Purpose. Recognition regarding the importance of health culture in the worksite health promotion literature is growing; however, little empirical evidence exists to guide programmatic or research efforts. The purpose of this study is to examine the relationship between the health supporting structural features of the workplace and perceived health culture. Design. Cross-sectional. Sample. Twenty-one worksites with culture data from 2467 employees from Western New York. Measures. The Heart Check (HC) and Lifegain Health Culture Audit (LHCA) were used to assess worksite environment and worksite health culture, respectively. Analysis. Pearson r was used to examine the associations between HC factors and LHCA mean scores. Multiple linear regression was used to predict LHCA mean scores from selected HC factors. Results. Adjusting for age and gender, several significant correlations between HC and LHCA scores were identified, ranging from r = .54 (p < .05) to r = .72 (p <. 001). The HC Environmental Structure factor (HCES) and HC Communication factor (HCC) were significantly correlated to LHCA scores (r = .55 and r = .72, respectively; p < .01) but not to each other. A regression model combining HCES and HCC was found to be predictive of LHCA score (R2 = .69, p < .001). Conclusions. Modifiable components of the worksite environment are strongly and positively related to employee perceptions of the worksite health culture.

Purpose - The purpose of this study is to determine results of an environmental approach to improving employee health status in a government employer setting.Design/methodology/approach - This is an observational study of one worksite and its employees from 2005 to 2007. Environmental interventions were part of the worksite environment, accessible, and applicable to employees regardless of health status. Outcomes were: change in the worksite environment using the Heart Check assessment, change in employee health risks using health risk appraisals (HRAs) and change in hours of sick time. The eligible population included active employees from 2005 to 2007 (n = 2,276).Findings - The Heart Check score increased by 26 percentage points. Despite aging of HRA participants, results showed maintenance of risk status with a non-significant increase in percent at low risk 51.6 percent to 53.1 percent). Percent at high risk had a non-significant decrease (21.1 percent to 20.2 percent). The three-month average for hours of sick time decreased from 12.7 to 11.6 hours (p = 0.03) for the larger eligible population.Originality/value - This paper offers qualitative information for others seeking to implement population-based health promotion interventions. This particular setting presented challenges related to union and non-union regulations, sub-contractors, and multiple administrative levels. Quantitatively, change of health risks and absenteeism serves as a reference to others engaging in workplace health promotion.

Many believe that the "next generation" of health promotion or health management programs will likely include a much more extensive alignment of environmental ['actors that support a healthy and productive workforce. To address this possibility, a model was conceptualized that integrates an environmentally-based intervention within a comprehensive health management effort. Intervention is direded at both enhancements to the physical aspects of the worksite as well as its cultural makeup, and a series of suggestions are provided for those who want to utilize this model. This comprehensive, environmentally-focused component of the next generation of health promotion programs will expand the population reach of health management to all employees and potentially enhance its overall success. This approach is viewed as critical in creating a healthy and productive work organization, and allows the employer to capture the full economic and human capital benefits of intervention. The creation of a "supportive environment" for health promotion and wellness is seen as an important develop­ ment in the field of worksite health promotion, thus our focus on this model within The Art of Health Promotion. In this edition we will examine the following topics:

Purpose. Develop and test a reduced-item version of an established tool to measure employer supports for cardiovascular health. Method. A random set of 1000 worksites throughout New York State was surveyed in 1999 with Heart Check, a 226–item assessment of employer supports for cardiovascular health. Correlation, Guttman, factor, and ordinary least squares (OLS) regression analyses were used to identify reduced-item versions. The reduced-item versions were then assessed for their abilities to similarly rank and detect changes in 255 different worksites participating in an intervention program. Regression, correlation, and k analyses were used. Results. Analysis of the Heart Check instrument identified two brief versions with 27 and 55 items. OLS regression of full Heart Check scores for these versions had adjusted R2 of .95 and .97, respectively. Discussion. Both reduced-item versions demonstrated a moderate to strong ability to reproduce the results observed with the full Heart Check.

A conccptual model for addressing the creation of supportive environments for worksite health promotion settings is presented. The authors also discuss the variety of organizational and cultural interventions that are necessary in creating a supportive environment for healthy behavior using a social ecology perspective. The connection to next generation strategies in worksite health promotion is proposed and summaries of the relevant literatures are cited.

Health care costs are staggering American businesses. One traditional approach to cost containment includes targeting individual employees with wellness programming often focusing on physical activity (PA), weight control and stress management. Recently, the Influence of the “health” of the corporate environment on individual employee health risks and behaviors has become an area of interest. PURPOSE: To examine the cross-sectional association between corporate environmental support for workplace wellness and individual employee health risks and behaviors in a community-based worksite project. METHODS: Individual health risk appraisals (HRA's) were administered to 2572 (1687 women, 885 men) workers representing 13 companies from 4 western NY counties. Corporate environmental support for workplace wellness for each company was assessed using the metrically tested Heart Check (HC) instrument, a 226-item inventory characterizing 7 environmental health components including support for physical activity and nutrition. Regression models, adjusted for age and gender were used to compare individual health risks obtained from the HRA with overall corporate environmental support (overall HC), and specific HC component scores. RESULTS: The overall total HC score was inversely associated with the number of individual employees health risks (p=0.007). Employees from companies with total HC scores above 60 percent reported fewer sick days/year (p=0.038) and were more likely to exercise >3 times/week (p=0.043) than those from companies with lower scores. The HC PA component score was inversely related to number of employee risks (p<0.001) and BMI (p=0.012), and was significantly associated with more frequent exercise (p=0.003) and fewer days off due to illness (p=0.008). The HC nutrition component was also inversely associated with employee BMI (p=0.000). CONCLUSION: These results provide important evidence of an association between corporate environmental support for workplace wellness and individual employee health risks. These findings have implications for health promotion interventions aimed at improving the health of both individual employees and the corporate environment.

Abstract Legalized gambling is growing substantially and provides both a dilemma and an opportunity for those in the health promoting professions. Gambling represents a form of economic development and, for certain segments of society, improved health and quality of life. On the other hand, gambling is a known addiction, with a host of sociological problems associated with its practice. Consequently, a number of opportunities and responsibilities emerge for health educators. This article provides both background information and suggestions for professional development, and begins a dialogue in the health education literature on this largely neglected and misunderstood topic.

OBJECTIVETo develop systems that measure and effect organizational support for employee health.METHODSMultiple studies and developmental projects were reviewed that show the process of instrument development, metric quality testing, utilization within intervention studies, and prediction modeling efforts.RESULTSDemographic patterns indicate high support levels and relationships of subsections to various employee health risks. Successes with the initial version have given rise to 2 additional evaluation tools.CONCLUSIONSThe availability of these systems illustrates how ecological models can be practically applied. Such efforts contribute to the paradigm shift in worksite health promotion that focuses on the organization as the target of intervention.

Purpose. The purpose of this article is to document the development, testing, and application of an organizational assessment tool used to measure employer support for heart health. Additional information is presented on its future research and applications plan. Design. This article represents the pooling of results from multiple studies using a variety of designs, including pilot tests, cross-sectional analyses, and quasi-experiments. Setting. Worksites covering the spectrum of employers across industry types and size, and throughout all of New York State. Subjects. Over 10,000 New York employees and 1000 New York employers are represented in the multiple phases of this research. Measures. Heart Check is a 226-item inventory designed to measure such features in the worksite as organizational foundations, administrative supports, tobacco control, nutrition support, physical activity support, stress management, screening services, and company demographics. Additional side studies used professional judgments and behavioral surveys. Results. As an assessment tool Heart Check shows evidence for reliability and validity. Applications of the instrument show characteristics that define high-scoring companies, quasi standards for New York employers, and, when applied during interventions, positive changes in organizational support levels. Conclusions. A relatively inexpensive, easy-to-use, and metrically tested instrument exists for measuring the construct of organizational support for employee heart health. The instrument shows promise as part of a system to enhance heart health through public health-based interventions in the workplace.

A behaviorally based, health education instructional model was developed from a review of successful health education interventions. The analysis identified three principles common to improvement of health behavior among program participants: 1) active involvement in the intervention process, 2) awareness of the positive and negative influences of the behavior on health, and 3) personal responsibility for managing health behavior. These principles and several theoretical premises then were organized into a structural framework for the model. Next, studies were conducted to validate applications of these conditions and refine strategic components. The model then was formatted into a curricular design to achieve optimum behavior and provide ease of replication. Research related to developing and field testing the model are included. The model's limitations and strengths, implications for school health education, and plans for the future are presented.

Purpose. Intervention at the organizational rather than the individual level is gaining greater attention in worksite health promotion efforts. However, little research has been done on instruments to measure this domain. Therefore, the purpose of this study was to further test the utility of an existing organizational heart health support instrument by examining relationships among worksite structural characteristics and comparing these results to other survey findings. Design. One-time cross-sectional. Setting. New York State. Subjects. One hundred fifteen volunteer worksites in the New York State Healthy Heart Program, representing manufacturing, government, education, health care, and other industries. Measures. A survey was conducted using HeartCheck, an organizational assessment of employee support for heart health. HeartCheck contains 175 items measuring organizational support for tobacco control, nutrition, physical activity, stress, screening, and administrative support structure. Results. On average, only 22% of all worksite resources assessed were present in the sample. Having a workforce greater than 250 provided a 12% increase in predicted overall worksite resources. A predominantly female workforce (>75%) provided 10% higher levels of worksite stress resources. Worksites with unions had higher levels of resources for physical activity (10%), screening (13%), and general supportive structures (10%). The presence of manual labor diminished support for tobacco control resources (−13%). Finally, manufacturing worksites demonstrated a clear advantage for all types of worksite resources, except for stress. Conclusion. A number of trends found in this study are consistent with earlier work. Industry type and size both predict worksite supports similar to previous studies. Other findings that appear to contradict previous work, including the relatively low level of support observed in this sample, can be explained by the comprehensive nature of the instrument. Overall, these findings demonstrate the utility of HeartCheck.

Purpose. The purpose of this study was to evaluate the effectiveness of a management training seminar, developed through a partnership among a college, a managed care company, and a state public health department, to increase the level of organizational support for employee heart health in selected companies. Design. Quasiexperimental. Setting. Worksites, including heavy and light industries, school districts, insurance companies, county health agencies, and health care centers. Subjects. Twenty western New York companies matched on size, industry type, and interest in worksite health promotion. Intervention. Seven training seminars held at a college for 1 year and directed primarily at human resource managers. Training was supplemented by the availability of student interns, faculty consulting, a vendors' fair, and various program planning aids. Measures. Groups were assessed using HeartCheck, a measure of organizational support for employee heart health. Results. A fourfold difference in change for HeartCheck was observed by the experimental vs. comparison groups (p < .01), along with significantly greater increases on five of the instrument's six subscales (p < .05). The level of HeartCheck reached in the experimental group matched those seen in highly acclaimed commercially sponsored programs. Conclusion. This study represents one of the first attempts to intervene at the organizational level within a worksite health promotion initiative. Positive results were observed that appear to be both meaningful and cost-effective.

Because of a growing need in the area of worksite health promotion to assess the employer as well as the employee, an organizational heart health support instrument and data collection process was developed and field tested. Modeled after criteria found in the 1992 National Survey of Worksite Health Promotion, the instrument was reviewed by experts in the field and found to have sufficient content and face validity. Following training of a group of 14 advanced health promotion majors serving as independent raters, the instrument was field tested at four cooperating worksites. Significant differences were observed by mean organizational support scores across these worksites. Of 134 total items, 133 were found to have inter-rater agreement of 80 percent or greater. Additionally, internal consistency reliability ranged from .83 to. 97 for the instrument's six sub-scales. Taken in total, the instrument was judged acceptable for field use to assess organizational need, heighten management's awareness of programming options, plan initiatives, and evaluate progress. For more sophisticated efforts, continued research is needed for this relatively unexplored area of activity.

The purpose of this study was to determine whether a computer-assisted instruction nutrition program would assist employees in maintaining weight loss and dietary intake improvements for a one-year period. Participants were assigned to three groups. Group A received the program with hands-on microcomputer use, Group B received the same program without hands-on microcomputer use, and a control group did not receive any nutrition education. The intervention emphasized use of a computer-generated dietary and exercise analysis. Post program data showed trends toward weight loss for both experimental groups, with a greater weight loss for Group A (20.3 lbs.) than Group B (2.3 lbs.) and a weight gain for the Control Group (2 lbs.). Dietary changes for the combined experimental groups indicated a significant difference post-intervention for polyunsaturated and monounsaturated fats. No differences were found in the Control Group. Despite the limitations of a small sample, the results suggest that computer assisted instruction may contribute to successful weight loss and improved diet content. Suggestions are provided to increase the probability of success in future programs.

PURPOSE OF THE REVIEW. The purpose of this review is to assist those who work in the field of health promotion when considering the implementation of an individually risk-rated health insurance plan. It does so by introducing the reader to the concept of individually risk-rating health insurance; uncritically reviewing selected risk-rated health insurance plans; and exploring several issues related to plan implementation, administration, and appropriateness. SEARCH METHODS USED. The review is based on the authors' awareness of the literature in the fields of preventive medicine, health promotion, and employee benefits. The six individually risk-rated health insurance programs that are reviewed were chosen because they demonstrate how aspects of the National Association of Insurance Commissioners' Model have been implemented using various combinations of administrative procedures, verification strategies, and types of economic incentives or disincentives. This review is not intended to be a comprehensive review of the literature. SUMMARY OF IMPORTANT FINDINGS. Individually risk-rated health insurance programs have been established using a variety of administrative procedures, verification strategies, and types of economic incentives or disincentives. The frequency with which these programs are being established is increasing. As the number of risk-rated programs grows, it will be increasingly important to address the many issues that implementing such plans generate: How should lifestyle behaviors be verified? Will healthy lifestyles save money? Can employees fully control their risk factors? Is risk-rating socially responsible? MAJOR CONCLUSIONS. As risk-rating becomes more widespread, there will be a continuing need to address the business, medical, ethical, and legal issues these programs create and to refine them accordingly. The health promotion community has both an opportunity and obligation to see to it that individually risk-rated health insurance programs are implemented in a socially acceptable manner and that the outcomes they generate are cost-beneficial.

The purpose of this research was to design “Back Up Your Back,” a health education program for improving behaviors related to low back health, and to experimentally evaluate its effectiveness. The results indicated that experimental subjects scored significantly better than control subjects on measures of back-related behavior and back extension. This research concluded that a back education program can, over the short term, effectively modify back-related indexes of health in a worker population.