Workplace wellness recognition for optimizing workplace health: a presidential advisory from the American Heart Association.

The workplace is an important setting for promoting cardiovascular health and cardiovascular disease and stroke prevention in the United States. Well-designed, comprehensive workplace wellness programs have the potential to improve cardiovascular health and to reduce mortality, morbidity, and disability resulting from cardiovascular disease and stroke. Nevertheless, widespread implementation of comprehensive workplace wellness programs is lacking, and program composition and quality vary. Several organizations provide worksite wellness recognition programs; however, there is variation in recognition criteria, and they do not specifically focus on cardiovascular disease and stroke prevention. Although there is limited evidence to suggest that company performance on employer health management scorecards is associated with favorable healthcare cost trends, these data are not currently robust, and further evaluation is needed. As a recognized national leader in evidence-based guidelines, care systems, and quality programs, the American Heart Association/American Stroke Association is uniquely positioned and committed to promoting the adoption of comprehensive workplace wellness programs, as well as improving program quality and workforce health outcomes. As part of its commitment to improve the cardiovascular health of all Americans, the American Heart Association/American Stroke Association will promote science-based best practices for comprehensive workplace wellness programs and establish benchmarks for a national workplace wellness recognition program to assist employers in applying the best systems and strategies for optimal programming. The recognition program will integrate identification of a workplace culture of health and achievement of rigorous standards for cardiovascular health based on Life's Simple 7 metrics. In addition, the American Heart Association/American Stroke Association will develop resources that assist employers in meeting these rigorous standards, facilitating access to high-quality comprehensive workplace wellness programs for both employees and dependents, and fostering innovation and additional research.

Mortality study update of acrylamide workers.

OBJECTIVE: The authors examined the long-term health effects of occupational exposure to acrylamide among production and polymerisation workers. METHODS: An earlier study of 371 acrylamide workers was expanded to include employees hired since 1979. In this updated study, 696 acrylamide workers were followed from 1955 through 2001 to ascertain vital status and cause of death. Exposure to acrylamide was retrospectively assessed based on personal samples from the 1970s onwards and area samples over the whole study period. RESULTS: Fewer of the acrylamide workers died (n = 141) compared to an expected number of 172.1 (SMR 81.9, 95% CI 69.0 to 96.6). No cause-specific SMR for any of the investigated types of cancer was exposure related. The authors did, however, find more pancreatic cancer deaths than expected (SMR 222.2, 95% CI 72.1 to 518.5). With respect to non-malignant disease, more diabetes deaths were observed than expected (SMR 288.7, 95% CI 138.4 to 531.0). To assess the influence of regional factors, the analysis was repeated with an internal reference population. The elevated SMR for diabetes persisted. CONCLUSION: This study provides little evidence for a cancer risk from occupational exposure to acrylamide at production facilities. However, the increased rates of pancreatic cancer in this study and another larger study of acrylamide production workers indicate that caution is needed to rule out a cancer risk. The authors believe that the excess of diabetes mortality in this study is most likely not related to acrylamide exposure, because a larger study of acrylamide workers reported a deficit in this cause of death. The authors conclude that the increased SMR for diabetes mortality is probably not related to regional influences.

Exploration Into the Business Priorities Related to Corporate Engagement in Community Health Improvement Partnerships.

OBJECTIVE: To explore factors that matter to business in making decisions regarding engagement in community health improvement efforts. METHODS: Using qualitative methods, domains of interest were identified through literature reviews and expert interviews. Relevance of the domains in terms of potential priorities for action was tested through employer and community stakeholder interviews. RESULTS: Factors that employers considered important to sustained community collaboration as a business priority included (1) credibility of the convener, (2) broad representation of the community, (3) strong mission and goals, (4) individual commitment to health, (5) organizational commitment to health, and (6) demonstrated commitment from leadership. CONCLUSIONS: Priorities have been identified for engaging business in community health efforts. Implications for research, practice, and policy include the need for measurement, transparency in reporting, and agreement on principles for public-private partnership in this area.

Creating a new structure for research on health care effectiveness.

Effectiveness research (a term we use in preference to the more confining and difficult health services or outcomes research) evaluates the clinical setting and the health care system on which it depends. It uses a variety of health care assessment techniques and the practical clinical trial to inform clinical practice, quality interventions, and health policy decisions. Effectiveness research had not had sufficient public or private funding to produce the information needed to facilitate evidence-based health care improvement. However, recent trends, such as the likelihood for continued substantial increases in health care costs and concern regarding the quality and safety of the US health care system, are among the important arguments for increasing its funding and capacity. We propose a new entity, a public-private consortium to expand and offer new capability and resources in this area. The consortium would consist of all relevant public and private entities. It would be organized into an executive committee, which would identify research priorities and panels to design requests for proposals. Competitive peer-reviewed proposals, transparency and balance of forces in choice of topics, conduct of research, and interpretation of results would be important features. Metrics for success would be use of the data derived from consortium projects in medical decision making and benefit design. The consortium would provide balance and potential mediation of conflicting or competing interests in which all stakeholders will be present to establish the rules. Broad representation of all interests would serve to avoid the economic, policy, and political issues that have bedeviled past efforts. Models for the consortium include the Health Effectiveness Institute, the Centers for Education and Research on Therapeutics, and the Transportation Research Board.

Estimating the return-on-investment from changes in employee health risks on the Dow Chemical Company's health care costs.

OBJECTIVE: We sought to estimate the impact of corporate health-management and risk-reduction programs for The Dow Chemical Company by using a prospective return-on-investment (ROI) model. METHODS: The risk and expenditure estimates were derived from multiple regression analyses showing relationships between worker demographics, health risks, and medical expenditures. RESULTS: A "break-even" scenario would require Dow to reduce each of 10 population health risks by 0.17% points per year over the course of 10 years. More successful efforts at reducing health risks in the population would produce a more significant ROI for the company. CONCLUSIONS: Findings from this study were incorporated into other components of a business case for health and productivity management, and these supported continued investments in health improvement programs designed to achieve risk reduction and cost savings.

The assessment of chronic health conditions on work performance, absence, and total economic impact for employers.

OBJECTIVE: The objective of this study was to determine the prevalence and estimate total costs for chronic health conditions in the U.S. workforce for the Dow Chemical Company (Dow). METHODS: Using the Stanford Presenteeism Scale, information was collected from workers at five locations on work impairment and absenteeism based on self-reported "primary" chronic health conditions. Survey data were merged with employee demographics, medical and pharmaceutical claims, smoking status, biometric health risk factors, payroll records, and job type. RESULTS: Almost 65% of respondents reported having one or more of the surveyed chronic conditions. The most common were allergies, arthritis/joint pain or stiffness, and back or neck disorders. The associated absenteeism by chronic condition ranged from 0.9 to 5.9 hours in a 4-week period, and on-the-job work impairment ranged from a 17.8% to 36.4% decrement in ability to function at work. The presence of a chronic condition was the most important determinant of the reported levels of work impairment and absence after adjusting for other factors (P < 0.000). The total cost of chronic conditions was estimated to be 10.7% of the total labor costs for Dow in the United States; 6.8% was attributable to work impairment alone. CONCLUSION: For all chronic conditions studied, the cost associated with performance based work loss or "presenteeism" greatly exceeded the combined costs of absenteeism and medical treatment combined.

How to present the business case for healthcare quality to employers.

Many employers in the US are investing in new programmes to improve the quality of medical care and simultaneously shifting more of the healthcare costs to their employees without understanding the implications on the amount and type of care their employees will receive. These seemingly contradictory actions reflect an inability by employers to accurately assess how their health benefit decisions affect their profits. This paper proposes a practical method that employers can use to determine how much they should invest in the health of their workers and to identify the best benefit designs to encourage appropriate healthcare delivery and use. This method could also be of value to employers in other countries who are considering implementing programmes to improve employee health. The method allows a programme that improves workers' health to generate four financial benefits for an employer - reduced medical costs, reduced absences, improved on-the-job productivity, and reduced turnover - and uses accurate estimates of the benefits of reducing absences and improving productivity.

Corporate America and community health: exploring the business case for investment.

OBJECTIVES: The principal aim of this project was to learn from corporate executives about the most important components of a business case for employer leadership in improving community health. METHODS: We used dialogue sessions to gain insight into this issue. RESULTS: The strongest elements included metrics and measurement, return on investment, communications, shared values, shared vision, shared definitions, and leadership. Important barriers included lack of understanding, lack of clear strategy, complexity of the problem, trust, lack of resources and leadership, policies and regulations, and leadership philosophy. Substantial variability was observed in the degree of understanding of the relationship between corporate health and community health. CONCLUSIONS: The business case for intentional and strategic corporate investment in community health occurs along a continuum has a set of clearly defined elements that address why investment may make sense, but also asks questions about the "what-to-do" and the "how-to-do-it."

Integrating health and safety in the workplace: how closely aligning health and safety strategies can yield measurable benefits.

OBJECTIVE: To better understand how integrating health and safety strategies in the workplace has evolved and establish a replicable, scalable framework for advancing the concept with a system of health and safety metrics, modeled after the Dow Jones Sustainability Index. METHODS: Seven leading national and international programs aimed at creating a culture of health and safety in the workplace were compared and contrasted. RESULTS: A list of forty variables was selected, making it clear there is a wide variety of approaches to integration of health and safety in the workplace. CONCLUSION: Depending on how well developed the culture of health and safety is within a company, there are unique routes to operationalize and institutionalize the integration of health and safety strategies to achieve measurable benefits to enhance the overall health and well-being of workers, their families, and the community.

Communication of epidemiology study results by industry: the Dow Chemical Company approach.

Communicating epidemiology study results to subjects, affected workers, and community members is an important part of compliance and alignment with our company's policies, industry's Responsible Care Principles, and the doctrines of Good Epidemiology Practices. It is the responsibility of the investigators to interpret their research appropriately for each audience, and to assure that all who have a need or right to know get information in a form meaningful to them. We discuss study communication with examples from a recent evaluation of communication efforts within Dow and our experience with occupational and community studies on dioxin. We also discuss how we currently structure worker and community communication based on this experience. Since each Dow protocol must include a communication plan, when we agree to undertake a study, we are also agreeing to communicate study results. Depending upon the nature and type of the study, there may also be some prestudy communication. We encourage all investigators to share the results of their studies more broadly than just scientific publication and plan for the study communication before the study is initiated.

Health-related workplace productivity measurement: general and migraine-specific recommendations from the ACOEM Expert Panel.

An establishment of health-related productivity measurements and critical evaluation of health-related productivity tools is needed. An expert panel was created. A literature search was conducted to identify health-related productivity measurement tools. Each instrument was reviewed for: 1) supporting scientific evidence (e.g., reliability and validity); 2) applicability to various types of occupations, diseases, and level of severity of disease; 3) ability to translate data into a monetary unit; and 4) practicality. A modified Delphi technique was used to build consensus. The expert panel recommended absenteeism, presenteeism, and employee turnover/replacement costs as key elements of workplace health-related productivity measurement. The panel also recommended that productivity instruments should: 1) have supporting scientific evidence, 2) be applicable to the particular work setting, 3) be supportive of effective business decision-making, and 4) be practical. Six productivity measurement tools were reviewed. The panel recommended necessary elements of workplace health-related productivity measurement, key characteristics for evaluating instruments, and tools for measuring work loss. Continued research, validation, and on-going evaluation of health-related productivity instruments are needed.

Reliability and validity of the Stanford Presenteeism Scale.

OBJECTIVE: This study reports the reliability and validity of the 13-item Stanford Presenteeism Scale (SPS). The SPS differs from similar scales by focusing on knowledge-based and production-based workers. METHODS: Data were obtained from administrative and medical claims databases and from a survey that incorporated the SPS, SF-36, and the Work Limitations Questionnaire. RESULTS: Sixty-three percent (7797) of employees responded. Cronbach's alpha (0.83) indicates adequate reliability. Factor analysis identified two underlying factors, "completing work" and "avoiding distraction." Knowledge-based workers load on "completing work" (alpha = 0.97), whereas production-based workers load on "avoiding distraction" (alpha = 0.98). There were significant and positive relationships between the SPS, SF-36, and Work Limitations Questionnaire. CONCLUSIONS: The SPS demonstrates a high degree of reliability and validity and may be ideal for employers who seek a single scale to measure health-related productivity in a diverse employee population.

Mindfulness goes to work: impact of an online workplace intervention.

OBJECTIVE: The objective of this study was to determine whether a mindfulness program, created for the workplace, was both practical and efficacious in decreasing employee stress while enhancing resiliency and well-being. METHODS: Participants (89) recruited from The Dow Chemical Company were selected and randomly assigned to an online mindfulness intervention (n = 44) or wait-list control (n = 45). Participants completed the Perceived Stress Scale, the Five Facets of Mindfulness Questionnaire, the Connor-Davidson Resiliency Scale, and the Shirom Vigor Scale at pre- and postintervention and 6-month follow-up. RESULTS: The results indicated that the mindfulness intervention group had significant decreases in perceived stress as well as increased mindfulness, resiliency, and vigor. CONCLUSIONS: This online mindfulness intervention seems to be both practical and effective in decreasing employee stress, while improving resiliency, vigor, and work engagement, thereby enhancing overall employee well-being.

Do workplace health promotion (wellness) programs work?

OBJECTIVE: To respond to the question, "Do workplace health promotion programs work?" METHODS: A compilation of the evidence on workplace programs' effectiveness coupled with recommendations for critical review of outcome studies. Also, reviewed are recent studies questioning the value of workplace programs. RESULTS: Evidence accumulated over the past three decades shows that well-designed and well-executed programs that are founded on evidence-based principles can achieve positive health and financial outcomes. CONCLUSIONS: Employers seeking a program that "works" are urged to consider their goals and whether they have an organizational culture that can facilitate success. Employers who choose to adopt a health promotion program should use best and promising practices to maximize the likelihood of achieving positive results.

Second-year results of an obesity prevention program at the Dow Chemical Company.

OBJECTIVE: Evaluate innovative, evidence-based approaches to organizational/supportive environmental interventions aimed at reducing the prevalence of obesity among Dow employees after 2 years of implementation. METHODS: A quasi-experimental study design compared outcomes for two levels of intervention intensity with a control group. Propensity scores were used to weight baseline differences between intervention and control subjects. Difference-in-differences methods and multilevel modeling were used to control for individual and site-level confounders. RESULTS: Intervention participants maintained their weight and body mass index, whereas control participants gained 1.3 pounds and increased their body mass index values by 0.2 over 2 years. Significant differences in blood pressure and cholesterol values were observed when comparing intervention employees with controls. At higher intensity sites, improvements were more pronounced. CONCLUSIONS: Environmental interventions at the workplace can support weight management and risk reduction after 2 years.

First-year results of an obesity prevention program at The Dow Chemical Company.

OBJECTIVE: To examine first-year results from a workplace environmental obesity prevention program at The Dow Chemical Company. METHODS: A quasi-experimental cohort study was conducted among employees at nine treatment worksites (n = 8013) who received environmental weight management interventions and three control worksites (n = 2269). Changes in employees' weight, body mass index (BMI), and other health risks were examined using chi2 and t-tests. RESULTS: After 1 year, a modest treatment effect was observed for weight and BMI largely because the control group subjects gained weight; however, no effect was observed for overweight and obesity prevalence. Other risk factors (tobacco use, high blood pressure, and systolic and diastolic blood pressure values) decreased significantly, although blood glucose (high risk prevalence and values) increased. CONCLUSIONS: Environmental changes to the workplace can achieve modest improvements in employees' health risks, including weight and BMI measures, in 1 year.

Using formative research to develop environmental and ecological interventions to address overweight and obesity.

OBJECTIVE: This paper presents the formative research phase of a large multi-site intervention study conducted to inform the feasibility of introducing environmental and ecological interventions. RESEARCH METHODS AND PROCEDURES: Using mixed methods that included an environmental assessment, climate survey, leadership focus groups and interviews, and archival data, information was collected on employee health and job factors, the physical environment, social-organizational environment, and current health programs. RESULTS: Results show that 83% of employees at the study sites were overweight or obese. Leadership was very supportive of health initiatives and felt integrating the strategies into organizational operations would increase their likelihood of success. Environmental assessment scores ranged from 47 to 19 on a 100-point scale. Health services personnel tended to view the organizational climate for health more positively than site leadership (mean of 3.6 vs. 3.0, respectively). DISCUSSION: Intervention strategies chosen included increasing healthy food choices in vending, cafeterias, and company meetings, providing a walking path, targeting messages, developing site goals, training leaders, and establishing leaders at the work group level.