Research Findings

The following are some recent research findings of significance to workplace wellness practitioners.

Newman, Lee S. MD, MA; Stinson, Kaylan E. MSPH; Metcalf, Dianne MD, PhD; Fang, Hai PhD, MPH; Brockbank, Claire vS. MS; Jinnett, Kimberly PhD, MSPH; Reynolds, Stephen PhD; Trotter, Margo RN, BScN, MHSc; Witter, Roxana MD, MSPH; Tenney, Liliana MPH; Atherly, Adam PhD; Goetzel, Ron Z. PhD, Implementation of a Worksite Wellness Program Targeting Small Businesses: The Pinnacol Assurance Health Risk Management Study, January 2015, JOEM, 57(1): 14–21.

Objective: To assess small business adoption and need for a worksite wellness program in a longitudinal study of health risks, productivity, workers’ compensation rates, and claims costs. Methods: Health risk assessment data from 6507 employees in 260 companies were examined. Employer and employee data are reported as frequencies, with means and standard deviations reported when applicable. Results: Of the 260 companies enrolled in the health risk management program, 71% continued more than 1 year, with 97% reporting that worker wellness improves worker safety. Of 6507 participating employees, 34.3% were overweight and 25.6% obese. Approximately one in five participants reported depression. Potentially modifiable conditions affecting 15% or more of enrollees include chronic fatigue, sleeping problems, headaches, arthritis, hypercholesterolemia, and hypertension. Conclusions: Small businesses are a suitable target for the introduction of health promotion programs.

Significance: This well-designed long term study will help test the applicability of worksite health promotion programming to small business settings.

Goetzel, Ron Z. PhD; Henke, Rachel Mosher PhD; Benevent, Richele MS; Tabrizi, Maryam J. PhD, MS; Kent, Karen B. MPH; Smith, Kristyn J. BA; Roemer, Enid Chung PhD; Grossmeier, Jessica PhD, MPH; Mason, Shawn T. PhD; Gold, Daniel B. PhD; Noeldner, Steven P. PhD; Anderson, David R. PhD, LP, The Predictive Validity of the HERO Scorecard in Determining Future Health Care Cost and Risk Trends, JOEM, February 2014, 56(2): 136 -144.

Abstract: Objective: To determine the ability of the Health Enhancement Research Organization (HERO) Scorecard to predict changes in health care expenditures. Methods: Individual employee health care insurance claims data for 33 organizations completing the HERO Scorecard from 2009 to 2011 were linked to employer responses to the Scorecard. Organizations were dichotomized into “high” versus “low” scoring groups and health care cost trends were compared. A secondary analysis examined the tool’s ability to predict health risk trends. Results: “High” scorers experienced significant reductions in inflation-adjusted health care costs (averaging an annual trend of −1.6% over 3 years) compared with “low” scorers whose cost trend remained stable. The risk analysis was inconclusive because of the small number of employers scoring “low.” Conclusions: The HERO Scorecard predicts health care cost trends among employers. More research is needed to determine how well it predicts health risk trends for employees.

Significance: One of first studies testing the predictive validity of the HERO Scorecard against health cost trends.

Kleinman, Nathan PhD; Abouzaid, Safiya PharmD, MPH; Andersen, Lenae MS; Wang, Zhixiao PhD; Powers, Annette PharmD, MBA, Cohort Analysis Assessing Medical and Nonmedical Cost Associated With Obesity in the Workplace, JOEM, February 2014, 56(2): 161 – 170.

Abstract: Objective: Quantify the impact of employee overweight and obesity on costs, absence days, and self-reported productivity. Methods: Employees’ retrospective body mass index (BMI) values (kg/m2) from 2003 to 2011 health appraisal data defined three cohorts: BMI < 27, 27 <= BMI < 30, BMI >= 30. Medical, pharmacy, sick leave, short-term disability, long-term disability, and workers’ compensation costs and absence days, and Health Productivity Questionnaire responses were compared using regression modeling, controlling for demographics, salary, and index year. Results: Among 39,696 (BMI < 27), 14,281 (27 <= BMI < 30), and 18,801 (BMI >= 30) eligible employees, per-employee adjusted total annual costs were $4258, $4873, and $6313, respectively. Medical, pharmacy, sick leave, workers’ compensation costs and days were higher for higher-BMI cohorts (P < 0.01). Employees with BMI >= 30 kg/m2 had the most short-term disability costs and days and least productivity (P < 0.001). Conclusions: Employees with higher BMI levels are associated with significantly more costs and absences and lower self-reported productivity.

Significance: Major effort to identify excess costs associated with overweight and obesity status.

Dori M. Steinberg, PhD, RD, Deborah F. Tate, PhD, Gary G. Bennett, PhD, Susan Ennett, PhD, Carmen Samuel-Hodge, PhD, RD, and Dianne S. Ward, EdD, Daily Self-Weighing and Adverse Psychological Outcomes: A Randomized Controlled Trial, American Journal of Preventive Medicine, January 2014, 46(1) :24-29.

Abstract: Background: Despite evidence that daily self-weighing is an effective strategy for weight control, concerns remain regarding the potential for negative psychological consequences. Purpose:The goal of the study was to examine the impact of a daily self-weighing weight-loss intervention on relevant psychological constructs. Design: A 6-month RCT. Setting/participants: The study sample (N=91) included overweight men and women in the Chapel Hill NC area. Intervention: Between February and August 2011, participants were randomly assigned to a daily self-weighing intervention or delayed-intervention control group. The 6-month intervention included daily self-weighing for self-regulation of diet and exercise behaviors using an e-scale that transmitted weights to a study website. Weekly e-mailed lessons and tailored feedback on daily self-weighing adherence and weight-loss progress were provided. Main outcome measures: Self-weighing frequency was measured throughout the study using e-scales. Weight was measured in-clinic at baseline, 3 months, and 6 months. Psychological outcomes were assessed via self-report at the same time points. Results: In 2012, using linear mixed models and generalized estimating equation models, there were no significant differences between groups in depressive symptoms, anorectic cognitions, dis-inhibition, susceptibility to hunger, and binge eating. At 6 months, there was a significant group X time interaction for body dissatisfaction (p=0.007) and dietary restraint (p<0.001), with the intervention group reporting lower body dissatisfaction and greater dietary restraint compared to controls. Conclusions: Results indicate that a weight-loss intervention that focuses on daily self-weighing does not cause adverse psychological outcomes. This suggests that daily self-weighing is an effective and safe weight-control strategy among overweight adults attempting to lose weight.

Significance: Again, this data counters the prevalent advice not to weigh yourself daily while attempting to lose weight.

J. Graham Thomas, PhD, Dale S. Bond, PhD, Suzanne Phelan, PhD, James O. Hill, PhD, and Rena R. Wing, PhD, Weight-Loss Maintenance for 10 Years in the National Weight Control Registry, American Journal of Preventive Medicine, January 2014, 46(1) :17-23.

Abstract: Background: The challenge of weight-loss maintenance is well known, but few studies have followed successful weight losers over an extended period or evaluated the effect of behavior change on weight trajectories. Purpose: To study the weight-loss trajectories of successful weight losers in the National Weight Control Registry (NWCR) over a 10-year period, and to evaluate the effect of behavior change on weight-loss trajectories. Methods: A 10-year observational study of self-reported weight loss and behavior change in 2886 participants (78% female; mean age 48 years) in the NWCR who at entry had lost at least 30 lbs (13.6 kg) and kept it off for at least one year. Data were collected in 1993–2010; analysis was conducted in 2012. Main outcome measures: Weight loss (kilograms; percent weight loss from maximum weight). Results: Mean weight loss was 31.3 kg (95% CI=30.8, 31.9) at baseline, 23.8 kg (95% CI=23.2, 24.4) at 5 years and 23.1±0.4 kg (95% CI=22.3, 23.9) at 10 years. More than 87% of participants were estimated to be still maintaining at least a 10% weight loss at Years 5 and 10. Larger initial weight losses and longer duration of maintenance were associated with better long-term outcomes. Decreases in leisure-time physical activity, dietary restraint, and frequency of self-weighing and increases in percentage of energy intake from fat and dis-inhibition were associated with greater weight regain. Conclusions: The majority of weight lost by NWCR members is maintained over 10 years. Long-term weight-loss maintenance is possible and requires sustained behavior change.

Significance: This data flies in the face of the usual pessimism about sustained weight loss.

Marc S. Mitchell, MS, Jack M. Goodman, PhD, David A. Alter, MD, PhD, Leslie K. John, PhD, Paul I. Oh, MD, Maureen T. Pakosh, MISt, Guy E. Faulkner, PhD, Financial Incentives for Exercise Adherence in Adults: Systematic Review and Meta-Analysis, American Journal of Preventive Medicine, November 2013, 45(5) 658-667.

Abstract: Context: Less than 5% of U.S. adults accumulate the required dose of exercise to maintain health. Behavioral economics has stimulated renewed interest in economic-based, population-level health interventions to address this issue. Despite widespread implementation of financial incentive-based public health and workplace wellness policies, the effects of financial incentives on exercise initiation and maintenance in adults remain unclear. Evidence acquisition: A systematic search of 15 electronic databases for RCTs reporting the impact of financial incentives on exercise-related behaviors and outcomes was conducted in June 2012. A meta-analysis of exercise session attendance among included studies was conducted in April 2013. A qualitative analysis was conducted in February 2013 and structured along eight features of financial incentive design. Evidence synthesis: Eleven studies were included (N=1453; ages 18–85 years and 50% female). Pooled results favored the incentive condition (z=3.81, p1 year), and two studies found exercise adherence persisted after the incentive was withdrawn. Promising incentive design feature attributes were noted. Assured, or “sure thing,” incentives and objective behavioral assessment in particular appear to moderate incentive effectiveness. Previously sedentary adults responded favorably to incentives 100% of the time (n=4). Conclusions: The effect estimate from the meta-analysis suggests that financial incentives increase exercise session attendance for interventions up to 6 months in duration. Similarly, a simple count of positive (n=8) and null (n=3) effect studies suggests that financial incentives can increase exercise adherence in adults in the short term.

Significance: Credible evidence on the effects of financial incentives on selected health behaviors.

Joint Consensus Statement, Biometric Health Screening for Employers: Consensus Statement of the Health Enhancement Research Organization, American College of Occupational and Environmental Medicine, and Care Continuum Alliance, JOEM, October 2013, 55(10): 1244-1251.

Abstract: Employer wellness programs have grown rapidly in recent years with the interest in making an impact on employees’ health. Successful programs are delivered through comprehensive solutions that are linked to an organization’s business strategy and championed by senior leadership. Successful employee health management programs vary in the services, yet typically include the core components of health risk identification tools, behavior modification programs, educational programs, as well as changes to the workplace environment and culture. This article focuses on biometric screenings and was intended to provide employers and other stakeholders with information and guidance to help implement a successful screening program as part of an overall employee health management approach. The article is organized into four sections: goals and key success factors; methods and oversight; operations and delivery; and engagement and evaluation.

Significance: Provides preliminary agreement on the role of biometrics in worksite wellness.

White, John DPM, MS; Hartley, Stephen K. BS; Musich, Shirley PhD; Hawkins, Kevin PhD; Ozminkowski, Ronald J. PhD, A More Generalizable Method to Evaluate the Association Between Commonly Reported Health Risks and Health Care Expenditures Among Employers of All Sizes, JOEM, October 2013, 55(10): 1179–1185.

Abstract: Objective: To evaluate the association between health risks and health care expenditures for employers of all sizes, generalizing to all employees, even those who did not complete a health risk assessment (HRA).Methods: Health risk assessments were obtained from 169,693 insured employees and spouses. Total health care expenditures were measured before HRA completion. Propensity score weighting, adjusting for HRA non-response, and multivariate regression analyses were used to estimate the relationship between health risks and health care expenditures. Results: These at-risk categories were significantly associated with increased health care expenditures: elevated blood pressure, body weight and cholesterol, medication/drug use for relaxation, physical inactivity, and stress. Conclusions: The large sample size, the use of data from small firms, and generalizability made this study unique. Targeted programs that promote management of health risks could result in health care cost savings for employers of all sizes.

Significance: Provides a new option to the HERO methodology.

Mitchell, Rebecca J. MPH; Ozminkowski, Ronald J. PhD; Serxner, Seth PhD, Improving Employee Productivity Through Improved Health, JOEM, October 2013, 55(10): 1142-1148.

Abstract: Objective: The objective of this study was to estimate productivity-related savings associated with employee participation in health promotion programs. Methods: Propensity score weighting and multiple regression techniques were used to estimate savings. These techniques were adjusted for demographic and health status differences between participants who engaged in one or more telephonic health management programs and nonparticipants who were eligible for but did not engage in these programs. Results: Employees who participated in a program and successfully improved their health care or lifestyle showed significant improvements in lost work time. These employees saved an average of $353 per person per year. This reflects about 10.3 hours in additional productive time annually, compared with similar, but nonparticipating employees. Conclusions: Participating in health promotion programs can help improve productivity levels among employees and save money for their employers.

Significance: Shows the time-related productivity savings associated with telephonic intervention and behavior outcome.

Short, Meghan E. MPH; Goetzel, Ron Z. PhD; Pei, Xiaofei PhD; Tabrizi, Maryam J. MS; Ozminkowski, Ronald J. PhD; Gibson, Teresa B. PhD; DeJoy, Dave M. PhD; Wilson, Mark G. HSD, How Accurate are Self-Reports? Analysis of Self-Reported Health Care Utilization and Absence When Compared With Administrative Data, JOEM, July 2009, 51(7): 786-796.

Abstract: Objective: To determine the accuracy of self-reported health care utilization and absence reported on health risk assessments against administrative claims and human resource records. Methods: Self-reported values of health care utilization and absenteeism were analyzed for concordance to administrative claims values. Percent agreement, Pearson’s correlations, and multivariate logistic regression models examined the level of agreement and characteristics of participants with concordance. Results: Self-report and administrative data showed greater concordance for monthly compared with yearly health care utilization metrics. Percent agreement ranged from 30% to 99% with annual doctor visits having the lowest percent agreement. Younger people, males, those with higher education, and healthier individuals more accurately reported their health care utilization and absenteeism. Conclusions: Self-reported health care utilization and absenteeism may be used as a proxy when medical claims and administrative data are unavailable, particularly for shorter recall periods.

Significance: One of the first formal published studies of HRA validity.