Worksite Health Promotion

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Worksite Health Promotion

• A Systematic Review for the Community Guide

Robin Soler, PhD David Hopkins, MD, PhD Kimberly
Leeks, MPH (ABD) Sima Razi, MPH
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Review Scope

• The Worksite Chapter is concerned with people who
  work and interventions that may impact their
  behavior and health
• Interventions of interest include
• Worksite-centered interventions
• Interventions made available to workers
• By employers
• Through benefits
• Interventions that may apply to workers

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Priority Topics and Sample Interventions

• Tobacco
• Incentives and competitions
• Policies and bans
• Group programs
• Physical Activity
• Point-of-decision Prompts to Increase Stair Use
  (an update)
• Enhanced Access (to venues, classes, information,
  etc.)
• The Assessment of Health Risk with Feedback
• Multi-component interventions
• Nutrition
• Enhancing access to healthy foods

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Chapter Update

• Completed Three Intervention Reviews
• Point-of-Decision Prompts to Increase Stair Use
• Smoke-Free Policies to Reduce Tobacco Use Among
  Workers
• Incentives to Reduce Tobacco Use Among Workers
• Initiated Review of the Assessment of Health
  Risks with Feedback to Improve Health Outcomes
  among Workers

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Point-of-Decision Prompts

• Point-of-decision prompt interventions are
  implemented to encourage individuals to increase
  stair use.
• Point-of-decision prompts are motivational signs
  placed on or near stairwells or at the base of
  elevators and escalators encouraging people to
  use the stairs.

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Task Force Conclusion

• The Task Force recommends point-of-decision
  prompts on the basis of strong evidence of
  effectiveness to promote a moderate increase in
  physical activity, as measured by an increase in
  the percentage of people choosing to take the
  stairs.

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Smoke-free Policies

• Smoke-free policies include private-sector rules
  and public-sector regulations which prohibit
  smoking in indoor work spaces and public areas.
  Smoke-free policies may establish a complete ban
  on tobacco use on worksite property, or restrict
  smoking to designated outdoor locations.

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Task Force Conclusion

• The Task Force recommends smoke-free policies on
  the basis of sufficient evidence that these
  interventions increase cessation and reduce the
  prevalence of tobacco use. Smoke-free policies
  are effective in reducing tobacco use when
  implemented by worksites and when implemented by
  communities.

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Incentives and Competitions

• Incentives and competitions to reduce tobacco use
  among workers offer a reward to individuals
  (incentives) or to teams of individuals
  (competitions) on the basis of participation in a
  cessation effort and/ or success in behavior
  change (such as abstaining from tobacco use for a
  period of time).

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Incentives When Used Alone

• Body of Evidence Insufficient
• One study was identified, but did not qualify for
  evaluation
• Conclusion Insufficient Evidence
• Plan Research agenda

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Incentives When Combined with Additional
Interventions Task Force Conclusion

• The Task Force recommends the use of incentives
  and competitions when combined with additional
  interventions as part of a worksite effort to
  increase tobacco use cessation among workers.
  The Task Force recommendation is based on strong
  evidence on the effectiveness of these
  combinations in increasing cessation rates among
  recruited smokers. The evidence that incentives
  increase recruitment and participation was
  inconsistent, however, the participation rates
  obtained in the qualifying studies was high
  (median of 29 of eligible smokers).

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Assessment of Health Risks with Feedback (AHRF)

• A process or event involving the collection of
  Information about at least 2 health behaviors or
  indicators
• Includes a questionnaire
• May include biometric measurements
• Individual data used to evaluate individual
  health risks
• Qualitatively (smoking is bad) or
• Quantitatively (risk estimate or score)
• Feedback of results is provided verbally or in
  writing to motivate individual action

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Focus on Recommendation Outcomes
Health Behaviors
Physiologic Indicators
Qualifying Studies Report a Variety of
Different Outcomes
Health Risk Estimates
Use of Health Care Services
Worker Productivity
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Body of Evidence AHRF(n 34 Studies)
Qualifying studies 29 studies, 38 study arms
Excluded 5 studies
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Preliminary Assessment

• Too few studies with the same outcome measurement
  to draw conclusions about specific change
• Moderate change in 4 health behaviors
• Small change in 1 physiologic outcome, no change
  in 2 others
• Is there a cumulative effect of moderate change
  across outcomes?

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Biases in the Literature

• Study intention
• Not always to examine AHRF
• May be a priori
• Before-after study designs included
• Volunteer samples
• High attrition
• Studies used different definitions for risk
• To define sample
• In feedback
• To measure change

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Biases (cont)

• AHR developed as an intervention tool, not a
  research tool
• Self-report for behavioral outcomes
• Multiple tests
• Number of studies presenting multiple outcomes
• The more analyses performed on a data set, the
  more results will meet the conventional
  significance level "by chance"

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Next Steps AHRF PlusAHRF as Gateway to

• Universal interventions
• Open to most or all employees
• Include policies and programs
• Targeted interventions (with advice)
• Participants at higher-risk
• May include efforts specific to a risk factor or
  condition

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Common Additional Interventions
AHRF

Health Education
Enhanced Access
Incentives
Reduced Out-of-Pocket Costs
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Current Status

• Completing AHRF Plus for June Task Force meeting
• Considering next intervention for review
• Collaborating with DNPA obesity review team
• Consulting on next CDC point-of-decision prompts
  study
• Connecting with others in CDC with interests and
  expertise in worksite health promotion

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Questions?
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Contact Information

• Robin Soler
• rsoler_at_cdc.gov
• 404-498-0981
• www.thecommunityguide.org