Please enable JavaScript.

Coggle requires JavaScript to display documents.

Chapter 1 Outline (Statement of the Problem (purpose statement and…

- - - - Importance
        
        Why universities? Many large public universities have health services for students. However, focus on staff/faculty too bc Universities are likely to be major employers in cities where they exist
        
        Esp. in Long Beach (is #3 major employer)
        
        OB rate in LB
        
        Demographics of city / of faculty, and implications for intervention need
        
        demographics of OB, diabetes, etc. by age, race, and education level in AHR 2018
        
        only gives headcount of faculty (not staff)
        https://data.ir.csulb.edu/t/IRA-Public/views/FacultyData_0/UniversityLevelInstructionalFull-TimeEquivalentFacultyFTEFHeadCountandTenureDensity?:embed=y&:showAppBanner=false&:showShareOptions=true&:display_count=no&:showVizHome=no
        
        People spend most of their time at work, so prime opportunity to target health behaviors
        
        Esp sedentary work results in negative health effects
        
        CITATION
        
        What do people cite for lack of health behaviors?
        ex. lack of time, ease, reliable sources of information, overwhelmed, etc.
        
        What are best practices?
        
        Best Practices
        
        Focus on health rather than ROI (Kaspin 2013)
        
        environment
        
        Key: Ease of participation
        
        on site
        
        during work hours
        
        whole team participates (including management)
        (Kaspin, 2013)
        
        enhance opportunities for active transport and leisure-time activity (AHR / CDC)
        
        Promote social support interventions
        walking groups, etc. (AHR/CDC)
        
        supportive work environment (stram 2011)
        
        3 more items...
        
        Intervention design
        
        Adapt to changing needs of workforce
        "Fairview’s program began in 2001 with a focus on health risk appraisals, health education, and self care,6 but by 2002 their focus had shifted to behavior change, lifestyle interventions, and health coaching. By 2004, they were integrating programs with other departments and vendors/partners." (Kaspin 2013)
        
        1 more item...
        
        based on employee feedback (Kaspin 2013; Stram 2011)
        
        2 more items...
        
        that benefit the most common health risks
        (most used; most cost-effective) (carlson, 2014)
        
        use of technology
        
        "Some of the most successful wellness programs made use of technical aptitude, especially computer technology. Examples included online offerings of weight management tools, health coaching, and classes, publicized through e-mail newsletters and disseminated through the Web or telecommunications." (Kaspin 2013)
        
        in order to individualize care + incr access and flexibility (Stram 2011)
        
        1 more item...
        
        create a culture of health
        
        evaluate outcomes/specific metrics
        (in order to track pptn, link to pdtivity /oth cost-related indicators
        (stram 2011)
        
        Incentives
        
        negative
        
        1 more item...
        
        positive
        
        find citation
      - Significance
        
        Staff will get to voice their opinions, and HR gets data on how they can improve work experience for the employees
        
        Also will be a way to increase awareness of health-related opportunities, etc. among staff
      - Justification
        
        "An an initial step," Need to research this bc don't want to implement measures that no one wants to use. - Gauge interest
        
        incr employee utilization / satisfaction
        
        How much of quality of life is directly related to job satisfaction?
        
        save money (don't waste money)
        
        despite the school's strong nutrition program,
        
        CSULB has a few physical activity things, but
        does not have a lot of nutrition-related programs
        
        Compared to other campuses?
        *Find data
        
        *note that the school does offer peer nutrition counseling for students
        
        find out if it's available for staff as well
        
        -> -> -> Improve the school's standing to continue to attract talented students and staff
        
        will higher grade professors/staff make the school rank higher? attract better students?
        
        List what is available and how heavily it's advertised
        
        From CSULB
        
        http://web.csulb.edu/divisions/students/caps/FSAP/ FASP
        
        Big population to target (environmental changes will affect both faculty and students; public health ramifications
  - - - What programs do employees currently utilize most? Find most useful?
        
        Was there anything that they did at your old job that you wish they did here?
        
        resources, supports and benefits
      - What are the factors that affect employee participation / health behaviors?
    - - What are the employees' [perception / attitudes toward worksite wellness / about the importance of nutrition?
        
        perceived benefits
        
        perceived risks
        
        Perceived barriers
        
        perceived significance
      - What additions to campus do employees desire?
      - Do programs/amenities provided by the university increase job satisfaction?
      - Perception of work-life balance
      - Perception of current nutrition quality of campus
      - Current work wellness culture
    - - **Should I measure this???
- - - - employee wellness, corporate wellness, workplace wellness, etc.
    - - interventions to minimize the number of people afflicted by a disease in a defined population (Koepsell)
- - - - a few examples of dif tactics out there: wellness challenges, provided food, improved lounge spaces, walking meetings, munch-n-learns, education via social media, inservice trainings,
        
        Program offerings
        
        -data collection on employee health risks
        -population-based strategies paired with individually focused interventions to reduce those risks.
        -Programs may be part of a group health plan or be offered outside of that context; they may range from narrow offerings, such as free gym memberships, to comprehensive counseling and lifestyle management interventions
        (Mattke, 2013)
        
        health assessment, lifestyle management, behavioral health (Kaspin, 2013)
        
        "For those larger employers, program offerings cover a range of screening activities, interventions to encourage healthy lifestyles, and support for employees with manifest chronic conditions" (Mattke, 2015)
        
        (Mattke, 2015): Based on RAND Employer Survey 2012,
        3 service categories: health risk screening, preventative lifestyle mngmt, chronic dz mngmt
        5 main configurations: (See table 1)
        
        limited: across all components (34%) <more likely among small employers
        
        comprehensive: extensive across all components (13%)
        
        screening-focused: broad range of screening services + limited other components (20%)
        
        intervention-focused: broad lifestyle/dz mngmt services, limited screening (21%)
        
        prevention-focused: broad screening/lifestyle mngmt, limited dz mngmt (12%)
        
        may be holistic: PA, Nutr, and mental health
        
        Physical environment: on-site gyms, walking paths
        (Kaspin, 2013)
        
        Financial support:
        
        subsidies + discounts on premiums, waived copays
        
        incentives: cash / prizes
        (Kaspin, 2013)
        
        (Carlson 2014)Network Engines: small employer.
        -. annual health risk screenings, 1:1 review of health -> offer face/phone outreach for behavior change -> premium discounts for participation.
        
        onsite screening events, walking meetings, stair campaigns, lunch seminars, walking clubs, relaxation training, department challenges,
        
        Don't need to add all of it here; talk more about it in the lit review
      - Rationale for programs
        
        attract and retain talent
        
        keep relevant
        
        desired outcomes:
        
        health
        
        chronic dz risk factors: weight, BP, BG/A1C, chol., etc...!
        
        improve work-life balance
        
        economic
        
        productivity, retention, V absenteeism, health care claims, incr customer service scores
        
        qualitative
        
        work satisfaction, engagement, stronger bonding/corporate culture, incr loyalty
        
        combat boredom? Dailey, 2018
        
        Wide range of programs (Johnson, 2018); therefore when evaluating there are Many measurements used
        
        Discourse: Employer vs employee priorities (rationale, participation, results (
        
        Need the most here in terms of finishing the intro- can also add to it during lit review of dif forms / looking at dif outcomes
    - - an employment-based activity or employer- sponsored benefit aimed at promoting health-related behaviors (primary prevention or health promotion) and disease management (secondary prevention).
        
        Mattke, 2013
      - “use of effective workplace programs and policies [that] can reduce health risks and improve the quality of life for American workers” (Centers for Disease Control and Prevention, 2017, para. 1). :
    - - 92% of employers (200+ employees) in 2009.
        Most frequent targets - PA 63%; smoking 60%; wt loss 53%
        
        Mattke, 2013
        
        Find more recent source
      - About four-fifths of all U.S. employers with more than 1,000 employees are estimated to offer such programs. (Mattke, 2015)
        
        employer size is predictor. 1/3 of smallest employers (50-100 employees) had WWP VS 4/5 of large (1000+ employers)
  - - - chronic dz rates are XXXX and trends XXX
        
        DM2
        
        10.5% of adults (AHR 2018)
        Continually growing trend - in california - "In the past six years, diabetes increased 18% from 8.9% to 10.5% of adults"
        
        Prediabetes: 33.9% of U.S. adults aged 18 years or older in 2015 (CDC 2017)
        
        highest rate in ages 65+, but in raw numbers, most affected: age 45-64 (AHR)
        
        depression/anxiety/overwork
        
        mental health
        
        suicide rate incr 16% from 12 to 13.9 deaths per 100k since 2012
        
        freq mental distress 11.2% -> 12% in past 2 years
        
        Fortunately, preventable with lifestyle changes...
        
        OW/OB
        
        31.3% OB (AHR 2018)
        
        UP from 29.9% 2017
        
        health disparities by race, gender, income, education.
        (AHR)
        
        can argue that non-faculty staff also need services
        
        CVD rates incr over last 3 years
        (AHR 2018)
        
        HD remains leading cause of death; stroke 3rd leading
        
        CDC estimates that 44% of adults will have some form of CVD by 2030.
        estimated costs (direct/indirect) in 2016 - 555bil; expected to rise to 1.1tril by 2035.
        
        freq physical distress 11.4% -> 12%
        (adults who reported poor physical health 14+ days out of 30)
        (AHR 2018)
        
        esp in those with chronic conditions
        
        according to 2015 DGA, ~1/5 of adults have 1+ preventable chronic conditions related to poor diet, phys inact. (CVD, HTN, DM2)
        
        5 leading causes of mortality (globally): high BP, tobacco use, high BG, phys inact., OW/OB (Stevens, 2009)
      - risk factors
        
        CVD; alcohol use, tobacco use, high blood pressure, high body mass index, high cholesterol, high blood glucose, low fruit and vegetable intake, and physical inactivity (Stevens, 2009)
        
        definition: a factor that raises the probability of adverse health outcomes (Stevens, 2009)
        
        may want to make a similar figure to Stevens, 2009 figure 1 on pg 2 (flow chart of causal chain of chronic dz)
      - medical and technological advancements significantly reduce infectious dz -> aging population -> increase in chronic lifestyle-related illnesses (Stevens, 2009)
    - - physical inactivity: 25.6%
        
        CDC found that 8.3% of deaths (age 25+) were due to insufficient lvls of PA.
        
        reported doing no physical activity or exercise other than their regular job in past 30 days
      - Diet
        
        12.2% had recommended fruit intake (1.5-2 c/day)
        
        barriers reported: high cost, perceived lack of prep time, limited availability/access
        
        factors that raise rates; higher density of healthy food retailers, farmers markets, acceptance of SNAP by retailers and farmers markets
        
        reliance on convenience foods, or some other info indicating importance of food availability at work?
        
        Find more on dietary habits
      - insufficient sleep (more than 1/3)
        
        total estimated cost: 411bil in missed work days, lost productivity
        
        if people who sleep <6hr -> 6-7 hours, 226.4bil could be added to economy
      - vegetables: <10% consume recc'd 2-3c veg/day
        
        rec'd interventions:
        
        farm-to-institution programs
        
        improve access to stores/markets w/ fresh produce
        
        adopt policies to ensure access to fruits/veg
    - - "Compared with healthy weight adults, individuals with obesity spend on average $3,429 more per person annually on medical care." (AHR 2018)
      - "After adjusting for age group and sex, average medical expenditures among people with diagnosed diabetes were about 2.3 times higher than expenditures for people without diabetes. "(AHR 2018)
      - Direct medical costs and lost productivity attributable to diagnosed diabetes is estimated to be $327 billion each year (AHR 2018)
      - https://www.cdc.gov/chronicdisease/about/costs/index.htm
      - https://www.ncbi.nlm.nih.gov/pubmed/29567642
      - the total direct and indirect estimated cost of diagnosed
        diabetes in the United States in 2012 was $245 billion ( https://www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdf )
- - - - what other kinds of biases might there be?
    - - any longer and employees would not have filled out the survey
    - - univ. in other places
      - workplaces that are not universities
- - - - truthful
      - understand their own behavior and motivations well enough to report them
      - Believe that they have a chance to affect change on campus
- - - - Risk Identification:
        
        self-identification of risk factors
        -- OW/OB
        -- poor nutr habits (veg/fruit intake, high fat, sodium, sugar)
        -- PA lvl
        
        Willingness to Change
        -- willingness to achieve healthy weight
        -- // incr PA
        (Joy, 2018; from survey questions from their risk assessment)
        
        Go back to Joy 2018 Table 1 + highlighted citations to see wellness suggestions for supports and strategies from employee surveys from other studies -> use to inform my own survey questions (asking for feedback on what people want - give them checkbox options)
      - Exercise self-efficacy (Butler, 2015)
        
        Barriers Specific Self-Efficacy Scale (BARSE)22
        
        [PubMed: 1583674]
        
        Multidimensional Outcome Expectations for Exercise Scale (MOEES).23
        
        [PubMed: 19181688]
      - (Butler, 2015)
        
        Reasons for enrolling in program
        
        free health assessments (74%)
        
        improve/maintain health (94%)
        
        components of greatest interest (list)
        
        health assessments + personalized health reports
- - - - 1) Economic (ROI)
      - 2) Critical (Mngmt-Employee dynamics, privacy, ethics, etc.)
      - 3) Praise health + personal benefits
- - - - of employees
        
        improve physical health
        
        health behaviors
        
        stress management? self-care activities
        
        diet
        
        quality
        
        physical activity
        
        (Butler, 2015) 8 wk mixed-strategy intervention increased walking (pedometer)
        
        Can altered health behavior of participant influence behaviors of family/community members?
        
        biomarkers
        
        risk factors (waistline, BG, BP, etc.
        
        wt
        
        (Butler, 2015) 8 wk mixed-strategy intervention mildly lowered CVD risk factors
        
        dz risk (DM2, CVD, etc)
        
        attitudes/perceptions
        
        perceived quality of life/job satisfaction/work-life balance
        
        attitudes about wellness programs and their effectiveness/usefulness
        
        Self-efficacy
        
        (Butler, 2015) 8-wk mixed-strat. program did not increase exercise self-efficacy
        
        If free and during work hours, employees understood program's rationale, workers' participation, and results of WHP through both organizational and employee discourses. (Dailey, 2018)
        
        control vs resistance; importance of building a workplace culture of health
      - benefit organizations
        
        Cost-benefit analysis
        
        How is ROI calculated across studies?
        
        cost savings from
        
        healthcare costs
        
        Mattke, 2015 found no associations w/ WWP implementation vs overall health care cost/utilization. (Does not specify what kind of program, what kinds of employees)
        
        incr engagement/productivity
        
        decr absenteeism
        
        retention of skilled employees
        
        (Mattke, 2015) cites no healthcare savings and minimal health results (CVD events over 20 years). However, does not mention DM2, QOL, costs associated with productivity/engagement/absenteeism, employee retention, dietary habits, etc.)
        
        See discussion section of (Mattke, 2015) for comparisons of large-scale survey data vs other case studies
        
        Healthcare costs w/o WWP
        
        highest direct costs: cancer, neck pain, chronic pain
        highest total cost impact: depression obesity, arthritis (Peiffer 2014)
        
        barriers: smallest employers cite money has biggest concern; large employers cite lack of employee interest
        (Mattke, 2015)
      - Note that it's hard to study these things due to studying different kinds of wellness programs (exercise programs, nutrition programs, environmental resources, wellness challenges, etc.) Johnson, 2018
      - Programs vary widely with respect to what they target, how well they are designed, and how well they are executed (Mattke, 2013)
      - Not about whether WWP work or not, but rather best practices on how they should be set up.
    - - Vanderbilt University
    - - physical health
        
        and their effects on productivity, etc...
      - mental health
  - - - carrot or stick debate
        
        prizes, time off, gift cards -> lower/higher premiums
      - participation-based or outcome-based?
        is a topic (Carlson 2014)
    - - Employee
        
        use of incentives
        
        incentive: ex. w/ smoking cessation program, negative financial incentives (surcharge for not ppt'ing) incr significantly but still remained <30%.
        
        Mattke, 2015: Few employee characteristics moderated effect of non=ppt charges on program uptake
        
        use of financial incentives increases participation only modestly (Mattke, 2015)
        
        Median ppt rate w/o incentives: 20%
        w/ positive incentives: 40%
        w/ negative incentives: 73%
        
        employee characteristic
        
        dz mngmt: highest ppt from those w/ mult. chronic conditions, older age (mattke, 2015)
        
        higher income zip code, healthier employees higher completion of screening. (Mattke, 2015)
        
        1/5-2/5 participated in eligible programs; varied by program component (screening, lifestyle, dz mngmt) (Mattke, 2015)
        * Based on large employer case study
        
        most comprehensive programs had highest ppt rate; less sensitive to use of incentives
      - employer
        
        employer size: smaller less likely to ppt (Mattke, 2015)
      - Discourse btwn employee and employer
        
        Differing priorities result in tension - Dailey, 2018
    - - See Aneni, 2014