Larry Chapman’s Blog

Results-Driven Worksite Wellness

Are we doing enough about Cancer?

Author: Larry Chapman

Think about that employee of yours that this year will receive a diagnosis with the “C” word.  Pretty chilling huh!  Even with the steady improvements in cancer incidence and survivability, it is still a primary health concern for a major portion of your employees.  The American Cancer Society (ACS) just released its national cancer estimates for 2018 that puts some perspective around this powerful health and wellness issue.

Wellness program managers would do well to look for some meaningful opportunities to help inform and educate employees about the health risk factors and treatment issues associated with cancer diagnosis, treatment and prevention.  Here are some suggestions:

  • Examine your health/well-being survey for cancer risk related questions.
  • Make sure the personal reports you provide to participants address cancer-related risk reduction.
  • Create an opportunity to use some of the global data in this article to raise awareness about cancer risk.
  • Remind employees through wellness coaches to make sure they have a PCP and to ask about cancer prevention.
  • Make sure your health plan has resources and services to help those who are newly diagnosed find their way through the health care “maze” when it comes to cancer treatment.
  • Look for an opportunity to incent your employees and their family members to stay “current” on all preventive screening that is cancer-related.
  • Review how your employees can access health plan provided, consumer information on cancer treatment and services including price transparency and options.
  • Keep an eye on the patient cost-sharing load for cancer patients so that we don’t financially overwhelm our employee families during treatment and follow-up.
  • Consider doing a lunch and learn session on cancer risk reduction strategies and issues.
  • Explore the possibility of a lunch and learn session on what to do if you or a family member gets a cancer diagnosis.
  • Depending on your work culture consider addressing complementary and alternative medical options.
  • Examine the option of looking at the primary, secondary and tertiary prevention issues connected with cancer. (Hint: primary = precursors, secondary = early detection, tertiary = help after confirmed diagnosis)

Lots of different things that can be done to help your employees deal with cancer issues.

Click here to download this document

NOTE: You will need to have an active WellCert Membership in order to download this document.

I hope this tool helps you reach your wellness programming goals!  Drop me a note and let me know your thoughts and if you found it to be helpful: [email protected].

The CDC Worksite Health ScoreCard

Author: Larry Chapman

The CDC Worksite Health ScoreCard (HSC) is a tool designed to help employers assess whether they have implemented evidence-based worksite health promotion and wellness interventions or strategies in their worksites to prevent heart disease, stroke, and related conditions such as hypertension, diabetes, and obesity.

The tool was developed by the CDC Division for Heart Disease and Stroke Prevention in collaboration with the Emory University Institute for Health and Productivity Studies (IHPS), the Research Triangle Institute, the CDC National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP) Workplace Workgroup, and an expert panel of federal, state, academic, and private sector. To ensure the validity and reliability of the tool, a validation study was conducted by Emory University’s IHPS on the tool’s original 12 modules.

This study involved a national sample of 93 employers of variable size who agreed to pilot test the survey and provide feedback on the survey’s content and structure. In 2013, four additional modules were developed and tested using a similar protocol as the original validation study. For more information on how the tool was developed and validated, refer to the Frequently Asked Questions (FAQs) in Appendix A.

The types of issues addressed in this document includes:

  • 126 questions that employers can ask of their comprehensive worksite health promotion programs.
  • Steps for use of the CDC Worksite Health ScoreCard.
  • Instructions for using the ScoreCard.
  • 16 health-related domains are included in the ScoreCard.
  • Active links to key health and wellness technical evidence sources.

Worksite Wellness professionals can use this information to:

  • Compare their own programming to evidence-based sources.
  • Educate management and employees about the technical soundness of their employee wellness programming.
  • Utilize these recommendations to help formulate additional organizational and wellness programming strategies.
  • Formulate an evidence-based organizational perspective on employee wellness programming.

In summary, this 81-page program management tool contains a survey and scoring process to help employers utilize evidence-based interventions and represents a thorough appraisal of current scientific thinking about worksite wellness programs, and therefore is of significant value to worksite wellness professionals.

Click here to download this document

NOTE: You will need to have an active WellCert Membership in order to download this document.

I hope this tool helps you reach your wellness programming goals!  Drop me a note and let me know your thoughts and if you found it to be helpful: [email protected].

Obesity in the Workplace: Impact, Outcomes, and Recommendations

Author: Larry Chapman

The American College of Occupational and Environmental Medicine (ACOEM) is the authoritative group that provides guidance to health professionals that serve and care for employee populations in work organizations.  This guidance statement provides a consensus among occupational health professionals about the impact, outcomes to be expected and recommendations for dealing with obesity in working populations.  Obesity status affects approximately 37.7% of the U.S. adult population and represents a major concern of virtually all employee and worksite wellness initiatives. A body mass index (BMI) of ≥ 30 kg/m2 is the generally accepted threshold for obesity.

Objective: To conduct a comprehensive literature review to develop recommendations for managing obesity among workers to improve health outcomes and to explore the impact of obesity on health costs to determine whether a case can be made for surgical interventions and insurance coverage. Methods: We searched PubMed from 2011 to 2016, and CINAHL, Scopus, and Cochrane Registry of Clinical Trials for interventions addressing obesity in the workplace. Results: A total of 1419 articles were screened, resulting in 275 articles being included. Several areas were identified that require more research and investigation. Conclusions: Our findings support the use of both lifestyle modification and bariatric surgery to assist appropriate patients in losing weight.

The types of issues addressed in this article includes:

  • Methodology used by ACOEM to weigh the evidence for evaluating the outcomes of employer efforts to reduce obesity.
  • Estimates of the economic burden associated with obesity.
  • Staging of obesity and its health and safety impact.
  • Impact of the workplace on obesity.
  • Social stressors and psychosocial work factors.
  • Recommendations for lifestyle modification interventions.
  • Pharmacotherapy recommendations.
  • Surgical interventions and emerging invasive therapies.
  • Recommendations for employers about obesity treatment and prevention.
  • Research gaps concerning obesity in the workplace.

Worksite Wellness professionals can use this information to:

  • Compare their own approaches to obesity with the ACOEM recommendations.
  • Educate management and employees about the economic and productivity costs of obesity.
  • Utilize these recommendations to help formulate organizational and wellness strategies.
  • Formulate organizational perspectives about obesity and overweight issues in their workforce.

In summary, this is an authoritative and recent source of information and consensus about the major problem of obesity among working Americans and provides summary information and recommendations that are useful for worksite wellness professionals.

Click here to download this document

NOTE: You will need to have an active WellCert Membership in order to download this document.

I hope this tool helps you reach your wellness programming goals!  Drop me a note and let me know your thoughts and if you found it to be helpful: [email protected].

Everything You Ever Wanted to Know About the USPSTF

Author: Larry Chapman

The U.S. Preventive Services Task Force (USPSTF) is an independent body of experts who make evidence-based recommendations about clinical preventive services using a transparent and objective process. Developing recommendations on a clinical preventive service requires evidence of its effect on health outcomes. Health outcomes are symptoms, functional levels, and conditions that affect a patient’s quantity or quality of life and are measured by assessments of physical or psychologic well-being. Intermediate outcomes are pathologic, physiologic, psychologic, social, or behavioral measures related to a preventive service. Given the frequent lack of evidence on health outcomes, the USPSTF uses evidence on intermediate outcomes when appropriate.

The ultimate goal is to determine precisely a consistent relationship between the direction and magnitude of change in an intermediate outcome with a predictable resultant direction and magnitude of change in the health outcomes. The USPSTF reviewed its historical use of intermediate outcomes, reviewed methods of other evidence-based guideline-making bodies, consulted with other experts, and reviewed scientific literature. Most important were the established criteria for causation, tenets of evidence-based medicine, and consistency with its current standards. Studies that follow participants over time following early treatment, stratify patients according to treatment response, and adjust for important confounders can provide useful information about the association between intermediate and health outcomes. However, such studies remain susceptible to residual confounding. The USPSTF will exercise great caution when making a recommendation that depends on the evidence linking intermediate and health outcomes because of inherent evidence limitations.

This compendium of 9 peer review articles published in this month’s edition of the American Journal of Preventive Medicine (January 2018) provides an in-depth look at the USPSTF. The 9 articles include: methodology they use, net benefits, rapid review procedures, use of risk stratification, group implications, communication issues, organized system uses, and research priorities.

The types of issues addressed in this article includes:

  • Methodology used by the USPSTF in relation to intermediate outcomes and health outcomes.
  • Use of USPSTF recommendations by employers.
  • Nature of the net benefits associated with the use of USPSTF recommendations.
  • Communication to individuals and groups of USPSTF recommendations.
  • Current research priorities and future initiatives.

Worksite Wellness professionals can use this information to:

  • Compare their own preventive medical benefits coverage adequacy and alignment with USPSTF recommendations.
  • Educate management and employees about these authoritative recommendations.
  • Enhance some selected elements of health literacy regarding the use of preventive care.
  • Augment planning around preventive care interventions and employee benefit design choices.

In summary, this is an authoritative and recent source of information about the role and methods of the United States Preventive Services Task Force (USPSTF) and the use of their recommendations by employers.

Click here to download this document

NOTE: You will need to have an active WellCert Membership in order to download this document.

I hope this tool helps you reach your wellness programming goals!  Drop me a note and let me know your thoughts and if you found it to be helpful: [email protected].

Employee Wellness Programs and Preventive Care Use

Author: Larry Chapman

Introduction: There is little research at the national level on access to employee wellness programs and the use of preventive care services. This study examined the use of seven preventive care services among U.S working adults with access to employee wellness programs.

Methods: The study population comprised 17,699 working adults aged ≥18 years, obtained from the 2015 National Health Interview Survey. Multivariate logistic regression models examined the relationship between access to employee wellness programs and use of seven preventive care services: influenza vaccination, blood pressure check, diabetes check, cholesterol check, Pap smear test, mammogram, and colon cancer screening. Data analysis began in Fall 2016.

Results: Overall, 46.6% of working adults reported having access to employee wellness programs in 2015. Working adults with access to employee wellness programs had higher odds of receiving influenza vaccination (OR¼1.57, 95% CI¼1.43, 1.72, p<0.001), blood pressure check (OR¼2.46, 95% CI¼2.17, 2.78, p<0.001), diabetes check (OR¼1.30, 95% CI¼1.12, 1.50, p<0.001), cholesterol check (OR¼1.48, 95% CI¼1.33, 1.67, p<0.001), and mammogram (OR¼1.57, 95% CI¼1.24, 1.98, p<0.001). However, there was no significant difference between access to employee wellness programs and the use of Pap smear test and colon cancer screening services.

Conclusions: Using a nationally representative sample of individuals, this study found a positive association between access to employee wellness programs and the use of preventive care services. The results support favorable policies to encourage implementing wellness programs in all worksites, especially those with <50 employees.

The types of issues addressed in this article includes:

  • Prevalence of preventive service use in a random national sample of employees.
  • Percentage of people with access to wellness programming at work.
  • Sociodemographic characteristics and their influence on preventive care use.
  • Age, race, gender and ethnicity differences in preventive care use.

Worksite Wellness professionals can use this information to:

  • Compare their own populations to national data.
  • Educate management about the likely impact of wellness programs on employee preventive care use.
  • Evaluate the incremental effects of strategies to increase preventive care use.
  • Make a stronger case for a more serious wellness program effort.

In summary, this is an authoritative national look at employees and their use of preventive care services when they have access to an employee wellness program demonstrating a significantly positive relationship.

Click here to download this document

NOTE: You will need to have an active WellCert Membership in order to download this document.

I hope this tool helps you reach your wellness programming goals!  Drop me a note and let me know your thoughts and if you found it to be helpful: [email protected].

Prevalence and Trends in Lifetime Obesity

Author: Larry Chapman

Introduction: Estimates of obesity prevalence based on current BMI are an important, but incomplete indicator of the total effects of obesity on a population. Methods: In this study, data on current BMI and maximum BMI were used to estimate prevalence and trends in lifetime obesity status, defined using the categories never (maximum BMI ≤30 kg/m), former (maximum BMI ≥30 kg/m ≥30 kg/m and current BMI ≤30 kg/m), and current obesity (current BMI). Prevalence was estimated for the period 2013–2014 and trends for the period 1988– 2014 using data from the National Health and Nutrition Examination Survey. Predictors of lifetime weight status and the association between lifetime weight categories and prevalent disease status were also investigated using multivariable regression.

Results: A total of 50.8% of American males and 51.6% of American females were ever obese in 2013–2014. The prevalence of lifetime obesity exceeded the prevalence of current obesity by amounts that were greater for males and for older persons. The gap between the two prevalence values has risen over time. By 2013–2014, a total of 22.0% of individuals who were not currently obese had formerly been obese. For each of eight diseases considered, prevalence was higher among the formerly obese than among the never obese.

Conclusions: A larger fraction of the population is affected by obesity and its health consequences than is suggested in prior studies based on current BMI alone. Weight history should be incorporated into routine health surveillance of the obesity epidemic for a full accounting of the effects of obesity on the U.S. population. The population burden of obesity is larger than indicated by data on current BMI alone. In total, half of the U.S. adult population has been affected by obesity in their lifetime compared to the 37% who are obese based on current weight status. The formerly obese population, which accounts for the gap between these two estimates, is an important and growing minority of the population with elevated disease risks. It should be distinguished from never obese individuals in routine health surveillance for a full accounting of the effects of obesity on the U.S. population.

The types of issues addressed in this article includes:

  • Prevalence and trends for obesity in the U.S. population.
  • Percentage of people who are obese now and where obese at some point in their lives.
  • Importance of obesity in employee health surveillance.
  • Age, race, gender and ethnicity differences in obesity.
  • Common disease conditions associated with obesity.

Wellness professionals can use this information to:

  • Compare their own populations to national data.
  • Educate management about the importance of weight management in working populations.
  • Evaluate the incremental effect of their obesity prevention efforts.
  • Make a stronger case for a more serious weight management initiative within their wellness program.
  • Relate data on obesity to the incidence and prevalence of 8 common diseases.

In summary, this is an authoritative look at the size, significance and occurrence of obesity for Americans.

Click here to download this document

NOTE: You will need to have an active WellCert Membership in order to download this document.

I hope this tool helps you reach your wellness programming goals!  Drop me a note and let me know your thoughts and if you found it to be helpful: [email protected].

Newly Released Health Insurance Chartbook for 2016

Author: Larry Chapman

Recently the federal government released one of the most comprehensive and authoritative chartbooks profiling health insurance coverage, costs and trends for working Americans.  This 168 page publication provides one of the most sweeping and most valid profiles of employer provided health insurance coverage and characteristics that has been published to date.  It also includes a large number of useful graphs and charts that can be extracted and used to educate senior management and employees on health cost and health insurance related issues.

The Medical Expenditure Panel Survey Insurance Component (MEPS-IC) is an annual survey of private employers and State and local governments. The MEPS-IC produces national and State level estimates of employer-sponsored insurance, including offered plans, costs, employee eligibility, and number of enrollees along with a number of other issues.

The types of issues addressed in the Chartbook includes:

  • Major trends affecting health insurance coverage.
  • Differences in health insurance coverage by firm size.
  • Trends and patterns for single, employee plus one and family coverage.
  • Health insurance offer and take up rates.
  • Premium costs and employee cost sharing trends.
  • Employee cost sharing patterns.
  • Employee eligibility and enrollment rates and trends.
  • Health plan characteristics by firm size and type.

Wellness professionals can use this information to:

  • Compare their organization or client organizations health plan coverage.
  • Design wellness health plan incentives.
  • Estimate potential for economic return for wellness programming.
  • Augment employee education on health care consumerism and medical self-care.
  • Estimate likely health plan premium growth rates.

In summary, this is an excellent comprehensive reference on health insurance coverage and costs in the U.S. up to and including 2016.

Click here to download this document

NOTE: You will need to have an active WellCert Membership in order to download this document.

I hope this tool helps you reach your wellness programming goals!  Drop me a note and let me know your thoughts and if you found it to be helpful: [email protected].

New Guidelines for the Diagnosis and Treatment of Hypertension

Author: Larry Chapman

On November 13, 2017,  the American College of Cardiology (ACC) and the American Heart Association (AHA) released a new report that recommends changing the clinical parameters for the diagnosis of hypertension from 140sbp/90dbp to 130sbp/80dpb.  This is a big deal and will affect everyone who performs blood pressure measurement including worksite wellness programs and specifically their preventive screening interventions.  This change also means that tens of millions of more people will now be diagnosed with hypertension and will now need lifestyle and prescription drug intervention.
The full report which is 400+ pages is available at no cost on the American College of Cardiology website at http://www.acc.org/guidelines.

Below you will find a much more readable and practical document called the 2017 ACC/AHA/AAPA /ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: GUIDELINES MADE SIMPLE: A Selection of Tables and Figures.

It is interesting that the full report has no mention of the United States Clinical Preventive Services Task Force (USCPSTF) which will ultimately have to weigh in on this significant change in clinical standards.  The ACC and AHA apparently feel that they have sufficient research data to meet the burden of proof required for USCPSTF agreement.  The National Institutes of Health (NIH) will also have to weigh in on this change as it relates to the National High Blood Pressure Education Program.

The document you can download below will allow you to:

  • See the full new standard including new numbers for various stages
  • Assess the epidemiological relevance of the change
  • Adjust your preventive screening activity and employee education efforts
  • See the recommended advice on hypertension that physicians are expected to give patients
  • Use this change to energize your preventive screening activity

In summary, this is an excellent quick reference on the newly recommended standards surrounding the diagnosis and treatment of hypertension.

Click here to download this document

NOTE: You will need to have an active WellCert Membership in order to download this document.

I hope this tool helps you reach your wellness programming goals!  Drop me a note and let me know your thoughts and if you found it to be helpful: [email protected].

Short Primer on Evaluation of Worksite Wellness Programs

Author: Larry Chapman

This 30 page document provides a quick and efficient look at key issues in program evaluation of worksite wellness and health promotion programs.  It includes discussion of a number of key issues and is a helpful reference in establishing your own approach to program evaluation.  The table of contents includes:
PURPOSE, SCOPE AND FORMAT …………………………………………………………………  1
IMPORTANCE OF EVALUATION …………………………………………………………………..  1
TYPES OF EVALUATION ……………………………………………………………………………….  1
Structure Evaluation …………………………………………………………………………………………. 1
Process Evaluation ……………………………………………………………………………………………. 2
Outcome Evaluation  ……………………………………………………………………………………….. 2
Interrelationship of Variables …………………………………………………………………………….. 2
Qualitative versus Quantitative Evaluation ……………………………………………………….. 2
SETTING REALISTIC EXPECTATIONS ………………………………………………………………  3
Program Budgets ……………………………………………………………………………………………… 4
HRA participation …………………………………………………………………………………………….. 4
Tobacco Cessation Rates …………………………………………………………………………………. 4
Medical Care Cost and Absenteeism Reduction ……………………………………………… 4
Other program outcomes ………………………………………………………………………………… 4
METHODOLOGY FOR OUTCOMES EVALUATION ………………………………………….  6
Study Structure …………………………………………………………………………………………………. 6
Posttest Only ……………………………………………………………………………………………………………..  6
Pretest/Posttest ………………………………………………………………………………………………………….  6
Pretest/Posttest Structure with a Comparison Group  …………………………………………………  6
Experimental Design  …………………………………………………………………………………………………  7
Solomon Four Group ………………………………………………………………………………………………….  7
Time Series or Longitudinal Analysis ……………………………………………………………………………  7
Measures………………………………………………………………………………………………………….. 8
Validity ………………………………………………………………………………………………………………………  8
Reliability ………………………………………………………………………………………………………………….  10
Study Sample …………………………………………………………………………………………………. 12
Representative ………………………………………………………………………………………………………..  13
Size  …………………………………………………………………………………………………………………………  13
Analysis …………………………………………………………………………………………………………… 14
TYPICAL EVALUATION STRATEGIES …………………………………………………………….  15
No Evaluation Efforts……………………………………………………………………………………….. 15
Compare Health Risk Assessment (HRA) Over time …………………………………………. 15
In-depth, longitudinal analysis.  ………………………………………………………………………. 15
REFERENCES …………………………………………………………………………………………….  21

Excellent quick reference on program evaluation.

Click here to download this document

NOTE: You will need to have an active WellCert Membership in order to download this document.

I hope this tool helps you reach your wellness programming goals!  Drop me a note and let me know your thoughts and if you found it to be helpful: [email protected].

Summary of Evidence on Text Messaging and Health Behavior Change

Author: Larry Chapman

This edition of Connections contains a brief summary of the findings from 15+ research studies on the effectiveness of text messaging (‘SMS’) in assisting with health behavior change.  ‘Mobile’ is old news. With mobile devices going from a curiosity to a virtual appendage for most workers in the 10 years since the launch of the iPhone, it is no surprise that more wellness programs have an associated app. But apps aren’t a silver bullet. They have a learning curve and are hard to get employees to download and consistently use. In addition, about 60% of app users disable notifications-making apps unable to drive engagement proactively. Unfortunately, most wellness programs ignore the most powerful engagement tool of all: the humble text message (AKA ‘SMS’).

TEXT MESSAGING USAGE STATS:
* 90% of texts are read in less than 3 minutes
* Texts have 4x the open rate of emails
* 81% of employees use text messaging at least weekly
* 95% of employees are on an unlimited text  messaging plan
* Text messaging is now the preferred channel  for customer service

Given the level of engagement of text messaging, it is surprising how few wellness programs leverage on this communication medium. In the past year, of the many employers we have spoken with, only a couple reported that they use SMS in their programs. Fear, uncertainty, and doubt persist about text messaging. Even though many dentists text patients, many HR leaders still feel worried about using text messaging to reach employees. Some fear that employees will be charged for text messages, even though almost all employees are on unlimited texting plans. Most employees want to text for work: In a recent survey, 70% of employees preferred text to any other channel for communicating on work topics.

Text messaging may well enable wellness professionals to move into both personalized and proactive programming resulting in significant boosts in employee participation and engagement. Wellness professionals need to consider harnessing the power of text messaging for their own programming.  If you want to explore the use of one of these newly emerging SMS tools please contact us.

Click here to download this document

NOTE: You will need to have an active WellCert Membership in order to download this document.

I hope this tool helps you reach your wellness programming goals!  Drop me a note and let me know your thoughts and if you found it to be helpful: [email protected].