[Obstacles to the development of workplace health promotion in Poland - the perspective of companies' representatives]

BACKGROUND

The aim of the paper is to present the barriers and difficulties faced by companies in Poland in their employee health promotion activities.

MATERIAL AND METHODS

The aforementioned obstacles were analyzed in terms of their quantity and quality. Quantitative data come from 5 nationwide surveys conducted in 2000 (N = 755), 2006 (N = 611), 2010 (N = 1002), 2015 (N = 1000) and 2017 (N = 1000), in companies employing ≥50 people. Qualitative data were collected from representatives of such companies by means of an audience survey conducted during a conference (N = 75), 8 focus group interviews (N = 64) and individual in-depth interviews (N = 14).

RESULTS

Invariably, the most frequently reported difficulty has been the shortage of financial resources for health promotion, as well as the lack of real support (legal, fiscal) from the government. By 2017, the former was indicated by 53% of companies, and the latter by 48%. A detailed analysis has shown that they are interrelated, and the key barrier is the mentality of employers and managers, i.e., their reluctance to health promotion, the fact that they are convinced of its high costs, a poor knowledge about its importance and implementation methods, and fear of the unknown. Other difficulties include: culture and work organization not fostering health care, a poor preparation and limited opportunities for the staff to implement health promotion, employees' reluctance to employer's health-related activities, some drawbacks of offers addressed to companies by external service providers, and, to a lesser extent, other difficulties arising from the business environment.

CONCLUSIONS

To effectively mitigate these barriers, it is necessary to involve the government in the implementation of a coherent strategy to support health promotion in companies. Its main directions would be: shaping employers' awareness, supporting health-related activities through fiscal mechanisms (tax and insurance), educating the managerial staff, and pursuing effective cooperation with external providers of health services for employees. Med Pr. 2020;71(5):569-86.

[Health promotion in medium-sized and large companies in Poland in 2017 - activities, implementation, effects and difficulties]

BACKGROUND

The paper presents the state of workplace health promotion in Poland as of December 2017.

MATERIAL AND METHODS

Standardized computer-assisted personal interviews (CAPI) were conducted on a representative sample of 1000 companies employing over 50 people.

RESULTS

Few companies (37%) actually know the health needs of their employees, whereas 25% admit that they care about health more than it is required by law, and declare their increased involvement in that area. At the same time, 55% of companies sponsor sports tickets, and 52% cover the costs of medical care. Every second company supports physical activity in other ways and improves the working environment. Every third offers medical prophylaxis, takes care of stress reduction and healthy eating habits, or solves the problems of alcohol consumption. The main reasons for such activities are the company's image (79%), good social atmosphere (72%) and employee's work performance (69%), while the prevention of health problems is rarely indicated (43%). The effects of workplace health promotion measures include improved productivity (50%), a better health condition (49%) and an increased identification with the company (47%). As for the obstacles, these is a shortage of financial resources (53%), the lack of favorable fiscal and legal solutions (48%), low interest among employees (45%), the lack of skilled people to manage health promotion (42%) and low awareness of its benefits (37%). Companies that are consciously involved in health promotion and monitor the actual health needs implement more activities, evaluate them more often, recognize their positive effects, and are able to better motivate their employees.

CONCLUSIONS

There is a need to develop systemic solutions that foster health promotion in companies, to disseminate knowledge about the benefits associated with it, and to train the staff responsible for employee health management. Med Pr. 2019;70(3):275-94.

Solving the problem of smoking in the Polish enterprises during 2003-2015

OBJECTIVES

Tobacco smoking is a major organizational, economical, and public relations-related (PR-related) problem for the company. Moreover, it is an important health determinant of the working population. The paper reports the results of the research which analyzed the current state and the tobacco control activities' transformations undertaken by Polish employers between 2003 and 2015.

MATERIAL AND METHODS

Data comes from the research performed in 2006, 2010 and 2015, involving random- selected representative samples of Polish enterprises, employing no fewer than 50 employees. The sampling pattern covered location and classification of activities (excluding public administration, national defense, social security, education, health care and social assistance sectors). Consecutive interviews were conducted with representatives of 611, 1002 and 1000 companies, respectively.

RESULTS

The companies improved their compliance with the national regulations on smoking in the workplace. The strategy for limiting smoking in public places resulted in a steady increase in the number of companies (11%, 23%, 38%, respectively) that introduced smoking ban. Approximately in every second company, smoking was allowed only in the smoking room or outdoors. Voluntary activities (e.g., education and support for employees wishing to cease smoking) were very rarely undertaken by medium and large companies (several percent) and since 2010, when the law had become more restrictive, such tendency reinforced. Employers also were seldom interested in the prevalence of tobacco smoking among their personnel, its consequences for the company's functioning and the effectiveness of the implemented tobacco control measures.

CONCLUSIONS

National anti-smoking policy caused that companies were more focused on smoking-bans at the expense of education and support for those who wanted to cease smoking. Although this contributes to reducing secondary smoking in the workplace, the companies' potential to become a major agent for tobacco control policies is neglected while the downward trend of smoking in the Polish society has slowed down. Int J Occup Med Environ Health 2018;31(3):261-280.

[How do Polish workers respond to the information concerning health-oriented lifestyle?]

BACKGROUND

Information overload, including commercial ones, about healthy lifestyle, is a challenge for perception of health education.

MATERIAL AND METHODS

The empirical data gathered from 100 employees in 2010 by means of free interviews with a standardized list of required information, aimed at analyzing a feeling of pressure to lead a healthy lifestyle, including reactions to meassages provided by the media.

RESULTS

Respondents feel pressure associated with a healthy lifestyle from doctors, the state, relatives, friends and themselves. They accept pressure exerted by doctors and appreciate it from relatives and friends, however, the latter may stimulate adverse behavior. As a negative pressure they perceive that imposed by the media, government's shifting the responsibility for citizens' health, information overload contradictory to their own knowledge, unattainable recommendations and their volatility. Such pressure evokes conviction for their own resistance or rejection of the messages. They criticize the media for promoting unhealthy behavior, attending interests of advertisers, hiding information about harmful environmental influence. They appreciate the media for facilitating learning about health and preventive examinations. Health education messages are only occasionally identified by better educated people.

CONCLUSIONS

"Dense" information environment is a hostile background for health education. An excess of critically evaluated information evokes pressure and lack of trust in information. Therefore, health education should facilitate the identification of its contents, avoid normative methods, limit the number of guidelines and better explain the faced changes, counteract tendencies to associate healthy lifestyle mainly with consumer behaviors, teach how to maintain self orientation in information overload conditions, and build up awareness of one's own brand. Med Pr 2017;68(4):525-543.

[Management of tobacco smoking in the prison service units - The effects of the health promotion program]

BACKGROUND

In 2014 the health promotion program aimed at managing personnel smoking was implemented in the Polish prison service (PS) in cooperation with the Nofer Institute of Occupational Medicine (NIOM). It combined education of managers, encouraging them to implement good practices, with employees' education. This paper describes the process of implementation and its effects in 159 units of PS, against the data on the management of smoking in medium and large companies in Poland gathered in 2010.

MATERIAL AND METHODS

Situations concerning smoking management in PS units before and after a half-year program implementation were compared. Data were gathered using self-diagnosis questionnaires (initial and final assessments) collectively filled in by representatives of management and employees.

RESULTS

Due to the program implementation there was an increase in the percentage of PS units with known number of smoking employees (19% vs. 61%), consultions on formal smoking regulations with personnel (14% vs. 57%), minimal antismoking medical interventions (46% vs. 59%), and assessments of effects of antismoking activities (14% vs. 55%). There was also increase in the number of PS units with personnel totally obeying smoking regulations (28% vs. 41%) and decrease in those where such rules are not completely met (9% vs. 7%). In 3/4 PS units there was an increase in employees' interest in quitting smoking and in 40% of them employees smoke less at work. Almost every second unit has set up a health promotion team.

CONCLUSIONS

In many aspects the program has brought along satisfying effects and allowed for depicting areas of improvement. Its scheme and tools can be used, after adaptation, in interventions concerning other health problems in workplaces. Med Pr 2016;67(5):605-621.

[Workplace health promotion in Poland in 2015 - Diagnosis based on a representative survey of companies employing more than 50 employees]

BACKGROUND

The workplace health promotion (WHP) activity of enterprises in Poland was examined. The findings referred to how many companies implemented non-obligatory actions for health and what actions were taken, what were the reasons and obstacles in the implementation, whether companies evaluated their activity, how they motivated staff to WHP, and whether the size and economic standing differentiated their activity.

MATERIAL AND METHODS

Representative survey, consisted of computer assisted telephone interviews with delegates of the boards of 1000 companies employing > 50 employees, held in November-December 2015.

RESULTS

Every second company undertook voluntary actions for workers health. Most often they offered medical care, supported physical activity and took care about the work environment in a higher range than required by binding regulations. They promoted health to build company's good image, improve productivity and reduce costs. The tradition of WHP in the company, attitudes of employers and intention to boost the vitality of employees also played a role . Despite good financial standing of companies, the shortage of funds was the main barrier in the implementation of WHP activities. Other impediments, such as lack of sufficient state incentives, workload of the management staff, lack of knowledge about WHP benefits and lack of good pro-health services were observed as well. Few companies motivated employees to WHP and carried out its evaluation.

CONCLUSIONS

The development of WHP requires dissemination of its benefits among employers, human resources and safety personnel trainings in WHP management, implementation of the system of relief and prestigious awards for active companies, increase in the number and scope of research works on WHP conditions and effectiveness. Crucial herein is the role of the state in cooperation with other major WHP actors. Med Pr 2017;68(2):229-246.

Polish employees on the internet as a source of information about health and disease

BACKGROUND

This paper presents the opinions of Polish employees on how they think of and use the Internet in the context of health, including occupational health. The outcomes show the usefulness of this medium in the ongoing activities regarding health education and promotion in this target group.

MATERIAL AND METHODS

The analysis focuses on the empirical data from the first representative research on the working population in Poland, conducted in 2012 among 1012 respondents, using the structured interview method.

RESULTS

Employees believe that the Internet plays a positive role in helping employees stay healthy. They appreciate its importance as a tool to support people with similar health problems and the alternative source of information on health issues. Workers are mostly unhappy with information overload about health and difficulty in identifying the reliable ones. Significant number of employees expect the websites expert control and even perpetrators' punishment. Around half of the workers look for the needed information on the Internet and the same number get acquainted with it, if they come across it by chance. The study shows that there was a small employees' interest regarding data on occupational health hazards, how to counteract them and legal regulations on health at work. If it was a case though, they used the web. Employees expect greater use of the Internet in their workplaces regarding occupational health issues than ever before.

CONCLUSIONS

It was found that there are necessary foundations to treat the Internet as an influencing tool in health education and promotion campaigns aimed at employees.

Health promotion--the rationale and the obstacles in workplaces with different employment and financial soundness

BACKGROUND

This paper presents the prevalence of health promotion in workplaces in Poland. It characterises the undertaken ac tions, their rationale and perceived obstacles. It analyses the diversity of these phenomena in the companies of different financial soundness and level of employment.

MATERIAL AND METHODS

The study was conducted with the use of Computer Assisted Telephone Interview in 2010 on the representative national sample of 1002 workplaces hiring more than 50 employees. The data was compared with the results of the survey conducted in 2006, with the use of a Paper and Pencil interview on 611 similar companies.

RESULTS

Both studies have shown that 40% of the companies are concerned about their employees' health to a greater extent than they are obliged to by the law. At the same time, more than 80% of the companies have been introducing various modifications and health-oriented actions without definite health intentions. Most companies improve their physical working environment, organise/sponsor medical services, sports activities and try to reduce stress and smoking. Managers have increased their awareness of business benefits re ceived from health promotion. They have displayed more personal involvement in health promotion implementation. The most often mentioned obstacles have included limited financial resources and little interest of employees regarding health issues.

CONCLUSIONS

The larger and wealthier the company is, the more often health promotion in the company is performed. Such a company is more convinced about an increase in its activities and has more reasons to care about health. Unequal access to health promotion of wor kers in different companies may contribute to an increase in health inequalities in the working population.

Actions reducing tobacco smoking at the workplace--do larger and richer companies solve the problem better?

BACKGROUND

Workplaces are an important subject of state policy regarding smoking. They are obliged to comply with the prohibition of smoking in public places, except special smoking-rooms--if the employer decides to create such. This paper discusses the Polish enterprises activity in relation to smoking, according to new legal obligations and principles of health promotion programs. Furthermore, the article raises the question whether companies' size and economic situation differentiate their attitude to smoking.

MATERIAL

1002 interviews (computer-assisted telephone interview - CATI) conducted in November/December 2010 (date of entry into force of the new law regarding smoking at the workplace) in a representative sample workplace employing above 50 employees.

RESULTS

A total smoking prohibition applies in 23% of companies, smoking is allowed only in special smoking-rooms and outside the building in 54% of enterprises, in 23% of companies regulations are inconsistent with the state policy (for example smoking allowed in the corridors). Apart from smoking bans, companies introduce disciplinary punishments for breaking them and health education (in the absence of other activities promoting non-smoking). In one in three companies' the management does not enforce the compliance with the introduced regulations. Generally, the management does not see a connection between employees smoking and the functioning of the company. In every second company, employees to a greater or lesser extent break the smoking ban. Companies' economic situation does not differentiate their attitude to the problem, the size of employment only slightly.

CONCLUSIONS

The results obtained can be used for future evaluation of the effectiveness of the state tobacco control policy and proper direction of the programs aimed at releasing companies from smoke as well as campaigns prepared for employers.

[Employees health education--challenges according to the educational level]

BACKGROUND

Article addresses the problem of increasing Polish employees health education effectiveness according to the differences in educational level.

MATERIALS AND METHODS

Research model assume that effective method of developing recommendations improving the health education will synthesise scientific findings regarding methodology of conducting such education and knowledge about needs of two target groups: low and high educated employees. Educational solutions were searched in publications related to: health education, andragogy, propaganda and direct marketing. The empirical material used to characterize two target groups came from four research (qualitative and quantitative) conducted by the National Centre for Workplace Health Promotion (Nofer Institute of Occupational Medicine) in 2007-2010.

RESULTS

Low educated employees' health education should be focused on increasing responsibility for health and strengthening their self-confidence according to the introduction of healthy lifestyle changes. To achieve these goals, important issue is to build their motivation to develop knowledge about taking care of health. In providing such information we should avoid the methods associated with school. Another important issue is creating an appropriate infrastructure and conditions facilitating the change of harmful behaviors undertaken at home and in the workplace. According to high-educated employees a challenge is to support taking health behaviors--although they are convinced it is important for their health, such behaviors are perceived as a difficult and freedom restriction. Promoting behavior change techniques, avoiding prohibitions in the educational messages and creating favorable climate for taking care of health in groups they participate are needed.

[The evaluation of the Kujawsko-Pomorski program of mental health promotion at work based on the institutions' self-assessment questionnaire: results of and experience gained from the first stage of implementation]

BACKGROUND

The program has been organized at two levels: (1) institution and (2) voivodeship. Institutions have prepared programs adapted to their needs. Their actions were supported by voivod coordinators. The implementation of the first stage ofthe program has been evaluated. The evaluation was based on the data gathered by using the institutions' self-assessment questionnaire. The aim of the study was to present main results obtained by the institutions participating in the program. Based on these the implementation strategies at the voivodeship level were analyzed.

MATERIAL AND METHODS

The questionnaire helps to identify stress risk factors, as well as to initiate intervention plans, assess determinants of their implementation, and also to evaluate the status quo of already completed ventures aimed at reducing stress. It helped to gather the information from all 30 institutions, which have participated in the program.

RESULTS

Before joining the program only 50% of institutions had considered stress at work in their evaluation of occupational risks. Only two third of them have been involved in any activities aimed at reducing stress, and only half of them have consulted them with employees. Twice as many institutions assessed the opportunities for reducing stress problems as small.

CONCLUSIONS

It is needed to improve the reliability of data and increase the utilization of the evaluation results by the institutions. The program strategy at the voivod level should be modified, employers' attitudes toward the problem of reducing stress at work properly shaped and the competence and involvement of leaders increased.

[Attitudes of Polish enterprises towards tobacco smoking in the context of state policy]

BACKGROUND

The aim of the paper is to give a picture of anti-tobacco activities in enterprises, their conditions and changes that have taken place since 2000.

MATERIAL AND METHODS

The data come from questionnaire-based interviews carried out in 2006 on an all-Poland representative sample of 611 companies employing at least 50 people. They were compared with outcomes of two mail surveys conducted on randomly selected samples of similar enterprises in 2000 (N = 755) and 2001 (N = 215).

RESULTS

Tobacco smoking is rarely considered by enterprises as their own problem (17% of them were aware of the range of this phenomena among employees, whereas 5% were interested in its consequences for a company). In every ten workplace there is a total ban on smoking, whereas the same proportion of workplaces have not incorporated any tobacco smoking regulations. Only one third of the companies have smoking rooms meeting the criteria set by the Minister of Labor. The same number accepts smoking in prohibited areas. In 40% of companies, which had set any kind of their own anti-tobacco bylaws, their employees did not always obey them. Only in a half of workplaces, the management consequently and successfully enforce anti-smoking regulations. Other activities aimed at solving tobacco smoking problems are very rare. Among them, penalties and education on harmfulness of tobacco smoking are most common. In comparison with the beginning of the decade, legal anti-tobacco regulations are now more commonly obeyed. However, an apparent decline in the frequency of educational activities is observed. Moreover, the management is seldom aware of the negative impact of tobacco smoking on the functioning of their companies on the market.

CONCLUSIONS

The introduction of more restrictive legislation and education on harmfulness of tobacco smoking cannot be regarded as sufficient methods of reducing smoking in enterprises.

[Workplace health promotion in public health policies in Poland]

In this paper the author analyses how far in Poland the idea of workplace health promotion (WHP) does exist in the area of public health understood in its broadest sense. The analysis encapsulates the following issues: (a) the national legislative policy, (b) strategies, programs and projects concerning health issues launched or coordinated by the state or local administration, (c) grassroots initiatives for health promotion supported by local and regional administration, (d) civic projects or business strategies for health. In addition, the author emphasizes the marginalization of workplace health promotion and lack of cohesive policy in this field as well as, the fact that health problems of the working population arising from current demographic, technological, economic and social changes that could be dealt with through developing and implementing WHP projects are not yet fully perceived by public health policy makers.

[Attitudes of occupational medicine nurses towards workers' health promotion]

BACKGROUND

The paper outlines the outcomes of a survey aimed at identifying the attitudes of occupational medicine nurses towards health promotion.

MATERIAL AND METHODS

The survey was carried out on a random sample of 277 nurses.

RESULTS

Almost all respondents think that their occupational group should undertake health promotion activities. However, half of them is convinced that health promotion is only a new name for health education and medical prophylaxis. The vast majority of nurses think that under health promotion programs they should mostly deal with individual health education of patients and encourage them to adopt healthy lifestyles, and they usually undertake this kind of activities. A large number of respondents are not willing to be involved in the organization, marketing, and evaluation of health promotion projects.

CONCLUSIONS

There is a great need to intensify measures to motivate nurses to play the roles that are neglected by them, such as looking for new professional groups to undertake activities stimulating health promotion in companies, and developing new institutional and systemic support conducive to making progress in such processes.

Opinions of Polish occupational medicine physicians on workplace health promotion

OBJECTIVES

According to the current Polish legislation on occupational health services, occupational medicine physicians should perform workplace health promotion (WHP) activities as a part of their professional work. The concept of workplace health promotion or health promotion programs, however, has not been defined in this legislation in any way. Therefore, two essential questions arise. First, what is the physicians' attitude towards workplace health issues and second, what is actually carried out under the label of health promotion? The main objective of the research described in this paper was to answer these questions.

MATERIALS AND METHODS

The survey was carried out by the National Center for Workplace Health Promotion in 2002. A questionnaire prepared by the Center for the purpose of this survey was sent to a random sample of occupational medicine physicians.

RESULTS

The results of the survey showed that 53% of occupational medicine physicians consider WHP just as a new name for prophylactics. On the other hand almost all of the respondents (94%) agree that occupational medicine physicians should perform WHP activities and find them useful in improving patients' health (78%). The main obstacle for the development of this activity in the perception of physicians is the lack of interest in workplace health promotion among employers (86%).

CONCLUSIONS

In the modern understanding of workplace health promotion concept this type of intervention includes not only safety measures and health education, but also a profound organizational change that allows employers, employees and social partners to improve wellbeing of people at work. Each of such projects should facilitate changes necessary to create a health promoting workplace. It also needs a skilled leader--well trained and aware of a multidisciplinary dimension of WHP interventions. Occupational medicine specialists should become natural partners of employers and employees. The majority of the occupational medicine physicians, however, are not sufficiently prepared to carry out workplace health promotion programs.

[Health behavior and its rational in the perception of employees in medium-size and large companies]

BACKGROUND

The paper presents beliefs of employees working in Polish medium-size and large enterprises concerning the most essential aspects of healthy lifestyles and reasons for undertaking particular activities.

MATERIALS AND METHODS

In the study, carried out in 2002, questionnaire-based interviews were taken in a group of 1134 employees of 250 Polish enterprises employing 100 or more workers.

RESULTS

The following forms of taking care of one's own health were perceived by the respondents as the best ones: healthy nutrition (68%); physical activity and fitness (46%); adequate rest and relaxation (45%); coping with stress (35%); and regular health checkups (34%). There are various reasons why respondents undertake particular activities. Among them willingness to take care of their own good health (79%); maintaining fitness (72%); and enhancing work ability (67%) were most frequently reported. Ill health and illness were less often mentioned (57% and 43%, respectively). Taking care of health is rather motivated by the will to avoid the dependence on negatively perceived health care institutions than by fear of discomfort due to ill health or occurrence of an illness. Health enhancing activities are more often undertaken by better educated, wealthier and younger people, while in case of illness, the opposite groups become more active.

CONCLUSIONS

Social differences in motivation for healthy behaviors stress the need to apply various methods in health promotion programs to be able to influence target social groups.

[Unhealthy behaviors and their reasons in the thinking of employees]

BACKGROUND

This paper outlines the beliefs of Polish employees about adverse effects of their own behavior on the health state along with underlying reasons for its health-damaging forms.

MATERIALS AND METHODS

The research was carried out in 2002 as a questionnaire-based interview. It covered a random sample of 1134 employees working in 250 enterprises that hire over 100 people.

RESULTS

More than a half of respondents positively evaluated the influence of their behavior on health, but only 12% of them did avoid any type of health-damaging behavior. The respondents believed that in their conduct the following factors were most detrimental to their health: shortage of rest (50%), neglect of physical fitness (38%), smoking (34%), unhealthy nutrition (33%) and disregard to morbid symptoms (28%). Among the reasons for unhealthy behavior they emphasized various habitual aspects, the wish to derive pleasure, relaxation, and sense of freedom, and also avoidance of thinking about adverse effects of such a behavior.

CONCLUSIONS

Health education should to a much greater degree take into account individual motives for health-damaging behavior instead of focusing on dissemination of general knowledge.

[Requirements and quality of health promotion in the workplace--evaluation study]

This paper presents the results of an attempt to assess the quality of voluntary activities aimed at improving the workers' health in Polish large and medium-sized enterprises in view of the health promotion requirements. Based on the data collected via a questionnaire mailed to enterprises selected at random in 1998 (147 enterprises), 2000 (755 enterprises) and 2001 (215 enterprises) the determinants of the health promotion quality are discussed. A long standing tradition to protect the workers' health was reported by 50% of enterprises as the major reason for undertaking health promotion activities. Only 25% of enterprises described their activities as health promotion understood as a tool for supporting their market strategy through well coordinated voluntary actions aimed at improving health and well-being of their employees, however, 85% of respondents reported the implementation of various health conducive programs. The most frequent failures of health-oriented activities to be of a required standard are: (a) regarding these activities as those of little importance compared with the enterprise priorities; (b) lack of a special section responsible for health promotion issues in an enterprise; (c) ignoring the employees' right to participate in planning and evaluating health promotion programs, which means that they are perceived as passive service recipients or passive performers of tasks assigned to them; (d) lack of cohesive approach towards health problems and strong belief that all the goals can be achieved through restrictions or education without any support; and (e) reluctance of enterprises to evaluate the organization, implementation and outcomes of health conductive activities. The major obstacle to health promotion is lack of money (reported by 60% of enterprises) and lack of statutory obligations (reported by more than 50% of enterprises). The former is usually reported by enterprises that are not active in this field, and the latter is an obstacle to enterprises that have invested in workplace promotion programs.

[The strategy for supporting anti-tobacco activities in Poland, "Project on tobacco-free workplace"]

This paper presents basic information on the assumptions, goals and progress of the activities under the project "Tobacco-free workplace" implemented by the National Center for Workplace Health Promotion as a part of the "Health and socio-economic policy aimed at the reduction of tobacco consumption", coordinated by the Epidemiology Division, M. Sklodowska-Curie Oncology Center, Warsaw. The main goal of the project, designed for the years 2000-2005, is a gradual increase in the number of enterprises implementing health promotion programs aimed at supporting their employees to quit or reduce smoking. The National Center for Workplace Health Promotion and the National Network of Workplace Health Promotion Centers work together to convince employers that the implementation of anti-tobacco policy in their enterprises is cost-effective and helps to achieve the main goals of the enterprise. They also instruct occupational medicine specialists how to support enterprises, which intend to work out and introduce anti-tobacco policy.

[Involvement of Polish enterprises in workplace health promotion. Trends observed in years 1998-2001]

The author presents voluntary activities aimed at improving the workers' health in medium-sized and large enterprises in Poland, as well as the dynamic of changes in this area. The data were collected from enterprises chosen at random in 1998 (147 enterprises), 2000 (755) and 2001 (215). At present, over 60% of enterprises declare that they do more for their workers' health than it is required by legal regulations. Since 1998, the number of such declarations has been constantly growing. It is observed that the larger enterprise and the better economic situation, the more frequent health promotion activities. Two areas of activities are most commonly carried out: (1) medical services, e.g. vaccinations, extra diagnostic examinations and therapeutical services; and (2) investments in the work environment, e.g. ergonomics, improvement of interior designs. Unfortunately, promotion of healthy lifestyles, e.g. non-smoking campaigns or stress management are definitely less frequent. Although a growing number of enterprises becomes involved in health promotion, the range of their activities is diminishing. The programs aimed at promoting health conductive behaviors among workers are in particular given up. As far as smoking cessation is considered, the enterprises disseminate materials on the adverse effects of smoking or related ill-health and punish smokers for breaking smoking bans instead of helping their workers and teach them how to quit smoking or support those who want to give up this habit. In the years 2000 and 2001, the educational and supporting activities decreased whereas the punitive policy was on the rise.

[Workplace health promotion program quality evaluation questionnaire]

There are substantial reasons for undertaking the evaluation of workplace health promotion (WHP) programs. The most important ones are: (a) the need to guarantee a competent organization of programs; (b) the feasibility to evaluate WHP programs, which take the form of medical services offered to employers on the health service market; (c) the need to disseminate the idea and support the workplace health promotion lobby; and (d) the use of evaluation as a tool for analyzing WHP promulgation process. The implementation of the scientifically-based evaluation of health promotion programs carried out in regularly functioning enterprises is very limited, hence the increasing interest in procedures of quality assessment already known and accepted by enterprises. This approach is recommended by the World Health Organization (WHO). In the European Union countries, a questionnaire on the workplace health promotion program evaluation is promulgated within the European Network for Workplace Health Promotion. The National Center for Workplace Health Promotion that coordinates the activities of the National Network for Workplace Health Promotion Centers in Poland has developed a Polish version of the questionnaire adopted to local conditions. The author presents the criteria and the most essential solutions that provided the ground for designing the questionnaire to be used by the organizers of WHP programs in enterprises for self-assessment of their own activities. It reflects the views on the strategy of the WHP evaluation presented by the National Center, and contains a simplified procedure that does not involve control groups so difficult to gather under the concept of "health promoting enterprise". The idea of control groups is usually misunderstood and disapproved by the management of enterprises involved in the implementation of WHP programs.

[Health promotion benefits and obstacles as perceived by occupational medicine physicians in Poland]

This article presents the views of occupational medicine (OM) physicians concerning the following: (a) whether OM physicians should be involved in workplace health promotion: (b) whether they can benefit (if so in what way) from involvement in this activity; (c) whether they find the existing conditions favorable for launching health promotion projects; (d) what are the major obstacles? This paper is based on a survey carried out in the fall of 2002 in a group of 325 OM specialists who attend large groups of patients. Over 90% of the respondents believe that OM physicians should be involved in health promotion, however, one third of them do not plan any action in this field in the following year. Among the key benefits from health promotion, health gain is indicated by 80% of OM physicians. Only a few respondents perceive their involvement in health promotion as an opportunity to be more competitive in health service market, thereby to increase their income. None of those interviewed thought that involvement in health promotion win them greater respect among peers. Almost 80% of the respondents complained about unfavorable conditions for carrying out workplace health promotion. As the most significant obstacles they reported the lack of interest in health promotion among employers (86% of respondents), unsatisfactory gratification (76%), limited skill to raise funds for health promotion (64%), limited opportunities to advance education in this field (59%), and the lack of interest in health promotion among employees (57%). In general, OM physicians express their willingness to advance their knowledge of health promotion, although 64% of respondents are convinced that they are well trained in this area. According to the respondents, a proper way to promote health is not only to become very active, but to commit employers to assure the development of health promotion at workplace and to allocate more funds for health promotion projects.

[How to solve the problem of smoking at workplaces]

This paper addresses the problem of the cessation of tobacco smoking at workplaces in major enterprises of Poland. The data were collected in 2000 by means of a questionnaire sent to 755 enterprises employing at least 100 workers. The Polish law on the health protection against harmful effects of tobacco consumption forbids smoking at workplace premises except for those isolated and specially set-up for smoking. Almost 80% of enterprises introduced appropriate bans on smoking. 14% of which are total bans. However, only 40% of companies control whether the regulations are followed by employees and 75% of the firms set up smoking-rooms that could effectively isolate tobacco smoke. Over 60% of enterprises introduced additional procedures to convince their staff to quit smoking. Educational materials stressing the relationship between ill health and smoking are usually distributed. About 17% of enterprises have introduced disciplinary measures. Financial bonuses, psychological or pharmacological therapy are rather rare (around 1%). The main reasons for antismoking measures are: legal regulations and care of employee's health (60% each), and fire protection (50%). Economical aspects have rarely been reported (25%). Together with non-smokers, the enterprise management have been recognized as the most substantial champions of quitting smoking. About 85% of medical staff attribute this role to themselves, but only 15% of managerial workers perceive them as partners in antismoking campaign. In conclusion, there is a great need to encourage medical staff, managers and workers to become more active in implementing programs on health promotion at work with special emphasis put on antismoking campaigns.

[Health promotion at the workplace--selected questions on implementation]

Health promotion viewed as health enhancement achieved mainly through stimulating and instilling health conducive behaviours (life styles) is now generally acknowledged, both in the theory and in the practice of health care as a principal means for preserving and increasing health potential of an individual and community.