CD04-002 Abstracts
1 R01 DP000097-01 - Smoking Cessation Intervention with Building Trade Union
BARBEAU, ELIZABETH M
DESCRIPTION (provided by applicant): Blue-collar workers are nearly twice as likely to be current smokers as white-collar workers, and this gap has been widening over time. Though they make as many quit attempts per year as their white-collar counterparts, blue-collar workers are less likely to succeed. Effective interventions applied in community-based channels that reach blue-collar workers are needed to reduce this growing disparity. Building trade unions are a potentially important, but largely unevaluated, channel for intervening with this population to reduce smoking prevalence. The proposed study builds upon our recently-completed pilot study in collaboration with 3 building trade union apprenticeship programs aimed at assessing smoking behaviors and determining the feasibility and effect size of a smoking cessation intervention. Pilot study results confirm that this population of workers is at very high risk of smoking (43% prevalence), that building trade unions can be recruited to a smoking cessation trial, and that our planned interventions are feasible and result in positive changes in smoking behavior. The proposed study uses a cluster randomized clinical trial study design to assess: (1) the efficacy of a smoking cessation intervention among unionized apprentices in the building trades; (2) the determinants of smoking cessation; and (3) the adoption (recruitment into the trial) among eligible apprenticeship programs, reach of the intervention among potential participants, elements of successful implementation and best processes of intervention activities delivered; and cost-effectiveness of the intervention. The intervention is based on prominent behavioral theories, empirical evidence from the peer-reviewed literature, and the US Public Health Service's guideline on smoking cessation, and it taps into essential elements of union culture. It will consist of: a toxics and tobacco curriculum module that includes information about disaster-related threats; group-based behavioral counseling; nicotine replacement therapy; do-it-yourself quit-kits; environmental cues for cessation; and written materials and quit groups for co-workers, friends, and family members. The study is innovative in its approach to intervening through building trade unions. If shown to be effective, this intervention could be readily disseminated to a national network of building trade union apprenticeship programs, which collectively train approximately 183,000 apprentices each year.
1 R01 CD000033-01- Impact of Health Promotion Programs on MCO Family Health
BECKER, EDMUND R
DESCRIPTION (provided by applicant): Developing and implementing comprehensive work site health promotion programs is anticipated to help employees live healthier lifestyles by creating supportive work environments and offering awareness, education and behavioral change programs. While evidence suggests that health promotion programs are economically viable and there is support for alternative strategies, there are limited empirical studies that have simultaneously analyzed different health promotion strategies and partitioned the influence of each specific strategy in the overall effect. In our investigation, we propose to evaluate three basic questions-Given the three major strategies for promoting healthy behavior in the workplace: worksite health promotion programs, MCO health education programs, and health promotion through primary care practices - (1) what is the overall contribution of these three approaches for individuals and families on selected work site health promotion activities, (2) what is the unique impact of each approach on the health promotion activity and what is the extent of the differences, and (3) what effect do factors like patient characteristics, primary practice culture, structure of the health education and health promotion program have on the individual and family health promotion behavior? We have selected a broad range of nine meaningful and widely applicable health promotion measures and we have assembled a strong team of investigators with a solid research record and database to build a comprehensive work site model for analyzing these questions. Specific Aim 1: Create a three-year longitudinal dataset that contains comprehensive health promotion intervention profiles and patient characteristics for approximately 115,000 MCO members. Specific Aim 2: Evaluate the hypothesis that primary care practices with more effective teamwork (collaboration, task delegation) make a significant contribution to better MCO member outcomes (rates of preventive health services, absentee days) when they work with work site wellness programs and health education programs and the data are controlled for patient characteristics (race, family type, income, comorbidities) and organizational characteristics (PCP training and experience, length of time employer has had a workplace health promotion program). Specific Aim 3: Develop recommendations to better integrate primary practice teams with traditional work site wellness programs and health education programs that provide health promotion services to employees and their families.
1 R01 DP000103-01- High Impact Interventions for Employee Health Promotion
BUTTERWORTH, SUSAN W
DESCRIPTION (provided by applicant): This proposal addresses significant goals of CDC's Health Protection Research Initiative (RFA-CD-04). The overarching objective is to compare high impact health promotion programs with employees at each stage of change on multiple behavior changes, cost effectiveness, quality of life, and productivity. This population-based project utilizes a 3 x 3 x 4 repeated measures design crossing 3 interventions (Motivational Interviewing (MI), tailored communications and control) x 3 recruitment strategies (email and regular mail; mail plus incentives; mail, incentives and proactive telephone calls) x 4 assessment occasions (0, 6,12 and 18 months). Multiple behavior risks (smoking, stress, diet and exercise) are targeted in of 2250 employees in a major health care system. The specific aims are: 1. To compare the two interventions and control groups on the number of health behavior risks that are effectively changed over time; 2. To compare the three recruitment strategies on the number of health behavior risks effectively changed over time; 3. To compare impacts (recruitment x efficacy x number of behaviors changed) of the three intervention conditions across the three recruitment approaches; 4. To compare the impacts of the three intervention conditions across the three recruitment approaches on cost effectiveness, quality of life, and productivity; and 5. To compare the impacts of the three intervention conditions across the three recruitment approaches on employee's utilization of and support for the worksite's current multilevel health promotion offerings, such as use of the employee's walking paths and new exercise facility, choice of healthy foods in the cafeteria and support for policies like smoking bans in buildings. The tailored communications are based on the Transtheoretical Model and have been found to produce multiple behavior changes in populations of employees, primary care patients, parents and patients with Type 2 diabetes. A series of three tailored communications are delivered at 0, 3 and 6 months along with a stage-based multiple behavior change manual at baseline. The MI coaching involves a 45-minute individual session at baseline and two proactive coaching calls at 3 and 6 months. A defined population of 2250 employees will be recruited from across employee groups of a major medical center. The population based health promotion programs have the potential to produce unprecedented impacts on multiple risks in a cost-effective manner that can also increase employee productivity and quality of life.
1 R01 OH008496-01- Sleep Disorders Management, Health and Safety in Police
CZEISLER, CHARLES A
DESCRIPTION (provided by applicant): Sleep Disorders may cause the deaths of up to 20,000 people each year in the United States, and lead to loss of health, poor quality of life, and decreased job productivity. Because of their career-long exposure to long work hours and frequent overnight shift duty, police officers are at extremely high risk of suffering sleep disorders, including obstructive sleep apnea, insomnia, and shift work sleep disorder. Our research group has conducted numerous studies of sleep deprivation and interventions to reduce the adverse effects of sleep deprivation on safety, health, and performance of personnel in numerous occupational groups: police, physicians in training (residents), astronauts, air force pilots, nuclear power plant workers, truckers, and industrial workers. We have a successful track record of disseminating research results to inform local and national policy changes. We propose to conduct a randomized, prospective study of the effect of a novel Sleep Disorders Detection and Treatment Program - Operation Healthy Sleep. Because of the high prevalence of sleep disorders among police, and the profound effect of sleep disorders on performance, safety, and job experience, we hypothesize that implementation of Operation Healthy Sleep will: 1. improve the mean nightly sleep and alertness of police officers; 2. improve police officer safety, as determined by: a. decreased rates of motor vehicle crashes; b. decreased on-the-job injuries; 3. improve police officer productivity, as determined by: a. increased arrest and conviction rates; b. decreased response time and completion time (clear time) for calls on duty; c. decreased rates of civilian complaints and inappropriate use of force; 4. improve officers' and families' job satisfaction and ability to cope with shift work. By establishing a comprehensive sleep disorders detection and treatment program and rigorously testing its effects across a range of health, safety, and work outcomes, we hope to develop a model program that can be broadly replicated to improve the safety, health, and performance of police officers, as well as other shift workers, across the country.
1 R01 DP000111-01- WAGES: Workplace Activity for Employee Goal Setting
DISHMAN, RODNEY K
DESCRIPTION (provided by applicant): Despite widespread attempts to increase physical activity levels in the general population, only 32% of U.S. adults regularly participate in recommended levels of either moderate or vigorous physical activity. Workplaces are important settings for physical activity programs, but the effectiveness of such programs for increasing physical activity has not yet been determined by a theoretically based, randomized controlled trial. The study we propose will involve 1,600 male and female employees recruited from 16 work sites of The Home Depot, Inc. The purpose of the study will be to determine the effects of a multi-level intervention aimed at personal goal setting by employees and ecologically based organizational action. Worksites will be paired according to size and workplace characteristics, and each site will be randomly assigned to either the intervention or control conditions. The primary outcome measure will be moderate to vigorous physical activity. Secondary outcomes will include stage of physical activity change; self-rated productivity, healthrelated quality of life, measures of workplace morale; and social-cognitive mediators of physical activity change derived from goal setting theory, social-cognitive theory, and stage theory. Statistical analysis of the intervention effects will be performed using hierarchical linear modeling. We hypothesize that the intervention will increase moderate to vigorous physical activity and the secondary outcomes. Innovative and unique features of the study will be: [1] implementation of a multi-level intervention that targets (a) the workplace culture using socio-ecologically based organizational action and (b) employee motivation using peer-group leadership of goal-based cognitive-behavior modification, aided by the use of low cost pedometers, and [2] assessment of the effects of the intervention on mediators of change in the outcome measures using structural equation modeling. The project will implement and rigorously evaluate a multilevel physical activity intervention that has potential for broad application to workplace health promotion.
1 R01 DP000111-01 – Policy/Environmental Changes: Effects on Employee Health
EDINGTON, DEE W
DESCRIPTION (provided by applicant): The objective of this research is to evaluate the impact of widescale workplace environmental and policy interventions on employee health. Specifically, the study will determine whether or not the implementation of a constellation of environmental and policy approaches designed to encourage healthy nutrition and physical activity behavior in employees is effective in maintaining low-risk status or improving self-reported health risks and behavior, and absenteeism, over a two-year period. This research will be conducted within a state government department, the California Department of Health Services (CDHS). Environmental and policy interventions will be implemented within the four-building CDHS headquarters in Sacramento, California. Employees at other (non-intervention) CDHS locations throughout the state will serve as a comparison group. Actual workplace environmental and policy interventions to be implemented will be determined in consultation with management and employees, and will include strategies such as open stairwells; nutrition requirements for vending machines; food policies for meetings; onsite exercise equipment; safe bicycle storage; incentives to utilize public transit; nutrition policies for fundraising; point of decision signage near elevators, stairs, and vending machines; and the development of walking/running clubs and mileage maps. Employee health status will be measured among treatment and comparison group CDHS employees using the University of Michigan's Health Risk Appraisal (HRA) questionnaire, modified to include additional questions on nutrition and physical activity. Health risks will be measured at baseline and two years later (with optional mid-point measures). The impact of the intervention on absenteeism will also be evaluated. Worksite environments and polices will be assessed at baseline and at 24 months to evaluate change over time; this will be done using the HeartCheck work environment assessment tool, as well as ongoing monitoring and tracking of intervention participation.
1 R01 DP000116-01 – Automated Assessement of Mental Health in the Work Place
FARZANFAR, RAMESH
DESCRIPTION (provided by applicant): The aim of this proposal is the development and initial evaluation of a confidential workplace program that uses computer telephony to communicate with workers, to evaluate whether they have a mental health disorder which could impact their workplace performance and that refers untreated and inadequately treated workers to alternate treatment settings. We propose to develop and conduct a randomized evaluation of Telephone-Linked Communications for Detection of Mental Health Disorders in the Workplace (TLC-Detect). TLC-Detect will: a) assess an employee's mental health for a group of relevant mental health disorders by administering the PRIME-MD (Primary Care Evaluation of Mental Disorders) Patient Questionnaire, 2) provide recommendations for referral and other treatment options for employees who have a mental health disorder, 3) educate and motivate employees to engage in treatment, 4) implement automated periodic follow-ups to monitor mental health symptom severity and treatment maintenance, 5) educate and motivate the employees to remain in treatment. The specific goals of this study are: to design and develop TLC-Detect that consists of a mental health Diagnostic Module that (a) will detect common mental health disorders that affect workplace productivity, (b) Symptom Severity Module that assesses the symptom severity for each identified mental health condition, (c) a Treatment Module that assesses the willingness of the employee who has a mental health condition to engage in treatment and educates and counsels that person to engage in treatment, (d) a Follow-up Treatment Module that will monitor the person's treatment maintenance. In the randomized clinical trial, the following hypotheses will be tested: 1) The TLC-Detect group will have less absenteeism and presenteeism compared to the control group measured in hours/days lost [e.g., absenteeism time and presenteeism time].2) A larger proportion of the TLC-Detect group will be in mental health treatment than the control group. 3) There will be a greater improvement in symptom severity in the TLC-Detect group than in the control group. 4) The TLC-Detect will be acceptable and considered useful by the employee participants.
1 R01 DP000098-01- Worksite Phone Counseling for Smoking Cessation
FISHER, EDWIN B
DESCRIPTION (provided by applicant): Telephone counseling and related intervention features such as social support provided through interventions have been found effective in smoking cessation. However, related to more general needs for understanding how social support influences behavior and contributes to health promotion interventions, an important question concerns the relative effectiveness of (a) protocol driven, standardized and/or Directive approaches to intervention delivery versus (b) person-centered, flexible, and/or Nondirective approaches. This project will examine the implementation, reach, efficacy, and likelihood of adoption of two approaches to telephone counseling for smoking cessation: Standardized Intervention and Flexible Nondirective Intervention. Employees of BJC HealthCare responding to announcements of the availability of free telephone counseling for smoking cessation will be randomized to Standardized Intervention - 7 calls in which callers will ascertain progress of the quitter and, according to predetermined protocols, provide encouragement and advice appropriate to the quitter's readiness to quit, or Flexible, Nondirective Intervention - 7 calls in which callers will inquire as to general issues and interests of the quitter in a manner intended to be pleasant and express nonintrusive interest in the quitter, inquire as to quitter's perception of their progress and areas in which they need help, reflect and endorse the quitter's perception of progress made. Both interventions will address Key Steps in Smoking Cessation (e.g., setting a quit date) supported by major reviews and individual research studies. Because smoking and burdens of smoking-related disease are increasingly economically stratified and disproportionate among underserved minority groups, promotional and recruitment efforts will place special emphasis on encouraging participation among low income, nonprofessional health care workers. Borrowing from the RE-AIM model, evaluation will include reach to and retention of potential participants, especially low income, nonprofessional health care workers, as well as outcomes in terms of abstinence and indicators of key variables in determining outcomes. The principal outcome will be reported abstinence (no smoking or use of other tobacco or nicotine products) for at least 1 month. Analyses will also examine roles of potential mediators or moderators of interventions, including smoking history, self efficacy, social support, pros/cons of smoking. Power will range from .66 to .99 depending on recruitment rates (projected to range from 15% to 25%) and the magnitude of difference in outcomes between the two conditions.
1 R01 DP000109-01- Economic Evaluation of Workplace Health Promotion
FLORENCE, CURTIS S
DESCRIPTION (provided by applicant): The long term objective of this proposal is to provide information to employers and public policymakers about the effect of workplace health promotion on worker productivity, health and health care costs. The specific aims of this proposal are to examine the prevalence, health benefits and health care cost impact of health promotion and disease prevention programs offered by employers to their workers. Workplace health promotion and disease prevention programs are defined as any workplace policy, facility or program intended to change employee behavior in a way to increase health. These include, but are not limited to: programs to encourage and facilitate exercise, programs and policies to discourage smoking and/or promote smoking cessation, Stress reduction programs, programs to screen for manageable chronic conditions such as hypertension and high cholesterol, cancer screening and health care policies to improve prenatal care and birth outcomes. We will examine these research questions using nationally representative data from the National Health Interview Survey (NHIS), the Medical Expenditure Panel Survey (MEPS) and the Pregnancy Risk Assessment Monitoring System (PRAMS). The use of nationally representative surveys will allow us to determine the extend of these programs in the United States, and their overall impact on both per capita and total health expenditures. The results of this study will increase our knowledge of the extent, effectiveness and costs impacts of these programs. The results of this study can be used to guide employers as to what type of health promotion programs to offer, and can be used by policymakers as a guide as to what type of programs to promote or mandate.
1 R01 DP000113-01- Partnering to Reduce Obesity with Environmental Changes
GatES, DONNA M
DESCRIPTION (provided by applicant): Obesity and its associated mortality and morbidity are a national health crisis. It is estimated that American employers spend more than $900 billion dollars annually on medical expenditures and that obesityattributable medical expenditures to be $75 billion dollars. Interventions to reduce or prevent obesity that are aimed at the individual level have been studied extensively. On the other hand, data from theory-based research using institutional-level (environmental) approaches are seriously lacking. Yet, institutional-level approaches have the potential to reach large numbers of persons at substantially lower costs than approaches based on individuals and are therefore of critical interest. The specific aim of this randomized, controlled trial is to test the effectiveness of an institutional-level intervention to prevent or reduce obesity at small manufacturing companies in Kentucky. As secondary aims we will determine whether the intervention increases health promoting behaviors, decreases cardiovascular and diabetic risk factors, and reduces productivity costs related to absences and work limitations. Small manufacturing companies in Kentucky were chosen to target because many of the workers are of Appalachian descent and low socioeconomic status, are at increased risk for heart disease and diabetes, and perform sedentary jobs. Although the work environments in manufacturing provide unique opportunities to address obesity, the literature lacks evidence of successful interventions from rigorous worksite trials. This proposal addresses the RFA's request to test a cost-effective health intervention using the synergy created through partnerships among academia, public health, and industry. The investigators and health planners will use the Social Ecological model and Diffusion of Innovations Theory to plan and test a year-long, company-wide campaign at three companies. The institutional-level components include tailored strategies to change knowledge, attitudes, and behavior. Three hundred randomly selected employees at the intervention and control worksites will be followed at baseline, 3, 6, and 12 months for anthropometric measures, lifestyle behaviors, absences, and work performance. Since the number of employees who worked in manufacturing in the United States in 2003 was estimated to be 14,701,000 (BLS, 2004), and since overweight and obesity affects up to 66 % of the working population, this project will make a significant contribution to the growing efforts to address the obesity epidemic in the United States.
1 R01 DP000107-01- Physical Activity, Learning Styles and Health Literacy
GAZMARARIAN, JULIE A
DESCRIPTION (provided by applicant): A major challenge facing the health community is the increasing rates of physical inactivity. This is of significant concern as more studies are documenting the relationship between physical inactivity and obesity, poor quality of life and health status. Since most adults spend the majority of their waking hours at work, the workplace environment is a promising area for physical activity interventions. A number of studies have documented the effectiveness of various programs, while many others have shown they are not effective. One avenue that has not been explored is the role of employee's learning styles and health literacy skills with various physical activity interventions. Perhaps if an employee's style is matched with an appropriate intervention method, they would be more likely to change their behavior. The overall project goal is to determine the effectiveness of a tailored innovative worksite health promotion program to increase physical activity. Specifically, the project's objectives are to: 1) enhance current health promotion activities for Emory employees; 2) determine if employee's choice of different intervention strategies vary by learning styles and health literacy skills; 3) evaluate the effectiveness of tailoring intervention programs based on learning styles and health literacy skills of the target population; and 4) examine the cost effectiveness of different components of the intervention program. The randomized control trial will involve over 1,600 Emory employees, including Emory University, Emory Healthcare and Emory Clinic and will build upon current efforts to improve the health of Emory employees. The trans-disciplinary and trans-sector project team consists of established researchers at Emory School of Public Health, key staff with various business units at Emory (Human Resources, Faculty and Staff Assistance Program, Healthcare), Emory employees representing a range of occupations (e.g., custodial, faculty), and an advisory panel of nationally renowned public health and learning theory professionals.
1 R01 DP000096-01- Worksite Health Promotion: Private-Public Partnerships
GOETZEL, RON Z
DESCRIPTION (provided by applicant): The business case for increased employer investment in health promotion and disease prevention programs remains tenuous. To support increased private sector investment in health promotion, this project will team a public health agency, the New York City Department of Health and Mental Hygiene (NYC DOHMH), with approximately 10 New York City employers, Cornell University researchers, analysts from Medstat, and the Wellness Council of America (WELCOA) to design, implement, and evaluate a comprehensive set of evidence-based worksite health promotion interventions. We will employ a quasi-experimental research design wherein employees at five worksites will be randomly assigned to a high-intensity (treatment) condition and employees at another five worksites (matched based on industry and other important characeristics) will be randomly assigned into a low-intensity (control) condition. The intervention period will last two years. The aim of the project is to determine the most effective methods that the Wellness at Work Division of the NYC DOHMH can apply to support area employers in their health promotion efforts. The demonstration will test the incremental effects of the high-intensity interventions developed and implemented by the NYC DOHMH, above and beyond interventions already being provided by New York City employers. The impacts of the NYC DOHMH programs will be assessed in terms of improvements in health behaviors, biometric measures, and health risk factors of employees; reductions in self-reported health care utilization and associated medical expenditures; improvements in employee productivity measured in terms of self-reported absenteeism and on-the-job presenteeism; and improvement in key organizational cost measures, employee attitudes toward work, satisfaction with the work environment, and improvement in overall wellbeing. A return-on-investment [ROI]) for this publicly supported health promotion intervention will also be determined.
1 R01 CD000122-01- Computerized Risk Assessment in an Employee Population
HELITZER, DEBORAH LYNNE
DESCRIPTION (provided by applicant): The overall goal of the proposed research is to test the effectiveness of a theoretically-based interactive behavioral and health risk assessment system to improve the mental and physical health outcomes of the primary care provided for the adult multicultural members of a university health center-employee-based practice. The new system will include (1) administration of a computerized behavioral and health risk assessment, (2) calculation of an individualized risk profile for each patient participant, (3) individual patient computerized video training in interaction focused on the risk profile, (4) physician training in patient-provider interaction, motivational interviewing and counseling, and in referral and triage focused on the risk profile, and (5) development of a negotiated care plan between patient and clinician for follow-up care. Expected outcomes include changes in: risk category scores, utilization patterns, costs for health care services, and health stage of change indicators. Expected impacts (mediating variables) are: compliance with recommendations, health locus of control, differences in patient-provider interaction patterns and patient and clinician satisfaction. If successful, this methodology would contribute significantly to the health promotion goals of Healthy People 2010 and provide much needed evidence of how a behavioral and health risk assessment system can help to reduce ethnic health disparities of multi-cultural populations. This proposal is responsive to CDC's RFA for Health Promotion in the Workplace; in particular it responds to requests for strategy #6: Identification and evaluation of public health informatics and communication strategies and tools to improve health decisions, health alerting, health literacy, or health assessment among employees and employers.
1 R01 DP000106-01- PRISE: Worksite Fitness for African American Women
HOGUE, CAROL J
DESCRIPTION (provided by applicant): Investigators seek to develop and test worksite interventions designed: a) to increase physical activity among employed African American women; b) thereby to reduce racial and ethnic health disparities; and c) to address two of the seven CDC Health Protection Research Initiative priorities: "1) identification of the determinants of successful implementation and dissemination of evidence-based health promotion [in this study, a test of the Dishman/Simpson Adherence Model of Exercise (AME)]; and 2) identification of the determinants of successful translation of evidence-based health promotion interventions to special employee populations to reduce health disparities [African American women employed at Grady Memorial Hospital (GMH), atlanta, GA]." GMH administration is highly supportive of this potentially sustainable approach to improved worksite health. Specific hypotheses, suggested by pilot data with GMH employees, and based on the AME theory are: 1) current physical activity, as measured by Average Daily Steps (ADS), is a function of levels of influence and self-efficacy; 2) an increase over time in ADS is associated with increased selfefficacy over time; 3) increased ADS is associated with improved cardiorespiratory risk factors. 300 participants with < 7,000 ADS at baseline will enroll in "Eyes on the PRISE," a novel, evidence-based workplace intervention. PRISE is an acronym for Preps-reducing personal barriers at the initiation of a new program and identifying workplace activity opportunities; Reps-home-based, graduated weight training with free weights; Increased Steps-setting and adhering to modest, meaningful, incremental goals over a 6-month intervention; and Encouragement with systematic, personalized feedback. Selected components of the intervention have been developed in an ongoing pilot study among GMH employees, and these women will continue to provide important, culturally-relevant feedback for refinement of the intervention. The interdisciplinary research team from Emory College and Medical, Nursing, and Public Health faculties is headed by a senior epidemiologist with extensive experience in health promotion research and includes experts in physical fitness, cardiovascular health, medicine, behavioral sciences, and biostatistics.
1 R01 CE000498-01- Bottom-Up Modeling of Evacuation Methodologies
HOLT, JUDITH M
DESCRIPTION (provided by applicant): The purpose of this research application is to improve the workforce's protection from urgent non-occupational infectious, environmental, or terrorist threats by improving our basic understanding of effective methods for evacuating individuals, specifically those with disabilities, from buildings and other settings in response to such threats. To accomplish the purpose of this research project, an innovative and cost-effective method, Agent-Based Modeling, will be developed for application as a new technology by a unique interdisciplinary research collaborative. This method will be used to examine the effect of evacuation methodologies on the dynamics of mass pedestrian flows (MPFs) during health-safety events in the built environment, as well as the effect of evacuation methodologies on the egress of individuals with disabilities. The effectiveness of evacuation methodologies in health-safety events has not been adequately studied due to the difficulty and expense of designing valid studies with high potential for application to diverse physical settings and contexts. Adequate provision for the safe evacuation of individuals with disabilities adds layers of complexity to an already-daunting task. Agent-Based Modeling is a powerful technology with enormous promise for applicability to the design of evacuation methodologies in health-safety events. Outcomes of the proposed research program will contribute greatly to the current body of knowledge through a more complete understanding of emergent population behaviors and MPFs which result from evacuation methodologies, their effects on the emergency egress of individuals with disabilities, and the evaluation of current practices in facilitating the egress of individuals from the built-environment during health-safety events. By addressing critical and fundamental gaps in our knowledge, the proposed research program will ultimately improve the effectiveness of planning for the emergency egress of individuals of all abilities from the build-environment during health-safety events, and decrease evacuation-related injuries and deaths for the workforce.
1 R01 DP000094-01- Cost Effective Health Promotion for Older Workers
HUGHES, SUSAN L
DESCRIPTION (provided by applicant): The number of workers over age 55 is expected to increase from 19.2 million in 2002 to 31.8 million by 2015 (GAO Report, 2003). Given these projected increases, the development and testing of cost-effective health promotion interventions for this population is an urgent national priority. If we can reach older adults while they are still working and engage them successfully in sustained health promotion activities, we may be able to make a major impact on future health care expenditures. This project addresses this urgent problem by testing the comparative cost effectiveness of two evidence-based health promotion/ behavior change interventions. The first intervention, the COACH program, uses individualized telephone reinforcement to bolster adherence. The second, the RealAge program, is totally web-based. Both programs administer standardized risk assessments, develop risk profiles, and provide a set of choices for older adult workers with respect to health behavior Action Plans to address improved diet/nutrition, physical activity, and smoking cessation. at present, the comparative appeal of these two approaches and their comparative cost-effectiveness is unknown. The proposed study will test the cost-effectiveness of the two interventions with support staff 50-59 years of age at a major inner city Midwest University using a randomized clinical trial design with 450 participants. Consenting participants will be randomly assigned to a COACH group, a RealAge group, or a health education control group. Process data on intervention use and adherence to Action Plans will be collected. Measures that will be collected at baseline, six, and 12 months include mediators, primary, and secondary outcomes. Mediating variables include stages of readiness for and self-efficacy for specific behavior changes, primary outcomes include health care use and cost, absenteeism, and disability days, and secondary outcomes include vitality, depression, quality of life, blood pressure, and BMI. Cost-effectiveness will be assessed by subtracting program costs from savings obtained in health care utilization and gains in short, intermediate, and long term quality of life adjusted years.
1 R01 DP000091-01- Quantifying the Value of Value-Based Purchasing
KESSLER, RONALD C
DESCRIPTION (provided by applicant): This application seeks support for an evaluation of the cost-effectiveness of an innovative health and work productivity demonstration project carried out in atlanta and Chicago by the employer business and health coalitions in those markets (the Georgia Healthcare Leadership Council and the Midwest Business Group on Health) in collaboration with the Institute for Health and Productivity Management and researchers from Harvard Medical School. The intervention in this atlanta-Chicago Health and Productivity (ACHP) demonstration project will feature expanded services for commonly occurring health problems that are known to have effects on work performance, that are known to be under-treated, and that are known to be responsive to existing interventions (e.g., obesity, flu, low back pain, seasonal allergies). Cost-effectiveness will be evaluated by comparing changes in treatment costs with changes in monetized measures of work performance obtained from annual employee health and productivity tracking surveys. The aims of the current application are to expand the evaluation of this intervention in three ways. First, we aim to expand the data collection effort to integrate individual-level data from the surveys with administrative data of three sorts (data on health plan benefits; individual-level pharmacy and health claims data; and individual-level objective payroll records on sub-optimal work performance, sickness absence, and disability). Second, we aim to expand data analysis to carryout rigorous quasi-experimental before-after case-control evaluations of the extent to which investments by employers in expanded employee healthcare are cost-effective from the employer perspective. Third, we aim to create an ongoing system of quality assurance monitoring that can be used by employers to track their returns on healthcare investments. Successful completion of these aims will generate unique data on the cost-effectiveness of value-based employer healthcare purchasing and create a practical quality-assurance system to encourage further employer investments in worker health.
1 R01 DP000101-01- Promoting Mental Health in the Workplace
LERNER, DEBRA
DESCRIPTION (provided by applicant): A wealth of research demonstrates that depression places a substantial burden on employees and the firms in which they work. This project's long-term goal is to develop an effective, efficient and sustainable intervention that will reduce depression's adverse impact on the employee's ability to function at work. This project's main innovation will be a multi-modal, work-focused intervention program delivered by employee assistance program (EAP) counselors who companies already employ. Named the Work and Health Initiative (WHI), it will offer employees: 1) depression screening; 2) coordination of care activities; 3) work-focused cognitive behavioral therapy (CBT) strategies; and 4) work modifications to reduce impairments secondary to depression. General Aim 1 is to evaluate alternative strategies for implementing the WHI. This project will include: 1) a randomized controlled trial (RCT), using a crossover design, to test the effectiveness of two different EAR counselor training methods; 2) an RCT comparing two different strategies for recruiting employees into a workplace depression screening survey; 3) employer interviews, which will identify standards for reporting back meaningful information about the impact of the WHI while protecting employee privacy. Aim 1 will generate several products that can contribute to the success of future workplace mental health promotion programs. These products will also be integrated into this project's WHI trial. General Aim 2 is to evaluate the effectiveness of the WHI using an RCT design. at least 14,000 employees of the Lockheed Martin Corporation, representing a wide range of occupations, will be eligible to complete a private, web-based depression and work problem screening. Employees with depression and work problems will be identified from the screening and, following an in-person interview and consent, half will be randomly assigned to the usual care group and half will be assigned to the experimental WHI group (total n=230). Subjects will be surveyed at baseline and four months later. The primary outcomes to be evaluated are employee work performance and productivity using the validated Work Limitations Questionnaire (WLQ) and its work absence module. An intent-to-treat analysis will quantify the impact of the WHI on employee ability to function at work, work productivity, and depression symptoms. The WHI potentially will help employees with depression to function more effectively at work. In addition, it may decrease the burden of productivity loss on employers. Thus, this project will generate important information for key health care system stakeholders including consumers, purchasers, providers, and policymakers.
1 R01 DP000102-01- Interventions to Control Obesity in Community Colleges
LINNAN, LAURA A
DESCRIPTION (provided by applicant): Despite the fact that obesity is at epidemic proportions and costs US employers an estimated $78.5 billion annually; national data indicate that less than 25% of employers are offering disease management programs to address obesity. Effective weight loss programs that are adaptable to busy work environments and maintain employee interest are needed, but few rigorous tests of these programs have been attempted. In collaboration with the North Carolina Community College System, NC Blue Cross Blue Shield, and the State Teachers and Employee Medical Plan, we will conduct a three year group-randomized weight loss intervention study where 1300 overweight/obese employees nested within 13 community colleges will be randomly assigned to receive one of three promising, state-of-the-art, theory-linked interventions: Environment/Usual Care (E); Web-based Weight Loss Program + Environment (WEB+E) or Web + Environment +Incentives (WEB+E+I). College is the unit of randomization and intervention; employee is the unit of analysis. After formative research in Year 1 to adapt interventions for community college employees, we will rigorously test the effects of these interventions on 12-month weight loss (primary outcome). Weight will be measured at baseline, 3, 6, 9 and 12 months; and most secondary outcomes (weight loss behaviors, moderate-vigorous physical activity; total calories, percent body fat, fruit/vegetable intake, absenteeism, productivity, medical expenditures, and quality of life) will be assessed at baseline, 6 and 12 months; along with potential mediators/moderators of weight loss outcomes. Process tracking data will measure fidelity, dose delivered/received and acceptability/satisfaction with the interventions. Extensive cost- and cost-effectiveness analysis, including return on investment, will be undertaken. If proven effective, this strong partnership between community colleges, the State Health Plan, and the research team, will help guide program adoption and institutionalization/dissemination throughout the community college campus system.
1 R01 IP000051-01- Surveillance and health promotion informatics at work
MANDL, KENNETH D
DESCRIPTION (provided by applicant): New strategies are needed to accelerate the translation of data from public health research and surveillance to practice. There are well-documented barriers to the implementation of evidence based health promotion recommendations, and limited ability to adjust those recommendations to the current conditions as defined by information from regional surveillance, or to tailor them to the individual needs of citizens. We propose to adapt newly mature informatics technology, leveraging the emerging National Health Information Infrastructure (NHII) to shift the paradigm for health alerting and health promotion. The goal is to firmly ground these activities on real time information collected from and delivered to employees, in an interactive, secure, electronic environment. We will study influenza prevention and control, an archetype of public health practice requiring surveillance, communication, and timely influence of health-related behaviors. Specifically, we aim to develop a system for delivering tailored, targeted health messages to the workforce, through a personally controlled health record. The content and tempo of these messages will be modulated by real time surveillance of syndromes and laboratory data. Complex information gleaned from surveillance will be processed, translated and exchanged among citizens, public health practitioners and health care delivery systems. The goal is to provide citizens and employees with timely, individualized health promotion messages to improve their knowledge, attitudes and beliefs regarding influenza immunization, and to increase their rate of seasonal influenza immunization. We will measure the impact of the intervention primarily on the influenza vaccination rate among study participants. Secondary outcomes will be impact on rates of self-reported illness, and on knowledge, attitudes and beliefs about influenza. The formative evaluation will occur in two test beds, a major US corporation and a Canadian Province.
1 R01 DP000105-01- Optimizing the Health of Pre-Diabetic Healthcare Workers
MCLELLAN, ROBERT K
DESCRIPTION (provided by applicant): This project will implement and evaluate a new approach to engage employees, their employer and providers to improve employee health and productivity with the support of information technology. Specifically, our research team proposes to: 1. identify the population of employees at risk for developing diabetes (pre-diabetes) through the use of a voluntary health risk appraisal survey and fasting blood sugar; 2. offer this sub-group of employees individually oriented health promotion and disease prevention programs 3. subsequently implement a wide variety of "ecological" interventions aimed at creating a social environment at the workplace that optimizes employer support for individual behavioral change; 4. employ novel information technologies to create a more patient-centered and effective, shared care plan; 5. measure an array of outcomes at each phase of the study that includes measures of health behaviors and biometric risk factors and economic variables such as costs of health care, disability, workers' compensation, absenteeism and other indicators of impaired human performance.
1 R01 DP000110-01- A Mobile Team Approach to Health Promotion in Small Businesses
MESSERI, PETER A
The purpose of the proposed research is to evaluate whether principles for successful health promotion programs designed for large businesses can be adapted to small businesses in urban settings. For this research, we propose to develop a mobile team approach to worksite health promotion. The intervention will take a multi-risk factor approach. We will concentrate on identification and referral for preventive services for cardiovascular disease, cancer and smoking cessation. A package of health promotion and disease prevention activities will be developed that are based on the "10 Steps to a Longer and Healthier Life", a New York City's Department of Health and Mental Hygiene initiative. The intervention will be offered free charge to 50 Fifty small businesses located in Harlem, New York City evaluated through a group-randomized trial. Businesses agreeing to participate will be randomized in to one of two conditions: 1) a comprehensive mobile team intervention or 2) a low intensity intervention with receipt of the full intervention to follow after a 3-month delay. The primary outcomes of the study increased use of appropriate preventive services that are available in the community for minimal or no fee and reduction in selected health risk factors. All employee data will be collected as part of the health profile assessment that will be an integral component of the intervention. Additional information will be collected to document worksite and employee participation rates, the fidelity of the intervention to principles of successful health promotion design, and the cost of the intervention. The first year of the study will be devoted to formative research to develop the intervention and confirm hypothesized prevention needs of the target population. The intervention will be conducted during the second and first half of the third year of the grant Analysis of project results will be conducted in year three of the grant.
1 R01 CD000011-01- A New Method of Valuing Investments in Workers' Health
NICHOLSON, SEAN M
DESCRIPTION (provided by applicant): DirecTV, a large employer headquartered in Los Angeles, is implementing Work Well Plus, an innovative health and productivity program in a 1,300-employee call center in Boise, Idaho. The Work Well Plus program distinguishes itself from other health promotion programs by offering employees and their physicians a substantial financial incentive to participate, thereby involving all parties who affect an employee's health. To help achieve these goals, high-risk employees are offered personal coaching regarding how to reduce their health risks and adhere to clinical guidelines in the treatment of their chronic disease, physicians are offered patient-specific data and educational resources regarding optimal treatment methods, and physicians and employees share in the savings resulting from reduced medical expenditures and improved productivity. The three specific aims of this proposal are to: (1) Derive job-specific "multipliers" for every employee at DirecTV. A multiplier is the estimated cost to an employer of an employee's absence or diminished on-the-job productivity, measured as a proportion (often greater than one) of the worker's daily wage. (2) Perform a comprehensive cost-benefit analysis of Work Well Plus from the perspective of a profit maximizing employer by analyzing the impact of the program on the medical expenditures, absences, on-the-job productivity, and health of the participating employees. (3) Demonstrate the effectiveness of a new method for measuring the financial benefit to an employer of investing in the health and productivity of its workforce. The long-term objectives of this study are to 1) identify health promotion programs that have sufficiently large net benefits for businesses to implement; and 2) develop a better method for persuasively articulating why employers should invest in the health and productivity of their workforce. DirecTV's Work Well Plus program is an ideal program to evaluate to meet these objectives because of its innovative design, integrated data, and diversity of job types.
1 R01 DP000092-01- Worksite Opportunities for Wellness
RACETTE, SUSAN B
DESCRIPTION (provided by applicant): Overweight and obesity are the most prevalent health problems in the U.S. today, affecting more than 64% of adults, and contributing significantly to morbidity and mortality: There is substantial evidence that improving diet habits and increasing physical activity promote weight control, reduce disease risk, and enhance overall health. A health promotion program delivered at the worksite has numerous advantages, including the opportunity to reach a large number of people in a time-efficient and cost-effective manner. We propose to conduct a worksite intervention titled "Worksite Opportunities for Wellness" (WOW), which includes individual, group, and environmental components designed to promote healthier dietary and physical activity behaviors among university staff. The specific aims are to evaluate: (1) the feasibility of delivering our multi-component WOW program in 2 university worksites; (2) the efficacy of WOW on reducing the prevalence or severity of overweight and obesity; (3) the efficacy of WOW on improving risk factors for cardiovascular disease and type 2 diabetes; and (4) the impact of WOW on quality of life, absenteeism, and health care utilization. A delayed treatment design will be used, in which Site A has a 1-yr intervention with 1-yr follow-up, and Site B has a 1-yr control period followed by the 1-yr intervention. Assessments of weight, body mass index, body composition, waist circumference, lipids, glucose, fitness, quality of life, absenteeism, and health care utilization will be made at baseline and 6, 12, 18, and 24 months. The WOW intervention is comprised of a constellation of nutrition components, physical activity components, and incentives, including a weekly healthy snack cart, on-site Weight Watchers program, on-site exercise program, monthly healthy lunch seminars, healthier foods in vending machines and the cafeteria, free pedometers, colorful maps of walking routes, team competitions among coworkers, personal health reports, and several raffles.
1 R01 DP000117-01- Preventing Tobacco Use in Young Latino Workers in Texas
RAMIREZ, AMELIE G
DESCRIPTION (provided by applicant): This 3 year project, will develop and implement a program to reduce tobacco use among.at risk Latino young workers, aged 18 to 25, using mass media, peer networking, and Web based communications. Messages will be developed using theory-based objectives, diagnostic research, and pre-testing with samples of Latino young adults from the target audience. A program of thoroughly tested culturally appropriate messages and age appropriate tailored Web based navigation will be delivered over two years, to the defined audience segment in East End District of Houston. Three experimental groups will be included to test cumulative interaction effect including exposure to mass media messages alone, mass media plus peer networking, and mass media and peer networking plus web based intervention. A no-intervention control community in the Southwest District of the city of Dallas, Texas, with similar demographic characteristics will be selected. Impact of the program on targeted mediators and tobacco use behaviors will be assessed among samples of young adult workers from these communities through population surveys and an embedded cohort study.
1 R01 DP000108-01- Worksites overweight/obesity control/prevention trial
ROSS, ROBERT H
DESCRIPTION (provided by applicant): A 3-year 4-arm small-to-medium employer-randomized control trial is proposed based on interest across DHHS in confronting mounting overweight/obesity and at CDC in identifying cost-effective Interventions that can improve workers' health. The study will gauge relative effectiveness-compared to Standard worksite wellness (SWW) which features no deliberate overweight and obesity control and prevention (OO/CP) components-of three Standard-plus (SpWW) models: Individual per se (Ips), Environmental per se (Eps), Integrated environmental-individual (lei). Interventions will seek to modify employee behaviors that contribute to overweight/obesity, Ips by providing health services to subsets of employees, Eps by altering worksite and surrounding settings affecting all employees, lei by integrating the two approaches. Each will feature distinct health promotion/disease prevention (around food choices, physical activity, alcohol, tobacco) but common design/implementation (employer/employee program delivery collaboration) components. The test period will last 30 mos, enlist 32 employers. In phase 1 (4 mos) baseline measures will be taken of relevant employer and employee characteristics and Test site program delivery (PD) teams will be constituted to work with the study team a) to tailor Interventions by selecting general Worksite wellness and specific OO/CP components (study-defined range, fixed minimum) and b) to design Protocols by which PD teams with study personnel will guide phase 2 (26 mos) Interventions. Primary outcomes include morbidity: weight (overweight/obesity = BMI >25/>30), waist circumference (overweight=WC >35 [w], >40 [m]), lipids (total cholest, HDL-cholest), blood glucose; disability: work limitations (WLQ); health-related quality of life: physical, mental health status (SF-36); productivity: absenteeism (rate), productivity (WLQ); cost: employer, employee cost (health-related). Test site are expected to report significantly more positive outcome than Control site, lei significantly more positive outcomes than Ips or Eps, Ips no more or less positive outcomes than Eps employers.
1 R01 DP000115-01- Obesity in school staff: Participatory environmental model
SIEGEL, JUDITH M
DESCRIPTION (provided by applicant): Obesity in the United States is rapidly overtaking smoking as the number one cause of preventable disease and disability. The proposal is to develop and evaluate an intervention that reduces obesity by promoting healthy dietary and exercise behaviors among personnel in the Los Angeles Unified School District. This randomized control trial with a repeated crosssectional design will utilize a participatory process to develop an environmental intervention for elementary school personnel. Specifically, this study aims: 1. To assess the feasibility of using a participatory approach with elementary school personnel (teachers and staff) to develop a work site health promotion program that reduces obesity via an environmental intervention encouraging healthy eating and exercise. a. To identify facilitating factors and barriers to developing and implementing the program. 2. To evaluate the impact of the program on health (e.g., BMI, physical fitness), health behaviors (e.g., dietary intake, physical activity level), and work productivity (e.g., absenteeism). 3. To identify individual (gender, race-ethnicity), work site (characteristics of the school environment), and community factors (neighborhood SES) that influence exposure to the intervention and the impact of the intervention on the dietary and physical activity behaviors of school personnel. 4. To determine the impact of a participatory model work site health promotion intervention on the school environment, including policies, programs, and support for work site health promotion. 5. To determine the extent to which the school-based work site health promotion program is economically sustainable. Unhealthy dietary and physical activity behaviors are major contributors to overweight and obesity. The proposed intervention builds on the research team's Nutrition Friendly Schools and Communities (NFSC) model, a multi-level participative intervention that facilitates coordinated change in the school environment. The NFSC model incorporates elements of the coordinated school health model and participatory research. Sixteen elementary schools (8 intervention schools; 8 control schools), and 500 school personnel within those schools, will participate in the study. Several types of data collection activities are planned to assess the process and outcomes of the study. Data will be analyzed by means appropriate to the method of collection and include: content analysis of the observations; descriptive analysis of participant characteristics; and bivariate and multivariate analyses to determine the impact of the intervention and relationships among the key constructs. Beyond improving the health status of school personnel, healthy teachers have the potential to create an optimistic school climate, serve as role models to students, and reinforce positive health messages.
1 R01 DP000099-01- Health Promotion for Mobile Workers
SORENSEN, GLORIAN C
DESCRIPTION (provided by applicant): This study will adapt an evidence-based health promotion program and assess its implementation and effectiveness in a high-risk population of workers. Preliminary results of an on-going randomized controlled intervention study suggest that a tailored telephone-delivered intervention is efficacious in increasing smoking cessation and fruit and vegetable consumption among construction laborers. The proposed study will adapt this intervention to promote tobacco use cessation and weight management in another population of blue-collar workers: motor freight workers, including truck drivers, dock workers and mechanics. Across multiple studies of workers, truck drivers have been repeatedly shown to have among the highest smoking rates and high rates of overweight. Because of the mobile nature of this work, worksite health promotion programs are generally inaccessible for these workers. We will survey motor freight workers in eight randomly selected trucking terminals, and invite respondents to participate in a telephone-delivered health promotion intervention, including tailored educational materials and five telephone counseling calls delivered over four months. We will evaluate factors associated with participation in the health promotion program and assess change in tobacco use and weight between the Baseline Survey and Final Survey in the entire study cohort, following the intention to treat principle. We will also evaluate individual and program factors associated with the change in tobacco use and weight among participants, and assess the costs associated with program implementation. This study will additionally examine the impact of the intervention on secondary outcomes indicative of worker health, including general health status and satisfaction with daily functioning, absenteeism, and attentiveness, and will assess determinants of behavior change, as measured by a set of modifying conditions and mediating mechanisms defined by the social contextual framework for health behavior change. This study is a partnership among the Dana-Farber Cancer Institute (DFCI), the International Brotherhood of Teamsters, and the Motor Freight Carriers Association (MFCA), the trade association of unionized motor freight carriers. This intervention has the potential to influence health behaviors among a high-risk population of workers, and shows promise for long-term sustainability and dissemination through close collaboration with our union and management partners.
1 R01 DP000095-01- Email-Based Diet & Activity Promotion in Worksites
STERNFELD, BARBARA
DESCRIPTION (provided by applicant): Approximately 400,000 deaths in the United States each year are attributable to poor diet and physical inactivity. Despite the well-documented health benefits of regular physical activity and diets high in fruits and vegetables and low in fat, the prevalence of these behaviors remains relatively low in the population as a whole, and even lower in minority and socioeconomically disadvantaged subgroups. The overall purpose of this proposal is to evaluate the efficacy of a cost-effective, 4-month computerized diet and physical activity intervention program, delivered by e-mail, within the worksite environment. The intervention program will be built on an existing prototype that showed both technical feasibility and potential scientific merit in a 12-week pilot study. In the first stage of the current study, we will develop that prototype further both in terms of content and technical capabilities. Specifically, we will add a physical activity component (designed to increase walking and decrease sedentary behavior), and will further tailor messages to participants' stage of readiness for change, self efficacy and lifestyle characteristics. We will also enhance the interactive features, such as a tool that simulates the overall effects of a specific change in diet or physical activity. In the second stage of the study, we will conduct a 2-arm randomized trial of the intervention program in employees of Northern California Kaiser Permanente (KP). Approximately 2,000 employees from 20 regional KP departments will be invited to participate in the trial through an e-mail from KP leaadership that describes the study, followed by an e-mail from the study staff containing baseline assessments, instructions, and informed consent. Employees who are interested in participating will return the forms by e-mail directly to study staff. Employees will be randomly assigned, in roughly equal numbers, with the department as the unit of randomization, to the intervention group, who will receive the full intervention program, or the wait-list control group, who will receive standard diet and physical activity recommendations and information. The control group may choose to receive the intervention at the end of the study period. To determine both shortterm effects and longer-term sustainability of effects, both groups will complete dietary and physical activity assessments and other questionnaires (self efficacy, social support, health-related quality of life, and demographic characteristics) at the beginning of the trial, after the 4-month intervention, and then again 8 months from baseline. In addition to physical activity and dietary behaviors, study outcomes will include health-related quality of life, absenteeism, and health care utilization. Primary analyses of differences between the intervention and control groups will be based on "intent to treat," and will account for the cluster randomization design. This e-mail-based intervention, if proven successful, could be widely and cost-effectively disseminated and, thereby contribute significantly to achieving the dietary and physical activity goals for Healthy People 2010.
1 R01 DP000104-01- Standard Worksite Health Program vs Activated Consumer
TERRY, PAUL EDWARD
DESCRIPTION (provided by applicant): The emerging era of shifting health costs to employees and an aging workforce with more chronic diseases will require worksite programs that are cost effective and sustainable and health care consumers who are active partners in their care. This study is a randomized, controlled trial comparing the effectiveness of a standard worksite health promotion intervention with an innovative activated health care consumer intervention to reduce health risks and decrease inappropriate health care costs and absenteeism. The standard intervention assesses employee risks and interests and uses participatory research principles for program design and delivery. These programs include substantial promotional efforts and multiple educational offerings to address health behaviors such as tobacco cessation, and chronic disease management. Such programs generally do not emphasize links with health care delivery systems. In contrast, the activated consumer intervention will offer comparatively shorter education sessions and will be closely connected to the employees' use of health care systems. The activated consumer intervention includes decision tools, skills development for working with healthcare providers and education about preparing for medical emergencies including terrorist threats. Our aims include the development of an activated consumer intervention, a comparison of the cost effectiveness of the interventions in reducing risks, health care costs and absenteeism and a comparison of the sustainability of the interventions. The study design is a nested (hierarchical, multilevel) design. Within each company, three sites are chosen and randomly assigned to the control site or one of the two interventions. We hypothesize that the activated consumer intervention will be more cost-effective than the standard health promotion intervention in decreasing avoidable health claims costs and in reducing absenteeism.
1 R01 DP000100-01- Financial incentives for smoking cessation
VOLPP, KEVIN G
DESCRIPTION (provided by applicant): Smoking is the leading cause of preventable mortality in United States, accounting for approximately 435,000 of the 2.4 million deaths each year in the United States. Most smokers make multiple attempts to quit smoking, but only 2-3% succeed each year. Smoking cessation programs and pharmacological aids have proven effective in helping smokers quit, but only about 5% of smokers enroll in smoking cessation programs each year. The current prevalence of smokers in the United States is about 22%, meaning that achieving the Healthy People 2010 goal of having 12% or fewer current smokers in the adult population will require substantial increases in tobacco cessation rates. The investigators propose to conduct a randomized control trial (RCT) of financial incentives for smoking cessation among employees at General Electric worksites throughout the United States. This will be a 2-arm RCT in which smokers will get randomized to receive either usual care (information about local community-based smoking cessation resources, coverage of prescription drugs and physician visits) or usual care plus a package of financial incentives that includes $250 for completion of a community-based tobacco cessation program, $250 for smoking cessation 30 days post-quit date, and $250 for smoking cessation 6 months post-quit date (biochemically confirmed). Financial incentives have been shown to increase enrollment in smoking cessation programs and short-term quit rates, but have not been well tested as a mechanism for increasing long-term quit rates. The existing evidence suggests that they could be highly effective, particularly among heavy smokers and low income smokers. In addition, financial incentives for smoking cessation will likely be more cost effective than most covered health services and at least as cost effective as other recommended smoking cessation treatments. The primary outcome will be quit rates at 6 months. Secondary outcomes will be enrollment in and completion of community-based smoking cessation programs, 30-day and 12-month quit rates, and cost effectiveness of the incentives in increasing quit rates. The proposed intervention, designed to be highly cost effective and easy to replicate in employer settings, has the potential to substantially reduce the economic and health burden of smoking-related disease and disability among a large portion of the American population.
* Links to non-Federal organizations found at this site are provided solely as a service to our users. These links do not constitute an endorsement of these organizations or their programs by CDC or the Federal Government, and none should be inferred. CDC is not responsible for the content of the individual organization Web pages found at these links.
Please note: Some of these publications are available for download only as *.pdf files. These files require Adobe Acrobat Reader in order to be viewed. Please review the information on downloading and using Acrobat Reader software.
Page last modified: July 22, 2008
Content source: Office of the Chief Science Officer (OCSO)
