Quality assessment in worksite health promotion.

The rapid expansion of worksite health promotion programs and the proliferation of service providers have resulted in increased concern about the quality of such programs. And while employers may view health promotion programs as a service to be purchased, in general, quality standards, price, and outcomes are less well established for primary prevention programs than for other medical services. This trend creates substantial potential for inappropriate expenditures, undermining the general credibility of such programs. Recognizing the limits of epidemiologic data and the potential for misuse of health promotion activities in the workplace, the California Department of Health Services (CDHS) undertook the development of guidelines for employers' use in assessing the quality of the numerous employee health promotion or chronic disease risk reduction programs available to them. To make the use of such programs as productive as possible, the CDHS developed recommendations in two main areas: (1) general recommendations for six fundamental program planning and development activities that underlie sound health promotion programs, and (2) specific criteria for seven types of health promotion programs commonly implemented in work settings. Optimally, worksite-based health promotion programs should be part of a comprehensive effort that provides for appropriate medical oversight, referral, and follow-up procedures. These programs should be complemented by appropriate changes in the work environment and in organizational policies. Programs should also include strategies to assist employees in initiating healthier behaviors and maintaining the new behaviors once they are established. Preventive medicine and occupational medicine practitioners and medical directors should be familiar with the issues addressed by these recommendations.

Reducing tobacco consumption in California. Development of a statewide anti-tobacco use campaign.

Cigarette smoking continues to be the leading preventable cause of death in California and the United States. Although substantial progress has been made over the past 25 years, there is growing recognition of the need for large-scale efforts to reduce tobacco use. Given their central roles in implementing public health programs and their ability to reach many of the groups most at risk of tobacco use uptake and tobacco-related disease, state health agencies have an important challenge before them. This article describes the development and operation of a statewide, publicly funded anti-tobacco use campaign currently undertaken by the California Department of Health Services under the auspices of the state's Tobacco Tax and Health Promotion Act of 1988 (Proposition 99), which increased excise taxes on cigarettes by 25 cents per pack sold in the state. A discussion of problems in implementation and operation being incurred may be relevant to the planning of similar campaigns elsewhere.

California's approach to hypertension control: an overview.

California's Department of Health Services, recognizing the serious community health problem presented by uncontrolled hypertension, developed community-based programs of early detection and referral, follow-up and education. Special consideration was given to underserved populations at high risk. A statewide probability household survey was conducted and showed an improvement in control status during the past decade for definite and critical hypertension, but not for mild hypertension. With diminishing public resources, future efforts must be cost effective, focus on care for persons known to have hypertension and encourage maximum coordination between private and public agencies.