Drug Education and Intervention in the Workplace

Introduction to Company Health Promotion Programs

The last ten years has brought big changes in company attitudes toward Company Health Promotion Programs. Interest in self-help and self-care programs has increased as growth in health care costs have encroached substantially into profits. Changes in the company structures of health care facilities, in particular the growth of the for-profit health care sector, and the need to contain costs are changing the ways in which purchasers of health care plans are viewing their own efforts toward provision of workplace health care programs and facilities. Projections for the next decade indicate that workplace health programs will continue to become important factors in the provision of health care, including prevention activities, for both government and private industry. In organizations with existing Company Health Promotion Programs, administrative rationale for sponsoring these activities ranged from improving employee health (28%) to improving employee morale (9.7%). Programs include interventions associated with safety, health risk assessment, smoking cessation, Blood Pressure control, diet programs and stress management. Benefits cited range from improved health and productiveness to decreasing health care costs.

Demographics of the American Workforce
• 110 million American citizens were in the civilian labor force in 1981; by the year 2000 the civilian labor force is expected to be nearly 140 million.
• 44% of the 1984 labor force was female; ten% was Black.
• The median age of the workforce is 32 years and is expected to grow to 32 years by 2030.
• 57.9% of all employees work in companies with between 2 and 500 employees; 45% work in companies with fewer than 100 employees. An additional 7.5 million Americans are self-employed and 3 million are farmers.
• 18% of all wage and salaried workers in 1985 were union participants.
• 45% of all staff members are employed in offices.

Prevalence of Corporate Health Promotion Programs Activities

Based on a 1985 survey, almost 66% of worksites with 50 or more staff members had Company Wellness Programs activities in 1985.  The frequency of worksite-based activities by selected categories in 1985 was:

Activity

Smoking Control       35.6%
Health Risk Assessment    29.5 percent
Back Care             28.6%
Stress Management       26.6 percent
Exercise             22.1%
Off the Job Accidents    19.8%
Nutrition             16.8 percent
Blood Pressure Control    16.5 percent
Weight Control          14.7%

Job Site size is the strongest indicator of program prevalence.

Most staff members believe the advantages of their Workplace Health Promotion Programs activities outweigh the costs, although few formal evaluations exist.

The most usually cited reason for starting programs and perceived advance from programs is improved employee health.

At most worksites with activities (85.4%), all employees are eligible to participate. 30 percent of worksites with activities offer them to company dependents, and an equal percent offer them to retirees.

When worksites seek outside program assistance, they turn to voluntary, not-for-profit companies (57.1%), private for-profit providers-consultants (50%), local hospitals (44%), and insurance companies (43%).

Smoking Cessation Programs

Smoking related health issues cost American businesses $26 billion per year in lost productivity and $7 to $8 billion in smoking-related medical expenditures.

Employees who smoke are 50 percent more likely to be hospitalized than nonsmokers, have 2 times as many job-related accidents as nonsmokers and have absenteeism rates approximately 50 percent higher than nonsmokers.

People who smoked an average of one or more packs of cigarettes per day had 118 percent higher healthcare expenditures than nonsmokers.

76 percent of current smokers and 80 percent of former smokers and nonsmokers feel that companies ought to restrict smoking to certain areas.

In 1985, 65 percent of smokers, 85 percent of nonsmokers and 78 percent of former smokers, felt that tobacco users should refrain from smoking in the presence of nonsmokers.

In 1986, 17 states had laws regulating tobacco use in offices or workplaces either in government-controlled offices or offices of private workers.

Examples of smoking cessation intervention program used by businesses include:

• providing people that do not use tobacco a discount of health and life insurance;
• paying full or partial fees for tobacco cessation programs;
• offering cessation programs on employer or shared time;
• offering cash payments to quitters after 6 of 12 smoke-free months;
• participating in national quit smoking days; and
• adopting a smoke-free organization policy and setting deadlines for implementing the policy.

Physical Fitness Programs

An active 55-year-old man can lead as vigorous a lifestyle as a sedentary 35-year-old.

Differences in work-related activity has been demonstrated to provide a two- to three-fold difference in cardiovascular deaths between active employees and their more sedentary counterparts.

In addition to improving strength, balance, and flexibility, physical activity programs are able to cut the probability of back injuries among certain occupational groups.

93 million workdays in the United States are lost each year due to back concerns.

Research findings support the notion that worksite exercise programs better fitness and help cut other health risks, although results related to improved productivity are weak due to lack of methods for accurately calculating productivity.

A very small proportion of worksites have on-Site physical fitness facilities.

The majority of workers sponsored fitness programs involve skills training such as aerobic dance, low impact aerobics, weight training, preand post-natal exercise classes, and walking/jogging groups.

Some employers subsidize employee participation in neighborhood “Ys,” health clubs or other neighborhood programs if no onsite facilities are available.

Job Site physical activity programs may cut expenditures to employers by reducing employee medical claims and expenditures.

Those whose weekly exercise was equivalent to climbing less than five flights of stairs or walking less than a half mile, invested 114 percent more on health claims than those who ascended at least 15 flights of stairs or walked 1 1/2 miles weekly.

Medical Care costs for obese people are roughly 11 percent higher than those for thin people.

Nutrition and Weight Control

One-third of this country population is obese to the extent of decreasing their life expectancy.

Improvements in eating habits are able to lower the risk of serious health concerns such as elevated Blood Pressure (BP) and cholesterol levels and is instrumental in the control of non-insulin-dependent diabetes.

The workplace offers several advantages for nutrition education; support and effect of co-workers and upper management, availability of a daily eating situation, and opportunities for follow-up and monitoring.

Worksite diet programs can be grouped in 6 broad categories:

• cafeteria programs;
• multi-component programs;
• weight management programs;
• cholesterol reduction programs;
• programs for pregnant and lactating women; and
• other nutrition education issues.

Men are less likely to take part in weight-loss programs than are female employees.

Stress Management

Estimates suggest that 50% to 80% of physician visits are able to be attributed to psychosomatic or stress-related origins.

Organization pays many of the costs related to employee stress, both directly in the form of health care costs and in lower work rate.

Job factors which are associated with stress include:

• not allowing workers to take part in decisions about the work process;
• positions which require more or less skill than the employee has;
• changes in work demands;
• lack of clarity about expectations and standards; and
• conflict with co-staff members or supervisors.

Most worksite stress management programs are implemented as a result of requests from employees.

Stress management programs focus on three types of skills: relaxation skills, coping skills, and interpersonal skills.

Job Site stress management programs are frequently delivered in one of three formats:

• courses conducted by trained professionals;
• self-learning tools; and
• personal teaching to assist  with self-assessment, planning for changes, learning new skills and responding to life crises.

The two major techniques used in worksite stress management programs are:

• teaching people to reduce the detrimental physical effects of stress; and
• teaching people to recognize and control sources of stress at work and in personal life.

Safety Belt Usage

Motor vehicle accidents are the largest single cause of lost work time and on-the-job fatalities of American business.

Motor vehicle accidents account for 27% of all work-related deaths and 45 million days of lost work annually.

More than 36% of the 11,300 accidental work deaths in 1983 involved motor vehicles.

Workers who routinely fail to use seat belts may spend up to 54% more days in the hospital.

Traffic accidents caused about 3 times as many days of restricted activity as any other kind of disability.

Motor vehicle crashes cost $15.2 billion in lost productivity, 88% of which is attributed to losses from workforce activities and future earnings.

In corporate settings where safety belt policies, mandating use of belts by those riding in a company vehicle or using a personal vehicle for company business, have been enforced, 60% to 90% use has been stated.

Incentive programs, accompanied by education and use requirement restrictions have resulted in 40 percent to 70 percent initial usage rates.

Factors influencing the sources of workplace safety belt programs include:

• active responsibility on the part of senior staff;
• clearly defined and well enforced policy of needed belt use on the job;
• positive incentives; and
• ongoing education and training programs.

Case Studies of Company Health Promotion Programs

Based on an extensive assessment of its accross the board employee Corporate Health Promotion Program, LIVE FOR LIFE, Johnson & Johnson stated the break-even point for the program occurs in year 3 and by year 5 they have a net profit of $316 per employee. Their year 9 projected profit is $677 per employee.

workers at four Johnson & Johnson corporations who were exposed to the Employee Wellness Program increased their daily energy expenditure in vigorous exercise by 104 percent compared to a rise of 33 percent among workers at corporations that were offered only an yearly health screen.

Members in the United Methodist Publishing House’s Employee Health Promotion Program submitted more claims (1.14 per participating employee and .82 for the control in 1984, 1.44 and 1.3 respectively in 1985), but the average cost per claim was less for participants ($316 for participants and $567 for control, in 1984, $262 and $602 respectively in 1985, $270 and $566 respectively in the first four months of 1986).

The United Methodist Publishing House attributes some of the reduced than projected use in health care costs for 1985 ($902,116 projected with actual costs $142,884) to the Employee Wellness Program even though the results are not conclusive.

In 1985, the Adolph Coors Employer conducted a phone interview of a random sample of its 10,000 workers to determine changes in health practices since the introduction of an employee Company Wellness Program 4 years earlier. The sample of 495 workers was stratified to match the business profile in terms of age, sex and job description. The survey reported that 65% of respondents started working out in The previous 4 years, 37% had improved their diets, 20% were regular users of the wellness center, 9% had stopped smoking as the result of the business’s tobacco cessation program and active participants of the wellness center miss an average of 1.96 workdays annually because of illness or injury compared to 3.08 days for non-participating workers.

The Coors Company also achieved a cost savings from a cardiac rehabilitation program that was launched in 1981. In 1980 employees were out of work 7.2 months after a heart attack or bypass operation. In 1984, cardiac patients were out an average 1.9 months saving $152,000 in lost work time and in 1985 cardiac patients missed an average of 2.6 months, saving $125,000 that year.