The Health Status of Veteran Employees Compared to Civilian Employees in Veterans Health Administration.

INTRODUCTION: Veterans Health Administration (VHA) is undergoing changes in the practice of health care focusing on approaches that prioritize veteran well-being. Given transformation efforts, opportunities exist to enhance the health and well-being of patients and employees alike - a significant proportion of whom are veterans. To date, differences in health status between veteran and civilian employees within VHA have not been examined. MATERIALS AND METHODS: Data from an annual organizational census survey with health promotion module conducted in 2015 were analyzed to estimate the prevalence of health risk behaviors, mental health, and chronic health conditions by veteran status within genders (n = 86,257). To further examine associations by gender between veteran status and health measures controlling for covariates, multivariate logistic regression analyses were utilized. RESULTS: Prevalence estimates generally indicated veterans have worse health status and health risk behaviors than their civilian counterparts. Results from multivariate logistic regression analyses indicated many significant associations between veteran status and health by gender controlling for other important demographic variables and a total comorbidity score. Compared to civilian employees within respective genders, both male and female veteran employees have increased odds of being a current smoker. Both male and female veteran employees have decreased odds of physical inactivity compared to civilian employees. For mental health and chronic health conditions, there are several conditions that veteran employees have increased odds for when compared to civilian employees of like gender; these include low back problems, arthritis, anxiety, depression, and sleep disorders. CONCLUSIONS: Veteran employees in VHA have worse health status than their civilian counterparts on a number of measures of health risk behaviors, mental health, and chronic health conditions. Given current organizational priorities aimed at cultural transformation, the present time is an optimal one to work collaboratively to enhance the health and well-being services that are available for patients and employees alike. All employees, particularly our unique population of veteran employees, will benefit from such an approach.

Decreasing Physical Inactivity in the Veterans Health Administration Employee Population.

OBJECTIVE: The aim of this study was to describe a comprehensive approach to decrease physical inactivity in the Veterans Health Administration (VHA) employee population. METHODS: The approach included (1) initiatives to decrease physical inactivity in the workplace; (2) two operational surveys to assess system-wide service provision; and (3) two national employee surveys. RESULTS: From 2010 to 2012, 86 employee fitness centers were completed in VA medical centers. A grants program (2010 to 2015) funded smaller projects designed to decrease physical inactivity in the workplace. Projects involved the provision of equipment to decrease sedentary behaviors, including stability balls, treadmill and sit-to-stand desks, stairwell projects, and funding for on-site fitness classes, bicycle racks, and outdoor par courses and walking paths among others. CONCLUSIONS: A comprehensive approach to decrease physical inactivity in VHA employees was successful. Overall, self-reported, age-adjusted physical inactivity in VHA employees decreased from 25.3% in 2010 to 16.1% in 2015.

From Policy to Practice: Tobacco Use Cessation for Employees in the Veterans Health Administration.

OBJECTIVE: To describe a comprehensive approach to increase tobacco use cessation in the Veterans Health Administration (VHA) employee population. METHODS: The approach included: 1) national policy; 2) a pilot tobacco use cessation program; and 3) two operational surveys to assess system-wide tobacco use cessation service provision. RESULTS: The proportion of VHA facilities offering a comprehensive tobacco use cessation program increased from 51% in 2010 to 72% in 2014, with 83% of facilities providing nicotine replacement therapy to employees. The WIN by Quitting Tobacco program was successful; employees who participated in the pilot program quit tobacco at high rates (64% at 1 month post quit date). CONCLUSIONS: From policy to practice, the comprehensive approach to tobacco use cessation in VHA was successful and may serve as a model for future workplace health promotion and occupational safety and health initiatives.

Management support, worksite culture, and local resources for healthier employees: the Veterans Affairs experience.

OBJECTIVE: To determine whether a "worksite culture of health" exists within the Veterans Health Administration and implications on integrating employee health promotion programs. METHODS: Three national surveys were used-an organizational health survey, a health behaviors survey, and a worksite environment survey. Cross-sectional associations between measures of organizational health and employee health behaviors and between measures of organizational health and worksite environment were assessed. RESULTS: There were significant associations between a number of organizational health measures and a combined measure of health behaviors. Likewise, presence of employee-wellness committees and/or coaches was significantly associated with higher appraisal on organizational health measures. CONCLUSION: Results suggest that a worksite culture of health exists in some but not all facilities within Veterans Health Administration; this has implications for integrating employee health promotion programs systemwide. A phased-in approach is likely warranted.

Sitting on stability balls: biomechanics evaluation in a workplace setting.

Use of a stability ball alone and stability ball chair were evaluated in the Veterans Health Administration as possible alternatives to incorporate with regular office chair use. The evaluation of stability ball use was conducted under the auspices of a work site health promotion program as a cross-over trial with participants rotating through use of the stability ball, stability ball chair, and regular office chair on a monthly basis for a total duration of 3 months. Rotations on regular office chairs served as the control. Three medical facilities participated. A total of 193 employees completed a baseline questionnaire; 159 completed at least one post-rotation questionnaire. Self-reported measures included perceived posture when sitting, perceptions of overall balance, energy levels, job performance, safety, and pain. Use was associated with improvements in perceived posture (p < 0.0001) and energy levels (p = 0.007) for stability ball users compared with the office chair control, and improvements in perceived posture (p < 0.0001) and overall balance (p = 0.05) for stability ball chair users compared with the control. Use of stability balls at work decreases the likelihood of reporting pain from regular office chair use from approximately 45% to 21%. Alternatively, a high number of participants reported pain with use of the stability ball alone and stability ball chair, 42% and 45%, respectively. The perceived risks and benefits of stability ball use should be weighed when incorporating use.