Mark G. Wilson

A Comprehensive Review of the Effects of Worksite Health Promotion on Health-related Outcomes

Purpose. This article provides the foundation for a series of literature reviews that critically examine the effectiveness of worksite health promotion programs. This issue reviews the exercise, health risk appraisal, nutrition and cholesterol, and weight control literatures; a future issue will review the alcohol, HIV/AIDS, multicomponent program, seat belt, smoking, and stress management literatures. Methods. The literature search used a four-step process that included a computerized database search, a reference search, a manual search of relevant health promotion journals, and the writing of the review by a recognized expert in the area being searched. The databases were searched from 1968 through 1994 and included Medline, Aidsline, Psychological Abstracts, Combined Health Information Database, Employee Benefits Infosource, National Prevention Evaluation Research Collection, National Resource Center on Worksite Health Promotion, National Technical Information Service, and the Substance Abuse Information database. A total of 288 articles were identified by the search, not including the 37 articles in the hypertension literature. Authors of each review were requested to incorporate additional studies not identified by the search, provide a research rating for each individual article, and a rating for the overall literature for their respective area. The authors reviewed 316 studies. Findings. The overall ratings for the reviews reported in this issue were suggestive for exercise, weak for health risk appraisals, suggestive/indicative for both nutrition and cholesterol, and indicative for weight control. The ratings for the other reviews will be reported in the subsequent issue. Conclusions. Research reported in these reviews suggests the effectiveness of worksite health promotion programs, however, additional research is required to provide conclusive evidence of their impact.

How accurate are self-reports? Analysis of self-reported health care utilization and absence when compared with administrative data.

Objective: To determine the accuracy of self-reported health care utilization and absence reported on health risk assessments against administrative claims and human resource records. Methods: Self-reported values of health care utilization and absenteeism were analyzed for concordance to administrative claims values. Percent agreement, Pearson’s correlations, and multivariate logistic regression models examined the level of agreement and characteristics of participants with concordance. Results: Self-report and administrative data showed greater concordance for monthly compared with yearly health care utilization metrics. Percent agreement ranged from 30% to 99% with annual doctor visits having the lowest percent agreement. Younger people, males, those with higher education, and healthier individuals more accurately reported their health care utilization and absenteeism. Conclusions: Self-reported health care utilization and absenteeism may be used as a proxy when medical claims and administrative data are unavailable, particularly for shorter recall periods.

Move to Improve: a randomized workplace trial to increase physical activity.

BACKGROUND Workplaces are important settings for interventions to increase physical activity, but effects have been modest. PURPOSE To evaluate the efficacy of Move to Improve, a social-ecologic intervention delivered at the workplace to increase leisure-time physical activity. METHODS A group-randomized 12-week intervention consisting of organizational action and personal and team goal-setting was implemented in Fall 2005, with a multi-racial/ethnic sample of 1442 employees at 16 worksites of The Home Depot, Inc. Change in physical activity was analyzed in Fall 2007 using latent growth modeling and latent transition analysis. RESULTS Participants in the intervention had greater increases in moderate and vigorous physical activity and walking compared to participants in a health education control condition. The proportion of participants that met the Healthy People 2010 recommendation for regular participation in either moderate or vigorous physical activity remained near 25% at control sites during the study but increased to 51% at intervention sites. During the last 6 weeks of the study, intervention participants exceeded 300 weekly minutes of self-reported moderate-to-vigorous physical activity and 9000 daily pedometer steps. CONCLUSIONS The results support the feasibility and efficacy of the Move to Improve intervention and the role of goal-setting for attaining increased physical activity levels.

Individual reactions to high involvement work processes: investigating the role of empowerment and perceived organizational support.

This study sought to understand how high involvement work processes (HIWP) are processed at the employee level. Using structural equation modeling techniques, the authors tested and supported a model in which psychological empowerment mediated the effects of HIWP on job satisfaction, organizational commitment, job performance, and job stress. Furthermore, perceived organizational support (POS) was hypothesized to moderate the relationships between empowerment and these outcomes. With exception for the empowerment-job satisfaction association, support was found for our predictions. Future directions for research and the practical implications of our findings for both employees and organizations are discussed.

Organizational health promotion: broadening the horizon of workplace health promotion.

This article argues that efforts to improve the health and well-being of the workforce should begin with the organization itself. The term organizational health promotion is introduced to expand the scope of worksite health promotion. Organizational health promotion delves into the basic structural and organizational fabric of the enterprise—to how work is organized. The core themes of healthy work organization are introduced, and the status of our ability to identify organizational risk factors is discussed. A conceptual model of healthy work organization is presented, along with a process for expanding the health promotive capacity of the organization. The final section addresses challenges related to adopting an organizational health promotion perspective.

Second-year results of an obesity prevention program at the Dow Chemical Company.

Objective: Evaluate innovative, evidence-based approaches to organizational/supportive environmental interventions aimed at reducing the prevalence of obesity among Dow employees after 2 years of implementation. Methods: A quasi-experimental study design compared outcomes for two levels of intervention intensity with a control group. Propensity scores were used to weight baseline differences between intervention and control subjects. Difference-in-differences methods and multilevel modeling were used to control for individual and site-level confounders. Results: Intervention participants maintained their weight and body mass index, whereas control participants gained 1.3 pounds and increased their body mass index values by 0.2 over 2 years. Significant differences in blood pressure and cholesterol values were observed when comparing intervention employees with controls. At higher intensity sites, improvements were more pronounced. Conclusions: Environmental interventions at the workplace can support weight management and risk reduction after 2 years.

Assessing the impact of healthy work organization intervention

This research evaluates a healthy work organization intervention implemented in a retail setting. Using a participatory process, employee teams in I I intervention stores developed customized plans for improving work organization at their sites. Ten comparable stores served as controls. Employee surveys were administered prior to the intervention and twice again at 12-month intervals. Business results were compiled monthly for each store. The baseline data were used by the teams to identify needs and establish action priorities for their stores. Most study outcomes declined across time for all stores, due primarily to internal corporate events and a generally adverse economic environment. However, the intervention process appeared to buffer some of these declines; intervention stores fared better in terms of selected aspects of organizational climate and psychological work adjustment. Intervention stores also performed better than controls on general indices of perceived health and safety and two of the four business outcomes: employee turnover and sales per labour hour. These results are discussed in terms of the challenges involved in evaluating organizational-level interventions in work settings.

Making work safer: testing a model of social exchange and safety management

INTRODUCTION This study tests a conceptual model that focuses on social exchange in the context of safety management. The model hypothesizes that supportive safety policies and programs should impact both safety climate and organizational commitment. Further, perceived organizational support is predicted to partially mediate both of these relationships. METHODS Study outcomes included traditional outcomes for both organizational commitment (e.g., withdrawal behaviors) as well as safety climate (e.g., self-reported work accidents). Questionnaire responses were obtained from 1,723 employees of a large national retailer. RESULTS Using structural equation modeling (SEM) techniques, all of the models hypothesized relationships were statistically significant and in the expected directions. The results are discussed in terms of social exchange in organizations and research on safety climate. IMPACT ON INDUSTRY Maximizing safety is a social-technical enterprise. Expectations related to social exchange and reciprocity figure prominently in creating a positive climate for safety within the organization.

Development of the Environmental Assessment Tool (EAT) to measure organizational physical and social support for worksite obesity prevention programs

Objective: To describe the development, reliability, and validity of the Environmental Assessment Tool (EAT) for assessing worksite physical and social environmental support for obesity prevention. Methods: The EAT was developed using a multistep process. Inter-rater reliability was estimated via Kappa and other measures. Concurrent and predictive validity were estimated using site-level correlations and person-level multiple regression analyses comparing EAT scores and employee absenteeism and health care expenditures. Results: Results show high inter-rater reliability and concurrent validity for many measures and predictive validity for absenteeism expenditures. Conclusions: The primary use of the EAT is as a physical and social environment assessment tool for worksite obesity prevention efforts. It can be used as a reliable and valid means to estimate relationships between environmental interventions and absenteeism and medical expenditures, provided those expenditures are for the same year that the EAT is administered.

Health Promotion Programs in Small Worksites: Results of a National Survey

Purpose. This study documents the prevalence of workplace health promotion activities at small worksites with 15 to 99 employees. Design. A random sample of U.S. worksites stratified by size and industry (n = 3628) was drawn using American Business Lists. Measures. Each worksite was surveyed using a computer-assisted telephone interview system to document activities related to health promotion and related programs, worksite policies regarding health and safety, health insurance, and philanthropic activities. Subjects. Participation varied by industry and size, with an overall response rate for eligible worksites of 78% for a total sample of 2680 worksites. Data Analysis. Data were analyzed using SUDAAN statistical software. Results. Approximately 25 % of worksites with 15 to 99 employees offered health promotion programs to their employees, compared with 44% of worksites with 100+ employees. As with the larger worksites, the most common programs for worksites with 15 to 99 employees were those related to occupational safety and health, back injury prevention, and CPR. The majority of worksites in both size categories had alcohol, illegal drug, smoking, and occupant protection policies. The majority of both small and large worksites also offered group health insurance to their employees (92% and 98%, respectively), with many of the worksites also extending benefits to family members and dependents (approximately 80% for both business sizes). Conclusions. The results indicated that small worksites are providing programs to their employees, with a primary focus on job-related hazards. Small worksites also have formal policies regarding alcohol, drug use, smoking, and seatbelt use and offer health insurance to their employees at a rate only slightly lower than that of large worksites.