BACKGROUND: The workplace is an important setting for health protection, health promotion, and disease prevention programs. In the school setting, employee health and well-being programs can address many physical and emotional concerns of school staff. This systematic review summarizes evidence-based approaches from employee health and well-being interventions supporting nutrition and physical activity (PA) in a variety of workplace settings. METHODS: The 2-phase systematic review included a search for articles within systematic reviews that met our criteria (addressing employee health and well-being programs; published 2010-2018; Phase 1) and the identification of individual articles from additional searches (addressing school-based employee interventions; published 2010-2020; Phase 2). We included 35 articles. FINDINGS: Across all studies and types of interventions and workplace settings, findings were mixed; however, multicomponent interventions appeared to improve health behaviors and health outcomes among employees. IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY: Schools can apply this evidence from employee health and well-being programs in various workplace settings to implement coordinated and comprehensive employee health and well-being programs. CONCLUSIONS: Employee health and well-being programs may be effective at supporting nutrition and PA. Schools can use findings from employee health and well-being programs in workplaces other than schools to support school staff.

INTRODUCTION: The CDC Worksite Health ScoreCard (ScoreCard) is a free, publicly available survey tool designed to help employers assess the extent to which they have implemented evidence-based interventions or strategies at their worksites to improve the health and well-being of employees. We examined how, how broadly, and to what effect the ScoreCard has been applied. METHODS: We analyzed peer-reviewed and grey literature along with the ScoreCard database of online submissions from January 2012 through January 2021. Our inclusion criteria were workplace settings, adult working populations, and explicit use of the ScoreCard. RESULTS: We found that the ScoreCard had been used in 1) surveillance efforts by states, 2) health promotion training and technical assistance, 3) research on workplace health promotion program effectiveness, and 4) employer efforts to improve program design, implementation, and evaluation. CONCLUSION: The ScoreCard has been used as intended to support the development, planning, monitoring, and continuous improvement of workplace health promotion programs. Our review revealed gaps in the tool and opportunities to improve it by 1) enhancing surveillance efforts, 2) engaging employers in low-wage industries, 3) adding new questions or topic areas, and 4) conducting quantitative studies on the relationship between improvements in the ScoreCard and employee health and well-being outcomes.

The Centers for Disease Control and Prevention (CDC) Worksite Health ScoreCard (CDC ScoreCard) is a free and publicly available tool designed and validated to help employers assess the extent to which they have implemented evidence-based health promotion interventions or strategies at their worksites to improve the health and well-being of their employees.1 The current version of the CDC ScoreCard has 154 yes/no questions that address a range of health promotion and disease prevention strategies, including lifestyle counseling services, physical/social environmental supports, workplace policies, and health plan benefits across 18 core topic areas (see Table 1). Each question represents an individual intervention, strategy, or action an employer can put into practice at the worksite.

PURPOSE: To provide a nationally representative description on the prevalences of policies, practices, programs, and supports relating to worksite wellness in US hospitals. DESIGN: Cross-sectional, self-report of hospitals participating in Workplace Health in America (WHA) survey from November 2016 through September 2017. SETTING: Hospitals across the United States. PARTICIPANTS: Random sample of 338 eligible hospitals participating in the WHA survey. MEASURES: We used previous items from the 2004 National Worksite Health Promotion survey. Key measures included presence of Worksite Health Promotion programs, evidence-based strategies, health screenings, disease management programs, incentives, work-life policies, barriers to health promotion program implementation, and occupational safety and health. ANALYSIS: Independent variables included hospital characteristics (eg, size). Dependent characteristics included worksite health promotion components. Descriptive statistics and chi(2) analyses were used. RESULTS: Eighty-two percent of hospitals offered a wellness programs during the previous year with larger hospitals more likely than smaller hospitals to offer programs (P < .01). Among hospitals with wellness programs, 69% offered nutrition programs, 74% offered physical activity (PA) programs, and 84% had a policy to restrict all tobacco use. Among those with cafeterias or vending machines, 40% had a policy for healthier foods. Only 47% and 25% of hospitals offered lactation support or healthy sleep programs, respectively. CONCLUSION: Most hospitals offer wellness programs. However, there remain hospitals that do not offer wellness programs. Among those that have wellness programs, most offer supports for nutrition, PA, and tobacco control. Few hospitals offered programs on healthy sleep or lactation support.

OBJECTIVE: To evaluate the reliability and validity of the updated 2019 CDC Worksite Health ScoreCard (CDC ScoreCard), which includes four new modules. METHODS: We pilot tested the updated instrument at 93 worksites, examining question response concurrence between two representatives from each worksite. We conducted cognitive interviews and site visits to evaluate face validity, and refined the instrument for public distribution. RESULTS: The mean question concurrence rate was 73.4%. Respondents reported the tool to be useful for assessing current workplace programs and planning future initiatives. On average, 43% of possible interventions included in the CDC ScoreCard were in place at the pilot sites. CONCLUSIONS: The updated CDC ScoreCard is a valid and reliable tool for assessing worksite health promotion policies, educational and lifestyle counseling programs, environmental supports, and health benefits.

PURPOSE: To provide a nationally representative snapshot of workplace health promotion (WHP) and protection practices among United States worksites. DESIGN: Cross-sectional, self-report Workplace Health in America (WHA) Survey between November 2016 and September 2017. SETTING: National. PARTICIPANTS: Random sample of US worksites with >/=10 employees, stratified by region, size, and North American Industrial Classification System sector. MEASURES: Workplace health promotion programs, program administration, evidence-based strategies, health screenings, disease management, incentives, work-life policies, implementation barriers, and occupational safety and health (OSH). ANALYSIS: Descriptive statistics, t tests, and logistic regression. RESULTS: Among eligible worksites, 10.1% (n = 3109) responded, 2843 retained in final sample, and 46.1% offered some type of WHP program. The proportion of comparable worksites with comprehensive programs (as defined in Healthy People 2010) rose from 6.9% in 2004 to 17.1% in 2017 ( P < .001). Occupational safety and health programs were more prevalent than WHP programs, and 83.5% of all worksites had an individual responsible for employee safety, while only 72.2% of those with a WHP program had an individual responsible for it. Smaller worksites were less likely than larger to offer most programs. CONCLUSION: The prevalence of WHP programs has increased but remains low across most health programs; few worksites have comprehensive programs. Smaller worksites have persistent deficits and require targeted approaches; integrated OSH and WHP efforts may help. Ongoing monitoring using the WHA Survey benchmarks OSH and WHP in US worksites, updates estimates from previous surveys, and identifies gaps in research and practice.

Approximately 150 million Americans go to work each day, and where and how they work are closely linked to health and disease. Thus, workplace health promotion programs provide an opportunity to affect the health of the nation. Workplace health promotion programs traditionally rooted in occupational safety and health focus on preventing injury and illness resulting from the workplace environment. As gains have been made in reducing workplace hazards, and the prevalence of disease has shifted toward chronic diseases, employers have encountered rising health care costs. In the United States, chronic diseases are responsible for approximately seven in 10 deaths and account for 86% of health care costs (1,2). Approximately 20% of employer health care spending is associated with 10 modifiable health risks in the U.S. workforce: depression, high blood glucose, high blood pressure, obesity, tobacco use, physical inactivity, high stress, high cholesterol, poor nutrition and eating habits, and high alcohol consumption (3). Many employers have sought to establish workplace health promotion programs to improve employee health and lower health care costs; results of these efforts have been mixed. For example, some employers, especially smaller firms with limited resources, report barriers to implementing workplace health promotion programs, including lack of knowledge of program design, difficulty identifying credible information, and lack of awareness of program benefits (4,5). Evaluation and research continue to increase knowledge about workplace health promotion program design and identify ways to overcome the challenges of establishing effective programs. State health departments can provide assistance to employers and employees. In 2017, the CDC Workplace Health Resource Center was launched as a source for reliable evidence and best practices to improve worker health and productivity, address research gaps, and potentially reduce health care costs.

Evidence indicates a healthier workforce can improve productivity and lower direct health-care costs, as well as indirect costs such as employee absenteeism.1–8 Yet, the impacts of workplace wellness programs in small- (<100 employees) to mid-sized (100–500 employees) employers are not well known. | | This case study is based on CIPROMS, Inc. (CIPROMS), a mid-sized medical billing and coding company in Indianapolis, Indiana that participated in the Centers for Disease Control and Prevention National Healthy Worksite Program (NHWP).9 In collaboration with NHWP, CIPROMS developed a workplace wellness program with tailored interventions to improve the health, safety, and well-being of employees to create a healthy work environment.9 CIPROMS also built an infrastructure to maintain the wellness program and increase its potential for sustainability. This infrastructure includes establishing an active wellness committee, cultivating leadership support, providing employee coaching and counseling, and changing the physical environment. The resulting workplace wellness program included healthy choices in vending machines, tobacco cessation medication insurance coverage, and environmental changes such as stairwell signage for physical activity and on-site or nearby farmers’ markets.10

PURPOSE: Centers for Disease Control and Prevention (CDC) initiated the Work@Health Program to teach employers how to improve worker health using evidence-based strategies. Program goals included (1) determining the best way(s) to deliver employer training, (2) increasing employers' knowledge of workplace health promotion (WHP), and (3) increasing the number of evidence-based WHP interventions at employers' worksites. This study is one of the few to examine the effectiveness of a program designed to train employers how to implement WHP programs. DESIGN: Pre- and posttest design. SETTING: Training via 1 of 3 formats hands-on, online, or blended. PARTICIPANTS: Two hundred six individual participants from 173 employers of all sizes. INTERVENTION: Eight-module training curriculum to guide participants through building an evidence-based WHP program, followed by 6 to 10 months of technical assistance. MEASURES: The CDC Worksite Health ScoreCard and knowledge, attitudes, and behavior survey. ANALYSIS: Descriptive statistics, paired t tests, and mixed linear models. RESULTS: Participants' posttraining mean knowledge scores were significantly greater than the pretraining scores (61.1 vs 53.2, P < .001). A year after training, employers had significantly increased the number of evidence-based interventions in place (47.7 vs 35.5, P < .001). Employers' improvements did not significantly differ among the 3 training delivery formats. CONCLUSION: The Work@Health Program provided employers with knowledge to implement WHP interventions. The training and technical assistance provided structure, practical guidance, and tools to assess needs and select, implement, and evaluate interventions.

INTRODUCTION: Employers may incur costs related to absenteeism among employees who have chronic diseases or unhealthy behaviors. We examined the association between employee absenteeism and 5 conditions: 3 risk factors (smoking, physical inactivity, and obesity) and 2 chronic diseases (hypertension and diabetes). METHODS: We identified 5 chronic diseases or risk factors from 2 data sources: MarketScan Health Risk Assessment and the Medical Expenditure Panel Survey (MEPS). Absenteeism was measured as the number of workdays missed because of sickness or injury. We used zero-inflated Poisson regression to estimate excess absenteeism as the difference in the number of days missed from work by those who reported having a risk factor or chronic disease and those who did not. Covariates included demographics (eg, age, education, sex) and employment variables (eg, industry, union membership). We quantified absenteeism costs in 2011 and adjusted them to reflect growth in employment costs to 2015 dollars. Finally, we estimated absenteeism costs for a hypothetical small employer (100 employees) and a hypothetical large employer (1,000 employees). RESULTS: Absenteeism estimates ranged from 1 to 2 days per individual per year depending on the risk factor or chronic disease. Except for the physical inactivity and obesity estimates, disease- and risk-factor-specific estimates were similar in MEPS and MarketScan. Absenteeism increased with the number of risk factors or diseases reported. Nationally, each risk factor or disease was associated with annual absenteeism costs greater than $2 billion. Absenteeism costs ranged from $16 to $81 (small employer) and $17 to $286 (large employer) per employee per year. CONCLUSION: Absenteeism costs associated with chronic diseases and health risk factors can be substantial. Employers may incur these costs through lower productivity, and employees could incur costs through lower wages.

Creating healthy workplaces is becoming more common. Half of employers that have more than 50 employees offer some type of workplace health promotion program. Few employers implement comprehensive evidence-based interventions that reach all employees and achieve desired health and cost outcomes. A few organization-level assessment and benchmarking tools have emerged to help employers evaluate the comprehensiveness and rigor of their health promotion offerings. Even fewer tools exist that combine assessment with technical assistance and guidance to implement evidence-based practices. Our descriptive analysis compares 2 such tools, the Centers for Disease Control and Prevention's Worksite Health ScoreCard and Prevention Partners' WorkHealthy America, and presents data from both to describe workplace health promotion practices across the United States. These tools are reaching employers of all types (N = 1,797), and many employers are using a comprehensive approach (85% of those using WorkHealthy America and 45% of those using the ScoreCard), increasing program effectiveness and impact.

The workplace is recognized as a setting that can profoundly influence workers’ health and well-being (1,2). The Centers for Disease Control and Prevention (CDC) workplace health promotion efforts address cancer prevention by focusing on cancer screening programs, community–clinical linkages, and cancer risk factors (eg, tobacco use, physical inactivity) that also influence risk for other chronic diseases (http://www.cdc.gov/workplacehealthpromotion/). Some efforts focus specifically on cancer; some focus on general chronic disease prevention. Additionally, the National Institute for Occupational Safety and Health (NIOSH), part of CDC, provides research and recommendations to address workplace hazards posed by chemicals that may increase cancer risk (http://www.cdc.gov/niosh/topics/cancer/policy.html). | Existing resources can be leveraged to expand the scope of workplace initiatives to address additional cancer risk factors and disparities. Changes to the physical and social characteristics of work environments are likely to have greater impact than health education alone (3). Given the aging US population (which is expected to result in a marked increase in the number of cancer diagnoses over the coming decades) and the prevalence of numerous risk factors among working-aged adults (4,5), a multifaceted approach to cancer prevention in the workplace is timely and needed. In addition, community-based prevention efforts may offer unrealized opportunities to reach vulnerable working populations who are not served by workplace health promotion programs. In this essay, we draw attention to a wide variety of available CDC resources and provide ideas for new efforts to advance primary cancer prevention among working adults.

NIOSH defines TWH as an organizational strategy that integrates occupational safety and health protection with health promotion to prevent worker injury and illness and to advance health and well-being. This strategy provides oppor-tunities for workers to safeguard and improve their health, lengthen their working lives, and enjoy both the economic benefits and improvements in well-being that come from safe, satisfying work. Employers gain more productive employees and can see reductions in absenteeism, lower levels of health care spending, and improvements in work-related injury and illness rates.Research Advances Total Worker HealthNIOSH conducts research on the integration of health protec-tion and health promotion through a number of partnerships and mechanisms, both internal and external. TWH research efforts strive to recognize the synergies possible when efforts to reduce personal health risk factors in the workplace are com-bined with initiatives to eliminate traditional safety hazards and factors that produce psychosocial stress in that setting. Recent work by NIOSH and its Centers of Excellence includes the piloting of promising workplace policies and programs that have an established or emerging evidence base for their positive impacts on health outcomes; developing and dissemi-nating best practices and toolkits; developing strategies for overcoming barriers to organizational acceptance or adoption of comprehensive policies; implementing coordinated work-based health protection and promotion interventions; investi-gating costs and benefits associated with integrated programs; and promoting the increased discovery of physiological and biological markers of stress, sleep, and depression and their application for worker protection and improved health out-comes. NIOSH’s Centers of Excellence are located at Harvard University in Cambridge, Massachusetts; Oregon Health & Science University in Portland, Oregon; and the University of Iowa in Iowa City, Iowa. A fourth NIOSH Center of Excellence is co-located at the University of Connecticut in Farmington and Storrs, Connecticut, and the University of Massachusetts in Lowell, Massachusetts

The Patient Protection and Affordable Care Act of 2010 (ACA, Public Law 111-148) elevates disease prevention to the level of a national priority and provides unprecedented opportunities for health promotion and disease prevention. The ACA established the National Prevention, Health Promotion, and Public Health Council, which has aligned more than a dozen federal agencies to develop a prevention and health promotion strategy for the country, and it created the Prevention and Public Health Fund (PPHF) to support a variety of public health initiatives, including evidence- and practice-based community and clinical prevention and wellness strategies. Furthermore, the ACA requires new health plans to cover recommended preventive services at no charge. In addition, it encourages the adoption of worksite health programs as a vehicle for improving the health of the employed population through programs such as the National Healthy Worksite Program, which is funded through the PPHF. The newly released final rules on incentives in employment-based wellness programs should further strengthen and increase the uptake of workplace interventions described within the act (http://www.hhs.gov/news/press/2013pres/05/20130529a.html).1