 mo of follow-up. The Beck Depression Inventory (BDI) was used to measure depression. RESULTS: Those in the intervention group compared with the control group were 63% more likely to show a decrease in BDI through 6 wk (P < 0.0001) and 34% more likely to experience a decrease through 6 mo (P < 0.0001). Baseline levels of saturated fat were negatively associated with BDI (P < 0.0001) after adjusting for age, sex, exercise, body mass index, and exercise. Decrease in saturated fat over the study period was directly associated with a decrease in BDI. Increase in pyridoxine (B6) was also associated with a decrease in BDI. The intervention indirectly lowered BDI by lowering saturated fat and increasing dietary pyridoxine (B6). It also directly lowered BDI, possibly because of social interaction, positive reinforcement, and distraction. CONCLUSION: The CHIP, which improves daily nutrients from food and cardiovascular risk factors, also lowers depression.

Can newly acquired healthy behaviors persist? An analysis of health behavior decay.

INTRODUCTION: We evaluated data from the Coronary Health Improvement Project (CHIP) to determine whether improved health behaviors associated with this intervention persisted or decayed during 18 months of follow-up. METHODS: Participants were 348 volunteers aged 24 to 81 years from the Rockford, Illinois, metropolitan area enrolled in CHIP, a 4-week educational course delivered as lectures. The intervention taught the importance of making better lifestyle choices and improving dietary and physical activity behaviors. Physical activity and dietary behaviors were assessed at baseline, and changes in behaviors were assessed at 6 weeks and 18 months. Changes were evaluated according to quartile groupings of each variable at baseline. RESULTS: No baseline differences were found between participants who dropped out and participants who provided data through 18 months. Mean changes significantly improved through 6 weeks for each of the 21 selected physical activity and dietary behavior variables except percentage of daily calories from carbohydrates. Mean changes significantly improved through 18 months for each of the 21 variables except calories from protein, alcohol, and whole grain servings. The percentage of participants who improved their physical or dietary behavior at 6 weeks ranged from 49% for percentage of daily calories from carbohydrates (64% at 18 months) to 91% for intake of dietary cholesterol per day (84% at 18 months). The level of change through 18 months for all variables was significantly influenced by quartile groupings at baseline. Physical activity improved significantly through 18 months only for participants in the lowest two quartiles of physical activity at baseline. Exercise decreased significantly through 18 months for participants in the highest quartile of physical activity at baseline. CONCLUSION: During an 18-month period, participants' physical activity and dietary behaviors improved significantly. Even though behavior improvement tended to be greater at 6 weeks, most healthy behaviors did not return to baseline levels after 18 months.

The effects of an intensive lifestyle modification program on carotid artery intima-media thickness: a randomized trial.

PURPOSE: This study evaluated the effect of the Dr. Dean Ornish Program for Reversing Heart Disease on cardiovascular disease as measured by the intima-media thickness of the common carotid artery and compared this effect to outcomes from patients participating in traditional cardiac rehabilitation. DESIGN: Randomized clinical trial. SETTING: Swedish American Health System. SUBJECTS: Ninety three patients with clinically confirmed coronary artery disease were randomly assigned to the intervention (n = 46) or traditional cardiac rehabilitation (n = 47). INTERVENTION: Dr. Dean Ornish Program for Reversing Heart Disease. MEASURES: Ultrasound of the carotid artery and other cardiovascular risk factors were measured at baseline, 6, and 12 months. ANALYSIS: Intent-to-treat analysis. RESULTS: There was no significant reduction in the carotid intima-media thickness of the carotid artery in the Ornish group or the cardiac rehabilitation group. Ornish Program participants had significantly improved dietary habits (p < .001), weight (p < .001), and body mass index (p < .001) as compared with the rehabilitation group. The decrease in the number of patients with angina from baseline to 12 months was 44% in Ornish and 12% in cardiac rehabilitation. CONCLUSIONS: The Ornish Program appears to causes improvements in cardiovascular risk factors but does not appear to change the atherosclerotic process as it affects the carotid artery.

The behavioral and clinical effects of therapeutic lifestyle change on middle-aged adults.

INTRODUCTION: Chronic diseases such as cancer, cardiovascular disease, stroke, and diabetes are responsible for most deaths in the United States. Lifestyle factors--poor nutrition, sedentary living, and tobacco use--appear to play a prominent role in the development of many chronic diseases. This study determined the behavioral and clinical impact of a therapeutic lifestyle-modification intervention on a group of community volunteers. METHODS: Participants included 348 volunteers aged 24 to 81 years from the Rockford, Ill, metropolitan area who participated in a randomized clinical trial. The intervention group attended a 40-hour educational course delivered as lectures during a 4-week period. Participants learned the importance of making better lifestyle choices and how to make improvements in nutrition and physical activity. Changes in nutrition, physical activity behavior, and several chronic disease risk factors were assessed at baseline and 6 months. RESULTS: Intervention participants showed significant 6-month improvement in all nutrition and physical activity measures except calories from protein and whole-grain servings and all clinical measures except blood glucose, total cholesterol, triglycerides, and high-sensitivity C-reactive protein. Total cholesterol and low-density lipoprotein cholesterol were worse after 6 months in both groups but only significantly worse in the control group. The control group experienced small but significant improvements in systolic and diastolic blood pressure and high-density lipoproteins. Change-score comparisons between the intervention and control groups were significant for all nutrition and physical activity variables except total steps per week and daily sodium intake and were also significant for the clinical measures of weight, body fat, and body mass index. CONCLUSION: This therapeutic lifestyle-modification program can significantly improve nutrition and physical activity behavior and can reduce many of the risk factors associated with common chronic diseases.

Effect of intense lifestyle modification and cardiac rehabilitation on psychosocial cardiovascular disease risk factors and quality of life.

This study examined the effect of the Ornish Program for Reversing Heart Disease and cardiac rehabilitation (CR) on psychosocial risk factors and quality of life in patients with confirmed coronary artery disease. Participants had previously undergone a revascularization procedure. The 84 patients self-selected to participate in the Ornish Program for Reversing Heart Disease (n = 507 28), CR (n = 28), or a control group (n = 28). Twelve psychosocial risk factors and quality of life variables were collected from all three groups at baseline, 3 months, and 6 months. At 3 and 6 months, Ornish group participants demonstrated significant improvements in all 12 outcome measures. The rehabilitation group improved in 7 of the 12, and the control group showed significant improvements in 6 of the variables. Intensive lifestyle modification programs significantly affect psychosocial risk factors and quality of life.

Effects of an intensive diet and physical activity modification program on the health risks of adults.

BACKGROUND: This study assessed the clinical impact of lifestyle change education on chronic disease risk factors within a community. DESIGN: Randomized clinical trial. SETTING/PARTICIPANTS: Participants included 337 volunteers age 43 to 81 years from the Rockford, IL, metropolitan area. INTERVENTION: The intervention group attended a 40-hour educational course delivered over a 4-week period. Participants learned the importance of making healthful lifestyle choices and how to make improvements in nutrition and physical activity. MAIN OUTCOME MEASURES: Changes in health knowledge, nutrition, and physical activity behavior, and several chronic disease risk factors were assessed at baseline and 6 weeks. RESULTS: Beneficial mean changes in scores tended to be significant for the intervention group but not for the control group. Variables with improved scores included health knowledge, percent body fat, total steps per week, and most nutrition variables. Clinical improvements were seen in resting heart rate, total cholesterol, low-density lipoprotein cholesterol, and systolic and diastolic blood pressure. The control group experienced comparatively small but significant improvements in health knowledge, systolic and diastolic blood pressure, glucose, and in some nutrition variables. For almost all variables, the intervention group showed significantly greater improvements. CONCLUSIONS: This lifestyle modification program is an efficacious nutrition and physical activity intervention in the short term and has the potential to dramatically reduce the risks associated with common chronic diseases in the long term.

The effects of a worksite chronic disease prevention program.

OBJECTIVE: This study determined the behavioral and clinical impact of a worksite chronic disease prevention program. METHODS: Working adults participated in randomized clinical trial of an intensive lifestyle intervention. Nutrition and physical activity behavior and several chronic disease risk factors were assessed at baseline, 6 weeks, and 6 months. RESULTS: Cognitive understanding of the requirements for a healthy lifestyle increased at the end of the program. Program participants significantly improved their cognitive understanding of good nutrition and physical activity and had significantly better nutrition and physical activity behavior at both 6 weeks and 6 months. Participants had significantly lower body fat, blood pressure, and cholesterol. CONCLUSIONS: This worksite chronic disease prevention program can significantly increase health knowledge, can improve nutrition and physical activity, and can improve many employee health risks in the short term.

The diabetes prevention program: a worksite experience.

The purpose of this study was to determine if the U.S. National Institutes of Health Diabetes Prevention Program (DPP) could be successfully implemented in a worksite setting. Thirty-seven adult employees of BD Medical Systems of Sandy, Utah were enrolled in a single-group time-series study using the DPP. Two-hour oral glucose tolerance tests (OGTT) and other outcomes were measured at baseline, 6 months, and 12 months. Weight, body mass index, waist circumference, 2-hour OGTT, very low density lipoproteins, triglycerides, and aerobic fitness were significantly improved at 6 and 12 months and showed overall significant improvement across time. Fasting blood insulin, total cholesterol, low density lipoproteins, and total cholesterol/high density lipoproteins ratio were significantly improved at 6 months, but not at 12 months. Eighteen of the program participants (51%) were no longer in the pre-diabetes and diabetes categories after 1 year. Existing worksite health promotion and occupational health professionals can successfully offer the DPP and help employees improve glucose tolerance.

Impact of the coronary health improvement project (CHIP) on several employee populations.

The greatest potential to improve public health lies in the ability of individuals to adopt healthful behaviors. The purpose of this study was to determine whether participation in a facilitator-based video version of the Coronary Health Improvement Project (CHIP) would improve health behaviors and significantly reduce employee health risks. Employees (n = 442) from six worksites in metropolitan Rockford, Illinois, were used in a pretest/posttest design. Employees self-selected to participate in a facilitator-based, CHIP video program. Participants received instruction twice a week, for 8 weeks, via 15 videos shown at each participating worksite. Demographic and biometric data (body weight, body mass index, blood lipids, blood pressure, and fasting blood glucose) were evaluated at baseline and at 8 weeks. All sites individually and collectively demonstrated significant and meaningful reductions in body weight, body mass index, total cholesterol, low-density lipoprotein cholesterol, triglycerides, and fasting blood glucose. Men demonstrated greater improvement than women, and individuals with higher baseline health risks experienced the greatest reductions in risk. The CHIP video program appears to be an effective method of lowering employee health risks. Future research is needed to determine how long these reductions may persist.

The influence of an intense cardiovascular disease risk factor modification program.

In an effort to make intensive lifestyle modification programs more accessible to patients with cardiovascular disease, the Ornish Program was offered at eight independent medical centers located across the United States. The purpose of this study was to determine if one of these independent sites was able to replicate outcomes produced by the original Ornish Program. Fifty program participants from six different cohorts provided baseline, 3- and 12-month data consisting of blood lipids, body fat, blood pressure, anginal pain, quality of life, stress, depression, social support, and hostility. A pooled analysis showed significant reductions in almost all physiological and psychosocial variables with most reductions persisting for at least 12 months. These findings suggest that cardiovascular disease patients who choose to participate in an independent, intensive lifestyle modification program can experience significant improvements in both physiological and psychosocial cardiovascular disease risk factors.

Cardiovascular risk reductions associated with aggressive lifestyle modification and cardiac rehabilitation.

BACKGROUND: Patients who have been treated for coronary heart disease can enroll in traditional cardiac rehabilitation, the Ornish Program, or no rehabilitation at all. No study has compared the impact of each on cardiovascular disease risk (CVD) factors. METHODS: The current study compared CVD risk changes in post coronary artery bypass graft or percutaneous coronary intervention procedure patients who participated in the Ornish Heart Disease Reversing Program, a traditional cardiac rehabilitation, and a control group that received no formal cardiac risk-reduction program. This was a longitudinal, observational study of 84 patients receiving CVD standard of care who elected to participate in 1 of the 3 study groups. Assessments of CVD risk factors and anginal severity were obtained at baseline, 3 months, and 6 months. RESULTS: Ornish program participants had significantly greater reductions in anginal frequency, body weight, body mass index, systolic blood pressure, total cholesterol, low-density lipoprotein cholesterol, glucose, dietary fat, and increases in complex carbohydrates than were documented in the rehabilitation or control groups. The control group experienced the greatest reduction in anginal pain severity, but also had significantly higher systolic blood pressure, total cholesterol, and low-density lipoprotein cholesterol. CONCLUSIONS: These findings suggest that CVD patients who choose to participate in the Ornish program can experience greater improvements in CVD risks than patients who choose to participate in traditional cardiac rehabilitation or no formal program.

Self-rated job performance and absenteeism according to employee engagement, health behaviors, and physical health.

OBJECTIVE: To better understand the combined influence of employee engagement, health behavior, and physical health on job performance and absenteeism. METHODS: Analyses were based on 20,114 employees who completed the Healthways Well-Being Assessment from 2008 to 2010. Employees represented three geographically dispersed companies in the United States. RESULTS: Employee engagement, health behavior, and physical health indices were simultaneously significantly associated with job performance and also with absenteeism. Employee engagement had a greater association with job performance than did the health behavior or physical health indices, whereas the physical health index was more strongly associated with absenteeism. Specific elements of the indices were evaluated for association with self-rated job performance and absenteeism. CONCLUSION: Efforts to improve worker productivity should take a holistic approach encompassing employee health improvement and engagement strategies.

A review of the knowledge base on healthy worksite culture.

OBJECTIVE: To identify the need for worksite cultures of health, the organizational factors that support worksite cultures of health, the tools that have been used to measure worksite cultures of health, and the research needs related to healthy worksite culture. METHODS: A cross-sectional survey involving a sample of 500 companies representing a broad spectrum of industries and business sectors. A literature review was conducted. RESULTS: Similar to a culture of safety that encourages safer behaviors and enables a safer workplace, a culture of health provides a supportive work leadership with a favorable work environment and health-related policies that promote employee health and result in substantial decrease in employee health risks and medical costs. CONCLUSION: Worksite policies and environments supporting a culture of health are important to helping employees adopt and maintain healthy behaviors.

Presenteeism according to healthy behaviors, physical health, and work environment.

The objective of this study is to identify the contribution that selected demographic characteristics, health behaviors, physical health outcomes, and workplace environmental factors have on presenteeism (on-the-job productivity loss attributed to poor health and other personal issues). Analyses are based on a cross-sectional survey administered to 3 geographically diverse US companies in 2010. Work-related factors had the greatest influence on presenteeism (eg, too much to do but not enough time to do it, insufficient technological support/resources). Personal problems and financial stress/concerns also contributed substantially to presenteeism. Factors with less contribution to presenteeism included physical limitations, depression or anxiety, inadequate job training, and problems with supervisors and coworkers. Presenteeism was greatest for those ages 30-49, women, separated/divorced/widowed employees, and those with a high school degree or some college. Clerical/office workers and service workers had higher presenteeism. Managers and professionals had the highest level of presenteeism related to having too much to do but too little time to do it, and transportation workers had the greatest presenteeism because of physical health limitations. Lowering presenteeism will require that employers have realistic expectations of workers, help workers prioritize, and provide sufficient technological support. Financial stress and concerns may warrant financial planning services. Health promotion interventions aimed at improving nutrition and physical and mental health also may contribute to reducing presenteeism.

Effectiveness of a workplace wellness program for maintaining health and promoting healthy behaviors.

This study assessed the effectiveness of a worksite wellness program. A within-group study design was conducted. Assessment was based on 3737 continuously employed workers at a large agribusiness during 2007-2009. More than 80% of employees participated in the program, with a higher percentage of women participating. Clinically significant improvements occurred in those who were underweight, those with high systolic or diastolic blood pressure, high total cholesterol, high low-density lipoprotein, low high-density lipoprotein, high triglycerides, and high glucose. Among obese employee participants, significant improvements occurred in selected mental health and dietary variables. Among those who lowered their BMI, significant decrease occurred in fat intake, and significant increase resulted in weekly aerobic exercise and feelings of calmness and peace, happiness, ability to cope with stress, and more physical energy.