Kimberly Jinnett

Health and Productivity as a Business Strategy: A Multiemployer Study

Objective: To explore methodological refinements in measuring health-related lost productivity and to assess the business implications of a full-cost approach to managing health. Methods: Health-related lost productivity was measured among 10 employers with a total of 51,648 employee respondents using the Health and Work Performance Questionnaire combined with 1,134,281 medical and pharmacy claims. Regression analyses were used to estimate the associations of health conditions with absenteeism and presenteeism using a range of models. Results: Health-related productivity costs are significantly greater than medical and pharmacy costs alone (on average 2.3 to 1). Chronic conditions such as depression/anxiety, obesity, arthritis, and back/neck pain are especially important causes of productivity loss. Comorbidities have significant non-additive effects on both absenteeism and presenteeism. Executives/Managers experience as much or more monetized productivity loss from depression and back pain as Laborers/Operators. Testimonials are reported from participating companies on how the study helped shape their corporate health strategies. Conclusions: A strong link exists between health and productivity. Integrating productivity data with health data can help employers develop effective workplace health human capital investment strategies. More research is needed to understand the impacts of comorbidity and to evaluate the cost effectiveness of health and productivity interventions from an employer perspective.

The Temporal Relationship Between Emotional Distress and Cigarette Smoking During Adolescence and Young Adulthood

Empirical evidence regarding the causal nature of the relationship between emotional distress and tobacco use in male and female adolescents provides support for both the distress-to-use and the use-to-distress hypotheses. Using a cross-lagged model with 3 waves of data from 2,961 adolescents followed into young adulthood, the authors tested the hypothesis that this relationship changes over time. As hypothesized, emotional distress in Grade 10 was associated with increased smoking in Grade 12 for both boys and girls. Smoking in Grade 12 was in turn associated with increased emotional distress in young adulthood. The addition of 3 third factors (rebelliousness, deviance, and family problems) to the model did not alter the results. Results suggest that the relationship between tobacco use and emotional distress is a dynamic one in which distress initially leads to use but then becomes exacerbated by it over time.

Access to Inpatient or Residential Substance Abuse Treatment Among Homeless Adults With Alcohol or Other Drug Use Disorders

Objectives.We conducted a theoretically guided study of access to inpatient or residential treatment among a probability sample of homeless adults with alcohol or drug use disorders in Houston, Texas. Methods.This study used a cross-sectional, retrospective design with data collected from a multistage random sample of 797 homeless adults age 18 or older who were living in Houston shelters and streets in 1996. Structured, face-to-face interviews produced screening diagnoses for alcohol and drug use disorders, treatment use data, and candidate predictors of treatment use. Logistic and linear regression analyses were performed on the subset of 326 homeless persons with either alcohol or drug use disorder. Results.27.5% of persons with substance use disorder had accessed inpatient or residential treatment during the past year. Controlling for additional need factors such as comorbidity, persons having public health insurance and a history of treatment for substance problems had greater odds of receiving at least one night of treatment. Contrary to expectation, contact with other service sectors was not predictive of treatment access. Schizophrenia and having a partner appeared to hinder access. Greater need for treatment was associated with fewer nights of treatment, suggesting retention difficulties. Conclusions.This study adds to previous findings on access to health care among homeless persons and highlights a pattern of disparities in substance abuse treatment access. Health insurance is important, but enhancing access to care involves more than economic considerations if homeless persons are to receive the treatment they need. Referral relationships across different service sectors may require strengthening.

The Influence of Organizational Context on Quitting Intention

This study uses multilevel methods to investigate the effects of organizational context on job satisfaction and quitting intention among staff working in long-term mental health care settings. Two types of organizational features are examined: group job satisfaction and structural features of the work unit (unit size, workload, and level of client functioning on the unit). A review of the organizational literature reveals that most empirical research has investigated job satisfaction at the individual level of analysis rather than the group level. The authors argue that the affective context of a group has real and measurable consequences for individual attitudes and behavior, independent of individual attitudes toward the job. Using multilevel modeling, study findings support the premise that group job satisfaction exercises effects on intention to quit independent of individuals’ dispositions toward their jobs. These effects are both direct and interactive. The findings underscore the importance of affective context in shaping individual attitudes and behavioral intentions.

Predicting the impact of chronic health conditions on workplace productivity and accidents: results from two US Department of Energy national laboratories

Objective: Examine associations of chronic health conditions on workplace productivity and accidents among US Department of Energy employees. Methods: The Health and Work Performance Questionnaire–Select was administered to a random sample of two Department of Energy national laboratory employees (46% response rate; N = 1854). Results: The majority (87.4%) reported having one or more chronic health conditions, with 43.4% reporting four or more conditions. A population-attributable risk proportions analysis suggests improvements of 4.5% in absenteeism, 5.1% in presenteeism, 8.9% in productivity, and 77% of accidents by reducing the number of conditions by one level. Depression was the only health condition associated with all four outcomes. Conclusions: Results suggest that chronic conditions in this workforce are prevalent and costly. Efforts to prevent or reduce condition comorbidity among employees with multiple conditions can significantly reduce costs and workplace accident rates.

Cases, contexts and care: the need for grounded network analysis

This paper argues that case-centered network analysis requires the integration of both quantitative and qualitative analysis. First, we discuss the importance of linkages or connections between individual clients, providers and agencies in forming networks of care. Next, we explore the linkage between the public mental health and HIV treatment systems. A discussion of the potential influence of cases on networks and network change follows. Finally, we argue the value of incorporating a qualitative analytic approach to understanding inter-organizational linkages.

Perceptions of Barriers to Effective Obesity Care: Results from the National ACTION Study

ACTION (Awareness, Care, and Treatment in Obesity maNagement) examined obesity‐related perceptions, attitudes, and behaviors among people with obesity (PwO), health care providers (HCPs), and employer representatives (ERs).

Reoccurring Injury, Chronic Health Conditions, and Behavioral Health: Gender Differences in the Causes of Workers’ Compensation Claims

Objective: The aim of this study was o examine how work and nonwork health-related factors contribute to workers’ compensation (WC) claims by gender. Methods: Workers (N = 16,926) were enrolled in the Pinnacol Assurance Health Risk Management study, a multiyear, longitudinal research program assessing small and medium-sized enterprises in Colorado. Hypotheses were tested using gender-stratified logistic regression models. Results: For both women and men, having incurred a prior WC claim increased the odds of a future claim. The combination of incurring a prior claim and having metabolic health conditions resulted in lower odds of a future claim. Behavioral health risk factors increased the odds of having a claim more so among women than among men. Conclusion: This study provides data to support multifactorial injury theories, and the need for injury prevention efforts that consider workplace conditions as well as worker health.

The Impact of Worksite Wellness Programs by Size of Business: A 3-Year Longitudinal Study of Participation, Health Benefits, Absenteeism, and Presenteeism

Objective Worksite wellness programs (WWP) may positively impact employee health, medical expenditures, absenteeism, and presenteeism. However, there has been little research to assess the benefits of WWP in small businesses. The purpose of this study is to prospectively evaluate changes in health, absenteeism, and presenteeism for employees who participated in a WWP. Methods We conducted an observational, 3-year cohort study of 5766 employees from 314 businesses of differing sizes. We followed two cohorts of employees, who completed at least two annual health risk assessments (HRA) between May 2010 and December 2014. Changes from baseline to the first and second follow-up periods were assessed for chronic and non-chronic health conditions, absenteeism, and presenteeism. Results Small business employees were more likely to participate in the WWP than were employees from large businesses. Changes in chronic and non-chronic health conditions varied by size of business, with small business employees showing improvements in stress, overall health, depression, smoking status, vegetable and fruit consumption, and physical activity, and in their perceptions of job health culture. In contrast, large business employees experienced improvements in stress, vegetable consumption, and alcohol use. No changes in absenteeism or presenteeism were observed. Conclusions Small businesses achieve higher employee participation rates and more health improvements when compared to employees from large employers. Findings suggest that small businesses may gain the most from a WWP.