Meta-evaluation of worksite health promotion economic return studies: 2012 update

Workplace wellness across the lifespan: A pilot program for health promotion in a low- and middle-income country

Considering that a sizable segment of the population spends significant amount of time at work, workplaces have been identified as practical platforms for health educational programs. Although employee wellness programs in high-income countries have shown measurable benefits in productivity and physical and mental health, evidence-based programs in low- and middle-income countries, such as Lebanon, are unavailable. The aim is to develop and implement a pilot workplace wellness program focusing on health-related areas to improve health knowledge and behavior among working men and women of reproductive age. In collaboration with March of Dimes, the National Collaborative Perinatal Neonatal Network developed a culturally sensitive health education program focusing on lifestyle, infection, nutrition and family planning. Sessions were delivered by a multidisciplinary team of specialists at a local bank in Lebanon. To assess the impact of the program, participants completed Knowledge and Behavior Assessment Questionnaire (KBAQ) before and after implementation. KBAQ was conducted 6 months after implementation to measure retention and continuing impact. Forty-seven participants completed the program, of whom 44.7% are male, 98% have university degree and 56.5% are married. Total knowledge score improved significantly from 64.2 to 74.3 and remained significant at 6 months post-implementation with a score of 71.7 (p < 0.001). At 6-month follow-up, emotional score improved (p = 0.028), while smoking decreased (p = 0.008). Also, employees' health knowledge and behavior showed sustained and significant improvement. We plan to implement our program at other sites and among employees from different backgrounds to understand the impact of the wellness program on employees' knowledge and behaviors at a larger scale.

Does a GP service package matter in addressing the absence of health management by the occupational population? A modelling study

OBJECTIVE

To assess the influence of supply and demand factors on the contract behavior of occupational populations with general practitioner (GP) teams.

METHODS

We employed a system dynamics approach to assess and predict the effect of the general practitioner service package (GPSP) and complementary incentive policies on the contract rate for 2015-2030. First, the GPSP is designed to address the unique needs of occupational populations, enhancing the attractiveness of GP contracting services, including three personalized service contents tailored to demand-side considerations: work-related disease prevention (WDP), health education & counseling (HEC), and health-care service (HCS). Second, the complementary incentive policies on the supply-side included income incentives (II), job title promotion (JTP), and education & training (ET). Considering the team collaboration, the income distribution ratio (IDR) was also incorporated into supply-side factors.

FINDINGS

The contract rate is predicted to increase to 57.8% by 2030 after the GPSP intervention, representing a 15.4% increase on the non-intervention scenario. WDP and HEC have a slightly higher (by 2%) impact on the contract rate than that from HCS. Regarding the supply-side policies, II have a more significant impact on the contract rate than JTP and ET by 3-5%. The maximum predicted contract rate of 75.2% is expected by 2030 when the IDR is 0.5, i.e., the GP receives 50% of the contract income and other members share 50%.

CONCLUSION

The GP service package favorably increased the contract rate among occupational population, particularly after integrating the incentive policies. Specifically, for a given demand level, the targeted content of the package enhanced the attractiveness of contract services. On the supply side, the incentive policies boost GPs' motivation, and the income distribution motivated other team members.

Evaluating the impact of a sleep health education and a personalised smartphone application on sleep, productivity and healthcare utilisation among employees: results of a randomised clinical trial

OBJECTIVES

We evaluated an online Sleep Health and Wellness (SHAW) programme paired with dayzz, a personalised sleep training programme deployed via smartphone application (dayzz app) that promotes healthy sleep and treatment for sleep disorders, among employees at a large healthcare organisation.

DESIGN

Open-label, randomised, parallel-group controlled trial.

SETTING

A healthcare employer in the USA.

PARTICIPANTS

1355 daytime workers.

INTERVENTION

Participants were randomised to intervention (n=794) or control (n=561) on consent. Intervention participants received the SHAW educational programme at baseline plus access to the personalised dayzz app for up to 9 months. The control condition received the intervention at month 10.

PRIMARY AND SECONDARY OUTCOME MEASURES

Our primary outcome measures were sleep-related behavioural changes (eg, consistent sleep schedule); sleep behaviour tracked on an electronic sleep diary and sleep quality. Our secondary outcome measures included employee absenteeism, performance and productivity; stress, mood, alertness and energy; and adverse health and safety outcomes (eg, accidents).

RESULTS

At follow-up, employees in the intervention condition were more likely to report increased sleep duration on work (7.20 vs 6.99, p=0.01) and on free (8.26 vs 8.04, p=0.03) nights. At follow-up, the prevalence of poor sleep quality was lower in the intervention (n=160 of 321, 50%) compared with control (n=184 of 327, 56%) (p=0.04). The mean total dollars lost per person per month due to reduced workplace performance (presenteeism) was less in the intervention condition (US$1090 vs US$1321, p=0.001). Employees in the intervention reported fewer mental health visits (RR 0.72, 95% CI 0.56 to 0.94, p=0.01) and lower healthcare utilisation over the study interval (RR 0.81, 95% CI 0.67 to 0.98, p=0.03). We did not observe differences in stress (4.7 (95% CI 4.6 to 4.8) vs 4.7 (95% CI 4.6 to 4.8)), mood (4.5 (95% CI 4.4 to 4.6) vs 4.6 (95% CI 4.5 to 4.7)), alertness (4.9 (95% CI 4.8 to 5.0) vs 5.0 (95% CI 4.9 to 5.1)) or adverse health and safety outcomes (motor vehicle crashes: OR 0.82 (95% CI 0.34 to 1.9); near-miss crashes: OR=0.89 (95% CI 0.5 to 1.5) and injuries: 0.9 (95% CI 0.6 to 1.3)); energy was higher at follow-up in the intervention group (4.3 vs 4.5; p=0.03).

CONCLUSIONS

Results from this trial demonstrate that a SHAW programme followed by access to the digital dayzz app can be beneficial to both the employee and employer.

TRIAL REGISTRATION NUMBER

NCT04224285.

Nutritional Wellness for the Busy Health Care Provider: Small Everyday Wins

When describing health care provider wellness, diet and nutrition are typically not addressed. This, in combination with the lack of decent food and diet resources typically available to the typically busy health care provider, exposes a significant gap in the road to advancing clinician wellness. This article aims to describe the relationship between nutrition and well-being, and potential barriers to optimal nutrition encountered by health care providers in the workplace. Readily available and practical strategies to improve physician diet and nutrition include: mindful eating practices, home meal preparation, food journaling, and mobile applications. From an organizational level, once physicians are making more informed food choices it is the hospital's responsibility to make nutritional options available in the workplace.

The economic impact of workplace physical activity interventions in Europe: a systematic review of available evidence

Purpose

There is growing interest in the economic impact of workplace physical activity interventions, but the evidence is still lacking — especially in Europe. Although, some evidence on the return on investment (ROI) is found in literature, the included studies may not be applicable to the Europe situation. Therefore, the objective of this study was to review current evidence on the economic impact of workplace physical activity interventions in European countries.

Design/methodology/approach

A systematic review on the economic impact of worksite health promotion programs aiming at increasing physical activity was conducted. Five electronic databases (MEDLINE (Ovid), MEDLINE (PubMed), EMBASE, NHS-EED and Emerald Insights) were searched for relevant studies published between 2000 and 2020.

Findings

A total of 953 abstracts were screened, and 28 were reviewed, 11 of which met all inclusion criteria. The studies varied substantially in sample size, intervention type, duration and frequency of follow-up measurements, valuation methods and assessed economic outcomes. There is inconclusive evidence for decreasing absenteeism, positive net benefit (NB) and positive ROI. No evidence was found to indicate an effect on self-assessed productivity or job satisfaction.

Originality/value

This study is the first try to take the different working conditions from Europe into consideration. The authors found that working conditions could have some impact on the valuation of absenteeism costs and thereof on the ROI. Further, this study provides insight into how to deploy effective and efficient workplace physical activity interventions, based on a standardized and validated methodology and program scope.

Physical Activity and Adherence to the Mediterranean Diet among Spanish Employees in a Health-Promotion Program before and during the COVID-19 Pandemic: The Sanitas-Healthy Cities Challenge

Physical activity and a healthy diet are key factors for avoiding major noncommunicable diseases. The aim of the present study was to analyze how physical activity (PA) and adherence to the Mediterranean diet among employees participating in the Healthy Cities program have been affected during confinement due to the COVID-19 pandemic. The sample was composed of 297 employees from 40 leading companies based in Spain, who participated in the 5th edition of the Sanitas “Healthy Cities” challenge. The participants (148 women and 149 men), aged between 24 and 63 years old (M = 42.76; SD = 7.79) completed the short form of the International Physical Activity Questionnaire (IPAQ) and the PREDIMED (Prevención con Dieta Mediterránea) questionnaire to measure adherence to the Mediterranean diet before and during the pandemic. Pearson χ² tests revealed that workers were more likely to show sedentary behaviors during the pandemic than before (83.5% vs. 66.7%). Additionally, they were more likely to reach high levels of PA (51.2% vs. 64%), and Wilcoxon tests revealed that energy expenditure measured in Metabolic Equivalent of Task (MET) was higher during the pandemic (4199.03 METs) than before (3735.32 METs), due to an increase in moderate PA. Lastly, a higher adherence to a Mediterranean diet during the pandemic (76.4%) than before (54.5%) was reported. The findings of this investigation suggest a positive effect of working from home for employees involved in a health-promotion program, and highlight the relevance of this kind of action among this population.

Association of organizational factors with knowledge of effectiveness indicators and participation in corporate health and productivity management programs

OBJECTIVES

The working-age population is rapidly declining in Japan, so the government has adopted "health and productivity management" (HPM). This policy initiative aims to encourage corporations to view health promotion activities as an investment in their employees' health. The objective of this study was to examine the association between organizational factors and knowledge of the organization's effectiveness and program participation levels, and to understand the factors that affect effectiveness of corporations' activities.

METHODS

We used data from all corporations that completed the HPM Survey Sheets in 2018 (n = 1800). The explanatory variables were organizational factors: written company-wide policy, agenda item at management-level meetings, regular education for managers, and full-time occupational health staff. The outcome variables were knowledge of the corporation's status on the effectiveness indicators (employees' exercise habits, risk for high blood pressure, visiting hospital after a health examination, and long-term sickness absences) and rates of participation in four areas (health education, exercise program, dietary program, and influenza vaccination). The associations between organizational factors and knowledge on effectiveness indicators and rates of program participation were analyzed using multiple logistic regression analysis.

RESULTS

All the organizational factors were related to knowledge of effectiveness indicators, but only some were associated with the program participation indicators in the model, including all explanatory variables.

CONCLUSION

Enhancing organizational factors may lead to improvement of HPM programs and higher program participation among employees in corporations.

Eight-Year Health Risks Trend Analysis of a Comprehensive Workplace Health Promotion Program

Research has shown that workplace health promotion (WHP) efforts can positively affect employees' health risk accumulation. However, earlier literature has provided insights of health risk changes in the short-term. This prospective longitudinal quasi-experimental study investigated trends in health risks of a comprehensive, eight-year WHP program (n = 523-651). Health risk data were collected from health risk assessments in 2010-2011, 2013-2014, and 2016-2017, applying both a questionnaire and biometric screenings. Health risk changes were investigated for three different time-periods, 2010-2013, 2014-2017, and 2010-2017, using descriptive analyses, t-tests, and the Wilcoxon Signed Rank and McNemar's test, where appropriate. Overall health risk transitions were assessed according to low-, moderate-, and high-risk categories. Trend analyses observed 50-60% prevalence for low-, 30-35% for moderate-, and 9-11% high-risk levels across the eight years. In the overall health risk transitions of the three time-periods, 66-73% of participants stayed at the same risk level, 13-15% of participants improved, and 12-21% had deteriorated risk level across the three intervention periods. Our findings appear to indicate that the multiyear WHP program was effective in maintaining low and moderate risk levels, but fell short of reducing the total number of health risks at the population level.

A Corporate Wellness Program and Nursing Home Employees' Health

Background: Many employed Americans suffer from chronic conditions like obesity, diabetes, and cardiovascular diseases. Worksite wellness programs provide opportunities to introduce health promotion strategies. While there is evidence of the effectiveness of workplace health promotion, this is tempered by concern that benefits may be less available to low-wage workers with inflexible working conditions. Objective: The aim was to evaluate a workplace health promotion (WHP) in the long-term care sector (skilled nursing facilities). Methods: Nursing home employees from 18 facilities within a single company were surveyed by a standardized, self-administered questionnaire. A company-sponsored WHP program was offered to the facilities, which were free to take it up or not. We categorized the facilities by level of program adoption. Cross-sectional associations were estimated between program category and prevalence of individual-level worker health indicators, adjusting for center-level working conditions. Results: A total of 1,589 workers in 5 job categories completed the survey. Average levels of psychological demands and social support at work were relatively high. Supervisor support stood out as higher in centers with well-developed WHP programs, compared to centers with no programs. There were no differences among program levels for most health outcomes. Workers in centers with well-developed programs had slightly lower average body mass index and (unexpectedly) slightly lower prevalence of non-smoking and regular aerobic exercise. Conclusions: Only small health benefits were observed from well-developed programs and working conditions did not appear to confound the negative results. This low-intensity, low-resourced workplace health promotion program may have benefited a few individuals but seems to have had only modest influence on average levels of the measured health indicators. Many nursing home employees experience obstacles to health behaviors; approaches that provide more environmental and economic supports for healthy behaviors, such as Total Worker Health®, may yield larger health benefits.

Migrant Workers' Willingness to Participate in Workplace Health Promotion Programs: The Role of Interpersonal and Political Trust in China

High-level willingness to participate in WHPPs (Workplace Health Promotion Programs) can not only benefit employers and employees, but also can produce many positive social effects. In order to expand the existing body of research, the effects of subject cognition, interpersonal trust, political trust, and occupational safety and health concerns were explored. We surveyed 680 Chinese migrant workers who were in charge of participation decisions in their households (2,500 residents involved) from the three typical provinces. The association of social-economic determinants with the willingness to participate and the participating behavior was studied by logistic regression analysis. We find that almost all of workers show relatively high levels of willingness to participate, while nearly seventy percent of the migrant workers had not engaged in actual participation behavior. Regression analyses revealed that subject cognition, interpersonal trust, political trust, and concern for occupational safety and health were factors significantly influencing participating subjects' willingness to engage in WHPPs. Furthermore, mediation analyses demonstrated that the influence of subject cognition was partially mediated by political trust. The influence of subject cognition was partially mediated by political trust. We discuss why political trust may impact the influence of subject cognition on the willingness to participate. Our results provided important insights for both academic and practical application.

"I need to take care of myself": a qualitative study on coping strategies, support and health promotion for social workers serving refugees and homeless individuals

Background

Social workers provide support for various groups of clients, such as refugees and homeless people. Refugees and homeless individuals represent particularly vulnerable groups in precarious living conditions. Therefore, social workers serving these clients are likely to be confronted with extensive job demands. The aim of this study was to investigate the coping strategies of social workers serving refugees and homeless individuals and to explore their support sources and health promotion offers at work as well as their respective needs.

Methods

26 semi-structured qualitative interviews were carried out with social workers in Berlin and Hamburg and analysed according to Mayring’s qualitative content analysis.

Results

The respondents reported various coping strategies to deal with their job demands which involved both problem-oriented (e.g. time management, setting boundaries, seeking support in conflict situations) and emotion-focused approaches (e.g. self-care, distance from work, leisure activities). In addition, they emphasised various sources of workplace (social) support, e.g. provided by team members, supervisors, and other institutions. However, unmet needs for support were also formulated by the workers, e.g. in terms of individual supervision and regular exchange. Furthermore, several employees did not know about any health promotion offers at their workplace and expressed a desire for structural and behavioural health promotion measures.

Conclusions

In view of the diverse needs of the workers, the results can provide a basis to design needs-based health promotion interventions for staff in social work.

Employee wellness on the frontline: an interactional psychology perspective

Purpose

Employee wellness is vital to creating high-quality employee–customer interactions, yet frontline service workers (FLSWs) do not typically engage in, or benefit from, wellness initiatives. This paper aims to conceptually model the interactive influences of organizational and employee factors in influencing FLSW involvement in wellness programs and provides suggestions on how service organizations can enhance wellness behaviors and outcomes.

Design/methodology/approach

This paper builds upon classical and contemporary management theories to identify important gaps in knowledge about how employees and firms engage with wellness. Interactive psychology, emphasizing multidirectional interaction between person (employee) and situation (organization) wellness orientation, is introduced.

Findings

The paper develops a model that can be used to assess organizational wellness program effectiveness by emphasizing the interaction of employee and organizational wellness orientation. The model illustrates that wellness effectiveness relies equally on employee agency through an active wellness orientation matched with the organizational wellness orientation.

Originality/value

This paper questions the dominant approaches to assessing the effectiveness of workplace wellness initiatives, arguing for a more humanistic and agentic perspective rather than traditional organizationally centered fiscal measures.

Health and transitions into nonemployment and early retirement among older workers in Canada

Extending working lives is considered a viable solution to fiscal and macroeconomic challenges related to population ageing. Opportunities for sustained employment, however, are not experienced equally among older population, particularly among those with a health problem. This study aims to examine the longer-term effect of health on employment trajectories in later part of working life using a unique survey-administrative linked dataset for Canada. Specifically, we apply competing-risks models to analyze whether different aspects of health conditions at baseline predict subsequent exit routes, including nonemployment and early retirement. The nonparametric findings of the paper show that only about 33% of workers aged 50-62 with a health problem at baseline remained employed at age 64, compared to 55% of healthy workers. Exiting into nonemployment seemed more common among leavers with activity limitations, while early retirement was more likely among healthy leavers. These results are robust even when individuals' preferences for work and financial factors were controlled for. Moreover, we identify differential impacts of specific chronic diseases on early work exit. Not all symptoms affect employment transitions to a similar extent. Older workers who reported the comorbidity of mental and musculoskeletal disorders faced an increased risk of nonemployment, while the presence of diabetes and cardiovascular problems at baseline were more predictive of early retirement.

What do Workplace Wellness Programs do? Evidence from the Illinois Workplace Wellness Study

Workplace wellness programs cover over 50 million U.S. workers and are intended to reduce medical spending, increase productivity, and improve well-being. Yet limited evidence exists to support these claims. We designed and implemented a comprehensive workplace wellness program for a large employer and randomly assigned program eligibility and financial incentives at the individual level for nearly 5,000 employees. We find strong patterns of selection: during the year prior to the intervention, program participants had lower medical expenditures and healthier behaviors than nonparticipants. The program persistently increased health screening rates, but we do not find significant causal effects of treatment on total medical expenditures, other health behaviors, employee productivity, or self-reported health status after more than two years. Our 95% confidence intervals rule out 84% of previous estimates on medical spending and absenteeism.

Organizational-level determinants of participation in workplace health promotion programs: a cross-company study

BACKGROUND

Attracted by the expected benefits such as reduced absenteeism and increased productivity, more and more firms decide to implement workplace health promotion programs (WHPPs). However, those programs can only be effective if employees actually participate. This study aims to (1) gain insight into the degree of enrolment rates in such programs across companies and (2) identify organizational level factors that are associated with employee participation. Building on existing theory on organizational drivers of participation in corporate wellness programs, the study's main goal is to investigate which organizational factors determine whether employees enroll in a corporate fitness program or not.

METHODS

A business-to-business fitness platform company provided organizational level data on 61 client firms that have recently implemented a corporate wellness program. The data contained information on the enrolment rate per company and different organizational level variables. The following potential determinants of participation were analyzed: firm size, organizational program support and employee co-payment. A random effects model was used to examine associations between potential determinants and the program enrolment rate.

RESULTS

The average participation is limited (15.37%) but varies highly across companies (range 0.07-100.00%, monthly basis). Looking at the determinants of program enrolment, we find that organizational program support - the degree to which firm leadership encourages participation - positively influences the enrolment rate (β = 0.051 p < 0.001) while employee co-payment - the financial contribution employees have to make to participate - has a negative impact (β = - 0.002, p < 0.001). Furthermore, firm size has a negative relationship with firm enrolment.

CONCLUSIONS

Enrolment rates in WHPPs are limited, as many companies have difficulties to promote participation in WHPPs among employees. Strong organizational program support and low employee co-payment were identified as drivers of employee participation in corporate health programs. Hence, intensifying both social and financial support of employee participation may help to drive enrolment rates. Firm size was found to negatively affect the enrolment rate in WHPPs, implying that larger firms have to account for their size and corresponding complexity when implementing such a program.

Predictors of Health Self-Management Program Preference Among Lower-to-Middle Wage Employed Adults With Chronic Health Conditions

PURPOSE

We examined the extent to which demographic, chronic disease burden, and financial strain characteristics were associated with a preference for engaging in the Chronic Disease Self-Management Program (presented as a "health self-management program" [HSMP]) over a financial self-management program (FSMP) and a no program preference (NPP) group among employed adults.

DESIGN

Cross-sectional, correlation design using baseline data from a randomized controlled trial (RCT).

SUBJECTS

The analytic sample included 324 workers aged 40 to 64 years with 1 or more chronic disease conditions recruited into the RCT from 2015 to 2017.

MEASURES

Chronic disease burden measures included the number of chronic conditions, body mass index (BMI), and the 8-item and 15-item Patient Health Questionnaire (PHQ-8 and PHQ-15). Financial strain was measured as the inability to purchase essentials and food assistance receipt. Both individual and household measures of income were assessed.

ANALYSES

Multinomial logistic regression and post-hoc marginal effects models.

RESULTS

Moderate-to-severe depressive symptoms increased the likelihood of having an HSMP preference when compared with those preferring the FSMP (RR = 4.2, P < .05) but not those having NPP; while higher BMI marginally increased HSMP preference over FSMP preference, but not NPP groups (RR = 1.04, P < .05). Financial strain differentially, but significantly, reduces the likelihood of HSMP preference at varying levels of household poverty, depressive symptom severity, and financial strain.

CONCLUSION

Middle-aged, lower-to-middle income workers with moderate-to-severe depressive symptoms opt for HSMPs over FSMPs, but preference for HSMPs significantly diminished when they are experiencing financial strain.

Wellness programme at the workplace promotes dietary change and improves health indicators in a longitudinal retrospective study

OBJECTIVE

To determine the effectiveness of a workplace wellness programme intervention in improving participants' behaviour towards choosing a healthy diet and the correlation with health indicators.

DESIGN

A retrospective cohort study.

SETTING

Wellness programme in the Midwest, USA.

SUBJECTS

Employees (n 12 636) who participated in a wellness programme for three consecutive years during years 2004 to 2013 and who completed web-based health risk questionnaires. The wellness programme included annual health screening, laboratory measures, health risk questionnaire and personalized health-care programme. Participants' food group intakes, BMI and health indicators were compared between the first and last year of participation. McNemar's non-parametric test was used for paired nominal data. Pearson correlations were computed for paired food and health indicator measurements. Correlations between dietary intake and BMI, cholesterol and TAG were computed using Pearson correlations and McNemar's test.

RESULTS

There were negative correlations between intakes of fruits, vegetables, grains, dairy, healthy eating pattern and health outcome indicators such as BMI and TAG levels. Additionally, the percentage of employees who increased their consumption of fruits (16·88 v. 12·08 %, P&lt;0·001), vegetables (15·20 v. 11·44 %, P&lt;0·001) and dark green leafy vegetables (12·03 v. 7·27 %, P 0·001) was significantly higher than the percentage of participants who decreased their intake of these food groups during the third-year follow-up.

CONCLUSIONS

The wellness programme improved some health indicator parameters and had a positive impact on increasing participants' intakes of fruits, vegetables and whole grains at the third year of follow-up.

Workplace health promotion for employees working in offshore wind parks in the German exclusive economic zone: a mixed-methods study

OBJECTIVES

To investigate the awareness and use of health promotion offers among offshore wind workers and to study associations with demographic and workplace characteristics. To examine employees' reasons for (non-)participation and their wishes for health promotion activities offshore.

DESIGN

Mixed-methods study presenting the results from semistructured telephone interviews and a web-based cross-sectional survey.

SETTING

Offshore wind parks in the German exclusive economic zone in the North and Baltic Seas.

PARTICIPANTS

21 offshore workers in the qualitative study (19 male/2 female; all German). 303 offshore workers in the quantitative study (287 male/13 female; 275 German/24 other nationalities).

OUTCOME MEASURES

Awareness and use of workplace health promotion offers and associations with demographic and workplace characteristics (age, work schedule and wind park phase); reasons for (non-)participation; needs and wishes for health promotion offers.

RESULTS

Few workers indicated being aware of health promotion programmes at their workplace. Single offers were reported, with fitness facilities being the most common offer employees recognised and had used (n=168, 55.6%). Employees with a regular work schedule were more likely to have used fitness facilities offshore (adjusted OR (AOR)=3.22, 95% CI 1.53 to 6.80). Workers in the construction phase were more likely to have used massages (AOR=8.19, 95% CI 2.82 to 23.77). Younger workers were less likely to belong to the group of those who were aware of fitness facilities but had not used them (AOR=0.43, 95% CI 0.19 to 0.98). Employees expressed various needs and wishes for behavioural and environmental preventive measures offshore.

CONCLUSIONS

The results demonstrate a perceived need among the workers for the development of health promotion programmes offshore. Since the awareness and use of offers may partly depend on personal and organisational characteristics, this should be taken into account in the planning of health promotion activities.

Assessment of a physical activity program on the medical-hospital costs of a healthcare company

Background

The protective effect of regular physical activity against risk of development of noncommunicable diseases and reduction of medical-hospital costs are well established in the literature. However, no study investigated the financial impact of workplace physical activity promotion programs in Brazil.

Objective

To investigate the financial impact of a workplace physical activity promotion program on the medical-hospital costs of a private healthcare company.

Methods

The average healthcare cost per capita was monitored along one year and compared between employees who performed physical activity with sufficient frequency and the ones who did not adhere to the program. Employees were matched per age, sex and length of work at the company.

Results

From 3,744 employees offered participation in the program, only 80 performed physical activity 2 or more times per week. The average medical-hospital cost per capita/year was BRL 2,874.00 (SD=5.259), being BRL 125.00 higher, on average, for the employees who did not adhere to the program. The average medical-hospital cost per capita/year was BRL 1,901.00 lower, on average, for the employees who performed physical activity 3 or more times per week (n=3) compared to the ones who did not (p=0.34).

Conclusions

The results of the present study do not allow asserting that the medical-hospital costs of employees who adhered to the program decreased. Longer follow-up and adjustments in the program design are needed to assess its actual impact.

Does Implementation Follow Design? A Case Study of a Workplace Health Promotion Program Using the 4-S Program Design and the PIPE Impact Metric Evaluation Models

Objective:

The aim of this study was to describe the content of a multiyear market-based workplace health promotion (WHP) program and to evaluate design and implementation processes in a real-world setting.

Methods:

Data was collected from the databases of the employer and the service provider. It was classified using the 4-S (Size, Scope, Scalability, and Sustainability) and PIPE Impact Metric (Penetration, Implementation) models. Data analysis utilized both qualitative and quantitative methods.

Results:

Program design covered well the evidence-informed best practices except for clear path toward sustainability, cooperation with occupational health care, and support from middle-management supervisors. The penetration rate among participants was high (99%) and majority (81%) of services were implemented as designed.

Conclusion:

Study findings indicate that WHP market would benefit the use of evidence-based design principles and tendentious decisions to anticipate a long-term implementation process already during the planning phase.

Factors Associated With Interest in Worksite Health-Related Discussions/Events Among Employed Adults With Chronic Conditions

OBJECTIVE

Worksite health promotion interventions have the potential to reach half of Americans nationally, but low participation rates hinder optimal intervention effectiveness. This study examines factors associated with employee interest in worksite health-related discussions/events.

METHOD

We analyzed cross-sectional survey data from a representative sample of employed adults in California with one or more chronic conditions. An ordinal regression model was developed.

RESULTS

Employees who reported more interest in worksite health-related discussions/events had higher coworkers support, perceived greater value from learning health-related knowledge and getting practical tips from others, and reported higher interest in health discussions/events held in community settings.

CONCLUSION

Efforts are needed to enhance the culture of worksite health and encourage communication and support among workers. Practitioners should consider connecting different settings to enhance reach and accessibility, and applying multiple delivery strategies to increase employee interest and engagement.

Effectiveness of a Multilevel Workplace Health Promotion Program on Vitality, Health, and Work-Related Outcomes

OBJECTIVE

Evaluation of the effectiveness of a workplace health promotion program on employees' vitality, health, and work-related outcomes, and exploring the influence of organizational support and the supervisors' role on these outcomes.

METHODS

The 5-month intervention included activities at management, team, and individual level targeting self-management to perform healthy behaviors: a kick-off session, vitality training sessions, workshops, individual coaching, and intervision. Outcome measures were collected using questionnaires, health checks, and sickness absence data at baseline, after the intervention and at 10 months follow-up. For analysis linear and generalized mixed models were used.

RESULTS

Vitality, work performance, sickness absence, and self-management significantly improved. Good organizational support and involved supervisors were significantly associated with lower sickness absence.

CONCLUSIONS

Including all organizational levels and focusing on increasing self-management provided promising results for improving vitality, health, and work-related outcomes.

Expert opinions on good practice in evaluation of health promotion and primary prevention measures related to children and adolescents in Germany

Background

Determining what constitutes “good practice” in the measurement of the costs and effects of health promotion and disease prevention measures is of particular importance. The aim of this paper was to gather expert knowledge on (economic) evaluations of health promotion and prevention measures for children and adolescents, especially on the practical importance, the determinants of project success, meaningful parameters for evaluations, and supporting factors, but also on problems in their implementation. This information is targeted at people responsible for the development of primary prevention or health promotion programs.

Methods

Partially structured open interviews were conducted by two interviewers and transcribed, paraphrased, and summarized for further use. Eight experts took part in the interviews.

Results

The interviewed experts saw evaluation as a useful tool to establish the effects of prevention programs, to inform program improvement and further development, and to provide arguments to decision making. The respondents’ thought that determinants of a program’s success were effectiveness with evidence of causality, cost benefit relation, target-group reach and sustainability. It was considered important that hard and soft factors were included in an evaluation; costs were mentioned only by one expert. According to the experts, obstacles to evaluation were lacking resources, additional labor requirements, and the evaluators’ unfamiliarity with a program’s contents. It was recommended to consider evaluation design before a program is launched, to co-operate with people involved in a program and to make use of existing structures.

Conclusion

While in in this study only a partial view of expert knowledge is represented, it could show important points to consider when developing evaluations of prevention programs. By considering these points, researchers could further advance towards a more comprehensive approach of evaluation targeting measures in children and adolescents.

An analysis of healthy workplace accreditation and health promotion efforts based on employees' perspectives

This study was conducted to analyze the effects of health promotion efforts in relation to a workplace accreditation program and differing workplace sizes. The research population for the study consisted of 966 employees working at a total of 84 different worksites located in Taipei, Taiwan. The survey instructions used were developed by the European Network for Workplace Health Promotion (WHP). The results indicate that accredited workplaces have better WHP quality than nonaccredited workplaces (p < .001) and commonly implement health promotion measures related to specific health issues. It is recommended that the government provide more health-related resources in workplaces, especially those of small and medium companies.

Cardiovascular Disease Risk Factors After an Employer-Based Risk Reduction Program: An Observational Cohort Study

Context

The burden of cardiovascular disease (CVD) continues to be a public health concern. Workplace interventions that focus on modifying lifestyle habits may reduce CVD risk factors in people at risk.

Objective

To determine the effectiveness of a comprehensive lifestyle intervention program that integrated dietary modification, physical activity, stress management, and behavior modification counseling to reduce the risk of CVD in at-risk adults.

Methods

Twelve 1-year cohorts who participated in a comprehensive employer-sponsored lifestyle intervention program targeting diet, exercise, behavior modification, and stress management between 2006 and 2010 at a rural university in Appalachian Ohio were studied. Body composition, fasting glucose and lipid levels, and maximal oxygen consumption were measured at baseline, after 100 days, and at 1 year. Repeated-measures analyses of variance were conducted to compare measures at baseline with measures at 100 days and at 1 year.

Results

Seventy-four participants (57 women [77.1%], 17 men [22.9%]) of 97 completed the program (76.3% completion rate). Body weight (P<.001); percentage of body fat (P<.001); fat mass (P<.001); body mass index (P<.001); waist circumference (P<.001); blood levels of high-density lipoprotein (P=.035), low-density lipoprotein (P=.011), and glucose (P=.008); serum triglyceride levels (P=.019); blood pressure (systolic P=.028; diastolic, P=.001); and maximal oxygen consumption (P<.001) improved from baseline to 1 year after the intervention. Lean body mass (P=.111) and total cholesterol (P=.053) did not improve.

Conclusions

This employer-based lifestyle intervention program was effective in reducing CVD risk factors after 1 year of treatment. Future studies should examine the effects of the intervention at 2 and 5 years to further assess long-term adoption of the lifestyle changes and maintenance of health promoted by this program.

Physical Activity and Exercise Interventions in the Workplace Impacting Work Outcomes: A Stakeholder-Centered Best Evidence Synthesis of Systematic Reviews

Background:

The prevention of work disability is beneficial to employees and employers, and mitigates unnecessary societal costs associated with social welfare. Many service providers and employers have initiated workplace interventions designed to reduce unnecessary work disability.

Objective:

To conduct a best-evidence synthesis of systematic reviews on workplace interventions that address physical activities or exercise and their impact on workplace absence, work productivity or financial outcomes.

Methods:

Using a participatory research approach, academics and stakeholders identified inclusion and exclusion criteria, built an abstraction table, evaluated systematic review quality and relevance, and interpreted the combined findings. A minimum of two scientists participated in a methodological review of the literature followed by a consensus process.

Results:

Stakeholders and researchers participated as a collaborative team. 3363 unique records were identified, 115 full text articles and 46 systematic reviews were included, 18 assessed the impact of physical fitness or exercise interventions. 11 focused on general workers rather than workers who were absent from work at baseline; 16 of the reviews assessed work absence, 4 assessed productivity and 6 assessed financial impacts.

Conclusion:

The strongest evidence supports the use of short, simple exercise or fitness programs for both workers at work and those absent from work at baseline. For workers at work, simple exercise programs (1–2 modal components) appear to provide similar benefits to those using more complex multimodal interventions. For workers off-work with subacute low back pain, there is evidence that some complex exercise programs may be more effective than simple exercise interventions, especially if they involve workplace stakeholder engagement, communication and coordination with employers and other stakeholders. The development and utilization of standardized definitions, methods and measures and blinded evaluation would improve research quality and strengthen stakeholder-centered guidance.

Strategies for Worksite Health Interventions to Employees with Elevated Risk of Chronic Diseases

Chronic disease rates have become more prevalent in the modern American workforce, which has negative implications for workplace productivity and healthcare costs. Offering workplace health interventions is recognized as an effective strategy to reduce chronic disease progression, absenteeism, and healthcare costs as well as improve population health. This review documents intervention and evaluation strategies used for health promotion programs delivered in workplaces. Using predetermined search terms in five online databases, we identified 1,131 published items from 1995 to 2014. Of these items, 27 peer-reviewed articles met the inclusion criteria; reporting data from completed United States-based workplace interventions that recruited at-risk employees based on their disease or disease-related risk factors. A content rubric was developed and used to catalogue these 27 published field studies. Selected workplace interventions targeted obesity (n = 13), cardiovascular diseases (n = 8), and diabetes (n = 6). Intervention strategies included instructional education/counseling (n = 20), workplace environmental change (n = 6), physical activity (n = 10), use of technology (n = 10), and incentives (n = 13). Self-reported data (n = 21), anthropometric measurements (n = 17), and laboratory tests (n = 14) were used most often in studies with outcome evaluation. This is the first literature review to focus on interventions for employees with elevated risk for chronic diseases. The review has the potential to inform future workplace health interventions by presenting strategies related to implementation and evaluation strategies in workplace settings. These strategies can help determine optimal worksite health programs based on the unique characteristics of work settings and the health risk factors of their employee populations.

Cardiovascular Risk Factors of Long-Term Care Workers

Little is known about long-term care workers’ cardiovascular disease (CVD) risk. Thus, the authors used baseline objective and subjective data from 98 long-term care staff participating in a worksite health promotion study to provide a comprehensive CVD assessment. The median age of the sample was 32 years ( SD = 13.38). Nine (12.2%) participants smoked and 27 (37.0%) participants reported exposure to secondhand smoke. The average nightly hours of sleep was 6.5 ( SD = 1.18), with 24 (32%) participants reporting sleeping at least fairly bad. Sixty-eight participants (73.1%) were overweight or obese. The median aerobic activity was 0 ( SD = 18.56). Participants ate on average 27 ( SD = 17.34) servings of high fatty and/or salty foods per week. Although blood pressure and cholesterol levels were within normal limits, this population demonstrated poor behavioral CVD risk factors. Given this finding and the young age of the sample, these workers may be ideal candidates for health promotion efforts before health risk factors are present.

A call to action on women's health: putting corporate CSR standards for workplace health on the global health agenda

Business operates within a Corporate Social Responsibility (CSR) system that the global health community should harness to advance women's health and related sustainable development goals for workers and communities in low- and middle-income countries. Corporations and their vast networks of supplier companies, particularly in manufacturing and agribusiness, employ millions of workers, increasingly comprised of young women, who lack access to health information, products and services. However, occupational safety and health practices focus primarily on safety issues and fail to address the health needs, including reproductive health, of women workers. CSR policy has focused on shaping corporate policies and practices related to the environment, labor, and human rights, but has also ignored the health needs of women workers. The authors present a new way for global health to understand CSR - as a set of regulatory processes governed by civil society, international institutions, business, and government that set, monitor, and enforce emerging standards related to the role of business in society. They call this the CSR system. They argue that the global health community needs to think differently about the role of corporations in public health, which has been as "partners," and that the global health practitioners should play the same advocacy role in the CSR system for corporate health policies as it does for government and international health policies.

The Stock Performance of C. Everett Koop Award Winners Compared With the Standard & Poor's 500 Index

OBJECTIVE

To explore the link between companies investing in the health and well-being programs of their employees and stock market performance.

METHODS

Stock performance of C. Everett Koop National Health Award winners (n = 26) was measured over time and compared with the average performance of companies comprising the Standard and Poor's (S&P) 500 Index.

RESULTS

The Koop Award portfolio outperformed the S&P 500 Index. In the 14-year period tracked (2000-2014), Koop Award winners' stock values appreciated by 325% compared with the market average appreciation of 105%.

CONCLUSIONS

This study supports prior and ongoing research demonstrating a higher market valuation--an affirmation of business success by Wall Street investors--of socially responsible companies that invest in the health and well-being of their workers when compared with other publicly traded firms.

Worksite Food and Physical Activity Environments and Wellness Supports Reported by Employed Adults in the United States, 2013

PURPOSE

To examine the workplace food and physical activity (PA) environments and wellness culture reported by employed United States adults, overall and by employer size.

DESIGN

Cross-sectional study using web-based survey on wellness policies and environmental supports for healthy eating and PA.

SETTING

Worksites in the United States.

PARTICIPANTS

A total of 2101 adults employed outside the home.

MEASURES

Survey items were based on the Centers for Disease Control and Prevention Worksite Health ScoreCard and Checklist of Health Promotion Environments and included the availability and promotion of healthy food items, nutrition education, promotion of breast-feeding, availability of PA amenities and programs, facility discounts, time for PA, stairwell signage, health promotion programs, and health risk assessments.

ANALYSIS

Descriptive statistics were used to examine the prevalence of worksite environmental and facility supports by employer size (<100 or ≥100 employees). Chi-square tests were used to examine the differences by employer size.

RESULTS

Among employed respondents with workplace food or drink vending machines, approximately 35% indicated the availability of healthy items. Regarding PA, 30.9% of respondents reported that their employer provided opportunities to be physically active and 17.6% reported worksite exercise facilities. Wellness programs were reported by 53.2% working for large employers, compared to 18.1% for smaller employers.

CONCLUSION

Employee reports suggested that workplace supports for healthy eating, PA, and wellness were limited and were less common among smaller employers.

The relationship between return on investment and quality of study methodology in workplace health promotion programs

OBJECTIVE

To determine the relationship between return on investment (ROI) and quality of study methodology in workplace health promotion programs.

DATA SOURCE

Data were obtained through a systematic literature search of National Health Service Economic Evaluation Database (NHS EED), Database of Abstracts of Reviews of Effects (DARE), Health Technology Database (HTA), Cost Effectiveness Analysis (CEA) Registry, EconLit, PubMed, Embase, Wiley, and Scopus.

STUDY INCLUSION AND EXCLUSION CRITERIA

Included were articles written in English or German reporting cost(s) and benefit(s) and single or multicomponent health promotion programs on working adults. Return-to-work and workplace injury prevention studies were excluded.

DATA EXTRACTION

Methodological quality was graded using British Medical Journal Economic Evaluation Working Party checklist. Economic outcomes were presented as ROI.

DATA SYNTHESIS

ROI was calculated as ROI = (benefits - costs of program)/costs of program. Results were weighted by study size and combined using meta-analysis techniques. Sensitivity analysis was performed using two additional methodological quality checklists. The influences of quality score and important study characteristics on ROI were explored.

RESULTS

Fifty-one studies (61 intervention arms) published between 1984 and 2012 included 261,901 participants and 122,242 controls from nine industry types across 12 countries. Methodological quality scores were highly correlated between checklists (r = .84-.93). Methodological quality improved over time. Overall weighted ROI [mean ± standard deviation (confidence interval)] was 1.38 ± 1.97 (1.38-1.39), which indicated a 138% return on investment. When accounting for methodological quality, an inverse relationship to ROI was found. High-quality studies (n = 18) had a smaller mean ROI, 0.26 ± 1.74 (.23-.30), compared to moderate (n = 16) 0.90 ± 1.25 (.90-.91) and low-quality (n = 27) 2.32 ± 2.14 (2.30-2.33) studies. Randomized control trials (RCTs) (n = 12) exhibited negative ROI, -0.22 ± 2.41(-.27 to -.16). Financial returns become increasingly positive across quasi-experimental, nonexperimental, and modeled studies: 1.12 ± 2.16 (1.11-1.14), 1.61 ± 0.91 (1.56-1.65), and 2.05 ± 0.88 (2.04-2.06), respectively.

CONCLUSION

Overall, mean weighted ROI in workplace health promotion demonstrated a positive ROI. Higher methodological quality studies provided evidence of smaller financial returns. Methodological quality and study design are important determinants.

Impact of a Comprehensive Workplace Hand Hygiene Program on Employer Health Care Insurance Claims and Costs, Absenteeism, and Employee Perceptions and Practices

OBJECTIVE

The aim of this study was to determine the efficacy of a multimodal hand hygiene intervention program in reducing health care insurance claims for hygiene preventable infections (eg, cold and influenza), absenteeism, and subjective impact on employees.

METHODS

A 13.5-month prospective, randomized cluster controlled trial was executed with alcohol-based hand sanitizer in strategic workplace locations and personal use (intervention group) and brief hand hygiene education (both groups). Four years of retrospective data were collected for all participants.

RESULTS

Hygiene-preventable health care claims were significantly reduced in the intervention group by over 20% (P < 0.05). Absenteeism was positively impacted overall for the intervention group. Employee survey data showed significant improvements in hand hygiene behavior and perception of company concern for employee well-being.

CONCLUSION

Providing a comprehensive, targeted, yet simple to execute hand hygiene program significantly reduced the incidence of health care claims and increased employee workplace satisfaction.

Comparison of smoking cessation between education groups: findings from 2 US National Surveys over 2 decades

OBJECTIVES

We examined smoking cessation rate by education and determined how much of the difference can be attributed to the rate of quit attempts and how much to the success of these attempts.

METHODS

We analyzed data from the National Health Interview Survey (NHIS, 1991-2010) and the Tobacco Use Supplement to the Current Population Survey (TUS-CPS, 1992-2011). Smokers (≥ 25 years) were divided into lower- and higher-education groups (≤ 12 years and >12 years).

RESULTS

A significant difference in cessation rate between the lower- and the higher-education groups persisted over the last 2 decades. On average, the annual cessation rate for the former was about two thirds that of the latter (3.5% vs 5.2%; P<.001, for both NHIS and TUS-CPS). About half the difference in cessation rate can be attributed to the difference in quit attempt rate and half to the difference in success rate.

CONCLUSIONS

Smokers in the lower-education group have consistently lagged behind their higher-education counterparts in quitting. In addition to the usual concern about improving their success in quitting, tobacco control programs need to find ways to increase quit attempts in this group.

Economic impact of corporate wellness programs in Europe: A literature review

OBJECTIVES

The purpose of this review is to summarize the current evidence on the economic impact of corporate wellness programs (CWPs) in Europe from the results of randomized controlled trials (RCTs) published up to 2013.

METHODS

A review was undertaken by searching for RCTs with key words in the following databases: PubMed, SPORT-Discus, and Business Source Premier. Only RCTs that evaluated the economic impact of CWPs, and included analyses performed in Europe with results converted into monetary values, were eligible for inclusion. An approach to economic analyses from both an employer's perspective and a societal perspective was also undertaken.

RESULTS

Eleven RCTs were identified, and review of these studies determined that the economic impact of the majority of CWPs analyzed was mostly negative. We discuss a possible explanation for these discrepancies with regard to prior reviews in this area. Despite the fact that the RCT is the "gold standard" for investigating without bias, several limitations to the methodology may have influenced the results of the studies in this review and suggested the use of caution in the interpretation of the results.

CONCLUSIONS

The findings of this review could be a "wake up call" for companies regarding the high probability of bias from non-RCT studies, the majority of which report a positive economic impact of these programs, and the risk of taking inappropriate decisions based on the results of such studies.

Integrated health programs, health outcomes, and return on investment: measuring workplace health promotion and integrated program effectiveness

OBJECTIVE

To explore return on investment (ROI) in workplace health promotion studies.

METHODS

Studies with high ROI attribution for workplace health promotion were reanalyzed using standardized measures. Key variables included intervention duration, sector and population size, annualized cost, and health outcomes.

RESULTS

ROI was often overestimated. Programs with the highest reported ROI were concentrated in large corporations, where cognitive programs incurred low per person costs. Ten of the 12 studies involved individualized health promotion only, and did not engage work organizational modification or integration with occupational health. Some effective health interventions were discounted because they were not easily monetized.

CONCLUSIONS

ROI, an investment metric, amplifies short-term labor-related effects and discounts longer-term chronic disease prevention.

Impact of individual and worksite environmental factors on water and sugar-sweetened beverage consumption among overweight employees

Introduction

The worksite environment may influence employees’ dietary behaviors. Consumption of water and sugar-sweetened beverages (SSBs) affect weight management; however, little research has evaluated the influence of worksite factors on beverage consumption. Our purpose was to determine whether individual and worksite factors are associated with water and SSB intake among overweight and obese employees.

Methods

Data were collected as part of baseline assessments for a worksite-based, weight-management intervention trial. Height and weight of participants (N = 1,482; 74% female; mean age = 47 y [standard deviation (SD) = 11y]; mean weight = 208 lbs [SD = 46 lbs]) were assessed, and participants completed a validated beverage intake questionnaire. Environmental characteristics of worksites (N = 28) were audited. A qualitative comparative analysis (QCA) was used to identify worksite conditions that may support healthier beverage intake patterns.

Results

Most participants were white (75% of sample) with at least some college education or a college degree (approximately 82% of sample). Mean water and SSB intake were 27 fl oz (SD = 18 fl oz) and 17 fl oz (SD = 18 fl oz), respectively; SSB intake (191 kcal [SD = 218 kcal]) exceeded the recommended discretionary energy intake. Statistical models did not identify any significant predictors of water intake. Female sex and increasing level of education and household income were associated with lower SSB intake; baseline body weight and greater number of worksite water coolers and vending machines were associated with higher SSB intake. The QCA identified worksite type (ie, not manual labor) as a condition necessary for healthier beverage consumption; a worksite break policy of 2 or more per day may lead to unhealthy beverage consumption.

Lower SSB consumption was noted among older participants, female participants, and among participants with higher education and income levels.

Conclusion

Workplace factors influence beverage consumption among overweight employees. Limiting vending machine availability and implementing policies that promote weight management may improve employee health.

Reliability and validity testing of the CDC Worksite Health ScoreCard: an assessment tool to help employers prevent heart disease, stroke, and related health conditions

OBJECTIVE

To develop, evaluate, and improve the reliability and validity of the CDC Worksite Health ScoreCard (HSC).

METHODS

We tested interrater reliability by piloting the HSC at 93 worksites, examining question response concurrence between two representatives from each worksite. We conducted cognitive interviews and site visits to evaluate face validity of items and refined the instrument for general distribution.

RESULTS

The mean question concurrence rate was 77%. Respondents reported the tool to be useful, and on average 49% of all possible interventions were in place at the surveyed worksites. The interviews highlighted issues undermining reliability and validity, which were addressed in the final version of the instrument.

CONCLUSIONS

The revised HSC is a reasonably valid and reliable tool for assessing worksite health promotion programs, policies, and environmental supports directed at preventing cardiovascular disease.

Do work relationships matter? Characteristics of workplace interactions that enhance or detract from employee perceptions of well-being and health behaviors

This qualitative case study adopted the position that health and health behaviors are complex social constructs influenced by multiple factors. Framed by the social ecological model, the study explored how work interactions enhanced or detracted from the perceptions of well-being and health behaviors. Despite the fact that previous studies indicated that the social workplace environment contributed to employee health, there was little information regarding the characteristics. Specifically, little was known about how employees perceived the connections between workplace interactions and health, or how social interactions enhanced or detracted from well-being and health behaviors. The participants included 19 volunteers recruited from four companies, who shared their experiences of workplace interactions through interviews and journaling assignments. The findings indicated that feelings of well-being were enhanced by work interactions, which were trusting, collaborative, and positive, as well as when participants felt valued and respected. The study also found that interactions detracted from well-being and health behaviors when interactions lacked the aforementioned characteristics, and also included lack of justice and empathy. The enhancing and detracting relationships generated physical symptoms, and influenced sleeping and eating patterns, socializing, exercise, personal relations, careers, and energy. Surprisingly, the study found that regardless of how broadly participants defined health, when they were asked to rate their health, participants uniformly rated theirs on physical attributes alone. The exclusive consideration of physical attributes suggests that participants may have unconsciously adopted the typical western medical view of health - an individually determined and physiologic characteristic. Despite research suggesting health is more than biology, and despite defining health broadly, participants uniformly adopted this traditional view. The study also offers human resource development professionals with evidence supporting interventions aimed at minimizing workplace incivility. Interventions designed to improve employee engagement could minimize financial and human costs of negative interactions. The bottom line is that workplaces should be physically, emotionally, and psychologically safe for well-being and healthy behaviors to flourish.