The relationship between modifiable health risks and health care expenditures. An analysis of the multi-employer HERO health risk and cost database

Health Care Expenditure Among People With Disabilities

Workplace health-promotion programs have the potential to reduce health care expenditures, especially among people with disabilities. Utilizing nationally representative survey data, the authors provide estimates for health care expenditures related to secondary conditions, obesity, and health behaviors among working-age people with disabilities. Furthermore, by computing the expenditures attributable to secondary conditions, obesity, and health behaviors, the authors emphasize the importance of disability-inclusive workplace health-promotion programs for employees with disabilities. Overall, the authors observed that the annual average health care expenditure among employed people with disabilities was US$4,524 (95% confidence interval [CI] = US$4,248–US$4,800) compared with US$1,325 (95% CI = US$1,299–US$1,351) for employed people without disabilities. Furthermore, obesity accounted for 27% to 41% of excess expenditures for people with various disability classifications compared with their nonobese peers with disabilities. Secondary conditions accounted for about 20% to 25% of higher health care expenditures among working people with various disability classifications, compared with their peers with disabilities who do not have secondary conditions. In addition, lack of exercise and alcohol consumption accounted for one fourth to over one third of excess health care expenditures among employed people with disabilities. The authors discuss implications of these findings for rehabilitation counselors and public health practitioners.

Cardiovascular fitness levels among American workers

OBJECTIVE

To explore cardiovascular fitness in 40 occupations using a nationally representative sample of the US population.

METHODS

Respondents aged 18 to 49 years (N = 3354) from the 1999 to 2004 National Health and Nutrition Examination Survey were evaluated for cardiovascular fitness and classified into low, moderate, and high levels. Comparisons were made among occupations.

RESULTS

Of all the US workers, 16% had low, 36% moderate, and 48% high cardiovascular fitness. Administrators, health occupations, wait staff, personal services, and agricultural occupations had a lesser percentage of workers with low cardiovascular fitness compared with all others. Sales workers, administrative support, and food preparers had a higher percentage of workers with low cardiovascular fitness compared with all others.

CONCLUSIONS

Cardiovascular fitness varies significantly across occupations, and those with limited physical activity have higher percentages of low cardiovascular fitness. Workplace strategies are needed to promote cardiovascular fitness among high-risk occupations.

The effect of 90 day administration of a high dose vitamin B-complex on work stress

OBJECTIVE

Occupational stress is increasing in Western societies and the impact is significant at a personal, organisational and community level. The present study examined for the first time the efficacy of 3 months administration of two forms of high dose vitamin B complex on mood and psychological strain associated with chronic work stress.

METHOD

Sixty participants completed the 3-month, double-blind, randomised, placebo-controlled trial in which personality, work demands, mood, anxiety and strain were assessed.

RESULTS

After individual differences in personality and work demands were statistically controlled, the vitamin B complex treatment groups reported significantly lower personal strain and a reduction in confusion and depressed/dejected mood after 12 weeks. There were no treatment-related changes in other measures of mood and anxiety.

DISCUSSION

The results of the study are consistent with two previous studies examining multivitamin supplementation and personal (non-work) feelings of strain and suggestive of significant decreases in the experience of workplace stress after 90 day supplementation of a B multivitamin.

CONCLUSION

Given the direct and indirect costs of workplace stress, these findings point to the utility of a cost-effective treatment for the mood and psychological strain effects of occupational stress. These findings may have important personal health, organisational and societal outcomes given the rising cost and incidence of workplace stress.

Psychosocial working conditions and the utilization of health care services

Background

While there is considerable theoretical and empirical evidence on how job stress affects physical and mental health, few studies have examined the association between job related stress and health care utilization. Using data from the Canadian National Population Health Survey from 2000 to 2008, this paper examines the association between stressful working conditions, as measured by the job strain model, and the utilization of health care services.

Methods

A zero inflated negative binomial regression is used to examine the excess health care utilization due to job strain. Separate regressions are estimated for both males and females since studies have shown gender differences in health care utilization.

Results

Estimates for the whole population show that high or medium job strain has a positive and statistically significant association with the number of visits to both a general practitioner (GP) and a specialist (SP). On average, the number of GP visits is up to 26% more (IRR = 1.26, 95% CI = 1.19-1.31) for individuals with high strain jobs compared to those in the low job strain category. Similarly, SP visits are up to 27% more (IRR = 1.27, 95% CI = 1.14-142) for the high strain category. Results are quantitatively similar for males and females, save for medium strain. In general, findings are robust to the inclusion of workplace social support, health status, provincial and occupational-fixed effects.

Conclusion

Job strain may be positively associated with the utilization of health care services. This suggests that improving psychosocial working conditions and educating workers on stress-coping mechanisms could be beneficial for the physical and mental health of workers.

A Review of Multiple Health Behavior Change Interventions for Primary Prevention

Most individuals engage in multiple unhealthy lifestyle behaviors with the potential for negative health consequences. Yet most health promotion research has addressed risk factors as categorically separate entities, and little is known about how to effectively promote multiple health behavior change (MHBC). This review summarizes the recent literature (January 2004 to December 2009) on randomized clinical trials evaluating MHBC interventions for primary prevention. Combining all the studies across all the reviews, fewer than 150 studies were identified. This is a fraction of the number of trials conducted on changing individual behavioral risks. Three primary behavioral clusters dominated: (1) the energy balance behaviors of physical activity and diet; (2) addictive behaviors like smoking and other drugs; and (3) disease-related behaviors, specifically cardiovascular disease (CVD) and cancer related. Findings were largely disappointing for studies of diet and physical activity, particularly with youth. Treating 2 addictions, including smoking, resulted in greater long-term sobriety from alcohol and illicit drugs. MHBC intervention effects were stronger and more consistent for cancer prevention than CVD prevention. MHBC interventions offer a new paradigm for broader, more comprehensive health promotion; however, the potential value in maximizing intervention impact is largely unmet.

A Review of Multiple Health Behavior Change Interventions for Primary Prevention

Most individuals engage in multiple unhealthy lifestyle behaviors with the potential for negative health consequences. Yet most health promotion research has addressed risk factors as categorically separate entities, and little is known about how to effectively promote multiple health behavior change (MHBC). This review summarizes the recent literature (January 2004 to December 2009) on randomized clinical trials evaluating MHBC interventions for primary prevention. Combining all the studies across all the reviews, fewer than 150 studies were identified. This is a fraction of the number of trials conducted on changing individual behavioral risks. Three primary behavioral clusters dominated: (1) the energy balance behaviors of physical activity and diet; (2) addictive behaviors like smoking and other drugs; and (3) disease-related behaviors, specifically cardiovascular disease (CVD) and cancer related. Findings were largely disappointing for studies of diet and physical activity, particularly with youth. Treating 2 addictions, including smoking, resulted in greater long-term sobriety from alcohol and illicit drugs. MHBC intervention effects were stronger and more consistent for cancer prevention than CVD prevention. MHBC interventions offer a new paradigm for broader, more comprehensive health promotion; however, the potential value in maximizing intervention impact is largely unmet.

Direct medical cost of overweight and obesity in the USA: a quantitative systematic review

To estimate per-person and aggregate direct medical costs of overweight and obesity and to examine the effect of study design factors. PubMed (1968-2009), EconLit (1969-2009) and Business Source Premier (1995-2009) were searched for original studies. Results were standardized to compute the incremental cost per overweight person and per obese person, and to compute the national aggregate cost. A total of 33 US studies met review criteria. Among the four highest-quality studies, the 2008 per-person direct medical cost of overweight was $266 and of obesity was $1723. The aggregate national cost of overweight and obesity combined was $113.9 billion. Study design factors that affected cost estimates included use of national samples vs. more selected populations, age groups examined, inclusion of all medical costs vs. obesity-related costs only, and body mass index cut-offs for defining overweight and obesity. Depending on the source of total national healthcare expenditures used, the direct medical cost of overweight and obesity combined is approximately 5.0% to 10% of US healthcare spending. Future studies should include nationally representative samples, evaluate adults of all ages, report all medical costs and use standard body mass index cut-offs.

Preterm birth prevention: a mandate for psychosocial assessment

Reviews panels on the prevention of preterm birth (PTB) conducted by the Office of the Surgeon General and the Eunice Kennedy Shriver National Institute of Child Health and Human Development made numerous novel recommendations for research on the assessment of risk factors for PTB and the development of personalized, specific interventions for the prevention of PTB. This paper discusses the particularly significant roles for nurses in assessment and intervention based on their education in pregnancy and in multiple health-related disciplines. General differences and specific anxiety assessment are presented based on the goals of research. An emphasis is placed on assessment of pregnancy-specific anxiety, and assessment and intervention methods that include the father/partner and couple using family system methodologies. The risks occurring with differences in partner intentions for pregnancy are discussed, and especially the benefits of male partner involvement and support. It is noted that interventions may need to be varied based on differences in gender, ethnic, cultural, and socioeconomic status. Differences in individual or group intervention psychotherapy approaches are considered. The special risks and needs of pregnant military couples, especially those with deployed partners are presented. Variations in anxiety are discussed in terms of implications for maternal/paternal fetal and child attachment from birth to adulthood. Discussion includes the considerable and varied parenting and financial strains that continue long after birth, with significant impact for parent-child mental and physical health, and the need for development of long-term interventions that include parental coping strategies and parental empowerment.

A collaborative university model for employee wellness

Universities are taking a more active approach in understanding and monitoring employees' modifiable health risk factors and chronic care conditions by developing strategies to encourage employees to start and sustain healthy behaviors. WellBama, the University of Alabama's signature health and wellness program, utilizes a collaborative model in partnership with select colleges and departments to implement strategies to improve employees' health status. The program provides onsite health screenings and assessments, timely health advising sessions, assistance in setting and monitoring individual health goals to promote improved health, and preventive examination referrals.

Predictive health: the imminent revolution in health care

Increasing social, economic, and political pressures to reform the U.S. approach to medical care makes change likely. A fundamental premise of predictive health is that it should be cheaper (at least per person life-year) and more efficient and have a greater return on the investment of keeping people healthy as opposed to waiting for disease to intervene. The Emory Predictive Health and Society Strategic Initiative and its Center for Health Discovery and Well Being have embarked on a program to define health to the extent that modern science permits in the context of the entire human experience, to identify measurable variables that describe and predict a healthy state, and to use that knowledge to design health-focused interventions that are affordable and effective. Initial results from a study of a randomly selected "essentially healthy" cohort, using extensive assessments and a health partner, are promising. Studies of healthy aging over the entire life spectrum promise valuable normative data for age-specific assessments of health and the setting of realistic health goals.

Healthcare use after screening for lung cancer

BACKGROUND

To evaluate the benefits of lung cancer screening, all effects of screening need to be considered. The aim of this study was to determine whether screening had an effect on healthcare use, specifically whether use increased for those with a false-positive or indeterminate screening result.

METHODS

Recruited were 400 individuals participating in a lung cancer screening study at the University of Pittsburgh. Self-reported outpatient healthcare use information was collected for the 6 months before, 0 to 6 months after, and 6 to 12 months after screening. The screening outcomes were negative, indeterminate, and suspicious. Repeated-measures Poisson regression models were used to examine changes in use over time and how changes over time varied among the screening outcome groups.

RESULTS

Approximately 58% of participants had a negative screening result, 36% had an indeterminate result, and approximately 6% had a suspicious result. The percentage of individuals who had any incidence of each type of outpatient use increased after screening, with the greatest increase noted for those with a suspicious screening result. Adjusted mean use significantly increased for nearly all types of use and for all 3 screening results categories in the 6 months after screening, but mostly declined to prescreening levels in the next 6 months.

CONCLUSIONS

Outpatient healthcare use was found to increase after screening for all individuals who were screened for lung cancer, regardless of the screening finding. The cost of the lung-related visits alone was substantial. Therefore, if lung cancer screening prevalence is increased, attendant follow-up healthcare costs are also likely to increase.

A Comparison of the Effectiveness of a Telephone Coaching Program and a Mail-Based Program

Many health promotion interventions have been developed and tested in recent years. Practitioners and researchers must continue to explore how various program delivery modalities can be used effectively and efficiently to optimize program outcomes. A sample of 6,055 participants was drawn from 10 large employers. Participants self-selected into a mail or telephone intervention. This study compared the demographics of those who selected each modality and assessed differences in program success relative to the modalities chosen. Telephone participants were more likely to be older, female, and salaried. Telephone participants were also more ready, confident, and motivated to make a behavior change, when compared to those in the mail program. Researchers found both the telephone and mail programs to be effective in reducing participants’ health risk status, though the telephone program was slightly more effective. These findings demonstrate the importance of offering a variety of interventions when promoting healthy changes. More research is needed to investigate the role of participant choice and the combinations of learning experiences that best facilitate sustainable behavior change.

Comparing alternative methods of targeting potential high-cost individuals for chronic condition management

OBJECTIVE

To compare the performance of predictive models based on health care claims, health risk assessment (HRA), or both in prospectively identifying high-cost individuals with chronic conditions.

METHODS

Participants included 8056 employees who completed an HRA and were enrolled in a health plan for at least 6 months during the 36-month study period. Two-stage multivariate regression identified predictors of claims cost in four age-by-gender groups.

RESULTS

All models predicted costs effectively, but the combined model performed better (R2 = 0.198 to 0.309) than either the claims-based (R2 = 0.168 to 0.263) or HRA-based model (R2 = 0.125 to 0.205).

CONCLUSION

An HRA-based predictive model appears to be a reasonable alternative to claims-based predictive models for identifying individuals for chronic condition management outreach. Where practical, a combined model offers advantages of both approaches and meaningfully increases accuracy.

The Novartis health index: a method for valuing the economic impact of risk reduction in a workforce

OBJECTIVES

To develop a calculator that measures the potential cost impact of changes in health risks and presents results graphically.

METHODS

Demographic and health risk data for Novartis employees were input into a calculator that estimated employer medical care, short-term disability, absenteeism, and presenteeism costs associated with risk prevalence, based on a previous cross-sectional analysis of the association between risks and costs. Estimated costs were presented as a relative score, the Novartis Health Index, which is a measure of the overall costs associated with the risk profile of a population of interest.

RESULTS

The population of Novartis employees had an index score of 81.5 (out of 100), indicating a relatively healthy risk profile, and baseline annual costs of $9619 per employee. Risk reduction of 1% and 10% for tobacco, alcohol use, and emotional health risks had the potential to generate annual savings of $91,500 and $915,000, respectively.

CONCLUSIONS

The Novartis Health Index framework allows employers to track performance relative to health risk management using a single, accessible, user-friendly measure.

Impact of worksite wellness intervention on cardiac risk factors and one-year health care costs

Cardiac rehabilitation and exercise training (CRET) provides health risk intervention in cardiac patients over a relatively short time frame. Worksite health programs offer a unique opportunity for health intervention, but these programs remain underused due to concerns over recouping the costs. We evaluated the clinical efficacy and cost-effectiveness of a 6-month worksite health intervention using staff from CRET. Employees (n = 308) and spouses (n = 31) of a single employer were randomized to active intervention (n = 185) consisting of worksite health education, nutritional counseling, smoking cessation counseling, physical activity promotion, selected physician referral, and other health counseling versus usual care (n = 154). Health risk status was assessed at baseline and after the 6-month intervention program, and total medical claim costs were obtained in all participants during the year before and the year after intervention. Significant improvements were demonstrated in quality-of-life scores (+10%, p = 0.001), behavioral symptoms (depression -33%, anxiety -32%, somatization -33%, and hostility -47%, all p values <0.001), body fat (-9%, p = 0.001), high-density lipoprotein cholesterol (+13%, p = 0.0001), diastolic blood pressure (-2%, p = 0.01), health habits (-60%, p = 0.0001), and total health risk (-25%, p = 0.0001). Of employees categorized as high risk at baseline, 57% were converted to low-risk status. Average employee annual claim costs decreased 48% (p = 0.002) for the 12 months after the intervention, whereas control employees' costs remained unchanged (-16%, p = NS), thus creating a sixfold return on investment. In conclusion, worksite health intervention using CRET staff decreased total health risk and markedly decreased medical claim costs within 12 months.

Using a personal health care cost calculator to estimate future expenditures based on individual health risks

OBJECTIVE

To describe the development and application of an innovative Health Improvement Cost Calculator tool designed to help individuals recognize the link between their current health risks, future medical costs, and productivity.

METHODS

We describe how the Calculator was developed using data from studies that tie health care costs and productivity to population health risks, and how changes in risks are projected to reduce future spending for individual workers.

RESULTS

Two simulations of the model illustrate how individuals may realize future economic costs or benefits depending on whether they maintain or change their health-risk profile.

CONCLUSIONS

The Calculator has the potential to be a powerful motivational tool for individuals, especially those heading toward retirement, who are looking to understand the relationships between their health risks, future medical spending, and impacts on productivity.

The association between changes in metabolic syndrome and changes in cost in a workplace population

OBJECTIVE

: To determine whether changes in metabolic syndrome (MetS) risks over time are associated with commensurate changes in health care costs, pharmacy costs and short-term disability costs in an employed population.

METHODS

: A total of 3270 employees of a Midwestern manufacturing corporation participated in a health risk appraisal, biometric screening and in the company's medical plan in 2004, 2005, and 2006. Changes in their MetS risks over time were compared with changes in costs.

RESULTS

: Risks for MetS in this manufacturing population are in a constant state of change. Changes in MetS status over time were associated with commensurate changes in health care, pharmacy, and short-term disability costs. Employees who reduced the greatest number of MetS risks over time had the largest cost decrease (-$437), whereas those who increased the greatest number of risks experienced the largest cost increase (+$1348).

CONCLUSIONS

: If organizations are successful in encouraging the high-risk individuals to reduce their risks while also helping the low-risk employees remain low risk, they will improve the health and vitality of employees while also improving cost and productivity outcomes.

Use of a normal impairment factor in quantifying avoidable productivity loss because of poor health

OBJECTIVE

Growing evidence demonstrates a relationship between excess health risk and preventable productivity loss. There is a need to quantify how much lost productivity is avoidable through employer-sponsored health management interventions. This study introduced the Normal Impairment Factor (NIF) to recognize the amount of productivity loss that cannot be mitigated through health management interventions.

METHODS

A health assessment questionnaire was administered to 772,750 employees, representing 106 employers within five industry sectors. Researchers used multivariate regression procedures to examine the association between preventable health risks and self-reported productivity loss.

RESULTS

Back pain, mental well being, and stress risk were the strongest predictors of on-the-job productivity loss. A strong association was also detected between the number of health risks and productivity loss ranging from 3.4% for those at lowest risk (the NIF group) to 24.0% loss for those at risk for eight risks.

CONCLUSIONS

This study demonstrated the utility of the NIF in estimating the level of productivity loss that cannot be regained through health management interventions.

Self-reported health risks linked to health plan cost and age group

BACKGROUND

Studies of private sector employee populations have shown an association between health-risk factors and healthcare costs. Few studies have been conducted on large, public sector employee populations. The objective of the current study was to quantify health plan costs associated with individual tobacco, obesity, and physical inactivity risks in Arkansas's state employee plan.

METHODS

De-identified medical and pharmacy claim costs incurred October 1, 2004-February 28, 2006 were linked with results from self-reported health-risk assessments (HRA) completed August 1, 2006-October 31, 2006. High- and no-risk groups were defined on the basis of cigarette use, BMI, and days/week of moderate physical activity. Annualized costs were compared between groups and across ages. Data were analyzed in September 2007.

RESULTS

Of the eligible adults (n=77,774), 56% (n=43,461) voluntarily accessed and completed an Internet-based HRA and had claims data-linked for analyses. Average annual costs across the eligible population totaled $3205. Respondents with high risks incurred greater annual costs ($4432) than those with no risks ($2382). Costs were greater among those with one or more risks, compared with no risks, and increased with age. The greatest average annual cost was for people aged 55-64 years in the high-risk group, who had a 2.2-fold higher cost than those aged 55-64 years in the no-risk group ($7233 versus $3266).

CONCLUSIONS

Healthcare costs increased with age and were differentially higher for those who used tobacco, were obese, or were physically inactive. The financial viability of the healthcare system is at risk, particularly in plans with a high proportion of adults with health-risk factors.

New hope for correctional officers: an innovative program for reducing stress and health risks

This study investigated the impact of a new stress management program on physiological and psychological stress and health risk factors among 75 correctional officers. The experimental group received training in emotion self-regulation techniques intended to reduce stress and health risk factors. Practice of the techniques was enhanced by heart rate variability feedback, which helped participants learn and sustain use of the self-management tools. Measures of physiological stress included cortisol, DHEA, cholesterol, triglycerides, fasting glucose levels, 10-min resting electrocardiogram, heart rate variability, and blood pressure. Three psychological questionnaires assessed emotional stress and work-related variables. There were significant improvements in the experimental group in cholesterol, glucose, heart rate, blood pressure and positive outlook and significant reductions in overall psychological distress. There were significant increases in productivity, motivation, goal clarity, and perceived support. The mean difference between pre- and post-intervention projected health care costs was calculated to be $1,179 per employee per year.

Stress perception and commuting

This paper analyzes the determinants of the perceived stress level of workers with a special focus on the effects of commuting, while controlling for personal and work-related characteristics. Using ordered logistic regression we find that several dimensions of the commuting situation, such as impedance, control and predictability of commuting, significantly influence the perceived stress level. Therefore, stress and stress-related health problems should be taken into consideration when analyzing the economic costs of commuting.

The Role of Incentive Design, Incentive Value, Communications Strategy, and Worksite Culture on Health Risk Assessment Participation

Purpose.

To examine the impact of financial incentives, communications strategy, and worksite culture on health risk assessment (HRA) participation rates.

Design.

A cross-sectional study design was used to examine factors that influence employee participation, including incentive value, incentive design, communications strategy, and worksite culture.

Setting.

Large private-sector and public-sector employers.

Participants.

Thirty-six employers (n = 559,988 employees) that provided financial incentives to promote employee HRA participation.

Intervention.

Organizations implemented the HRA as part of a more comprehensive worksite health promotion strategy that included follow-up interventions and a variety of other components. The primary outcome of interest was employee HRA participation.

Measures.

Information on program design and structure, as well as on HRA eligibility and participation, was collected for each organization via standard client report and semi-structured interviews with account managers. General linear regression models were used to examine the extent to which factors influence HRA participation independently and when controlled for other factors.

Results.

Incentive value (r2 = .433; p < .000), benefits-integrated incentive design (r2 = .184; p = .009), culture (r2 = .113; p = .045), and communications strategy (r2 = .300; p = .001) had positive bivariate associations with HRA participation rates. When all factors were included in the model, incentive value (p = .001) and communications strategy (p = .023) were significantly associated with HRA participation. Variance accounted for by all factors combined was R2 = .584.

Conclusion.

This study suggests that incentive value, incentive type, supportive worksite culture, and comprehensive communications strategy may all play a role in increasing HRA participation.

Modifiable health behaviors and short-term medical costs among health plan members

PURPOSE

Describe the relationship among modifiable health behaviors and short-term medical costs.

DESIGN

Prospective study linking cross-sectional survey data that assessed modifiable risk behaviors with insurance claims.

SETTING

A large health plan in Minnesota.

SUBJECTS

A stratified, random sample of 10,000 yielded an analytic data set for 7983 members.

MEASURES

The dependent variable was per-member-per-month insurance payment plus subscriber liability. Eighteen months of medical costs were analyzed. Control variables included subscriber age, sex, type of insurance plan, days of enrollment, chronic disease status, education, and marital status. Independent variables, included self-reported health behaviors of smoking, heavy drinking, nutrition, and physical activity.

ANALYSIS

Linear regression was performed on the natural log of the cost variable, followed by a retransformation to dollars.

RESULTS

Physical inactivity and smoking were significant predictors of higher medical costs. Each day a member did not exercise there was a 2.9% difference in cost. Compared with never smokers, current smokers had 16% higher costs. Former smokers who had quit more than 1 year before taking the survey had 15% higher costs than never smokers. Recent former smokers cost 32% more than never smokers and more frequently experienced smoking-related medical conditions before they quit. Alcohol consumption was nonsignificant. Nutrition also was not significant but was narrowly measured by only fruit and vegetable consumption.

CONCLUSION

Physical inactivity and smoking were associated with higher short-term medical costs among health plan members.

The impact of an integrated population health enhancement and disease management program on employee health risk, health conditions, and productivity

This study evaluated the impact of an integrated population health enhancement program on employee health risks, health conditions, and productivity. Specifically, we analyzed changes in these measures among a cohort of 543 employees who completed a health risk assessment in both 2003 and 2005. We compared these findings with 2 different sets of employees who were not offered health enhancement programming. We found that the DIRECTV cohort showed a significant reduction in health risks after exposure to the program. Relative to a matched comparison group, the proportion of low-risk employees at DIRECTV in 2005 was 8.2 percentage points higher; the proportion of medium-risk employees was 7.1 percentage points lower; and the proportion of high-risk employees was 1.1 percentage points lower (p < 0.001). The most noticeable changes in health risk were a reduction in the proportion of employees with high cholesterol; an improvement in diet; a reduction of heavy drinking; management of high blood pressure; improved stress management; increased exercise; fewer smokers; and a drop in obesity rates. We also found that a majority of employees who improved their risk levels from 2003 to 2005 maintained their gains in 2006. Employees who improved their risks levels also demonstrated relative improvement in absenteeism. Overall, this study provides additional evidence that integrated population health enhancement positively impacts employees' health risk and productivity; it also reinforces the view that "good health is good business."

A web-based approach to managing stress and mood disorders in the workforce

OBJECTIVE

To evaluate the effectiveness of a web-based multimedia health promotion program for the workplace, designed to help reduce stress and to prevent depression, anxiety, and substance abuse.

METHODS

Using a randomized controlled trial design, 309 working adults were randomly assigned to the web-based condition or to a wait-list control condition. All participants were assessed on multiple self-reported outcomes at pretest and posttest.

RESULTS

Relative to controls, the web-based group reduced their stress, increased their knowledge of depression and anxiety, developed more positive attitudes toward treatment, and adopted a more healthy approach to alcohol consumption.

CONCLUSIONS

We found that a brief and easily adaptable web-based stress management program can simultaneously reduce worker stress and address stigmatized behavioral health problems by embedding this prevention material into a more positive stress management framework.

Co-occurring mental illness and health care utilization and expenditures in adults with obesity and chronic physical illness

The objectives of the study were to compare health care expenditures between adults with and without mental illness among individuals with obesity and chronic physical illness. We performed a cross-sectional analysis of 2440 adults (older than age 21) with obesity using a nationally representative survey of households, the Medical Expenditure Panel Survey. Chronic physical illness consisted of self-reported asthma, diabetes, heart disease, hypertension, or osteoarthritis. Mental illness included affective disorders; anxiety, somatoform, dissociative, personality disorders; and schizophrenia. Utilization and expenditures by type of service (total, inpatient, outpatient, emergency room, pharmacy, and other) were the dependent variables. Chi-square tests, logistic regression on likelihood of use, and ordinary least squares regression on logged expenditures among users were performed. All regressions controlled for gender, race/ethnicity, age, martial status, region, education, employment, poverty status, health insurance, smoking, and exercise. All analyses accounted for the complex design of the survey. We found that 25% of adults with obesity and physical illness had a mental illness. The average total expenditures for obese adults with physical illness and mental illness were $9897; average expenditures were $6584 for those with physical illness only. Mean pharmacy expenditures for obese adults with physical illness and mental illness and for those with physical illness only were $3343 and $1756, respectively. After controlling for all independent variables, among adults with obesity and physical illness, those with mental illness were more likely to use emergency services and had higher total, outpatient, and pharmaceutical expenditures than those without mental illness. Among individuals with obesity and chronic physical illness, expenditures increased when mental illness is added. Our study findings suggest cost-savings efforts should examine the reasons for high utilization and expenditures for those with obesity, chronic physical illness, and mental illness.