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.

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.

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.

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.

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.

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.

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.

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.

Evaluation of a best-practice worksite wellness program in a small-employer setting using selected well-being indices.

OBJECTIVE: To measure the effectiveness of a wellness program in a small company using four well-being indicators designed to measure dimensions of physical health, emotional health, healthy behavior, and basic access to health-related conditions and services. METHODS: Indicator scores were obtained and compared between Lincoln Industries employees and workers in the neighboring Lincoln/Omaha community during 2009. RESULTS: Nearly all Lincoln Industries employees participated in the wellness program. Physical health, mental health, and healthy behavior were significantly greater for Lincoln Industries employees. Self-perceived access to basic needs was not significantly greater among Lincoln Industries employees. CONCLUSION: Well-being index scores provide evidence for the effectiveness of the wellness program in this small company setting with respect to better dimensions of physical health, emotional health, and healthy behavior than geographically similar workers.

The impact of worksite wellness in a small business setting.

OBJECTIVE: This study evaluates the level of participation and effectiveness of a worksite wellness program in a small business setting. METHODS: Three years of wellness participation and risk data from Lincoln Industries was analyzed. RESULTS: All Lincoln Industry employees participated in at least some level of wellness programming. Significant improvements in body fat, blood pressure, and flexibility were observed across time. The largest improvements in risk were seen among older employees and those with the highest baseline values. CONCLUSIONS: This small business was able to improve the health of the entire workforce population by integrating wellness deeply into their culture and operations. Replication of this program in other small business settings could have a large impact on public health since 60 million adults in the United States work in small businesses.

Efficacy of the Berkshire Health System Cardiovascular Health Risk Reduction Program.

OBJECTIVE: To assess the effectiveness of the Berkshire Health System Cardiovascular Health Risk Reduction Program. METHODS: A within-group study design was conducted. Analyses were based on 502 employees who completed an initial and follow-up personal health risk assessment. One-on-one nurse coaching occurred, with referrals and recommendations based on screening results. RESULTS: Clinically and statistically significant improvements occurred between initial and second screenings for individuals with high systolic blood pressure, high diastolic blood pressure, high total cholesterol, low high-density lipoprotein, high low-density lipoprotein, and high glucose. Decrease in body mass index for obese individuals was marginally insignificant. Improvements were also observed in exercise, pleasure doing things, and mental health. Improvement in mental health occurred primarily in women and among those aged <50 years. CONCLUSION: The Berkshire Health System Program significantly improves cardiovascular health.

Consequences of a plant-based diet with low dairy consumption on intake of bone-relevant nutrients.

OBJECTIVE: This study examines the extent to which a plant-based dietary intervention that discourages consumption of dairy products and meat influences bone-relevant nutrients. METHODS: A randomized controlled study design was used to evaluate the Coronary Health Improvement Project. The Project is a heart disease prevention intervention administered in an intensive 40-hour educational course delivered over a 4-week period. Participants were evaluated at baseline, 6 weeks, and 6 months. RESULTS: After 6 weeks, participants in the intervention group compared with the control group experienced significant increases in magnesium and daily intake of fruit, vegetables, and grains but significant decreases in dairy servings per day and calcium and vitamin D from food. After 6 months, those in the intervention group showed significant increases in daily intake of fruit, vegetables, and grains and significant decreases in dairy servings per day, daily meat consumption, and protein, phosphorous, calcium, total calcium, and vitamin D from food. Serum calcium levels are the primary determinant of parathyroid hormone (PTH) release, and within 6 weeks, the intervention group's PTH levels were elevated from baseline and significantly different from the control group's PTH levels. At 6 months, urinary type I collagen N-telopeptide (NTx) levels were significantly greater in the intervention group compared with the control group. CONCLUSIONS: The Coronary Health Improvement Project increases the intake of important food items but decreases calcium and vitamin D consumption. There is also some evidence of an increase in NTx biomarkers, consistent with increased bone resorption.

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.

Cardiovascular risk reduction and factors influencing loss to follow-up in the coronary health improvement project.

BACKGROUND: This study determined whether the Coronary Health Improvement Project (CHIP) can improve cardiovascular disease risk factors through one year of follow-up and identified factors influencing loss to follow-up. MATERIAL/METHODS: The CHIP program, an intensive four week community-based health education intervention designed to improve coronary risk factors, was evaluated using a quasi-experimental design. Analyses were based on 1,712 community volunteers, ages 30 to 87 from the Rockford, Illinois Metropolitan area. Of the participants, 97.7% completed the lifestyle evaluation at both baseline and after four weeks, and 51% provided data through one year. RESULTS: Participants showed significant improvements in all cardiovascular risk factors considered (body mass index, resting heart rate, systolic blood pressure, diastolic blood pressure, cholesterol, high-density lipoprotein, low-density lipoprotein, triglycerides, and glucose) after both four weeks and one year. Loss to follow-up was highest among those who were ages 30-39, had a history of diabetes, had a history of being overweight, smoked, lived with a heavy smoker, were physically less active, or were experiencing stress. Those with higher BMI, SBP, DBP, or glucose at baseline were also more likely to be lost to follow-up through one year. Those who failed to improve their BMI, resting heart rate, serum cholesterol, HDL, LDL, triglycerides, or glucose after four weeks were 16%, 9%, 22%, 21%, 16%, 22%, and 15% more likely to be lost to follow-up, respectively. CONCLUSIONS: The CHIP program improves cardiovascular disease risk factors through one year of follow-up. Poorer health status at baseline is associated with increased loss to follow-up. Failure to improve one or more cardiovascular risk factors after four weeks of intervention is predictive of loss to follow-up through one year.

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.

C-reactive protein levels according to physical activity and body weight for participants in the coronary health improvement project.

OBJECTIVES: To identify whether the Coronary Health Improvement Project (CHIP), an intervention designed to increase physical activity and improve diet, lowers serum C-reactive protein (CRP). The study will also assess whether changes in CRP over the study period are associated with baseline levels of and changes in selected coronary risk factors. METHODS: A randomized controlled study design assigned 348 individuals to the intervention or control group with measurements taken at baseline, 6 weeks, and 6 months of body weight, physical activity, and serum CRP levels. Participants attended an intensive 40-hour educational course delivered over a 4-week period, beginning March 2003, in Rockford, IL, USA. RESULTS: The intervention significantly increased physical activity and decreased BMI, weight, percent body fat, and saturated fat (P<0.0001). However, the intervention was not significantly associated with a decrease in CRP. Participants in both the intervention and control groups combined showed a decrease in high CRP (>3 mg/L), from 46% at baseline to 38% at 6 weeks and 41% at 6 months. Those with higher BMI at baseline showed a greater increase in CRP over time (P<0.0001), whereas those with higher CRP at baseline showed a greater decrease in CRP over time (P<0.0001). CONCLUSIONS: Over 6 week and 6 month follow-up periods, the intervention failed to discriminate changes in CRP. However, the percentage with high CRP did fall, more so for those with lower BMI and higher CRP at baseline. BMI may mediate the influence of physical activity on CRP.

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.

A video-based lifestyle intervention and changes in coronary risk.

If population-wide improvements in nutrition and physical activity behavior are to be made, behavior change interventions must use a variety of media. This study examines whether participation in a facilitator-based video version of the Coronary Health Improvement Project could significantly reduce coronary risk. A total of 28 video classes conducted in worksite, medical and community settings were used to teach 763 middle-aged adults, ages 30-79 years, about healthy lifestyles. Four to 8 weeks after baseline, follow-up measures were taken. Demographic and biometric data [body weight, body mass index (BMI), blood lipids, blood pressure and fasting blood glucose] were gathered. The class participants were evaluated in aggregate and showed significant improvements in body weight, BMI, resting heart rate, total cholesterol, low-density lipoprotein, triglycerides and fasting blood glucose. Males demonstrated greater improvement than females, and individuals with higher baseline health risks experienced the greatest reductions in risk. This video lifestyle change program appears to help participants make important lifestyle changes. For individuals empowered to make better choices regarding diet and exercise, significant improvements occurred in most coronary risk factors in as little as 4-6 weeks.

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.

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.