Combo with "Hlth 410 Exam 1 Module 2" and 13 others

Prenatal worksite health promotion program

* Prepregnancy counsling Identification of pregnancy Referral Education* Incentives include: Offering program on company time Waiving first year's insurance deductible and copay if attends all classes Offer monetary rewards Paying higher percentage of the bill

contributing factors of success

- corporate culture- wellness -executive support - employee support -favorable politics - well planned programs - continual evaluation for purposes of excellence

Why use a HRA?

-Identify health risk factors -Predict health-related costs -Measure absenteeism and presenteeism -Evaluate the efficacy and return on investment of health promotion strategies

Importance of corporate culture

...

Four Phase Planning Health Programs

1. Establish a shared vision and organize planning groups 2. Review and list needs and capacities 3. Develop a mission, goals and objectives 4. Design the interventions

3 general types of nutrition policy

1. Food access strategies • Improving healthfulness of available foods; decreasing unhealthy products, establishing healthy policy, catering 2. Nutrition information policy and strategies • Food labeling, point-of-choice nutrition information 3. Economic strategies • Incentives, pricing to encourage healthy choices

Types of objectives

1. process 2. outcome 3. impact

PEN 3

A conceptual model designed as a guide for culturally appropriate health education

Self-care topics

Allergy education Asthma management Back care Customizing health-risk assessments Diabetes management Fatigue management Home remedies for the flu and colds Managing high blood pressure Men's health issues Women's health issues

Theory of planned behavior

Behavioral beliefs + evaluation of outcomes = attitude toward behavior = intention to perform the behavior

Important considerations for HRA?

Ethics Technical features Mode of administration Incentives for HRA participation Type of feedback Who provides participant feedback Level of follow-up

Diffusion of Innovations ( what is it?)

How an idea moves sociological theory Ex: spread of technology through social system

Problems associated with poor nutrition

Hypertension; hypercholesterolemia; cancer; heart disease; diabetes; obesity; and overall mortality

Cultural Competency Framework is made up of what four parts?

Intercultural Concepts, Intercultural skills, intercultural attitudes, and knowledge

Success factors for companies implementing WHP programs

Measures of Success -Satisfied Participants -Decrease in Health Care Costs -Lower Absenteeism -Higher Moral -Increased Productivity Contributing Factors to Success -Corporate Culture - Wellness Executive support Employee support -Favorable Politics -Well planned programs -Continual Evaluation for Purposes of Excellence

Health Belief Model

Modifying factors, individual beliefs, actions

Wellness Committee

Potential responsibilities for employee wellness: -Evaluation -Assessment -Developing plans -Creating vision statements, goals and objectives -Assist in implementation and monitoring

Organizational Resilience Types of Social Influence

Potential to address workplace stress issues by examining both individual and organizational approaches to stressful and adverse events • Resilience approaches shift the conversation around stress from the concept of "managing" stress to recognizing and acknowledging that challenging events will occur in the workplace • Must prepare, navigate through, and recover quickly form those events

Rules and Guidelines

Rules Include a range of sanctions from the most serious, ultimate consequence to a general warning Guidelines Provide for the best interest of the individuals and do not contain sanctions.

The 5 "D's" for measuring and defining culture

The 5-Ds are design, diagnosis, development, delivery, and determination.

Health program vs intervention

The term intervention refers to a specific component of a more comprehensive program

cumulative trauma disorder

affect the bones, muscles, tendons, nerves and other tissues due to repetitive motion or trauma.

According to the attributes of innovations, who would fit in the reversibility?

easily go back to the old way, laggards, late majority

In the process of communication, which section does the health educator fall into?

encode and message channel sections - take message and turn into the message symbol and then the message channel - so they will be decoded appropriately by the target audience ex: creating brochure, newsletters that appeal to audience

Health Belief Model

evaluate or influence individual behavioral change person's behavior can be predicted based on how vulnerable the individual considers themselves to be (perceived susceptibility) seriousness of consequences (severity(. Pros and cons of performing a behavior; self efficacy (confidence in ability to perform the task) ultimately want to influence - likelihood of action

Main Chronic diseases

heart disease, stroke, chronic respiratory diseases, diabetes

vision statement

short, succinct, and inspiring statement of what the organization intends to become and to achieve at some point in the future. (competitive terms)

Fitness prescription dimensions

• Frequency • Intensity • Time (duration) • Type

Awareness activities for obesity prevention

• Pamphlets • Fliers • Posters • Signage • Emails • Tweets • Texts • Instant messages • Prompts and reminders also shown to be effective

Outcomes of obesity reduction programs

• Worker health and well-being • Reduced health care costs • Improved productivity • Improved employee morale • Improved company performance • Improved corporate climate • Improved corporate image in the community

*Definition of worksite health promotion*

"A combination of educational, organizational, and environmental activities designed to improve the health and safety of employees and their families." (Joint Committee of Health Education Terminology, 2000)

Guidelines

"If sanctions are not involved and you want to suggest some ways of complying with your issue, you should write a guideline" A set of instructions so to speak. Provide for the best interest of the individuals and do not contain sanctions.

Rules

"If sanctions for not doing the right thing will be involved with your issue, you should write a rule. While less formal than a policy, a rule defines acceptable behavior" Include a range of sanctions from the most serious, ultimate consequence to a general warning

Reasons to seek/definition of Employee Assistance Programs

"professional services provided to employees with the interdependent goals of improving employees' and family members' overall well- being, as well as enhancing the work organization's functioning and productivity"

Implementation schedule for tobacco cessation

* Months 1 through 3*- Establish committee, Review current policies and other companies' policies; legal liabilities; local/city ordinances *Months 4 and 5*- Assess attitudes and behaviors through questionnaire, During 5th month, develop draft of policy *Months 6 and 7*- Obtain support, Announce new policy and effective date in staff meeting or through memo *Months 8 and 9*- Implement partial restrictions, Remove cigarette machines, Devote 9th month to educate employees *Months 10 through 12*- Offer smoking cessation programs, Implement policy, Gather feedback about process and status

Draft the launguage

*ask the most experienced writer to draft the policy or get them on board - the first draft sets the tone *consider the following issues for the draft - an outline of topics(description of issue thats in policy), a clear statement of what employees can and can not do, an explanation of how to correct the action, provide definitions for confusing terms, list circumstances in which the policy would not apply *include the following information - the date the policy was written - the date the policy will be effective -the name of the department that created the policy - the name of the person who will approve the policy

Four phases of need assessment

*gather preliminary data/generate assessment questions - gather basic info, observe and take notes, talk to people *collect other data - assemble secondary data, gather preliminary data, identify gaps in knowledge * analyze data and interpret results - analyze data, compare perceptions and actual needs, compare to other sites ** prioritize needs, identify assets and make recommendations -prioritize needs, create asset map, report findings

communicate the policy to the community

*promotion of the policy -tech talk -technology -hard copy mailing - forums - meetings -note in paycheck ---most effective way for the company so all the affected know! *time of policy -timing actually determines the means of promoting the policy *assisting staff

four phases to implementing health programs

- identify funding levels and seek other support if necessary - market - determine program logistics - select and train staff, select faculties, develops schedules - create materials and purchase materials

How does Viverae explain the value of worksite health promotion to other companies?

- increase productivity at work, decreased absenteeism, how it can improve the culture, improving the health of the employees.

DRG

- numbers DRG constitute a MDC - about 500 DRGS are designed to reveal various groups of conditions to make up a specific group

HRA vendor questions

- population baseline - hra privacy to protect confidentiality - what steps do they take to make complience with the ADA, HIPPA AND GINE

measure of success

- satisfied participants - decreased in health care costs - lower absenteeism - higher moral - increased productivity

Application

-Aggie Consulting has constructed an onsite exercise facility including strength and aerobic exercise rooms and equipment. -A director, trainers, aerobic instructors and other staff have been hired. -The implementation committees must develop policy, rules and guidelines. -Think about the types of policies and guidelines that must be created.

Application

-Aggie consulting has constructed an onsite exercise facility including strength and aerobic exercise rooms and equipment - a director, trainers, aerobic instructors and other staff have been hired - the implementation committees must develop policy, rules and guidelines -think about the types of policies and guidelines must be created -can family and friends use new gym facility? --policy topic -when someone uses a machine and dosen't wipe it down--rule (please use towel to wipe down equipment if not you will not be able to use the gym) -guidelines - instructions for the equipment

Process of health programming:

-Assessing Needs and Capacity -Planning for Evidence-Based Programs -Creating a Shared Vision and Mission -Implementing Programs -Evaluating Programs

Four phases of planning

-Establish a shared vision and organize planning groups -Review and list needs and capacities -Develop a mission, goals and objectives -Design the interventions Look at ppt video.

Four phases of needs assessment

-Gather Preliminary Data/Generate Assessment Questions: Gather basic information, observe and take notes, talk to people -Collect Other Data: Assemble secondary data, gather primary data, identify gaps in knowledge -Analyze Data and Interpret Results: Analyze data, compare perceptions and actual needs, compare to other sites -Prioritize Needs, Identify Assets and Make Recommendations: Prioritize needs, create asset map, Report findings Look at ppt video

If a student wants to get into worksite health promotion, what can a student do to become more competitive when applying for jobs?

-Have to get there degree (preferably health education, public health, kinesiology, exercise physiology) -Internship (can result in a job afterwards) -Pick up certifications (lends credibility)

Four phases of implementation

-Identify funding levels and seek other support if necessary. -Market -Determine Program Logistics: Select and train staff, select facilities, develop schedules -Create Materials and Purchase Materials Look at ppt video.

What elements do you find to be most important for your clients to know about worksite health promotion?

-Learning the culture, doing a survey of the culture making sure it's a starting point. -Raise awareness (health screenings, health assessment programs, support, and strong educational content) -Report

Major employee health risks:

-Medical cost rise an estimated 25% between ages 40 and 50. -Medical cost rise an estimated 35% between the ages 50 and 60. -Age is a lesser factor in health care costs than the presence of such risk factors as smoking, obesity, physical inactivity, and diabetes. -The medical-cost differential between low-risk 40 and 50 year old workers and high-risk workers of the same ages is 3.0 and 2.8 times, respectively. -The medical-cost differential between low-risk 60 year old is estimated to be 2.4 times higher than that for a high-risk 60 year old.

Benefits of a HRA?

-Provides a snapshot of current health status -Allows health status to be monitored over time -Provides concrete information to prepare for lifestyle changes -Helps measure and monitor population status -Provides information for health promotion programs -Provides information on productivity -Allows evaluation of health behavior and health risk changes -Engages employers and employees in health management process

Review and get final approval

-Send the draft to reviewers -Revise based on suggestions or have a face to face meeting to review suggestions -Indicate changes based on comments -Circulate draft until everyone agrees on the wording -Send the policy to the approver(s)

From your experience, what characteristics make companies more likely to have success with worksite health promotion?

-Starts from the top, supportive administrative team and leadership. -Culture that endorses going through the wellness program. -Wellness committees. -Long term successful goals.

Why implement a HRA?

-Strategic planning and design of a health promotion program. -Cardiovascular Screening for Physical Activity Program Participation. -Individual Health Awareness, Education and Intervention. -Identifying of Individuals for Disease Management Services -Guidance for Refining Health Plan Services

from your experience, what characteristics make companies more likely to have success with worksite health promotion?

-always start at the top supportive administration t - don't serve donuts for breakfast if your trying to change the health of employees -wellness committees - long term specific goals and put objective and report successes

the process of health programming

-assessing needs and capacity (health education and promotion) - planning for evidence-based programs - creating a shared vision and mission -implementing programs - evaluating programs

Get background info

-before you draft the policy decide whether you need a policy, rule or guideline -confirm that you need a policy - identify the problem that requires a policy - determine how the policy would assist employees - detail the cost of implementing the policy - collect any materials needed for drafting the policy **too many policies not all are followed ( dont always need policy)

interest survey forms

-create your own, use commercial one or integrate specific questions into HRA -no longer than a page - generic format - good when you want to identify a single risk factor or program element - usually include *program options to reduce risk blood pressure cholesterol exercise nutrition *readiness to change levels (precontemplation, comtemplation, preparation, action and maintenance) * preference in program format (class self help personal coach internet based) *preferences in participation time (before work after lunch) * preferences in communication channels (email posters mail staff meetings) * invitations to assit WHP personel( serving on wellness committe on peer support group or wellness champion - if received less than 50% of response email a reminder and extend deadline

How important is corporate culture to the success of worksite health promotion programs?

-culture is key -starts at top administration reflects everything - culture can drive clients and increases participation

health oriented employee committee

-eligibility criteria used to select appoint or elect members - length of term served by committee members - ratio of management to non management members -desired frequency of meetings - group or person to who the committee reports - major roles defined for the committee (planning, implementing and so on) -level of influence of the committee (advisory only, policy making) -recognition or compensation for service on the committee (release time from job overtime pay

four phase planning health program

-establish a shared vision and organize planning groups -review and list needs and capacities - develop a mission, goals and objectives -design the interventions

Four step process

-gather background info - draft the language - conduct a review and get final approval - communicate the policy to the community

Health related data

-particular workforce personell should be evaluated - primary factors for worker absents - 5 most common medical claims filed by employees - what risk factors appear negativly affecting job productivity - are smoking breaks compromising productivity - ratio of corporate costs between medical care and prescription drugs over the past 5 years - is the number or lower back injuries sufficient to justify a prevention program -best times and days to offer particular program?

evaluating health programs

-process -impact -outcome -ethics

A smoke free workplace can enhance productivity in two ways:

-reducing the effects of ETS on nonsmokers -by reducing excess smoking-related absenteeism among smokers who are motivated to quit as a result of the smoke free policy.

Review and get final approval ** needs to be as clear as possible - want peoples perspectives

-send the draft to reviewers - revise based on suggestions or have a face to face meeting to review suggestions - indicate changes based on comments - circulate draft until everyone agrees on the wording (stake holders employees and followers) - send the policy to the approver

Tools to be considered when identifying an employees' needs:

-use appropriate methods of data acquisition and conversion. -take data on medical care claims -health culture audit -environmental check sheet

important aspects to consider when chosing a HRA

1) number and type of question items 2) mode of delivery most are online only but some are different - web is better because fewer response errors, faster completion time, case of revising response, immediate generation of personal report when hra complete, much lower cost 3) time required to complete the questions 4) availability of risk reduction follow up 5) pricing structure and options

What elements do you find to be most important for your clients to know about worksite health promotion?

1)learning the culture and understanding the culture - understand what it is 2) raise awareness -health screenings - learning about their health - support - strong educational content - put right incentives in place group appropriate - report (measuring successes from where they started and how far they have come)

Elements of fitness

1. *Flexibility* • Ability to have range of motion 2. *Body composition* • Relationship between fat and fat-free tissue and the comparison between the two 3. *Muscular strength and endurance* • Capability to generate force and make repeated contractions 4. *Cardiorespiratory endurance* • Ability of the body to transport oxygen and perform work on sustained basis

4 steps of health programming

1. Assessing Needs and Capacity 2. Planning for Evidence-Based Programs ▫ Creating a Shared Vision and Mission 3. Implementing Programs 4. Evaluating Program

Four categories of social support

1. Emotional support - empathy, love, trust, caring 2. Instrumental support - tangible aid and services 3. Informational support - advice, suggestions 4. Appraisal support - constructive feedback, affirmation

Current state of health care

1. Employer health costs are unsustainable 2. An aging workforce and the associated increase in chronic health conditions is driving higher health care utilization 3. Although the US spends the most per capita on health care, by many measures health outcomes are worse than in other developed countries. 4. Employers are decreasing or eliminating employee health benefits and shifting more costs onto other employees 5. Increased employee contributions to health care can lead to poor compliance and adherence to preventive and other clinical services 6. Indirect productivity-related costs are significant

No clear cut evidence for a particular type of WHP program exists:

1. Engage workers in focus groups or informal information on their interest. 2. Contact other local worksite with WHP programs. 3. Offer a pilot program on a specific topic for several weeks.

Types of nutrition policy

1. Food access strategies • Improving healthfulness of available foods; decreasing unhealthy products, establishing healthy policy, catering 2. Nutrition information policy and strategies • Food labeling, point-of-choice nutrition information 3. Economic strategies • Incentives, pricing to encourage healthy choices

4 Phases of Needs Assessment

1. Gather Preliminary Data/Generate Assessment Questions ▫ Gather basic information, observe and take notes, talk to people 2. Collect Other Data ▫ Assemble secondary data, gather primary data, identify gaps in knowledge 3. Analyze Data and Interpret Results ▫ Analyze data, compare perceptions and actual needs, compare to other sites 4. Prioritize Needs, Identify Assets and Make Recommendations ▫ Prioritize needs, create asset map, Report findings

6 Health models

1. Health Belief Model 2. Preceede/Proceede 3. Transtheorectical model 4. social ecological model 5. theory of planned behavior 6. social cognitive theory

What are the 4 constructs of Diffusion of Innovation?

1. Identify attributes of innovations (innovations) 2. Identify adopter category (time) 3. Choose communication channel (communication channel) 4. List possible change agents/opinion leaders (social system)

4 Phases of Implementing Program

1. Identify funding levels and seek other support if necessary. 2. Market 3. Determine Program Logistics Select and train staff, select facilities, develop schedules 4. Create Materials and Purchase Materials

Common pitfalls of work-site health programs

1. Lack of participation 2. Inadequate leadership 3. Lack of support from management 4. Lack of an appealing program 5. Lack of appropriate incentives 6. Lack of appropriately trained staff

Describe the process Viverae uses to assess a companies needs:

1. Learn about there culture; understand the industry that they are in. (manufacturing vs. production) 2. Look at the demographics (male vs. female) (white collar vs. blue collar) 3. Assess the needs of the employer (Are they reasonable? Expectations) 4. What is their track record? (have they tried wellness?)

Three main headings for obesity programs

1. Multilevel activities that can influence individuals, groups, the organization as a whole, and the community 2. Activities that address vision and engagement, involving leadership, cultural norms and values, and worker involvement 3. Activities that improve the work environment through changes in the physical, psychosocial, and socioeconomic environments, as well as efforts at the policy and advocacy levels

Principles for the workplace in regards to HIV/AIDS

1. People with HIV/AIDS are entitled to the same rights as others with serious/life-threatening illnesses 2. Employment policies must comply with federal, state, and local laws 3. Employment policies must inform that people with HIV/AIDS cannot transmit the virus through ordinary workplace contact 4. Highest levels of management should endorse nondiscriminatory employment policies 5. Employers should communicate their support of policies 6. Employers should provide risk reduction information 7. Employers have duty to protect confidentiality 8. Employers should educate all employees before incidents occur 9. Employers should not require HIV screening as part of employment but should provide resources for anonymous testing 10. In organizations where risk of exposure exists, employers should provide ongoing training and education to prevent the spread of blood borne pathogens

Demographic shifts:

1. The workforce is aging. (US) 2. More women are entering the workplace. 3. The proportion of people of color working in many countries is rising. 4. The # of people who have to work two jobs in different location to make a living is growing. (Most notable in America, Europe, and Asia) Hispanic more than 50% African American more than 20% White 10%

Questions for prioritizing needs

1. What is the most pressing need? 2. Are resources adequate to deal with the problem? 3. How can the problem be solved? 4. Can the problem be solved in reasonable time?

A needs Assessment Should Answer

1. Who is the priority population? 2. What are the needs of the priority population? 3. Which subgroups within the priority population have the greatest needs? 4. Where are these subgroups located geographically? 5. What is currently being done to resolve needs? 6. How well have the identified needs been addressed?

What are the Seven Stages of Developmental Model of Ethnosensitivity for family practice training?

1. fear 2. denial 3. superiority 4. minimization 5. relativism 6. empathy 7. integration

Factors driving health care costs?

1. longer lives 2. newer technology 3. catastrophic events 4. more women in the work field 5. malpractice and insurance rates are increasing

What are 3 modifiable risk factors?

1. physical inactivity 2. tobacco use 3.unhealthy diet

Historical Events related to work-site health

1879 Pullman athletic association 1884 National cash register horseback rides 1930 Hershey plans for rec center 1953 TI .5 mill rec complex 1958 Pepsico establishes a physical fitness program

Whether or not you need a policy

1st needs an issue that needs to be addressed (problem based) 2nd need to determine how the policy would assist people 3rd cost of implementation 4th collect info that goes into policy

Healthcare spending

2.7 trillion spent on healthcare 254 million obesity and diabetes

MDC Major diagnostic claims

25 different codes - represent body systems learned in 8th grade - so broad so hard to make program over to identify needs and assess

assessing employees interest

2nd phase of planing framework - focuses on interest and interventions and on ways to deal with problems

Measure heart rate

4-step Karvonen process 1. Maximum heart rate - number of maximum heart beats per minute can achieve without problems; 220 minus age (women); 205 minus age (men) 2. Basal/resting heart rate - number beats per minute relaxed and awake; subtract from max hrt rate for max hrt rate reserve 3. 60-90% of maximum heart rate is ideal; multiply max hrt rate reserve by .6 and .9 4. Add resting hrt rate to lower and upper range

mission statment

A "short narrative that describes the general focus or purpose of the program"

Vision

A brief description of where the program will be in the future What do we want to be? What will we look like in 3+ years

worksite health promotion

A combination of educational, organization, and environmental strategies to improve the health and safety of employees and their families

Worksite Health Promotion:

A combination of educational, organization, and environmental strategies to improve the health and safety of employees and their families.

Definition of Work site Health Promotion

A combination of educational, organizational, and environmental programs that aim to improve the health of employees and their families.

Cumulative trauma disorders

A disorder that can affect the bones, muscles, tendons, nerves and other tissues due to repetitive motion or trauma. The most common worksite injuries such as lower back strain and carpal tunnel syndrome. Affect approximately 19 million US workers annually. 2.5 suffer from carpal tunnel, 4.5 tendonitis, 9 mil have lower back pain. Since 1980 has risen nearly 600%.

Disability management

A form of case management designed to rehabilitate and enhance the health status and work performance of employees with an identified physical or mental disability. A small percentage of occupational accidents result in serious bodily injury from working, leading to placement in short term disability or long term disability.

Define Needs Assessment

A process of identifying, analyzing, and prioritizing needs of a population community assessment, collect data and get funding

Logic Model

A roadmap designed to convey connections between program activities and their desired outcomes.

Health

A state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.

Various federal laws require employers and their business partners to follow specific guidelines when accessing, acquiring, storing, and transmitting employees' personal health data.

ADA, GINA, HIPAA

Why businesses would want WHP programs:

Absenteeism Accessibility Aging workforce Business contacts Competition Growing interest Health insurance premiums Image Productivity Workers compensation costs Pg. 15

Assessing needs and capacity

Actual (blood pressure medication) and Perceived Needs -Are both important? YES!!! (assessed and part of the program planning) Types of Data -Secondary data (already exist) (health insurance carriers) -Primary Data (collected by the company) The Four Phases of Need Assessment

Actual & perceived needs

Actual: medical needs; you may need to have a medication for blood pressure or you may need to have foods that are high in a certain vitamin or mineral. Perceived: We have things that we really think we need but may not be actual. May not be important in terms of actual health. They are important though as far as what you want in a health promotion program. Both are important and both must be assessed/ implemented.

Draft the language

Ask the most experienced writer to draft the policy. -The first draft sets the tone Consider the following issues for the draft -An outline of topics, a clear statement of what employees can and can not do, an explanation of how to correct the action, provide definitions for confusing terms, list circumstances in which the policy would not apply

Elements of WHP programs

Assessing Needs and Capacities Planning for evidence based programs Implementing programs Evaluating programs

Four general aspects of successful programming

Assessing Needs and Capacities Planning for evidence based programs Implementing programs Evaluating programs

5 Steps of the Generalized Model

Assessing Needs-->Setting Goals and Objectives-->Developing an Intervention-->Implementing the Intervention-->Ovulating the Results

Explain Humor in the Appeals for Change

Attracts interest - sticks with you for a long time high message retention cultural competence is very important - cautious because it can offend people

Cost Calculators Instruments

Available for: Chronic Conditions -Depression calculator Lifestyle Factors -Alcohol Cost Calculator Behaviors and Obesity -CDC's LEAN Works!

Recommendations-DHHS Physical Activity Guidelines for Americans

Avoid sedentary behavior and inactivity • Engage in at least 150 minutes of physical activity that is of moderate-intensity or 75 minutes of vigorous-intensity, or a combination of each week • Participate in physical activity in bouts of at least 10 minutes • Engage in activities that strengthen muscles

Getting background information

Before you draft the policy decide whether you need a policy, rule or guideline. Confirm that you need a policy. -Identify the problem that requires a policy -Determine how the policy would assist employees -Detail the costs of implementing the policy -Collect any materials needed for drafting the policy.

Importance of gathering background information/assessing current situation for policies

Before you draft the policy decide whether you need a policy, rule or guideline. Confirm that you need a policy. Identify the problem that requires a policy Determine how the policy would assist employees Detail the costs of implementing the policy Collect any materials needed for drafting the policy.

Explain Fear in the Appeals for Change

Best for short term or non repetitive behaviors Doesn't stick with people for a long time -wont work for exercise Works for vaccine Strong fear and high effiicacy combo is best too much fear may paralyze people

Goal

Broad statement of direction, sets the fundamental and long term direction Who will be affected? What will change?

questions to ask with BATHE MODEL

B—Background: The simple question "What is going on in your life?" brings out the context of the patient's visit. A—Affect: Asking "How do you feel about what is going on?" or "What is your mood?" allows the patient to report and label the current feeling state. T—Trouble: "What about the situation troubles you the most?" helps the provider and patient focus, and may bring out the symbolic significance of the illness or event. H—Handling: "How are you handling that?" gives an assessment of functioning and provides direction for an intervention. E—Empathy: "That must be very difficult for you" legitimizes the patient's feelings and provides psychological support.

Policies

Can have sanctions involved but are much more formal and they've gone through a formal approval process.

What theory is used for: Client/person: little or no person contact, mass media Example Settings: wider settings Topic Examples: wider public issues: CHD, cancer, tobacco, infectious disease, prescription drugs

Communication persuasion matrix

Communicate the Policy to the community

Consider the following issues: -Promotion of the policy EX: Tech Talk, Hard copy mailings, Forums -Time of policy EX: Timing actually determines the means of promoting the policy. -Assisting staff

Needs assessments can be led by:

Coordinators Wellness committee

Contributing factors to success

Corporate Culture - Wellness -Executive support -Employee support Favorable Politics Well planned programs Continual Evaluation for Purposes of Excellence

Developing the mission

Create a mission statement: A mission statement is a "short narrative that describes the general focus or purpose of the program" (McKenzie, Neiger, & Thackeray, 2009, p. 139). Where the vision statement describes a future ideal condition, the mission statement clarifies the purpose of the program or what will be done through the program to achieve that vision. Example: The mission of the Aggie Consulting LiveWell Program is to promote total well-being and health-related quality of life among employees.

Culture

Culture is the collection of values, norms, legends, and beliefs that differentiates one group from another. And even though we have this notion that culture is amorphous, it really can be made more concrete.

What is primary date? Give one example.

Data you collect yourself-research

Health Care Decision Support

Defined as: "any combination of learning experiences designed to facilitate the personal diagnosis, treatment, self-management, and cure of illness" Teaching others the ability to distinguish between what can be treated alone and what needs professional attention at heart of health care decision support - Acute, emergency conditions - identify life- threatening problems and act quickly - Self-limiting - conditions go away without medical intervention - Chronic - lasting 6 months or longer

What categorizes as denial in the developmental model of ethnosensitivity? what is the goal of this stage?

Denial: culture blindness, overgeneralization is displayed, little udnerstanding of cultural variations/behave as if differences dont exist Goal: promote regognition of ethnicities through fostering the simple awareness of cultural differences; everyone has an ethnicity

Elements to include in drafting policies

Determine whom the policy will apply. The audience. Determine who the policy will apply to ex. exercise equipment. Who will administer the policy. Who will approve the policy Consider the following issues for the draft: An outline of topics, a clear statement of what employees can and can not do, an explanation of how to correct the action, provide definitions for confusing terms, list circumstances in which the policy would not apply So remember, clear statement of the topic, the can and can't dos, how to correct the action, and definitions for confusing terms.

Establish a Shared Vision

Develop a shared vision: Nike (Just Do It) -Vision statement should be: -Futuristic and reflect a conceptualized ideal -Understood and shared by all -Uplifting and inspiring -Easy to communicate Example statements: -Safe streets, safe neighborhoods -Every house a home -Education for all

Most Common Causes Of Death

Disease of the heart

Tips for culturally competent health communication?

Don't limit the scope of audience Be sensitive to anyone who may see the ad - may not be offensive to him, but may be senstive to anyone who may see it - also target audience Know the Culture of the Audience What will and will NOT be appealing

what are the types of formal system of communication?

Downward- management to subordinates Upward - Subordinates to management Horizontal - Peer to Peer Examples: newsletters, PA system, flyers, etc

ETHNIC Model

ETHNIC, a framework for culturally competent clinical practice, includes questions to bring out information about a patient's explanation of the following: E—Explanation: Ask questions to allow the patient to provide an explanation of his or her illness T—Treatment: Ask questions about how the patient is treating his or her illness H—Healers: Ask about the use of healers N—Negotiation: Negotiate options that incorporate your patient's beliefs and that will be mutually acceptable to you and your patient I—Intervention: Determine an intervention with your patient C—Collaboration: Collaborate with the patient and his or her support system

Identify factors behind rising health care costs:

Economic factors. Demographic shifts. Major employee health risks.

What categorizes as stage 6 in the developmental model of ethnosensitivity? what is the goal of this stage?

Empathy: framework shift to be able to experience events as a patient might Goal: need enrichment of cultural experiences not just empathy towards them

Social Cognitive model

Environment + Situation + Expectations = Cognitive Factors

Cost Calculators

Estimate the costs of lifestyle factors and preventable diseases. Information that can be useful for -baseline needs assessment -planning of targeted programs

What are the types of appeals for change?

Factual Humor Emotional Fear

types of appeals for change

Factual - better w/ high education level, knowledge does not predict behavior, knowledge can influence behavior Humor: Attracts interest, high message retention, cultural competence very important Emotional: May be more effective w/ lower education, may appeal to special audiences Fear: Best for short term or non-repetitive behaviors, strong fear and high efficacy combo best, too much may paralyze.

Explain Factual in the Appeals for Change

Fear is better with high education legels knowledge doesn't predict behavior but can influence it ex: binge drink is not healthy but ppl still do it

What is the Process of communication?

Feedback --> Sender Encode (message/symbol) message channel decode receiver

Elements of fitness

Flexibility • Ability to have range of motion Body composition • Relationship between fat and fat-free tissue and the comparison between the two Muscular strength and endurance • Capability to generate force and make repeated contractions Cardiorespiratory endurance • Ability of the body to transport oxygen and perform work on sustained basis

types and systems of communication

Formal: structured downward- management to subordinates Upward- subordinates to management Horizontal- peer to peer Newsletters, PA system, flyers, etc. Informal: lacking structure Word of mouth (VERY EFFECTIVE) tagged incentives

What are the types and systems of communication?

Formal: structured - health communication usually work in this Informal - lacking structure (water cooler at work, gossip)

Planning for Evidence-Based Programs

Four Phase Planning Health Programs -Establish a shared vision and organize planning groups -Review and list needs and capacities -Develop a mission, goals and objectives -Design the interventions

Implementing health programs

Four Phases of Implementing Program: -Identify funding levels and seek other support if necessary. -Market -Determine Program Logistics --Select and train staff, select facilities, develop schedules -Create Materials and Purchase Materials

Four steps to creating policy

Four step process -Gather background information. -Draft the language. -Conduct a review and get final approval -Communicate the policy to the community.

The four phases of need assessment:

Gather Preliminary Data/Generate Assessment Questions --Gather basic information, observe and take notes, talk to people Collect Other Data --Assemble secondary data, gather primary data, identify gaps in knowledge Analyze Data and Interpret Results --Analyze data, compare perceptions and actual needs, compare to other sites Prioritize Needs, Identify Assets and Make Recommendations --Prioritize needs, create asset map, Report findings

Creating a Policy:

Gather background information. Draft the language. Conduct a review and get final approval Communicate the policy to the community.

WHPP:

Gyms Organized physical activity contests Healthier lunch room/ vending machine snacks Prohibit smoking a the workplace

What theory is used for: Client/person: face to face, groups Example Settings: group settings Topic Examples: preventitive behavior: physical activity, sexual health, vaccinations, dietary changes

Health Belief Model

What is a health risk appraisal?

Health risk appraisal is a systematic approach to collecting information from individuals that identifies risk factors, provides individualized feedback, and links the person with at least one intervention to promote health, sustain function and/or prevent disease (Centers for Medicare and Medicaid)

Instruments Used for Needs and Interest Assessments:

Health risk appraisals -are used to assess health risk factors. Employee surveys -are used to assess WHP health needs and interests. Wellness committees -enable direct employee input on program design.

Obesity awareness activities

Help employees understand impact of various behaviors and decision making on success in maintaining a healthy body weight • Include use of: • Pamphlets • Fliers • Posters • Signage • Emails • Tweets • Texts • Instant messages • Prompts and reminders also shown to be effective

What is your opinion on health education?

I think health education is very beneficial so the community can be educated with knowledge and opportunities to maintain a healthy lifestyle

*CHES Areas of Responsibility *

I. Assess needs, assets and capacity for health education II. Plan health education III. Implement health education IV. Conduct evaluation and research related to health education V. Administer and manage health education VI. Serve as health education resource person VII. Communicate and advocate for health and health education

Mission Statement

In order to achieve its corporate and WHP vision an organization needs to develop and implement a mission. A mission statement describes the step that moves your strategic planning process from the present to the future. The mission statement is usually a multidimensional statement because it reflects the organization's philosophy, purpose, goals and commitment for achieving the vision. This statement consists of: Who we are, what we do, general population, employee health goal, organizational or corporate health goal, target population. -Where the vision statement describes a future ideal condition, the mission statement clarifies the purpose of the program or what will be done through the program to achieve that vision. -Example: The mission of the Aggie Consulting LiveWell Program is to promote total well-being and health-related quality of life among employees.

Draft (continued)

Include the following information -The date the policy was written -The date the policy will be effective -The name of the department that created the policy -The name of the person who will approve the policy

Socioecological model

Individual Interpersonal organizational community policy

Economic factors:

Inflation Cost shifting New technology Catastrophic cases Lawsuit happy society

Four elements of diffusion of innovations

Innovation Communication Channels Time Social System

Priority populations

Innovators 2-3% of pop., disposable income, eccentric, want tech before everyone else Early Adopters 14%, social leaders, disposable income, early access to tech Early Majority 34% ,made a decision to change, above avg social status, might be connected to early adopters (hang w/them) Late Majority 34%, skeptical,adopts after the avg. person, less money, mostly connected with other late majorities Laggards 16% of pop.,few info sources, poor, stubborn, don't like change

Healthcare Utilization Data

Inpatient Outpatient Mental health Emergency room claims

what are the function and purpose of communication?

Instruct Inform Transmit and Receive Messages Persuade Integrate

Employee surveys

Instruments may be designed or adopted -Don't collect data that you already have -Learn what is on employees minds -Align with company strategy and mission

What categorizes as integration in the developmental model of ethnosensitivity? what is the goal of this stage?

Integration: stands both inside and outside a culture, having both deep understanding and a critical viewpoint Goal: refinement of cultureal integration can continue thru fostering integrative skills/multiculturalism

Cultural Competency Framework

Intercultural Concepts o Culture is important in every patient's identity o Communication of cultural understanding and respect is essential for establishing rapport and confidence o Culture-related stresses and tensions can induce illness o Knowledge o Common dietary habits, foods, and their nutritional components o Predominant cultural values, health practices, traditional health beliefs o Family structure—patriarchal vs. matriarchal; nuclear vs. extended; role of individual members o Effect of religion on health beliefs and o practices o Intercultural Skills o (Should be specific for each culture represented and include the following) o Communicate an understanding of patient's culture o Recognize culture-related health problems o Negotiate a culturally relevant care plan with patient as partner o Interpret verbal and nonverbal behaviors in a culturally o Intercultural Attitudes o Recognize the importance of the patient's cultural o background and environment when constructing an approach to an illness o Acknowledge the patient's role as an active participant in o his or her care

Importance of reducing worksite stress

Job stress is the most common risk factor in today's worksites. Less than 1 of every 5 worksites provide programs for employee stress management. -1 of 4 employees views work as the greatest stressor in his or her life. -8 of 10 employees feel stress on the job and half of them express a need for help in managing their stress. -4 of 10 employees say their job is very or extremely stressful. -1 of 4 employees indicate being often or very often burned out or stressed by work. Some industry insiders contend their U.S. workers are more stress than European counterparts because of long working hours and less vacation time. European culture is starting to mimic American patterns. Japan has stress related disorders at the workplace. Japanese stats: -Nearly 86% of companies replied that depression is the most frequent stress related disorder. -In nearly 70% of the companies, some workers took more than a months leave of absence from work because of an emotional disorder. -Many companies are working to address mental health through health and safety committee. Distressed employees have higher rates of absenteeism, accidents, illnesses, and productivity errors than their less stressed counterparts.

Steps to advocacy

Know what is important ID what you want to happen ID decision makers/ audience get support Determine the priorities of decision makers/target audience Message delivery plan Create message Tailor to priorities of decision makers/audience Be simple, clear, concise Follow-up

Causes of chronic disease

Lack of physical activity Unhealthy diet Tobacco use

Lifestyle interventions for diabetes

Lifestyle interventions that focus on weight loss and increase of physical activity reduced likelihood of developing type 2 diabetes

LEARN MODEL

L—Listen E—Explain A—Acknowledge R—Recommend N—Negotiate L—Listen with sympathy and understanding to the patient's perception of the problem E—Explain your perceptions of the problem A—Acknowledge and discuss the differences and similarities R—Recommend treatment N—Negotiate agreement

What do you obtain from a HRA?

Main objectives are typically to: -Assess health status. -Estimate the level of health risk. -Inform and provide feedback to participants to motivate behavior change to reduce health risks. Clearly defined objectives guides tool selection, data collection and data use

Karvonen process

Measure Heart Rate 1. Maximum heart rate - number of maximum heart beats per minute can achieve without problems; 220 minus age (women); 205 minus age (men) 2. Basal/resting heart rate - number beats per minute relaxed and awake; subtract from max hrt rate for max hrt rate reserve 3. 60-90% of maximum heart rate is ideal; multiply max hrt rate reserve by .6 and .9 4. Add resting hrt rate to lower and upper range

What can a needs assessment do?

Measure and Identify- The feasibility of implementing a WHP program at a given workplace. Support for WHP at various levels of the organization. Employee needs and interests. How company policies support or present obstacles to healthy lifestyles. Cultural aspects of the organization that could impact program strategies. Current employee lifestyle behaviors. Productivity costs. Priorities for financial and other resources. Needs for practices that address specific diseases and conditions.

What categorizes as minimization in the developmental model of ethnosensitivity? what is the goal of this stage?

Minimization: acknowledges that cultural differences exist, but are unimportant compared with similarities; reductionism/universalism Goal: stress indivdual /group differences by stressing biopsychosocial awareness and by debunking the belief that common senes is all that is needed to establish good therapeutic relationships

Average Americans have not improved their healthy status:

More than 60% of American adults are obese. (physical inactivity is one of the strongest predictors of excess health care costs for American manufacturing and service workers)

Step 1 of starting a wellness program:

Needs Assessment- a process by which health education specialists gather information regarding health needs and desires of a population (NCHEC, 2010)

Give an example that we talked about in class for an environmental strategy change

New York in 1998 took out smoking in restaurants,

Back Health

One of the most common injuries at the worksite and is primary cause of absenteeism in many companies Minor injuries/strains cost employers $600/injury in medical care and lost productivity More severe injuries (i.e. bulging discs, fractured vertebrae) cost $30,000/case

One example of the relationship between health promotion and education

Organization, policy, social, economic, political

Example of a focus group, tell why you think they are beneficial.

Out loud surgery, qualitative research to get opinions, because you want to know how the community feels

Reasons for Worksite Health Promotion:

Over 50% of employer costs are due to potentially modifiable lifestyle risk factors (obesity, poor diet, tobacco use, physical inactivity) Workers with high-risk profiles generally have higher healthcare costs than those with low-risk profiles Studies have shown that initiation of WHPP have had positive outcomes on employees.

Worksites suitability for WHP:

Physical makeup Environmental quality Employee-centered policies Health-promoting culture

Tobacco Control Program

Policy can reduce smoking prevalence by at least 10% Programs include: Nicotine replacement therapies, Prescription drugs without nicotine, counseling

Draft

Policy needs to be short and clear

Be able to describe the stages of the Transtheoretical Model in a tobacco control intervention

Precontemplation Includes workers who: - Smoke and have no interest in quitting - Are unaware of dangers of tobacco - Are persistent or recalcitrant users who are not receptive to direct messages about health Interventions include: - Direct efforts to educate about dangers - Increase awareness and need for behavioral change - Indirect efforts such as education about health effects, financial costs, or success stories of others --- Contemplation • Include workers who are: - Tobacco users who are thinking about quitting • Require motivation and encouragement • Develop materials and activities focused on stressing benefits of cessation including health risk appraisals, health fairs, one-time free sample cessation seminar ---- Preparation Includes workers who: - Are ready to quit - Require assistance in developing concrete action plans and goals Interventions include: - Improved access to cessation group resources - Medication coverage - Flexible benefit credits to finance cessation interventions ----- Action • Includes workers who: - Are tobacco users who have implemented action plan • Best assisted with resources that offer relevant feedback, problem solving, social support, and reinforcement related to their quit attempt --- Maintenance • Includes workers who: - Are former tobacco users - Have achieved their desired behavior change • Best assisted with coping, reminders, and avoiding relapse • Need access to onsite or community counseling services and covered drug therapies ---- Termination • Includes workers who: - Are former tobacco users and have been tobacco free for 5 years - Have 0% temptation - Have 100% self-efficacy

Tertiary level of prevention

Primary care management of conditions Rehabilitation

What are the 2 types of data?

Primary-you collect your own data Secondary- data already collected, available for use

Four areas for evaluation

Process Impact Outcome Ethics

Evaluating health programs

Process (functioning of the program) (satisfied?) Impact (short term gains made by participants) Outcome (long term bottom line objectives you want participants to gain) Ethics (what happens all along) (honesty)

types of objectives

Process-function and quality Outcome-smaller picture; immediate or short term Impact- long term

8 planning p's of communication persuasion model

Product: the behavior Price: the sacrifice (money, time) Place: where you expose the message (environment, elementary school etc) Promotion: mechanism for message/product delivery (tv, newsletter, billboard) Publics: primary and secondary audiences (people you are trying to get to, are effecting the primary) Partnerships: collaborative relationships (joining health department) Policy: environmental supports (legislation, laws) Purse Strings: money

Mission

Program overview and aim, describes the focus and purpose of the program, reflects philosophy behind the program.

Employee assistance programs

Provide a full spectrum of services including financial counseling, substance abuse treatment, assistance with eldercare and child care, and retirement planning. EAPs: -Maximizes resources, especially for smaller companies with limited finances. -Makes the working environment healthier as more staff members work toward a common goal. -Reduces the stigma associated with getting personal help workers are more likely to view EAP services they way they consider other WHP. -Helps meet the holistic needs of high risk workers. (Ex. psychological problems related to alcoholism) Other programs must try to compliment EAP programs rather than try to replace them.

Health Risk Appraisals

Recommended for use in a comprehensive worksite health promotion program. Impact on health risk behavior change is not well-understood.

Physical Fitness Programs

Reduce the risk of heart disease, cancer, stroke, obesity, and many other conditions Increase on-the-job productivity Relieve financial stress of employers from having to pay billions of dollars to treat employees' illnesses and disorders Provide opportunities for the millions of baby boomers in the workplace Produce greater publicity on profound financial effect of physical inactivity on health care and productivity costs

What categorizes as relativism in the developmental model of ethnosensitivity? what is the goal of this stage?

Relativism: acceptance of ethnic and cultural differences, naivete regarding knowledge of specific differences and their implication on providing care remains Goal: gain experience through cultural exploration and education and to foster empathy

Wellness Committees

Representatives from multiple organizational levels. May have responsibility to employee health. Enable you to gain direct employee input.

Primary interventions for stress reduction

Risk assessment and organizational strategies • Normally involve entire organization • Goal of creating culture of well-being • Offer wide range of approaches to protect against developing mental health issues

Rules and Guidelines

Rule "If sanctions for not doing the right thing will be involved with your issue, you should write a rule. While less formal than a policy, a rule defines acceptable behavior" (MIT, 2009). Guideline "If sanctions are not involved and you want to suggest some ways of complying with your issue, you should write a guideline" (MIT, 2009).

SMART objectives

S specific M measurable A achievable R realistic T time bound

SMART

S- Specific M-Measurable A-Achievable R-Realistic T-Time Bound

Measures of success

Satisfied Participants Decrease in Health Care Costs Lower Absenteeism Higher Morale Increased Productivity

Primary vs. secondary data

Secondary data is the easiest. Data that already exist. Ex. health insurance carriers that a corporation may use. Primary data is information that is collected by the corporation for the purpose of the health promotion programming. Ex. survey sent out, screenings by physicians.

What are the five components of communication as reviewed in class?

Sender Message Symbol Message Channel Receiver

Example Heath Educator

Serves as a variety of roles, Physical Educator

Other Utilization Data

Short term disability Workers compensation EX: MyLifeCheck

Other than the generalized model what other have we gone over?

Specific Prevention Framework

Social norms in social relationships

Standards against which the appropriateness of specific behaviors, states, or beliefs are assessed • Descriptive norm - extent to which behavior, state, or belief is present among the members of the reference group for norm • Injunctive norm - extent to which behavior, state, or belief is approved by members of reference group • Social norms theory applies to situations where people tend to misperceive a descriptive norm; people modulate behavior to conform to the norm

List the 6 steps of Needs Assessment

Step 1: Determining the purpose and scope Step 2: Gathering Data Step 3: Analyzing Data Step 4: Identifying risk factors linked to health problems Step 5: Identifying the program focus Step 6: Validating the need

Cognitive Behavioral Theory

Stress awareness training (individual secondary prevention) • Cognitive behavioral therapy (CBT) for psychological and emotional stress

What categorizes as superiority in the developmental model of ethnosensitivity? what is the goal of this stage?

Superiority: negative stereotyping - ranking cultural differences according to ones culture or reversal - seeing their culture as superior Goal: to promote the recognition of similarities between cultural groups

BATHE MODEL

The BATHE Model is a useful memory aid for bringing out the patient's psychological and social context by asking simple questions about background, affect (feeling state), trouble, handling, and empathy. BATHE stands for: B—Background A—Affect T—Trouble H—Handling E—Empathy

CRASH MODEL

The CRASH memory aid is used to represent the values that help create a framework for providing culturally competent health care. CRASH stands for: C—Consider culture R—Respect A—Assess and affirm S—Sensitivity and self-awareness H—Humility

ESFT Model

The ESFT Model guides providers in understanding a patient's explanatory model (a patient's conception of his or her illness), social and environmental factors, fears, and concerns, and in contracting for therapeutic approaches. E—Explanatory model of health and illness What do you think caused your problem? Why do you think it started when it did? What kind of treatment do you think you should receive? F—Fears and concerns Does this medication sound okay to you? Are you concerned about the dosage/side effects? S—Social and environmental factors How do you get your medications? Are they difficult to afford? Do you have time to pick them up? T—Therapeutic contracting Do you understand how to take the medication? Can you tell me how you will take it?

OSHA

The primary federal law establishing health and safety standards in the workplace. In 1970, OSHA was signed into law to establish comprehensive health and safety standards in the workplace. Since then the incidence of occupational illnesses and injuries and the number of lost workdays have dropped. Yet, overall costs continue to climb because declining incidence rates do not offset higher year to year percentage cost inflation rates for costs related to medical care, absenteeism, disability, and workers compensation that are associated with occupational illnesses and injuries.

health promotion

The provision of information, education, and resources to individuals and communities that encourage the development of healthy behaviors.

Health Promotion

The provision of information, education, and resources to individuals and communities that encourage the development of healthy behaviors.

What theory is used for: Client/person: face-to face, groups, mass media Example Settings: Group settings/wider settings Topic Examples: physical activity, accident/injury prevention, tobacco uptake, oral health, alocohol, drug misuse

Theory of Planned Behavior

What is the number one indicator of this cause

Tobacco Products

Tobacco Use

Top 3rd Modifiable risk

Prevalence—Tobacco Use

Top 3rd modifiable risk

function and purpose of communication

Transmit and receive messages is the function and purpose. This is done by instructing, informing, integrating and persuading

What theory is used for: Client/person: face-to-face, groups, self help Example Settings: medical settings, group settings, service settings Topic Examples: tobacco, physical activity, alochol/drug misuse, accident/injury prevention, cancer screening, nutrition/diet

Transtheoretical model/perceived behavior control

Economic consequences of nutrition-related diseases

US spends more on healthcare than any other nation - cardiovascular disease, cancer, and diabetes accounting for 75% of costs • More than 20% of GDP (total values of goods and services; estimates health of country's economy) is spent on healthcare • Individuals - SES level, education, and access to medical care can influence food choices • Workplace - consequences of employee's dietary practices include absenteeism, reduced productivity, disability, and high health care utilization • Productivity losses related to personal and family health problems cost US employers $1,685 per employee per year or $225.8 billion annually

Obesity background

US today - more than one-third of adults are obese; rates have more than doubled since the late 1970s • 17% of children and adolescents are obese; rates have tripled during the course of a single generation • Obesity rate projected to be 51% by 2030, increasing medical care expenditures by as much as $550 billion • Solutions come from wide variety of changes made at the level of families, groups, workforces, communities, the nation, and even the world

Causes of chronic disease

Underlying Determinants of Chronic Disease - Socioeconomic - Cultural - Environmental - Political *Modifiable Risk Factors* - Unhealthy diet - Physical inactivity - Tobacco use Intermediate Risk Factors - Elevated BP - Elevated blood glucose - Abnormal blood lipids - Overweight/obesity Main Chronic Diseases - Heart disease - Stroke - Chronic respiratory diseases - Diabetes

Stress management interventions

Usually take form of self-management techniques • Sometimes implemented by the organization and sometimes adopted by the individual independently of the organization • Implemented at: • Primary - organizational and/or stress management skills training intended to avoid stress • Secondary - exercise, healthy diet, meditation all designed to minimize stress • Tertiary - one-to-one psychological therapy intended to remediate stress levels

Vision and mission statements

Vision Statement is a short, succinct, and inspiring statement of what the organization intends to become and to achieve at some point in the future. It is often stated in competitive terms. Ex: To be the leading worldwide clothing brand in the women's sportswear manufacturing business. At WHP level a vision statement reflects the goals of worksite health personnel and the organization's identity. Develop a shared vision Vision statement should be: -Futuristic and reflect a conceptualized ideal -Understood and shared by all -Uplifting and inspiring -Easy to communicate Example statements: -Safe streets, safe neighborhoods -Every house a home -Education for all

Planning a needs assessment

What do you want to get out of a worksite wellness program? What could realistically be done in a year or two? What would employees like to see done?

Whom will the policy apply?

Who will need to abide by the policy? -The entire worksite or formal subsets EX: Night shift -Will the policy apply to users of a given product or service? EX: Exercise equipment users Who will Administer the Policy? Who will approve this policy?

Secondary level of prevention

Work-site monitoring Screenings EAP

List many different types of health-related data

Workforce demographic profiles. Employee health records. Status according to health risk assessments. Medical care claims and costs. Workers' compensation claims and costs. Worksite culture or environmental health. On-the job productivity.

prospective medicine

a discipline concerned with the identification for the individuals changing risk of disease and the recognition of his earliest deviation from health - essentially promotes health prevention disease and thus extends useful life expectancy by complementing the art of medical care with scientific method which reduced long term health risks

prospective medicine

a discipline concerned with the identification of the individual's changing risks of disease and the recognition of his earliest deviations from health. -aims to promote health, prevent disease, and extend life expectancy.

Community

a group of individuals linked by geographic location, race, gender, organization, religion, etc.

Healthy People 2020

a national broad-based initiative based on 10 year objectives for promoting health among all populations within a society.

mission statement

a short narrative that describes the general focus or purpose of the program

Employees' interest and incentive preferences can be simultaneously assessed with:

a single integrated format.

assessing needs and capacity

actual and perceived needs - are both important? YES both accessed and part of program planning *medical needs actual health needs * perceived needs what you want in program types of data - secondary data- data that already exist (health insurance carries take records of health issues of employees) - primary data- data you collect the four phases of need assessment

Cost shifting

adds 25% to 33% more to the average health care bill. (involves hidden tax that doctors and hospitals shift to employers and paying customers to compensate for patients who cannot or o not pay their bills).

TPA (third party administrator)

administers claims payments to health care providers - at designated intervals they usually give a group data to employers shows claims and cost by MDC (major diagnostic category) and DRG (diagnostic related group) or (ICD) international classification of diseases

ICD

are the most revealing type of classification since they reflect specific types of conditions within a particular DRG - employers want this but have to settle for DRGs

Cost sharing

arrangements in which employees an employers share a predesigned percentage of employee-incurred health care costs (deductible & copayment)

how data assessed

at an aggregate (group) level or individual level

Disability-adjusted life expectancy

average number of years a person can expect to live free of any disability.

Employee assistance program

became popular in the latter half of the 20th century • Currently over 10,000 companies have such programs *Assistance for:* • Alcohol problems, stress management, eldercare, personal counseling, financial planning, and others

identification

begins with forming a task force to highlight a companies demographics (age, ethnicity women to men ratio), the existing and potential health related problems of its workforce and employee interest in programs to improve health and well being

Most commonly used tobacco product

cigarrettes, e-cig is an emerging trend

Development

closing the gap between stated values and how things actually get done at the organization. At this point you involve people, you communicate, and you actually develop and provide skills and support for people to make necessary changes personally, professionally, and within the organization at large.

Integrated health management system

comprehensive framework of various data-driven programs, polices, and incentives for health promotion, risk reduction, productivity enhancement, and health care consumers.

Catastrophic cases

consume a lot of health care resources. EX: transplant operations, HIV & AIDS cases, kidney dialysis, complications among premature infants.

According to the attributes of innovations, who would fit in the costs?

costs to adapt, laggards, late majority

identification phase

data can be imported into a group profile to preserve identity of employees personal health

What is secondary data? Give one example.

data someone else has collected-journals

mission statement

describes the step that moves your strategic planning process from the present to the future.

The 5-D's of culture building:

design, diagnosis, development, delivery, and determination. (allow you to make culture building an ongoing process that actually has visibility in the board room. It's not just an abstract notion that becomes a throw-away item when times get tough)

employee motivation

determine appropriate incentives by asking what motivated them to participate in health promotion programs

prevalence

disease is always there ex malaria

Diagnose

doing a survey that asks how important the norms and values are within the organization. How strong are the norms and values right now in the culture? Are they getting better or getting worse? *As a result of the diagnosis, you'll be able to validate the importance of the written values we talked about earlier. You can look at the strengths and weaknesses in the culture, and you can see which norms are getting better and which ones are getting worse.

x- test

draw a line between a topic that appears in both the list of needs and interest once identified both see if X formers by crossing lines are elongated tall or compressed short - short or compressed x indicate that the topic of high need is also high interest so it should be given priority

Most common risk factors:

excess stress high blood pressure cigarette smoking back injuries overweight alcohol abuse high blood cholesterol drug abuse depression other mental health problems

What is an example of fear taptic of developmental model of ethnosensitivity? what is the goal of this stage?

fear a specific group and idea or have a general mistrust of differences Goal: decrease/eradicate fear by using basic approaches and understandings

2 phases to help achieve WHP

first phase * identification- focuses on identifying understanding and prioritizing employees needs second phase * assessment - focuses on evaluating understanding and prioritizing the level of employees interest in specific types of incentives and WHP programs

disability management

form of case management designed to rehabilitate and enhance he health status and work performance of employees with an identified physical or mental disability.

creating policy

four step process

Design

getting together with people in the organization—from the executive level all the way down—to determine what kind of culture is wanted and needed in order to be successful.

back health program

greater affect if it were designed to - strength abdominal muscles - enhance flexibility in the hip flexor muscles lower back and hamstrings - motivate proper lifting

WHP examples:

gyms organized physical activity contest prohibit smoking at a workplace healthier lunchroom and vending machines

incidence

happening at a certain time ex ebola

HHA

health hazard appraisal - involved a biometric screening and obtained info on a persons reported lifestyle demographic profile and family medical history - estimated a person with a specific illness would die from a specific condition in 10 year intervals

According to the attributes of innovations, who would fit in the complexity?

how hard it is to use;

According to the attributes of innovations, who would fit in the Pervasiveness?

how much influences your life;

guideline

if sanctions are not involved and you want to suggest some ways of complying with your issue, you should write a guideline - provide the best interest of the individuals and do not contain sanctions (suggestions for using a service)

rules

if sanctions for not doing the right thing will be involved with your issue, you should write a rule. While less formal than a policy, a rule defines acceptable behavior - include a range of sanctions from the most serious, ultimate consequence to a general warning

Santion

if you do this then this will happen -usually in rules but can be in policies not in guidelines

Primary level of prevention

immunizations health promotion

Deliverey

implementing programs you've conceptualized and providing people with the skills and support they need to be successful. Determination means constantly maximizing the process. It means evaluating your efforts, identifying areas to improve, and recycling the effort.

WHP

important to determine employees needs and interest

What are the types of informal system of communication?

incredibly effective - rumors but difficult to mimic word of mouth tagged incentives - stamp symbol on it and travels

According to the attributes of innovations, who would fit in the Reinvention?

innovators - want new product for themselves ; custamomize it

According to the attributes of innovations, who would fit in the perceived relative advantage?

innovators, early adopters, early majority, late majority, laggards

Health and productivity management

integrated management of health risks, chronic disease, and disability to reduce employee's total health related costs, including direct medical expenditures, unnecessary absence from work, and lost productivity at work.

pts cultural backgorund/enviornment when consturcting approact to illness pts role as an active participant in care accept repsonsibity for pt who has few support systems

intercultural attitudes

culture is important in every pts identity comm of cultural understanding/respect is essential culture related stress and tension can cause illness culture affects acceptance/adherence to therapy nonverbal/verbal comm may differ in diff cultures

intercultural concepts

comm an understanding of pts cultur elicit pts understanding of pts culture recognize culture related hlth problems culturally relevant care plan with pts/partner interpret verbal/nonverbal behaviors basic or essential language proficiency aply principles of clinical epidemiology common illnesses

intercultural skills

wellness committees

involve employees in planning and implementing the program - WHP usually driven from the bottom by employees not the top - the personalize approach may not be good for large companies - in large companies it usually pays off to for a committee of management and employee representatives traditionally called wellness committees - wellness considered soft fuzzy entity by employers -important for wellness committees to collaborate with other personel

assessment

is a crutial phase in the framework for planning you WHP program - misjudging can have negative affects on the program - accurate assessments can get the WHP started on the right tracka nd greatly increase the chances for long term success

common dietary habits, foods, and their nutritional components predominant cultural values, health practices, traditional health beliefs family structure -patriarchal/matriarchal, nuclear vs extended effect of religion on hlth beliefs/practices common verbal/nonverbal communication customs/attitudes of death culture shock - very poor immigrants cross cultural tensions/psychological issues

knowledge

New technology

leads to innovative but costly treatments.

Theory of Planned Behavior

main determinant of behavior is based on the person's intention to perform that behavior, and intention is determined by three factors: attitude towards the behavior, subjective norm, received behavioral control understanding/predicting behavior good for kids

Lawsuit happy society

more doctors and hospital practices are using what is known as defensive medicine. EX: they do more procedures than necessary in an effort to protect themselves from a potential lawsuit.

According to the diffusion of innovations, who are the laggards

more traditional int heir disposition, are relatively isolated, have precarious economic situations and are suspicious of change?

health risk assessment

most publicized tool 1) risk identification 2) risk assessment 3) risk reduction that was developed by dr lewis robbins created HHa - initially scored using paper and pencil questionnaires based on a simple risk assessment - now 50 commercialized risk assessment tools with a variety of price ranges, self scoring, computerized phone based and interactive online versions - past financial incentives were offered to get employees to fill out HRA

Health Risk Assessment

most publicized tool for needs identification. 1. risk identification 2. risk assessment 3. risk deduction that was developed by Dr. Lewis Robbins in 1959.

health educators goal

motivate, persuade, change, and manipulate

Barriers to physical activity

motivation, lack of will power or energy, fatigue, lack of childcare, lack of safe places to exercise

after committee form

next step establish protocol

Transtheoretical Model (stages of change) - what are the stages?

people change their behavior at certain stages in life, rather than making one major change; usually in targeting intervention programs and tailoring info to appropriate stages of change Precontemplation Contemplation Preparation Action Maintenance Relapse

According to the diffusion of innovations, who are the early majority

people who are deliberate, highly connected within a peer system, and are ahead of the average

Briefly describe these areas of the innovation perceived relative advantage - compatibility Demonstrability - clarity of results - reversibility - reinvention - Complexity - cost - pervasiveness -

perceived relative advantage - is it better than what I have now? compatibility - does it match my needs / values? Demonstrability - can i try it before I buy it? clarity of results - do I know what the outcomes will be? reversibility - If I don't like it, can I go back? reinvention - can I customize it? Complexity - hard to use? cost - benefits outweigh expenses? pervasiveness - how much will i have to change my life/adjust to use it?

How health promotion could impact health care costs:

pg. 10

In your own words define health Education

planned learning experience that uses evidence to help benefit the community and acquire knowledge and skills to have a healthy community

Trans-theoretical Model

precontemplation, contemplation, preparation, action and maintenance

IRS

prohibits employers from collecting family medical history

quantitative vs qualitative

quantitative-deals with numbers qualitative-interviewing people; no numbers

scope

refers to the range and variability of needs identified at the employee, environmental and organizational level

specificity

refers to the type and prevalence of identified needs

ADA GINA HIPAA

require employees and their buisness partners to follow specific guidelines when accessing acquiring storing and transmitting employees personal health data

Inflation

rises two to three times as fast as others

equal employment opportunity commission (EEOC) r

ruled that a county emploters policy requiring employee to complete a HRA in order to participate in a company funded health plan did on record violate ADA policy

Smoker who quits smoking:

save $960 in excess illness costs each year. (nonsmokers account for about 75% of adult American consumers of goods and services)

Today's tools for health risk assessment continue to evolve in terms of:

scope, specificity, cost, and administration.

According to the attributes of innovations, who would fit in the clarity of results?

see results; everyone (workout videos)

five components of communication

sender message (words) symbol (picture or thing) message channel receiver

process of communication

sender → encode (message, symbol) → message channel → decode → receiver → RECEIVE FEEDBACK→ back to square one of the sender if changes are needed. Encode and message channel are health educators role--- to produce and disseminate messages that work!

According to the diffusion of innovations, who are the late majority?

skeptical, responsive to economic necessity, responsive to social norms, have limited economic resources and have low tolerance for uncertainty

Population health management

strategic and operational processes used to generate the health outcomes of a define group of people collectively associated with a company's efforts to improve health.

Processes of Behavior Change - steps?

the model is a series of steps where a person moves up towards the final goal - not a circle 1. preknowledge 2. knowledgeable 3. approving 4. intending 5. practicing 6. advocating

OSHA

the primary federal law establishing health and safety standards in the workplace.

health promotion

the process of enabling people to increase control over thier health and its determinants and thereby improve health

Gross domestic product

the total monetary value of all goods and services produced annually by businesses and industries in a nation.

According to the attributes of innovations, who would fit in the compatibility?

those towards the end

According to the attributes of innovations, who would fit in the deomonstrability?

use before you buy - towards the end

Communication Persuasion model

used predominately in field of advertising - using mass media external factors: example price or location internal directive factors: individual attitudes or beliefs internal dynamic factors: demographic characteristics such as age/ethnicity main concren is the internal factors

Health culture audit

used to identify culture

environmental check sheet

used to identify existing and potential problems at a worksite especially those resulting from working patterns or environmental factors - can be customized

workers comp

usually handled by the medical, safety, risk management benefits or human resource departments - these claims show the type of injury and what resulted which helps programs that reduce accidents and injuries on the job

vision vs mission vs goals

vision -> mission -> goals

establish a shared vision

vision statement - futuristic and reflective a conceptualized ideal -understood and shared by all -uplifting and inspiring - easy to communicate EXamples: safe streets, safe neighborhoods - every house a home - education for all - nike: just do it

According to the diffusion of innovations, who are early adopters

well respected opinion leaders and well integrated and judicious individuals classified as?

developing the mission

where the vision statement describes a future ideal condition the mission statement clarifies the purpose of the program to achieve the vision Example: the mission of aggie consulting is to promote total well being and health related quality of life among employees

ask other questions

who will administer the policy? - make sure someone will administer and make sure its followed who will approve the policy? -could be axed later on if its in the wrong hands

Determine to who the policy will apply

who will need to abide the policy? ** need to know audience and who will be of service -the entire worksite for formal subsets -night shift - certain group?? - will the policy apply to uses of a given product or service -exercise equipment users - or just people able to use test kitchen?

Reasons for decrease in physical activity

• *Increasing use of technology* • *Concerns of workplace safety* • *More jobs that do not require manual labor - 80% of worktime is sedentary behavior* • More sitting time associated with increased waist circumference and metabolic risk profiles including blood pressure, cholesterol, and blood glucose • Risk reduced when sitting time interrupted by frequent but brief breaks of walking at normal pace

Dietary habits

• *Many Americans:* • Have poor dietary habits • Consume excess calories • Leads to obesity and increased risk of chronic diseases • Obesity rates have doubled in the past 30 years • Medical costs associated with obesity estimated $147 billion; medical costs were $1,429 higher than those of normal weight

Obesity

• 34% of the American adult population • A critical current health problem • Over-consumption of calories • Eating away from home too often • Sweetened beverages = increase in pediatric obesity; artificial sweeteners also associated with increase in weight • 85-95% regain weight

Types and prevalence of employee personal concerns addressed by EAPs

• Alcohol and drugs - 4.4% • Psychological / emotional - 26.8% • Family / marital / relationship - 27.4% • Work-related - 25.5% • Other problems: including legal, financial, medical, and miscellaneous - 15.9%

Condition-specific decision support programs

• Arthritis - Millions of workers have undiagnosed and/or undertreated arthritis - Programs aim to reduce arthritic symptoms - Teach arthritis self-management skills - Employees who are taught self-care for their arthritis utilize health care resources less often ------- • Diabetes - Among costliest of the chronic conditions - Most difficult and complex to manage - Utilize ADA "National Standards for Diabetes Self- Management Education" - More common method - self-management record • Checklists for exercise, meals, abstaining from beverages with added sugars, and other diabetes control goals ------ • Asthma - High prevalence; high cost if poorly managed - Make employees active partner in health care management - Patient education critical component - Employers provide classroom instruction, group support, behavior contracting, at-home activities, individual instruction

Recommendation for exercise

• Avoid sedentary behavior and inactivity • Engage in at least 150 minutes of physical activity that is of moderate-intensity or 75 minutes of vigorous-intensity, or a combination of each week • Participate in physical activity in bouts of at least 10 minutes • Engage in activities that strengthen muscles

Prevalence-Tobacco

• Cigarettes most commonly used tobacco product in US • 19% of US adults current cigarette smokers - 77.8% smoke daily - 22.2% smoke some days • 21.6% males; 16.5% females • Highest among non-Hispanic American Indians/Alaskan Natives • Lowest among older adults (65+); highest among 25-44 (22.1%) and 45-64 (21.4%) • Highest among adults living in poverty • Highest among adults with disability • Highest in Kentucky; lowest in Utah -------- Second-hand smoke 88 million nonsmokers exposed to secondhand smoke from 2006-2007 Disparities exist - Higher among males than females - Higher among non-Hispanic blacks than non-Hispanic whites - Higher among children 3-11 and youth 12-19 than adults aged 20 or more - Higher among those living in poverty than at or above poverty level 20.4% of US workers reported being exposed to secondhand smoke at their workplace

Trends in dietary habits of Americans

• Decrease in physical activity • Increase in quick, processed food options • Increase in portion size • Half of Americans estimated to be obese by 2030 • 5 of top 10 leading causes of death are nutrition related

Interrelated factors of obesity

• Food marketing • Television viewing • Use of video games • Policy • Food prices • Behavioral economics • Food availability • Bias • Stigma • Discrimination

Fitness prescription dimensions

• Frequency - # of sessions per week • Intensity - level of stress • Time (duration) - length of workout •Type - dependent on goals

Decrease in physical activity

• Increasing use of technology • Concerns of workplace safety • More jobs that do not require manual labor - 80% of worktime is sedentary behavior • More sitting time associated with increased waist circumference and metabolic risk profiles including blood pressure, cholesterol, and blood glucose • Risk reduced when sitting time interrupted by frequent but brief breaks of walking at normal pace

Be able to describe stages of the Socioecological Model when implementing a physical activity program

• Intrapersonal - technology providing individuals with access to information • Interpersonal - social media • Organizational - modifications to the physical environment • Community - work, live, play in setting where PA is supported rather than discouraged • Public policy - provisions in the ACA serve as incentives to workplaces; many modifying benefits plans

Factors associated with stress

• Job strain • Highly demanding jobs • Long working hours • Roles involving lack of involvement in decision making • Low social support from managers and/or colleagues • Effort-rewarded imbalance • High job insecurity

Factors associated with stress

• Job strain • Highly demanding jobs • Long working hours • Roles involving lack of involvement in decision making • Low social support from managers and/or colleagues • Effort-rewarded imbalance • High job insecurity

Reasons for high healthcare costs

• Longer life equals longer and higher utilization of health care • Economic factors such as new technology, inflation, cost shifting • Catastrophic cases • Growing number of women and increase in older Americans in the workplace • Malpractice insurance and defensive medicine

Dietary habits

• Many Americans: • Have poor dietary habits • Consume excess calories • Leads to obesity and increased risk of chronic diseases • Obesity rates have doubled in the past 30 years • Medical costs associated with obesity estimated $147 billion; medical costs were $1,429 higher than those of normal weight • Trends • Decrease in physical activity • Increase in quick, processed food options • Increase in portion size • Half of Americans estimated to be obese by 2030 • 5 of top 10 leading causes of death are nutrition related

Strategies for improving nutrition

• Modification of cafeterias and dining facilities • Catered lunches • Vending services • Focused on reducing barriers or increasing opportunities for healthy eating

Organizational interventions for stress management

• Offering comprehensive organizational-level health promotion programs to reduce stress and increase job satisfaction has become increasingly popular in the last 3 decades • Aim to promote health-related activities and reduce stress indirectly by improving mental health in general • Include: • single health-related component - on-site gym or off-site gym membership, nutrition, stress reduction classes • Combination of components - gym, seminars on health nutrition

Reasons for worksite health pormotion

• Over 50% of employer costs are due to potentially modifiable lifestyle risk factors • Workers with high-risk profiles generally have higher healthcare costs than those with low-risk profiles • Studies have shown that initiation of WHPP have had positive outcomes on employees

Impact of worksite stress

• Physical illness • Psychological distress • Mental illness • Link between stress at work and coronary heart disease is well documented (those who experience stress at work have a 50% higher risk of heart disease than those that do not)

Impact of worksite stress

• Physical illness • Psychological distress • Mental illness • Link between stress at work and coronary heart disease is well documented (those who experience stress at work have a 50% higher risk of heart disease than those that do not)

Common pitfalls to successful programs

• Poor participation • Poor leadership and associated personnel issues • Lack of appealing programs • Lack of appropriate incentives • Lack of appropriately trained staff • Lack of support/involvement by administration • Lack of tailoring programs to meet needs • Lack of options of program delivery • Lack of coordination with other health-related units • No flex time to participate • Distrust of how personal data may be used

Organizational resilience

• Potential to address workplace stress issues by examining both individual and organizational approaches to stressful and adverse events • Resilience approaches shift the conversation around stress from the concept of "managing" stress to recognizing and acknowledging that challenging events will occur in the workplace • Must prepare, navigate through, and recover quickly form those events

Diabetes

• Prevalence dramatically increased over the last 20 years - 1 in 3 will have diabetes by 2050 • 8.3% of the population has diabetes; 7 million are undiagnosed • Lifestyle interventions that focus on weight loss and increase of physical activity reduced likelihood of developing type 2 diabetes • Mediterranean diet consistently effective - legumes, fruits, vegetables, whole grains

Tobacco control programs

• Primary objective - encourage tobacco users to quit • Secondary objective - reduce tobacco use initiation and behavior among subpopulations such as visitors and employee's family members

History of worksite wellness promotion • 1879 • 1884 • 1930 • 1953 • 1958 • 1970 • 1980s

• Pullman Company formed athletic association • National Cash Register Corporation took employees out for pre-work horseback rides • Hershey Food Corp built a recreation complex • Texas Instruments started the process to build a half million dollar recreation center • PepsiCo established a physical fitness program • The Occupational Safety and Health Act passed(• Regulates the worksite environment• Protects the safety of the worker) • Worksite Wellness Programs integrated diverse types of offerings(• Smoking cessation, stress management, nutrition counseling, weight control, etc. )

Skill enhancement strategies for fitness

• Tailored to impact fitness element relevant to target audience • EXAMPLE: Jobs that put employees at increase for back injuries should implement programs focusing on strength training or flexibility to increase core strength • Programs can aim at multiple types of fitness • EXAMPLE: Basketball enhances cardio-respiratory endurance and body composition; stair climbing enhances muscular strength and muscular endurance • Overcoming barriers - motivation, lack of will power or energy, fatigue, lack of childcare, lack of safe places to exercise • EXAMPLE: improve time management skills; goal setting; relapse planning and prevention; accountability and experiential learning

Workplace counseling

• Targeted at the tertiary level • Aim is to treat and/or reduce symptoms related to possible mental health symptoms that may be experienced by employee • Provided by outside professionals contracted with the organization and can be directed at alleviating the symptoms at the individual level or removing the stressors at the worksite • CBT often used to provide the individual with necessary tools and/or training to cope with or manage stress and is primarily used as a tertiary form of support • Challenge negative thoughts • Physical and relaxation techniques • solution-focused and goal-oriented training

Workplace counseling

• Targeted at the tertiary level • Aim is to treat and/or reduce symptoms related to possible mental health symptoms that may be experienced by employee • Provided by outside professionals contracted with the organization and can be directed at alleviating the symptoms at the individual level or removing the stressors at the worksite • CBT often used to provide the individual with necessary tools and/or training to cope with or manage stress and is primarily used as a tertiary form of support • Challenge negative thoughts • Physical and relaxation techniques • solution-focused and goal-oriented training

Background on tobacco

• Tobacco use is leading cause of preventable disease, disability, and death in the US • 1 in 4 Americans use some form of tobacco; 1 in 5 uses cigarettes • 2/5 exposed to secondhand smoke • Workplace represents suitable and important setting for prevention and control of tobacco

Background of Obesity

• US today - more than one-third of adults are obese; rates have more than doubled since the late 1970s • 17% of children and adolescents are obese; rates have tripled during the course of a single generation • Obesity rate projected to be 51% by 2030, increasing medical care expenditures by as much as $550 billion • Solutions come from wide variety of changes made at the level of families, groups, workforces, communities, the nation, and even the world

Osteoporosis

• Weakening of the bones that cause bones to be brittle and break easily • Caused by excess weight, smoking, insufficient exercise, and estrogen use • Increase in calcium and vitamin D may help prevent • Consume low or non-fat dairy products such as milk, yogurt, and cottage cheese as well as plant-based foods including broccoli, collard greens, soy milk, and legumes • Vitamin D is in fatty fish, low fat milk, fortified cereals, and eggs

Outputs, impact, and outcome of obesity programs

• Worker health and well-being • Reduced health care costs • Improved productivity • Improved employee morale • Improved company performance • Improved corporate climate • Improved corporate image in the community