The Association between Social Determinants of Health, Risk Factors, Job Performance and Healthcare Costs in an Employed Population.

OBJECTIVE: To compare employees of a US school district based on their social determinants of health (SDoH). METHODS: Employees (N = 5006) were categorized into low, medium, or high need SDoH tiers. Of them, N = 2469 also participated in a health risk appraisal in 2019. Subjects' average healthcare costs, health risk factors, and self-rated job performance were compared by SDoH tier and race. RESULTS: Significant differences were observed among the SDoH comparison groups regarding age, gender, race, and marital status. SDoH was associated with health care costs, number of health risk factors, and self-rated job performance differently for Black and White employees. CONCLUSIONS: SDoH are complex and multi-faceted. Black employees in the high need SDoH group had higher average healthcare costs, lower self-rated job performance, and more average health risk factors than subjects in the lower need tiers.

Migraine Headache in an Employed Population: Demographics, Health Risks, Pharmaceutical Utilization, and Productivity Loss.

OBJECTIVE: Demographics, health risks, pharmaceutical utilization, and other characteristics of adults with and without migraine who were employed by a school district in the southern United States were compared. METHODS: A total of 4528 employees completed a health risk appraisal. A diagnosis of migraine was reported by 11%. Employees with and without migraine were compared on several measures. RESULTS: Demographic and health risk differences were observed among the comparison groups. One-fifth of migraineurs had a prescription for an opioid, which was associated with very high average annual health care costs ($17,791) compared with migraineurs without opioid ($3907). CONCLUSIONS: Migraine is common in the workforce. Employers may want to educate employees with migraine about evidence-based treatments. Benefit plan design should be consistent with current accepted treatment guidelines for opioid use.

Results of a Virtual Migraine Education Program in an Employed Population.

OBJECTIVE: Migraine affects about 15% of the world's population and disproportionately affects adults who are working age. It is associated with higher healthcare costs, absenteeism, and lost productivity. A metropolitan school district in the southern United States offered a virtual migraine education program to their teaching employees. METHODS: Seventy-nine employees completed a migraine questionnaire at both baseline and 3-month follow-up. The program included webinars, educational videos, and other intranet-based resources. RESULTS: Results found that program participants reported a significant improvement in the frequency and severity of migraine as well as a reduction in lost on-the-job productivity. A majority of participants reported making positive changes to reduce triggers and better manage stress. CONCLUSIONS: An employer-offered migraine education program distributed virtually to remote workers has the potential to improve migraine symptoms and treatment as well as productivity.

Demographics, Preventive Services Compliance, Health, and Healthcare Experiences of Lesbian, Gay, and Bisexual Employed Adults.

OBJECTIVE: This study examined demographics, health risks and conditions, preventive services, and health care experiences of lesbian, gay, bisexual, transgender, or questioning (LGBTQ) adults who are employed in the United States. METHODS: Male and female gay, lesbian, or bisexual employees (N = 1191) from seven companies participated in an online survey. RESULTS: Differences were observed in the characteristics of gays, lesbians, and bisexuals on a number of demographic, health, and preventive services measures. Differences were also seen compared to previous studies about LGBTQ adults in the general population. CONCLUSIONS: Employers have a vested interest in making sure their employees have access to quality health care that addresses their unique needs. There is much room for improvement in this area, since a large percentage of respondents reported negative health care experiences, avoiding or postponing care, and difficulty finding an LGBTQ-experienced healthcare provider.

Lifestyle Medicine and Worker Productivity.

The issue of employee productivity has become a major concern for companies. Inefficiency can occur at every stage of production either as poor design, worker limitation, or other factors. It is generally assumed that a healthy worker is more productive than an unhealthy worker. As early as 1776 Adam Smith observed and published in The Wealth of Nations that poor worker health was a detriment to industrial productivity. The objective of this article is to review the literature documenting the gain or loss of productivity related to the health of workers, as well as any lifestyle management strategies that can be used to improve employee health and productivity. The impact of employee obesity, smoking, physical activity, sleep, and behavioral health on productivity will be explored. By identifying and addressing health risks that impair worker performance, lifestyle medicine professionals can demonstrate a significant return on investment by creating a healthier and more productive work force.

Health and Economics of Lifestyle Medicine Strategies.

The cost of medical care in the United States is increasing at an unsustainable rate. The lifestyle medicine (LM) approach is essential to influence the root causes of the growing chronic disease burden. LM addresses health risk factors in primary, secondary, and tertiary prevention of developing disease rather than limiting resources and medical expenditures on acute care and reacting to illness, injury, and disease. Employers have much to gain financially from such an approach due to their status as the payer of health care costs for their employees, and as the recipient of productivity gains among their employees. This article discusses LM programs delivered at the worksite, including important findings from the University of Michigan Health Management Research Center. Examples of evidenced-based population LM interventions are summarized for physical activity, weight management, and nutrition programs that address chronic diseases such as cardiovascular disease, cancer, and diabetes mellitus. These approaches have the potential to reduce health care cost trends, increase employee performance/productivity, and improve patient health outcomes.

The Association Between Changes in Employee Sleep and Changes in Workplace Health and Economic Outcomes.

Sleep disturbance is negatively associated with workplace productivity. This study sought to identify whether or not changes in sleep from 2012 to 2013 were associated with changes in health risks, medical conditions, or workplace economic outcomes. Employees of a Fortune 100 financial services corporation were categorized based on changes in self-reported hours of sleep from 2012 to 2013 and compared based on their health risk factors, medical conditions, health care costs, and productivity measures. Consistently poor sleepers had more health risks and medical conditions compared to consistently optimal sleepers. Sleep improvers had a significant reduction in lost on-the-job productivity while consistently poor sleepers and downgraders had significantly more lost productivity compared to optimal sleepers. Employers may wish to incorporate sleep education initiatives as part of their overall health and wellness strategy.

The Association of Employee Engagement at Work With Health Risks and Presenteeism.

INTRODUCTION: Employee engagement is a key factor in work performance and employee retention. The current study seeks to examine the relationship between employee engagement and health risks and productivity. METHODS: In 2012, employees of a global financial services corporation participated in a health risk appraisal (HRA) which measured employee engagement, health risks, and on-the-job productivity loss (presenteeism). Three engagement categories were created. RESULTS: The highest engaged employees had significantly fewer health risk factors (69.7% overall low-risk status; 1.91 average health risks) and significantly less presenteeism (7.7%) than the mid engagement (67.9% low-risk, 1.98 risks, 9.2% presenteeism) and worst engagement (55.0% low-risk, 2.53 risks, 14.0% presenteeism) groups. CONCLUSIONS: Work engagement appears to be good for both the organization and the individual. Organizations may wish to make use of strategies which increase employee engagement.

Association Between Employee Dental Claims, Health Risks, Workplace Productivity, and Preventive Services Compliance.

OBJECTIVE: This study examined differences in health risks and workplace outcomes among employees who utilized preventive dental services compared with other employees. METHODS: A retrospective observational study of employees of a large financial services corporation, with data from health risk appraisal questionnaires, medical claims, pharmacy claims, and dental claims. RESULTS: Employees with no dental claims were significantly more likely to have a variety of health risk factors (such as obesity and tobacco use), health conditions (such as diabetes), absenteeism, and lost on-the-job productivity, and were significantly less likely to be compliant with clinical preventive services compared with those with preventive dental claims. CONCLUSIONS: Employees with preventive dental claims had fewer health risks and medical conditions and better health and productivity measures. Study employees underutilized free dental care; employers should incorporate preventive dental care awareness into their worksite wellness programs.

Association Between Employee Sleep With Workplace Health and Economic Outcomes.

OBJECTIVE: Poor sleep can impact occupational functioning. The current study examines health risks, medical conditions, and workplace economic outcomes associated with self-reported hours of sleep among employees. METHODS: Employees of a global financial services corporation were categorized on the basis of their self-reported average hours of sleep. Differences in health care costs, productivity measures, health risks, and medical conditions were analyzed by hours of sleep while controlling for confounding variables. RESULTS: A strong U-shaped relationship between health care costs, short-term disability, absenteeism, and presenteeism (on-the-job work loss) and the hours of sleep was found among employees. The nadir of the "U" occurs for 7 or 8 hours of sleep per night. CONCLUSIONS: Worksite wellness programs often address health risks and medical conditions and may benefit from incorporating sleep education.

Evaluation of a Workplace-Based Sleep Education Program.

INTRODUCTION: Poor sleep is common among working adults. Chronic sleep deprivation is associated with health problems. A healthy sleep educational program (using webinars and other intranet-based resources) was offered to employees of a financial services corporation. METHODS: In 2015, a total of 357 employees (50% completion rate) completed both a pre- and post-program questionnaire assessing sleep quality and workplace productivity. RESULTS: Many aspects of sleep statistically improved from T1 to T2 for program participants. These included improvements in hours of sleep, sleep quality, ease of getting asleep, feeling rested, nights of poor sleep, job performance, days of sleepiness, and others. Employees reporting any limitation in productivity also showed significant improvement. CONCLUSIONS: This workplace healthy sleep intervention was associated with significant improvements in sleep quality and quantity among program participants.

Evaluation of a Workplace-Based Migraine Education Program.

OBJECTIVE: Migraine affects approximately 10% of working-age adults and is associated with increased health care costs, absenteeism, and presenteeism in the workplace. A migraine education program was offered to United States employees of a global financial services organization. METHODS: Two hundred forty three employees (46% response rate) completed both a baseline and 6-month follow-up migraine questionnaire. The program included webinars, E-mailed educational tips, and intranet-based resources. RESULTS: No change was found in the frequency of migraines but improvements were observed in the severity, workdays missed, effectiveness at work during migraine, and work/activity limitations. Participants reported taking action to identify and reduce migraine triggers. CONCLUSIONS: A worksite disease education program for migraine headache has the potential to significantly impact lost productivity and absenteeism for migraineurs.

The Future of Health Promotion in the 21st Century: A Focus on the Working Population.

The purpose of this article is to synthesize developments from various disciplines including the medical, wellness, psychology, and sociology fields to shed light on where health promotion is headed in the next 25 years. Lifestyle medicine practitioners will continue to play a large role in helping people achieve the highest levels of wellness, which does not simply mean the absence of disease. New research identifies the important roles of many diverse factors such as relationships, lifestyle behaviors, emotional outlook, positive environment, mind-body connection, use of technology, and work styles, which can help each person achieve the fullness of life, vitality, and flourishing that characterizes a high level of well-being.

The Portion of Health Care Costs Associated With Lifestyle-Related Modifiable Health Risks Based on a Sample of 223,461 Employees in Seven Industries: The UM-HMRC Study.

OBJECTIVE: This study estimates the percent of health care costs associated with employees' modifiable health risks. METHODS: Cross-sectional multivariate analysis of 223,461 employees from seven industries who completed a health risk assessment during 2007 to 2012. RESULTS: Modifiable health risks were associated with 26.0% of health care costs ($761/person) among employees with no self-reported medical conditions and 25.4% among employees with a medical condition ($2598/person). The prevalence and relative costs of each of the 10 risks were different for those without and with medical conditions, but high body mass index was the most prevalent risk for both groups (41.0% and 63.9%) and also contributed the largest percentage of excess costs (7.2% and 7.3%). CONCLUSIONS: This study, coupled with past work, gives an employer a sense of the magnitude that might be saved if modifiable health risks could be eliminated.

The association of self-reported employee physical activity with metabolic syndrome, health care costs, absenteeism, and presenteeism.

OBJECTIVE: To examine employees' self-reported physical activity and metabolic syndrome (MetS) risks and their association with health-related workplace outcomes. METHODS: Employees participated in a health risk appraisal in 2010. Generalized Linear Modeling was used to test the association between MetS risk factors, physical activity, and the outcome measures while controlling for confounders. RESULTS: MetS was found in 30.2% of employees. Health care costs for employees with MetS who reported sufficient exercise (150 or more minutes/week) totaled $2770 compared with $3855 for nonsufficient exercisers. The percentage of employees with MetS who had absenteeism and presenteeism was also significantly lower for employees achieving sufficient physical activity. All risk factors for MetS were mitigated for regular exercisers. CONCLUSIONS: Employers should consider programs and services to support regular aerobic exercise to address the growing prevalence and costs of MetS in the workforce.

Evaluation of a comprehensive employee wellness program at an organization with a consumer-directed health plan.

OBJECTIVE: Consumer-directed health plans (CDHPs) are popular among employers in the United States. This study examined an employee wellness program and its association with employee health in an organization that recently initiated a CDHP. METHODS: This retrospective observational analysis compared the health risks, employer-paid health care costs, and short-term disability absences of employees of a large financial services corporation from 2009 to 2010. RESULTS: The two-time health risk appraisal participants had a significant improvement in the percentage of employees in the overall low-risk category. The average annual employer-paid medical and pharmacy costs did not significantly change. For employees who improved their health risk category, there was a commensurate change in costs and absences. CONCLUSIONS: In a difficult economic climate, this organization began a health promotion program for employees as well as a new CDHP benefit structure. No short-term reduction in health care usage or overall health status was observed.

Reduction in health risks and disparities with participation in an employer-sponsored health promotion program.

There is an increasing awareness among employers and health care providers that health care needs to be tailored to address the diversity of the workforce. Population-based data have shown significant differences in health behaviors and health risks among different racial/ethnic groups in the United States. The purpose of this study was to examine health risks and changes in health risks over time in an employed population at a financial services corporation. This large financial services corporation is naturally concerned about any disparities in health among employees. The study population consists of employees who participated in the organization's medical plan and also the annual health risk appraisal questionnaire in both 2009 and 2010. Significant demographic differences exist among the four ethnic groups studied: whites, African Americans, Hispanics, and Asians. At baseline, African American employees had a significantly higher average number of health risks measured by the health risk appraisal, but they also experienced the greatest improvement in health risks by time 2. There were differences in the health risk profiles of the ethnic groups, with certain risk factors being more prevalent among some ethnicities than among others. The health care costs were not significantly different among the groups studied here. It is likely that other large employers may also find health risk differences among employees belonging to various ethnicities. Future research in this field should seek to understand the reasons behind differences in health among ethnic groups and how best to address them so that all employees can achieve a high level of health and wellness.

The burden and management of dyslipidemia: practical issues.

The objective of this study is to describe briefly the burden of dyslipidemia, and to discuss and present strategies for health professionals to improve dyslipidemia management, based on a review of selected literature focusing on interventions for dyslipidemia treatment adherence. Despite the availability of effective lifestyle and pharmaceutical therapies for dyslipidemias, they continue to present a significant economic burden in the United States. Adherence to evidence-based guidelines for the treatment of dyslipidemias is unsatisfactory. The reasons for medication nonadherence are complex and specific to each patient. The lack of progress in achieving optimal lipid targets is caused by many factors: patient (medication adherence, cost of medication, literacy), medication (adverse effects, complexity of regimen), provider (lack of adherence to evidence-based practice guidelines, poor communication), and the US healthcare system (being focused on acute care rather than prevention, lack of continuity of care, general lack of use of an electronic health record). Combined interventions that target each part of the system have been effective in improving treatment adherence and achieving lipid goals. Patients, providers, pharmacists, and employers all play a role in management of dyslipidemia. No single approach will solve the complex issue of improving dyslipidemia management. The required lifestyle changes are known and effective medications are available. The challenge is for all interested parties-including nurses, nurse practitioners, doctors, pharmacists, other health care professionals, employers, and health plans-to help patients achieve behavioral changes.