Steven G. Aldana

Financial Impact of Health Promotion Programs: A Comprehensive Review of the Literature

Purpose. The purpose of this review is to summarize the literature on the ability of health promotion programs to reduce employee-related health care expenditures and absenteeism. Search Process. Using key words in a literature-searching program, a comprehensive search was conducted on the following databases: MEDLINE, Embase, HealthSTAR, SPORTDiscus, PsycINFO, SciSearch, ERIC, and ABI Inform. Study Inclusion and Exclusion Criteria. All data-based studies that appeared in peer reviewed journals in the English language. Theses, dissertations, or presentation abstracts that were not published in peer reviewed journals were excluded. The initial search identified 196 studies, but only 72 met the inclusion criteria and were included in the review. Data Extraction Methods. Summary tables were created that include design classification, subject size, results, and other key information for each study. Data Synthesis. Both the nature of the findings and the overall quality of the literature were evaluated in an attempt to answer two questions: Do individuals or populations with high health risks have worse financial outcomes than individuals or populations with low health risks? Do health promotion programs improve financial outcomes? Major Conclusions. There are good correlational data to suggest that high levels of stress, excessive body weight, and multiple risk factors are associated with increased health care costs and illness-related absenteeism. The associations between seat belt use, cholesterol, diet, hypertension, and alcohol abuse and absenteeism and health care expenditures are either mixed or unknown. Health promotion programs are associated with lower levels of absenteeism and health care costs, and fitness programs are associated with reduced health care costs.

Health promotion programs, modifiable health risks, and employee absenteeism.

This literature review demonstrates that the health risks and failure of employees to participate in fitness and health promotion programs are associated with higher rates of employee absenteeism. When determining how to manage absenteeism, employers should carefully consider the impact that health promotion programs can have on rates of absenteeism and other employee-related expenses.

Improving Exercise Behavior: An Application of the Stages of Change Model in a Worksite Setting:

Randomized trial of 527 corporate employees was conducted to evaluate an exercise intervention based on the transtheoretical model and tailored to individual stages of change. No significant difference in physical activity by stage was evident at baseline among three treatment groups. At follow-up, the group receiving a staged-based message increased activity by 13% and a significant difference was evident in the magnitude and direction of movement across stages, suggesting that tailored messages to stages of change may be an effective strategy for physical activity interventions.

The Relationship Between Perceived Stress and Self-reported Illness-related Absenteeism

Purpose. To investigate the association between perceived stress and illness-related work absenteeism. Design. A standardized health profile questionnaire developed by Johnson & Johnson Advanced Behavioral Technologies, Inc., was used to collect demographic and personal health data between June 1988 and January 1993. Chi-square, odds ratio, and stepwise regression tests were used to analyze perceived stress and self-reported absenteeism data. Setting. Worksite health promotion programs in 250 U.S. companies. Subjects. Subjects consisted of 79,070 employees. Measures. Stress data, grouped as low, moderate, and high, were correlated with absenteeism data grouped by annual days missed (None, 1 to 2, 3 to 4, and 5+). Results. Significant relationships were found (p ⩽ .05) between high stress and absenteeism for both genders. Female workers reported higher stress levels and absenteeism than men. Those with high stress were 2.22 more likely to be absent 5+ days per year than those with low stress. Work, finances, and family were the highest stress sources. Greatest absenteeism predictors were health, legal, social, and financial stress. Conclusions. These data primarily represented self-selected white workers and may not apply to all employees. However, if high stress relates to absenteeism, these data may provide valuable information for program design in stress management.

Health care costs of worksite health promotion participants and non-participants

Total and lifestyle-related medical care costs for employees of a major corporation participating in a worksite health promotion (WHP) program over a three-year period were compared with the costs for non-participants in a cross-sectional study. The study population consisted of 8,334 active employees based in the Cincinnati headquarters of The Procter & Gamble Company. Adjusting for age and gender, participants (n = 3,993) had significantly lower health care costs (29% lower total and 36% lower lifestyle-related costs) when compared with non-participants (n = 4,341) in the third year of the program. Similarly, in the third year of the program, participants had significantly lower inpatient costs, fewer hospital admissions, and fewer hospital days of care when compared with non-participants. No significant differences in costs were found between participants and non-participants during the first two years of the WHP program. Conclusions drawn from this study are that long-term participation in a WHP that includes high-risk screening and intensive one-on-one counseling results in lower total and lifestyle-related health care costs, as well as lower utilization of hospital services.

Relationships between Leisure Time Physical Activity and Perceived Stress

This study investigated the relationship between physical activity during leisure time and perceived stress among working adults (N = 32,229). Data were gathered on physical activity, perceived stress, current health status, age, gender, life changes, ongoing problems, number of techniques used for stress reduction, and number of personality traits related to Type A behavior. To control for confounding variables Mantel-Haenszel summary risk estimates were used. Employees who expended more than 3.0 Kcal/kg−1 · day−1 in physical activity during leisure time were 0.78 and 0.62 times less likely to have moderate and high perceived stress, respectively. Working adults participating in moderate amounts of these activities have about half the rate of perceived stress as nonparticipants.

The effects of a worksite chronic disease prevention program.

Objective: This study determined the behavioral and clinical impact of a worksite chronic disease prevention program. Methods: Working adults participated in randomized clinical trial of an intensive lifestyle intervention. Nutrition and physical activity behavior and several chronic disease risk factors were assessed at baseline, 6 weeks, and 6 months. Results: Cognitive understanding of the requirements for a healthy lifestyle increased at the end of the program. Program participants significantly improved their cognitive understanding of good nutrition and physical activity and had significantly better nutrition and physical activity behavior at both 6 weeks and 6 months. Participants had significantly lower body fat, blood pressure, and cholesterol. Conclusions: This worksite chronic disease prevention program can significantly increase health knowledge, can improve nutrition and physical activity, and can improve many employee health risks in the short term.

Cardiovascular risk reductions associated with aggressive lifestyle modification and cardiac rehabilitation

BACKGROUND Patients who have been treated for coronary heart disease can enroll in traditional cardiac rehabilitation, the Ornish Program, or no rehabilitation at all. No study has compared the impact of each on cardiovascular disease risk (CVD) factors. METHODS The current study compared CVD risk changes in post coronary artery bypass graft or percutaneous coronary intervention procedure patients who participated in the Ornish Heart Disease Reversing Program, a traditional cardiac rehabilitation, and a control group that received no formal cardiac risk-reduction program. This was a longitudinal, observational study of 84 patients receiving CVD standard of care who elected to participate in 1 of the 3 study groups. Assessments of CVD risk factors and anginal severity were obtained at baseline, 3 months, and 6 months. RESULTS Ornish program participants had significantly greater reductions in anginal frequency, body weight, body mass index, systolic blood pressure, total cholesterol, low-density lipoprotein cholesterol, glucose, dietary fat, and increases in complex carbohydrates than were documented in the rehabilitation or control groups. The control group experienced the greatest reduction in anginal pain severity, but also had significantly higher systolic blood pressure, total cholesterol, and low-density lipoprotein cholesterol. CONCLUSIONS These findings suggest that CVD patients who choose to participate in the Ornish program can experience greater improvements in CVD risks than patients who choose to participate in traditional cardiac rehabilitation or no formal program.

A Worksite Diabetes Prevention Program Two-Year Impact on Employee Health

The purpose of this study was to determine the 2-year impact of a worksite-based diabetes prevention program. Thirty-seven pre-diabetic and previously undiagnosed diabetic employees participating in a 12-month worksite diabetes prevention program were included. Weight, body mass index, waist circumference, oral glucose tolerance testing, fasting insulin, blood lipids, and aerobic fitness had improved significantly after 6 months. Much of this improvement continued through 12 months. One year following the intervention, oral glucose tolerance and aerobic fitness had improved significantly. Of the 22 employees remaining in the study through 24 months, more than half had normal results on glucose tolerance testing. Worksite diabetes prevention programs may reduce blood glucose below pre-diabetic and diabetic levels. Improvements in diabetes risk factors persisted for at least 2 years in most of these employees.

Presenteeism According to Healthy Behaviors, Physical Health, and Work Environment

The objective of this study is to identify the contribution that selected demographic characteristics, health behaviors, physical health outcomes, and workplace environmental factors have on presenteeism (on-the-job productivity loss attributed to poor health and other personal issues). Analyses are based on a cross-sectional survey administered to 3 geographically diverse US companies in 2010. Work-related factors had the greatest influence on presenteeism (eg, too much to do but not enough time to do it, insufficient technological support/resources). Personal problems and financial stress/concerns also contributed substantially to presenteeism. Factors with less contribution to presenteeism included physical limitations, depression or anxiety, inadequate job training, and problems with supervisors and coworkers. Presenteeism was greatest for those ages 30-49, women, separated/divorced/widowed employees, and those with a high school degree or some college. Clerical/office workers and service workers had higher presenteeism. Managers and professionals had the highest level of presenteeism related to having too much to do but too little time to do it, and transportation workers had the greatest presenteeism because of physical health limitations. Lowering presenteeism will require that employers have realistic expectations of workers, help workers prioritize, and provide sufficient technological support. Financial stress and concerns may warrant financial planning services. Health promotion interventions aimed at improving nutrition and physical and mental health also may contribute to reducing presenteeism.