A Case Study of 10-Year Health Risk Appraisal Participation Patterns in a Comprehensive Health Promotion Program

Meta-analysis of workplace physical activity interventions

CONTEXT

Most adults do not achieve adequate physical activity levels. Despite the potential benefits of worksite health promotion, no previous comprehensive meta-analysis has summarized health and physical activity behavior outcomes from such programs. This comprehensive meta-analysis integrated the extant wide range of worksite physical activity intervention research.

EVIDENCE ACQUISITION

Extensive searching located published and unpublished intervention studies reported from 1969 through 2007. Results were coded from primary studies. Random-effects meta-analytic procedures, including moderator analyses, were completed in 2008.

EVIDENCE SYNTHESIS

Effects on most variables were substantially heterogeneous because diverse studies were included. Standardized mean difference (d) effect sizes were synthesized across approximately 38,231 subjects. Significantly positive effects were observed for physical activity behavior (0.21); fitness (0.57); lipids (0.13); anthropometric measures (0.08); work attendance (0.19); and job stress (0.33). The significant effect size for diabetes risk (0.98) is less robust given small sample sizes. The mean effect size for fitness corresponds to a difference between treatment minus control subjects' means on VO2max of 3.5 mL/kg/min; for lipids, -0.2 on the ratio of total cholesterol to high-density lipoprotein; and for diabetes risk, -12.6 mg/dL on fasting glucose.

CONCLUSIONS

These findings document that some workplace physical activity interventions can improve both health and important worksite outcomes. Effects were variable for most outcomes, reflecting the diversity of primary studies. Future primary research should compare interventions to confirm causal relationships and further explore heterogeneity.

The prevalence of metabolic syndrome in an employed population and the impact on health and productivity

OBJECTIVE

To investigate the prevalence of metabolic syndrome in an employed population and its association with health risks, health perception, illness days, work limitation (presenteeism), and short-term disability (STD).

METHODS

Five thousand five hundred twelve employees of a financial services company responded to an on-site health risk appraisal which included measured waist circumference and biometric results. The metabolic syndrome criteria were based on the 2005 AHA/NHLBI scientific statement on the diagnosis and management of metabolic syndrome. Perceived health, illness days, and presenteeism were self-reported; STD days were obtained from claims data.

RESULTS

In this employee population (61% women, average age 41 years), 22.6% met the criteria for metabolic syndrome and were more likely to report more health risks, poorer health perception, and more absent days due to illness. There was no clear association with presenteeism or STD incidence. However, as the number of metabolic risk factors increased, there was an increase in STD incidence, decrease in health perception, and increase in illness days. No association was found with number of metabolic risk factors and presenteeism.

CONCLUSIONS

Metabolic syndrome was associated with poor perceived health, increased illness days, and an increased trend of STD incidence. Worksite health promotion programs could be useful in helping employees and employers to identify metabolic syndrome risks and take steps to reduce risk and potential productivity losses.

Protective behavioral strategies and negative alcohol-related consequences in college students

OBJECTIVE

Alcohol abuse among college students is associated with a quality of life burden. The current study replicated and extended previous research on protective behavioral strategies (PBS) by examining relationships between PBS use and negative alcohol-related consequences.

METHOD

A national sample of 29,792 U.S. college students who completed the National College Health Assessment during spring 2004 was included. Using a retrospective analysis of cross-sectional data, relationships between PBS use and negative alcohol-related consequences were examined.

RESULTS

Greater PBS use was associated with fewer negative alcohol-related consequences, while less frequent use of PBS was correlated with increased negative alcohol-related consequences.

DISCUSSION

The current study findings strongly support expanded educational alcohol-intervention programs promoting greater PBS use aimed at reducing or completely alleviating negative alcohol-related consequences (e.g., BASICS, ASTP). Future research should further investigate such PBS-based intervention programs, examine the existence of latent PBS, and study use of combined PBS.

Worker productivity loss associated with arthritis

This study at a major financial services corporation sought to investigate the association of arthritis with on-the-job productivity, also termed "presenteeism." Using a modified version of the Work Limitations Questionnaire (WLQ) incorporated into a Health Risk Appraisal (HRA), 17,685 employees responded to the survey in 2002. Of the 16,651 respondents meeting inclusion criteria, 2,469 (14.8%) reported having arthritis, and 986 (39.9% of those with arthritis) also reported that they were under medical care and/or taking medication for arthritis. Employees with arthritis were older, predominantly female, and reported a higher number of comorbidities. Although all four domains of the WLQ (physical, time, mental, and output) were impacted by arthritis, the greatest productivity effect, as expected, was on physical work tasks. Health risks also play a role in the relationship between arthritis and presenteeism, with high-risk individuals reporting 7%-10% additional loss of productivity compared to lowrisk individuals. In addition, those who reported receiving medication and/or treatment for arthritis had a 2.5% excess productivity loss independently attributed to their arthritis, which equals approximately 1,250 US dollars per employee per year, or 5.4 million US dollars to the corporation. This arthritis effect was discernible in those with low and moderate levels of health risk, but was not as evident in those with high health risks; in that group, health-associated decrements in productivity were much larger. Arthritis is associated with work productivity loss. Disease management programs should focus on pain management and arthritis-associated health risks and comorbidities in order to significantly decrease arthritis-related losses in on-the-job productivity.

Purging and alcohol-related effects in college women

OBJECTIVE

Previous research indicates that college students who purge are more likely to consume alcohol in an unhealthy manner. The current study replicates and extends a previous study but employs a much larger, national sample. This study addresses 2 questions: (a) Are 18-24-year-old college women who purge more likely to engage in high-risk alcohol behavior? (b) Are 18-24-year-old alcohol-drinking college women who purge more likely to report greater negative consequences of alcohol use.

METHOD

47,202 U.S. students completed the National College Health Assessment during Spring 2004. Alcohol consumption and negative alcohol-related consequences were compared in purging and nonpurging groups.

RESULTS

Respondents who purged reported heavier alcohol use and more negative consequences.

CONCLUSION

The current study expands previous research regarding the association between purging behaviors and consequences of alcohol use. Further research is necessary to elucidate the most effective prevention and treatment programs.

Cardiovascular Health Status and Health Risk Assessment Method of Preference Among Worksite Employees

We investigated whether employees (n = 62) selecting a self-report Health Risk Assessment (HRA) would be at increased CVD risk compared to employees (n = 114) choosing an HRA with measurement of cardiovascular (CVD) health indicators. Participants were mostly middle-aged (44.1 +/- 0.8 yr) men (71.6%) displaying borderline features of the cardiometabolic syndrome. Although there were no significant differences between the groups regarding their measured CVD health status or self-reported lifestyle habits, employees in both groups consistently over-stated their level of cardiovascular health. Contrary to reports in the literature, cardiovascular health status did not appear to influence employee HRA method of preference.Editors' Strategic Implications: These findings await replication in other samples, both more diverse and less self-selected. Nonetheless, the authors' methods and their conclusions about workers' over-estimation of their health and the lack of differences across assessment methods will be useful to employers, health professionals, and all practitioners with an interest in health risk assessments.

The association of health status, worksite fitness center participation, and two measures of productivity

OBJECTIVES

We sought to examine the associations between participation in a worksite fitness center and worker productivity.

METHODS

A modified Work Limitations Questionnaire (WLQ) and employees' short-term disability claims were used as productivity measures with multivariate logistic regression models to control for health risk, age, gender, and work location.

RESULTS

Nonparticipants in a worksite fitness center were more likely to report health-related work productivity limitations for time management (odds ratio [OR] = 1.62, 95% confidence interval [CI] = 1.09-2.41), physical work (OR = 1.58, CI = 1.03-2.43), output limitations (OR = 2.24, CI = 1.01-2.12), and overall work impairment (OR = 1.41, CI = 1.00-1.96) than fitness center participants. Fitness center participation also was associated with 1.3 days fewer short-term disability days per year per employee (P = 0.02) and 0.39 fewer health risks (P = 0.01).

CONCLUSIONS

These results support the association of worksite fitness center participants with improved worker productivity and fewer short-term disability workdays lost.

Caregiving for ill dependents and its association with employee health risks and productivity

This study examined the loss of productivity and health risk status associated with employees who provide care for an ill dependent. A total of 16,651 employees (23% response rate) of a major financial services company completed a confidential Health Risk Appraisal (HRA) that included an eight-item version of the Work Limitations Questionnaire and a self-report of time missed from work during the previous 2 weeks to care for an ill dependent. A total of 10.6% of the respondents reported an average of 7.7 hours absent from work during the previous 2-week period to provide care for an ill dependent. Caregiving also was associated with a significant increase in the number of health risks for the employee. As the demand for caregiving time increased, caregivers reported a significant increase in work limitations. Caregiving for an ill dependent is associated with increased absenteeism and significant work limitations while on the job. Programs and work organization that helps employees balance their caregiving responsibilities for ill dependents may have a positive effect on health and productivity.

The association of medical conditions and presenteeism

A self-reported measure of four domains of work impairment based on the Work Limitations Questionnaire was completed by 16,651 employees of a large financial services corporation. Using a multivariate model to control for coexisting conditions, age, and gender, significant relationships were observed between medical conditions and patterns of impaired work performance. Depression was highly associated with work limitations in time management (odds ratio [OR] = 2.05), interpersonal/mental functioning (OR = 2.50), and overall output (OR = 2.24). Arthritis (OR = 1.56) and low back pain (OR = 1.32) were associated with physical function limitations. These same two conditions were associated with limitations in mental/interpersonal functioning but with low back pain having the higher odds ratio (OR = 1.54 vs. 1.22). These results suggest that worksite interventions (eg, disease management programs) should be tailored to the unique effects observed with specific medical conditions. More targeted programs could have important benefits for productivity in the workplace.

Measuring the relationship between employees' health risk factors and corporate pharmaceutical expenditures

This study demonstrates the relationship between self-reported health risk factors on a health risk appraisal and pharmaceutical expenditures for a large employer. A total of 3554 employees who were participants in a pharmacy benefit plan for the entire year of 2000 completed a health risk appraisal. As the number of self-reported health risk factors increased from zero to six or more, corporate pharmaceutical costs increased in a stepwise manner: US dollars 345, 443, 526, 567, 750, 754, and 1121 US dollars, respectively. After controlling for age, gender, and the number of self-reported diseases, each additional risk factor was associated with an average annual increase in pharmacy claims costs of 76 US dollars per employee. Specific health risks were associated with significantly higher expenditures. The results provide estimates of incremental expenditures associated with common, potentially modifiable risk factors. Pharmaceutical expenditures should be considered by corporations in their estimates of total health-related costs and in prioritizing disease management initiatives based on health risk appraisal data.

The economic burden of lost productivity due to migraine headache: a specific worksite analysis

Large, epidemiologic survey studies have established that migraine headaches affect approximately 6% of men and 18% of women in the United States and that the condition peaks during the prime working years (25 to 55 years of age). The consequent economic burden experienced by employers is substantial. The majority of this economic burden is realized by employers in terms of lost productivity, a combination of costs attributable to absenteeism and to lost productivity while on the job ("presenteeism"). Although large survey studies have produced estimates of national prevalence and have suggested substantial national costs, specific employers are rarely able to apply these projections to their specific workforce. Using demographic and payroll data available from a large financial services corporation with over 80,000 employees, this study used established prevalence data to estimate corporate costs stemming from migraine-related absenteeism and reduced on-the-job productivity to total at least $21.5 M and $24.4 M. In addition, a comparison of predicted prevalence and cost impact was conducted using a simpler and less costly health risk appraisal. This assessment proved to be a reliable tool in assessing prevalence of migraineurs in this corporation's workforce. Its use with a sample of 19,853 employees at this corporation produced prevalence rates of 7.7% of men and 23.4% of women, estimates closely comparable to those of national surveys. Suggestions are made regarding a corporate response to the substantial costs of lost productivity associated with migraine headache.

Emerging research: a view from one research center

The Health Management Research Center at the University of Michigan has assembled a database on health risks, medical care costs, an in some cases, productivity measures for over 2,000,000 individuals. For employees of its corporate consortium members, the database contains seven to eighteen years of data. Working with this data, the research team has observed a number of emerging trends. These trends have been stable in this data set for a number of years, but some of them are yet to be subjected to rigorous external peer review. The trends are summarized below. 1) Annual participation rates of 20% to 30% in Health Risk Appraisal are typical; over 10 years, 80% participate at least once, 60% at least twice and 40% at least three times. 2) Among the employers in the data base, excess risk factors account for 21% to 31% of medical care costs, with a mean of 25%. 3) Medical care costs increase as the number risk factors and age increase. As risk factors increase, medical costs increase; as risk factors decrease, medical care costs decrease. The mean cost increase per risk factor increased ($350) may be more than double the mean cost decrease per risk factor decreased ($150). 4) Cost savings greatest among those who participate in programs multiple times. 5) Absenteeism seems to be higher and other measures of productivity lower for those with health risk factors. 6) Programs designed to keep healthy people healthy in addition to reducing the risks of those with multiple risks will probably provide the greatest return to the employers. 7) Best results may be achieved by focusing efforts on employees who have clusters of risk factors associated with low perceived health status. 8) A corporate wellness score which combines risk factor levels and participation rates may provide a "corporate wellness score" which can be used to compare health status across employer. 9) Increased use of longitudinal data sets, fuzzy cut points for data categories and data mining techniques may allow breakthroughs in future analysis efforts.