Rapid onset of functional tic-like behaviors among adolescent girls-Minnesota, September-November 2021.

Background: On October 15, 2021, the Minnesota Department of Health began investigating a school cluster of students experiencing tic-like behaviors thought to be related to recent COVID-19. The objective of this report is to describe the investigation, key findings, and public health recommendations. Methods: Affected students and proxies were interviewed with a standardized questionnaire including validated depression and anxiety screens. Results: Eight students had tic-like behaviors lasting >24 h after initial report with onset during September 26-October 30, 2021. All eight students were females aged 15-17 years. All students either had a history of depression or anxiety or scored as having more than minimal anxiety or depression on validated screens. Four students previously had confirmed COVID-19: the interval between prior COVID-19 and tic symptom onset varied from more than a year prior to tic symptom onset to at the time of tic symptom onset. Conclusion: The onset of tic-like behaviors at one school in Minnesota appeared to be related more to underlying mental health conditions than recent COVID-19. These findings highlight the need to better understand functional tic-like behaviors and adolescent mental health.

Influence of Incentive Design and Organizational Characteristics on Wellness Participation and Health Outcomes.

OBJECTIVE: To explore how changing incentive designs influence wellness participation and health outcomes. METHODS: Aggregated retrospective data were evaluated using cluster analysis to group 174 companies into incentive design types. Numerous statistical models assessed between-group differences in wellness participation, earning incentives, and over-time differences in health outcomes. RESULTS: Four incentive design groups based on requirements for earning incentives were identified. The groups varied in support for and participation in wellness initiatives within each company. All four design types were associated with improved low density lipoprotein (LDL) (P < 0.01), three with improved blood pressure (P < 0.001), and two with improved fasting glucose (P < 0.03). No incentive plan types were associated with improved body mass index (BMI), but designs predominantly focused on health outcomes (eg, Outcomes-Focused) exhibited a significant increase over time in BMI risk. CONCLUSION: Incentive design and organizational characteristics impact population-level participation and health outcomes.

Measuring Participation in Employer-Sponsored Health and Well-Being Programs: A Participation Index and Its Association With Health Risk Change.

PURPOSE: To develop an index of participation in workplace health and well-being programs and assess its relationship with health risk status. DESIGN: Study design comprised a retrospective longitudinal analysis of employee health risk assessment (HRA) and program participation data. SETTING: Data from 6 companies that implemented health and well-being programs from 2014 to 2016. PARTICIPANTS: Employee participants (n = 95 318) from 6 companies who completed an HRA in 2014 to 2016. After matching those who completed the HRA in all 3 years, the longitudinal file included 38 789 respondents. MEASURES: Participation indicators were created for 9 different program components. The sum of these 9 components established the total participation index. ANALYSIS: Descriptive and correlation analyses were conducted on all participation measures. Repeated-measures analysis of variance was used to assess the impact of participation level on health risk over time. RESULTS: Higher levels of participation were associated with a greater reduction in risks, with each participation dose yielding a reduction of 0.038 risks (P < .001). CONCLUSION: Results suggest that employees who participate more in workplace health and well-being programs experience more health risk improvement. The study also supports a more granular definition of participation based on the number of interactions and type of program.

Association Between Sleep and Productivity Loss Among 598 676 Employees From Multiple Industries.

PURPOSE: To examine the relationship between sleep habits and employee productivity. DESIGN: Cross-sectional health risk assessment analysis. SETTING: Employer-sponsored health and well-being programs. PARTICIPANTS: A total of 598 676 employed adults from multiple industries. MEASURES: Self-reported average hours of sleep, fatigue, absence days, and presenteeism. ANALYSIS: Bivariate analyses to assess the relationships between self-reported hours of sleep and self-reported fatigue and mean and median absence and presenteeism. RESULTS: The relationship between sleep hours and both measures of productivity was U-shaped, with the least productivity loss among employees who reported 8 hours of sleep. More daytime fatigue correlated with more absence and presenteeism. Median absence and presenteeism was consistently lower than mean absence and presenteeism, respectively, for the various hours of sleep and levels of fatigue. CONCLUSION: Organizations looking to expand the value of their investment in employee health and well-being should consider addressing the employee sleep habits that may be negatively impacting productivity.

Analyzing best practices in employee health management: how age, sex, and program components relate to employee engagement and health outcomes.

OBJECTIVE: Examine the influence of employee health management (EHM) best practices on registration, participation, and health behavior change in telephone-based coaching programs. METHODS: Individual health assessment data, EHM program data, and health coaching participation data were analyzed for associations with coaching program enrollment, active participation, and risk reduction. Multivariate analyses occurred at the individual (n = 205,672) and company levels (n = 55). RESULTS: Considerable differences were found in how age and sex impacted typical EHM evaluation metrics. Cash incentives for the health assessment were associated with more risk reduction for men than for women. Providing either a noncash or a benefits-integrated incentive for completing the health assessment, or a noncash incentive for lifestyle management, strengthened the relationship between age and risk reduction. CONCLUSIONS: In EHM programs, one size does not fit all. These results can help employers tailor engagement strategies for their specific population.

Impact of financial incentives on behavior change program participation and risk reduction in worksite health promotion.

PURPOSE: To examine the impact of financial incentives on behavior change program registration, completion, and risk improvement rates. DESIGN: Retrospective cohort study conducted to observe the relationship between financial incentives and behavior change program registration, completion, and risk improvement rates. SETTING: Large public- or private-sector employers. SUBJECTS: Twenty-four organizations (n = 511,060 eligible employees) that offered comprehensive worksite health promotion (WHP) programs. INTERVENTION: Financial incentives offered for completion of a behavior change program as part of a WHP program. MEASURES: Behavior change program registration and completion data were obtained from standard reports. Company-level risk change was calculated from the average per-person number of risks on baseline and follow-up health risk assessments. Incentive design was determined from questionnaires completed by WHP program managers. ANALYSIS: Average registration rates, program completion rates, and risk improvement rates were compared using t-tests for companies that did versus did not offer incentives. Comparisons were also made between companies with incentives of less than $100 and those with incentives of $100 or more. Correlations between incentive value and outcome variables were assessed using Pearson correlations. RESULTS: Companies that offered incentives had significantly higher health coaching completion rates than companies not offering an incentive (82.9% vs. 76.4%, respectively, p = .017) but there was no significant association with registration (p = .384) or risk improvement rates (p = .242). Incentive values were not significantly associated with risk improvement rates (p = .240). CONCLUSION: Offering incentives for completing behavior change programs may increase completion rates, but increased health improvement does not necessarily follow.

A comparison of the effectiveness of a telephone coaching program and a mail-based program.

Many health promotion interventions have been developed and tested in recent years. Practitioners and researchers must continue to explore how various program delivery modalities can be used effectively and efficiently to optimize program outcomes. A sample of 6,055 participants was drawn from 10 large employers. Participants self-selected into a mail or telephone intervention. This study compared the demographics of those who selected each modality and assessed differences in program success relative to the modalities chosen. Telephone participants were more likely to be older, female, and salaried. Telephone participants were also more ready, confident, and motivated to make a behavior change, when compared to those in the mail program. Researchers found both the telephone and mail programs to be effective in reducing participants' health risk status, though the telephone program was slightly more effective. These findings demonstrate the importance of offering a variety of interventions when promoting healthy changes. More research is needed to investigate the role of participant choice and the combinations of learning experiences that best facilitate sustainable behavior change.

The duration of mumps virus shedding after the onset of symptoms.

To determine how long people shed virus after the onset of mumps, we used logistic regression modeling to analyze data from the 2006 outbreak of mumps in Iowa. Our model establishes that the probability of mumps virus shedding decreases rapidly after the onset of symptoms. However, we estimate that 8%-15% of patients will still be shedding the virus 5 days after the onset of symptoms and, thus, may still be contagious during this period.