Andrea Foote

Worksite wellness programs: incremental comparison of screening and referral alone, health education, follow-up counseling, and plant organization.

Background. Worksite wellness programs vary considerably in their design. This study tested four models to compare effectiveness at controlling high blood pressure, obesity, and cigarette smoking. Methods. Baseline screening was conducted in four manufacturing plants. Site 1 offered screening only, with referral recommendations for those found to have CVD risks. Site 2 also provided health education information and classes. Site 3 added routine follow-up counseling and a menu of intervention types, and Site 4 added social organization within the plant. Random samples of 400 to 500 employees were rescreened at the end of three years. Results. Major improvements in risk levels were found with the addition of routine follow-up counseling and a menu of interventions (Sites 3 and 4, compared with Sites 1 and 2). More hypertensives entered treatment and showed greater reductions in blood pressure. Participation in worksite weight loss and smoking cessation programs was significantly increased, and those who participated showed significantly better maintenance of improvements where follow-up was provided. Discussion. The program models that offered short-term interventions promoted through local media suffered in comparison with models that included personal outreach to people at risk, a variety of health improvement intervention modalities, and ongoing follow-up counseling to help people make decisions and sustain health improvements.

Hypertension control at the work site. Comparison of screening and referral alone, referral and follow-up, and on-site treatment.

Four methods for improving hypertension control among employees were tested in one manufacturing plant each: screening and referral to a physician but no other intervention; referral to a physician and semiannual follow-up; referral to a physician and more frequent follow-up as needed; and on-site treatment or care by a family physician. All methods significantly increased the proportion of subjects under treatment, but only the three programs offering follow-up or treatment significantly improved the adequacy of control. At the end of the three years of the project, 56 to 62 per cent of the hypertensive employees in these three programs had blood-pressure readings below 140/90 mm Hg, and 86 to 90 per cent had readings below 160/95. In contrast, among employees who received no intervention after screening, only 21 per cent had readings below 140/90 mm Hg at the end of the study, and only 47 per cent had readings below 160/95. Employees selecting on-site treatment had the highest level of blood-pressure control, but this finding appeared to be due to self-selection of previously untreated patients into on-site treatment and to exclusion of employees with other medical problems. We conclude that work-site hypertension programs can produce substantial improvements in blood-pressure control if they include systematic, routine follow-up that provides employees with information about their condition and offers support for maintenance of therapy.

Improving Participation in Worksite Wellness Programs: Comparing Health Education Classes, a Menu Approach, and Follow-Up Counseling

Findings are presented from a study to compare four types of worksite wellness programs to reduce cardiovascular risks. Using a quasi-experimental design, the study was implemented in four large manufacturing plants, similar in demographic characteristics. At the end of the three-year study period, the two sites that included individual outreach and counseling had engaged about 46 percent of identified smokers and 54 percent of the overweight into smoking cessation and weight loss activities, respectively. This compares with fewer than 10 percent at the site offering health education classes only, and less than one percent at the control site. In order to achieve these results, the outreach and follow-up counseling was coupled with a menu of interventions for smoking cessation and weight loss, to accommodate the needs of people who cannot or will not participate in classes. The menu includes guided self-help, one-to-one counseling, mini-groups, and full classes.

Controlling Hypertension: A Cost-Effective Model

Abstract A model system for controlling hypertension that was developed and tested in three industrial settings and three community settings is described. Data

Cost-effectiveness of work-site blood pressure control programs.

The cost-effectiveness of work-site hypertension programs was examined at three manufacturing plants. A fourth plant was used as a control site to estimate expected levels of hypertension control from screening without further intervention. The annual cost per hypertensive employee of the three intervention programs was

Worksite Follow-Up and Engagement Strategies for Initiating Health Risk Behavior Changes

26.26 for semiannual follow-up,

Maintenance of blood pressure treatment and control after discontinuation of work site follow-up.

35 for full follow-up, and

Establishing Communication Networks for Health Promotion in Industrial Settings

96.19 for on-site treatment. Each intervention resulted in an additional 1% of hypertensive employees maintained under control, per dollar spent annually, with the highest cost per unit of effectiveness being incurred for free on-site treatment. Cost-effectiveness may vary considerably, however, depending on the additional costs a company may incur as a result of program adoption.

Effectiveness of Comprehensive Employee Assistance Programs at Reaching Alcoholics

Information is presented from a multiplant study of interventions to improve cardiovascular health among employees. Risk factors targeted were high blood pressure, obesity, and cigarette smoking. The study utilized on-site wellness counselors who periodically contacted all employees identified through screening as having one or more of the three risks. Use of a structured protocol for client outreach resulted in the large majority of clients being seen in follow-up during the three-year intervention period. Drawing from caseload experience and from various theoretical perspectives, seven engagement strategies were used to help guide at-risk clients toward successful behavior changes to reduce health risks. Results showed that of the three at-risk groups, clients with high blood pressure were most likely to be seen in follow-up, and most likely to begin a risk reduction program. For the overweight and smokers, clients seen three or more times were more likely to begin a weight-loss/smoking cessation program than clients seen less often. Frequency of follow-up showed a positive relationship with risk reduction for all three risks, in samples of employees rescreened at the end of the intervention period, but the relationship was not statistically significant for smoking cessation.

Implementing long-term EAP follow-up with clients and family members to help prevent relapse-With implications for primary prevention.

Participants in a 3-year study of hypertension control at four work sites were rescreened 4 years after discontinuation of the study protocols. At the end of the 3-year study period, employees at the study sites that provided routine follow-up monitoring had shown significantly better levels of blood pressure control than at initial screening and significantly better levels than employees at the site that did not provide follow-up monitoring. But 4 years after discontinuation of the follow-up services this was no longer true. The level of blood pressure control at the experimental sites was no better than at the control site, and the level of control at all study sites was no better than would have been predicted for a population that had aged by 7 years. Some 17.6% of the participants were found to be in remission (with normal blood pressure readings, not under treatment), but the data suggested that they were at risk of future blood pressure elevations, warranting continued monitoring. The major predictor of continuation in treatment was frequency of blood pressure monitoring, but frequency of monitoring was not associated with maintenance of good control. It is concluded that follow-up monitoring programs at the work site should be treated as permanent services, not short-term programs.