| The New Year is a time of self reflection, recouping from holiday eating, self improvement and visions of getting healthier. It is also a big kick-off time for a lot of worksite health promotion programs aiming to support employees in their pursuits of getting healthier.
For behavior changes — be it healthier eating, quitting smoking, exercising, or drinking more water—the old adage “Failing to plan is a plan to fail” is at least as applicable for health-related goals as it is for any other objective.
Research soon to be published in the American Journal of Health Behavior shows that higher stress and perception of poorer physical health are predictors of intending-to-change behaviors. Of course, stress and not feeling our best are sensible triggers for making changes. However, these feelings should send up big caution flags too, since stress and physical limitations can be major barriers to success. In other words, people are more likely to commence changing behaviors when they may be least likely to be successful. So, how can we be more successful in changing behaviors and then maintaining that change? First, awareness is key. The second key is to plan meticulously and strategically. Third, be understanding with yourself. If you have stress (who doesn’t?) and physical limitations (yes, they come with age and being human), then plan carefully and realistically. Rather than a full-blown eating and exercise overhaul, start by changing a few small things and then have a structured plan of adding more as you go. Put back-up strategies in place. For example, if the morning is too rushed to pack the perfect healthy lunch, grab some carrots to munch during the day to balance a “bought” lunch that might be less than ideal. If it has been a while since you've been active, start with some basic stretching and walking. Always remember to respect your body and work within your limits. Don’t let the stress of a busy life or physical limitations stop you. Use and appreciate them as triggers to get better. Just plan accordingly, have back-up strategies, start small, and add gradually.
So whether you are working toward your own goals or encouraging others within a worksite wellness program, be aware that the very things that motivate us also need to be accounted for in our plans and within wellness programs. If you would like more information on our current research in this area contact Mary Marzec at mmarzec@umich.edu Mary L. Marzec, PhD Candidate Health Management Research Center |
| In the fall, a yellow wave fills almost all parts of Ann Arbor. Colored leaves make it the yellow city, but it is also filled with the yellow t-shirts of Michigan football fans, especially on the weekend. When I first came to Ann Arbor from Korea in 2009, there were two things that surprised me. One was the Big House full of yellow Michigan fans. The other was a lot of men cooking meat on the grill. They gathered around the meat at their tailgate parties in reverence and anticipation. Cooking meat before the game may not seem unusual to Americans, but it made a strong impression on me about the eating habits of the American male. To me, it seemed that most American men are carnivores at heart.
Recent research in the Foodborne Disease Active Surveillance Network has found that women are much more likely to eat vegetables and fruits than men. The findings found women opted for vegetables, especially carrots, tomatoes, and fruits more than men, while men seemed to enjoy a hint of danger in their diet. For example, a greater proportion of men than women reported consuming several high-risk foods. Men were more likely to consume pink (or undercooked) hamburger, raw oysters, and runny eggs. Also, less men than women reported consumption of organic produce. The study posited that the knowledge difference on diet and nutrition between men and women would lead to their different eating behavior.
Another study (published in the journal Appetite) assessed the extent to which differences in fruit and vegetable intake (FVI) are attributable to gender differences according to constructs from the Theory of Planned Behavior (TPB)[1]. The study gathered data from more than 3,000 people in the National Cancer Institute’s Food Attitudes and Behavior survey. In the results, American men reported less favorable attitudes than American women about the value of eating fruits and vegetables. The reason was that men do not believe as strongly as women that FVI is a significant part of maintaining health and a better appearance. The study also showed that men feel less confident in their ability to eat fruits and vegetables when at work, when tired, when watching television, and when junk foods are available. The study author suggests that promoting favorable attitudes and perceived behavioral control over FVI would be helpful to improve the diets of American men.
Of course, the studies cannot explain all American men’s eating behavior and their attitudes toward vegetables and fruits. However, if you, your husband or your adult children have a disdain for fruits and vegetables, we can try to understand the ideas behind their perceptions and why they behave the way they do. Let’s get this message out: Real Men Eat Fruits and Vegetables!
Youngbum Kwon, PhD Candidate
Health Management Research Center
University of Michigan
[1] The Theory of Planned Behavior (TPB): A theory about the link between beliefs and behavior. The TPB has been applied to healthy eating (e.g., high fiber diet, low fat diet, FVI) with some predictive success. The TPB model suggests that intention is directly driven by three major constructs attitude, subjective norm, and perceived behavioral control and the stronger the intention, the more likely an individual will perform the behavior (Ajzen, 1988).
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| Typically health promotion practitioners are recommending “clean living” to everyone they meet. A healthy diet, plenty of exercise, manage your stress, and don’t smoke are their mantras. It appears we have a new behavior to add to the list... getting dirty. Exposure to a certain bacteria that occurs naturally in soil (Mycobacterium vaccae) is about more than just improving your immune system, however. You may be aware of the hypotheses about our ultra-clean interior environments and the association with allergies, asthma, eczema, and other immune-related conditions. But there’s more to M vaccae than meets the eye.
Recent research has found that exposure to this particular bacteria stimulates the release of serotonin and norepinephrine in the brain by inducing the birth of neurons that produce those two important compounds. Serotonin and norepinephrine are neurotransmitters greatly associated with mood. Mice that were injected with M vaccae showed increased levels of serotonin and decreased anxiety -- tested by placing the mice in a miniature swimming pool. The mice who received the M vaccae injection enjoyed their time swimming around. A second study fed the bacteria to mice (smeared on a sandwich!) and those mice ran through a difficult maze. The M vaccae mice navigated the maze twice as fast with half the anxiety behaviors compared to mice that did not ingest the bacteria.
Of course animal studies cannot always be replicated in humans. I don’t know of any M vaccae sandwiches in my cafeteria, anyways. But a review paper summarized the results of ten studies comparing indoor exercise with outdoor exercise and found that, regardless of the type of exercise, performing it outside rather than inside resulted in significant improvements in feelings of anger, depression and tension. This particular study was not investigating M vaccae (or any other bacteria), but it does provide support for the benefits of being outdoors.
As health promotion seeks to encourage not just the absence of disease, but a fulfilled and happy clientele, perhaps we can add a few more recommendations to our list of healthy habits:
Spend time outside every day. Work in your garden – either vegetables or flowers will do, but those home-grown veggies have additional health benefits. Get some “green exercise” – choose to exercise outside rather than in the gym. Encourage your workplace and community to expand and preserve the outdoor spaces available for people to use recreationally.
Now get out there and get dirty!
Alyssa B. Schultz, PhD
Data Analyst
Health Management Research Center
University of Michigan |
| Danger in the workplace: when you hear those words, what images immediately come to mind?
If you’re like many people, you think of jobs that are intrinsically hazardous or unsafe. According to the Bureau of Labor, the occupations with the highest fatality rates per 100,000 workers are fishermen, loggers, airplane pilots, farmers/ranchers, and miners. Anyone who’s watched Deadliest Catch or Axe Men knows that there are risky, physically demanding jobs out there, where a bad day at the office can actually mean serious injury or death (and not just a boring meeting or a paper cut). Fortunately, these jobs are much safer today than they once were; 2010 was the safest year ever, in terms of on-the-job fatalities, and levels appear to have remained flat since then.
Then there’s workplace violence. For those of us old enough to remember the wave of postal shootings in the eighties and nineties, “workplace violence” implies a disgruntled coworker with a gun and a grudge. Although it may seem like today there are many such examples of employees “going postal,” the reality is actually different: the number of homicides in the workplace has dropped dramatically since 1993. Nonfatal violence in the workplace is also down by 35% from 1993, according to the U.S. Department of Justice. Other sources of danger in the workplace have also diminished. Chemical exposures? Unsafe machinery? Fires and explosions and accidents? State and federal regulations as well as corporate policies have helped reduce, even eradicate, many such workplace hazards. Today’s working environments are generally safer and healthier than ever before. So, are there still dangers in the modern workplace? Sure there are. They may not be as spectacular as mining disasters, but risks such as avoidable accidental injury and job stress persist, despite programs designed to eliminate them. In addition, overuse injuries caused by repetitive movements (such as carpal tunnel syndrome) occur in any work environment and may result in chronic pain and disability. Recently, another workplace culprit – prolonged inactivity – has been shown to affect long-term health and mortality. The dangers of sitting may not be as sensational as the dangers of firefighting, but in this era of increasing obesity and higher rates of diabetes, the real-life consequences associated with inactivity may be serious.
Although workplaces are safer than ever before, there are still risks associated with many jobs. At the HMRC, we are interested in the culture of health at the worksite – a culture that embraces health, supports safety, and champions wellness. In fact, we encourage employers to build on the “culture of safety” so prevalent in many industrial and manufacturing workplaces and expand that outlook to the culture of health. There will always be dangers, at work and at home, but an enlightened, supportive culture helps minimize risk and promotes healthy behavior.
Susan Hagen M.S
Data Analyst
Health Management Research Center
University of Michigan |
| Recently, I attended the 17th Annual International Meeting of the International Society for Pharmacoeconomics and Outcome Research (ISPOR) in Washington, DC. The overall theme of the meeting was “improving health care efficiency,” so there were workshops and presentations on such topics as health care decision making, comparative effectiveness research, and improvements in statistical strategies/medical research - lots of very smart people discussing very complicated subjects.
The HMRC presented several posters at ISPOR, all dealing with the relationship between adherence to medications and costs to an employer. In collaboration with Ron Finch and the National Business Group on Health, three researchers at the HMRC (Doug Wright, Susan Hagen, and Dee Edington) looked at the associations between patient adherence to drug treatments for chronic diseases (diabetes, cardiovascular disease, and depression) and their healthcare and disability costs, which were paid by their employer. In other words, we wanted to know: are people who take their medications as prescribed less expensive, healthcare-cost-wise, than those who do not take their medications as they should?
The answer is important for many reasons. Most studies have shown that people who take their medications as prescribed have better clinical outcomes and fewer serious complications than people who don’t. Therefore, compliance with a drug therapy usually means better health for the patient. Furthermore, studies have also shown that, in general, those individuals who take their medications as prescribed also have lower medical costs than those who don’t AND may have lower disability costs as well. Obviously, this is particularly important to employers, since in the U.S. employers often pay the healthcare and disability costs of their employees. It’s no secret that rising healthcare costs are a serious problem for most businesses in this country, so any information on possible solutions or interventions to control costs is valuable.
The results of our study showed that for all conditions studied, the short-term disability costs for those who were adherent to their medications were significantly lower than the disability costs for the non-adherent. Employers who are looking at ways to curb rising disability costs for their employees might consider ways to improve prescription drug compliance in their workers with chronic diseases.
Finally, why is this kind of research important to the HMRC? Why are we focusing here on sick people - after all, aren’t we the people who believe in “keeping the healthy people healthy”? While that is true, we are also the people who believe in partnering with businesses and organizations concerned about the health of their workforces to seek out new solutions. And fundamentally, we also believe that anyone can be healthy, even those with serious chronic disease. Good health is an attainable goal for everyone, not just the young fitness enthusiasts out there. It’s even more important that those people with diabetes or cardiovascular disease eat well, exercise regularly, and reduce stress – and oh, by the way, keep taking those medications as prescribed!
Susan Hagen M.S
Data Analyst
Health Management Research Center
University of Michigan
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| “It ain't what you don't know that gets you into trouble. It's what you know for sure that just ain't so.” Mark Twain
To most people, the rationale behind preventive care and routine screenings makes perfect sense. Early testing is designed to find disease before signs of that disease actually appear. After all, if I have cancer, doesn’t it make sense to find it and get rid of it as quickly as possible? We’ve all heard those stories about Aunt Susie, who was saved by her annual mammogram, and Uncle Bert, who owes his life to routine PSA testing. What kind of fool would disagree with the wisdom of prevention?
Enter the US Preventive Services Task Force (the USPSTF), an independent, non-partisan panel of experts in prevention and evidence-based medicine. The USPSTF regularly reviews the science behind preventive health care services and develops recommendations. Recently, those recommendations have made headlines: no more annual PSA tests for men and less frequent pap smears for most women. While both of these recommendations were controversial, nothing compares to the public reaction to the USPSTF decision on mammography. According to the panel, most women under the age of 50 should not receive routine screening mammograms and those between the ages of 50 and 74 should be screened every 2 years.
Predictably, the uproar from women’s health groups, cancer societies, and the media was loud and immediate. There were grim accusations of health care rationing, and advocacy groups insinuated that dark forces were conspiring to harm innocent Americans. Lost in the commotion was the real reason behind the USPSTF decisions – that is, a careful review of scientific studies and medical research showed that while these screening procedures are beneficial to some, they also have very serious limitations and very real risks. Although doctors and patients believed for years that these screenings saved lives (even when there was no clear evidence to support such belief), now many experts believe that the risks outweigh the benefits of some routine screenings.
So, in the debate over these preventive cancer screenings, we have science on one side and perception on the other. Unfortunately, if you tell people they’re wrong about something that they seriously, passionately believe to be true, they will usually ignore the science and go with their feelings. Dr. Otis Brawley, director of the American Cancer Society, spoke to this struggle between science and emotion in his commentary, “More than anything, the battle over prostate cancer screening raises a disturbing question: Are we as a society prepared to pay attention to scientific evidence?” So far, the answer seems to be a qualified maybe.
At the HMRC, we believe in prevention; however, we also believe in science. A patient should consult his or her own doctor in decisions about cancer screenings but should also keep an open mind about risks and benefits. Who knows where science may lead us in the years to come?
Susan Hagen, MS
Data Analyst
Health Management Research Center
University of Michigan
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| It turns out that about 40% of the daily activities we do are habits—something we do every day in a certain way. Though we are comfortable with our habits they can be changed. In the world of health management it is the mission of wellness program managers to establish good health behavior within their population. Employees are tempted with company swag, cajoled by health-based social networks, and trapped by upcharges to health care co-pays, but what is really happening here? We are trying to get people to change their habits, to become less sedentary, to visit the doctor and dentist for preventive rather than illness care, to eat less, to eat healthier, to quit smoking, to be mindful of their bodies and the way they are using them. We are looking for the magic bullet of motivation to help people become self-affirming, but perhaps we haven’t had the right focus.
The book, The Power of Habit: Why We Do What We Do in Life and in Business by Charles Duhigg, is about habits and how to change them. The secret to getting someone to buy a product over and over again requires that they develop a habit of using that product. For example, 90 years ago, Pepsodent sold toothpaste by creating a habit of teeth brushing. Behavior change specialists discovered that, in order to establish a new daily routine, a person typically follows three steps:
- Find the cue, and for toothpaste use, the cue is “film on the teeth”.
- Make a routine, such as “brush every day to get rid of the film”.
- Experience a reward. For tooth brushing, the reward is “tingling”. If the reward is a good one, people will crave the reward which makes the habit occur automatically.
Find the cue, establish a routine, and experience a reward to crave.
For the Wellness Manager, how do you create that cycle in a group of people, such as at a corporation? It can be very difficult to see a daily cue that tells one to establish a healthier version of an unhealthy habit and relish the reward of feeling better. If the ‘cues’ that are being sent to employees in the first place won’t trigger the healthy behavior in the end, then perhaps it is time to re-think the strategy. When employees enter the cafeteria do they see fresh veggies or smell French fries in the deep fryer? Are they around co-workers who break for smoking or exercise? Is the routine of work filled with stress or people who are enthusiastic about their jobs and complementary to each other? What reward do people see when they live healthier?
The UM-HMRC recently launched a Culture of Health survey which will help companies determine what their environment and culture have to offer employees to support a healthful lifestyle at work. This survey will help identify gaps between the way the work place should be and the way it is. Resolving these gaps will help to create healthy behaviors within the workplace and turn spotty participation into healthy routines, leading to lifestyle change and self-fulfillment, every Wellness program manager’s dream.
Catherine Fillmore
Project Manager
Health Management Research Center |
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Everyone knows the classic stereotype about the nagging girlfriend, or wife, or mother (why are they all women??). But the truth is, we’ve all experienced nagging from one person or another and we’ve all nagged someone else about something or other (whether we’d like to admit it or not). Despite the fact that no one enjoys being nagged, we continue to think it’s effective at changing behavior or influencing others.
I’m afraid the health promotion industry has become the big nagger in people’s lives today. You’ve probably seen it, too. People see the wellness coordinator walking down the hall and they quickly turn around or duck into the nearest cubicle to avoid a lecture on exercise or diet. Or, you tune out when your doctor is telling you, for the fifth year in a row, that you are overweight and you need to quit smoking. Or, you receive your annual health risk appraisal report and you don’t bother reading it. But what are we to do? People continue to lead sedentary lives and gain weight. We can’t just ignore it! It’s our job to try and do something about it.
Webster’s dictionary defines nagging as “fault-finding; teasing; persistently annoying; as a nagging toothache.” What I see in that definition is a whole lot of negativity. So, the solution to nagging that I propose is to focus on the positive. A common management and parenting tool is to praise, correct, praise or PCP. If we first provide realistic praise for things people are doing well, they are naturally more open and accepting of the comments we have for needed improvements.
Dee Edington’s Zero Trends book gives specific guidance on this principle. The third pillar of his framework is “self-leadership”. The road to creating self-leaders is paved by creating winners through 1) helping employees not get worse; 2) helping healthy people stay healthy; and 3) providing improvement and maintenance strategies. The fourth fundamental pillar is “reward behavior”. The goal of this pillar is reinforcing the culture of health through 1) rewarding champions; 2) setting incentives for healthy choices; and 3) reinforcing at every touch point.
By implementing those strategies in addition to the other pillars (senior leadership creates the vision, operations leadership aligns the workplace with the vision, and quality assurance that allows outcomes to drive the strategy) it seems that the nagging, negative messages of traditional health promotion programs can be transformed into positive, encouraging messages. Can we all agree to stop nagging the people we are serving? Let’s seek to first reward the positive actions, since we can find at least one nice thing to say about everyone. Then, we can agree to “not get worse”. Finally, we can set goals for improvement in a realistic, achievable and measureable way. This doesn’t mean we should forget about the ultimate goal or lower our standards or expectations. But thirty years of experience in health promotion shows us that intermediate goals can be helpful for long-term success.
Now get busy! Just kidding; that sounded like nagging.
Alyssa B. Schultz, PhD
Data Analyst
Health Management Research Center
University of Michigan |
| As we enter this New Year, research in the field of health promotion and occupational health and wellness is faced with many challenges in finding an optimal way to address individual as well as population health. I think one of the basic reasons that this has become a great challenge is because of the way health is approached, both at the individual level as well as at the population level. Both the individual and the population react only after sickness and/or an epidemic has occurred. The next step in such a process is to undergo some kind of treatment using allopathic medicine (i.e. diagnosis-treatment-medication), which probably seeds another round of sickness/epidemic in the future due to side effects from allopathic approach. My point is this: we are somehow trained to react to sickness by searching for hospitals and doctors to fix it, just like we take our car to a mechanic to fix it when it’s making a funny noise. As long as such as reactive attitude toward health exists, it is not surprising to see the demand for medical professionals as well as see more “mechanic shops” in your neighborhood. If you will, we are relentlessly working and focusing much of our attention and energy towards forming and reforming healthcare and building new “mechanic shops” that address sickness and indirectly promote being reactive and irresponsible. While I acknowledge the advancements in the field of allopathic medicine, medicine should be viewed as a necessary contingency plan, just as in the field of safety and its relationship with emergency preparedness.
A part of such a responsible approach is to first understand that a reactive approach towards health is an irresponsible strategy, be it at an individual or at a population level; and begin to think about embracing a celebrative approach towards good health. An example of a celebrative approach is to think about increasing calmness as opposed to reducing agitation, increasing relaxation as opposed to reducing stress, increasing energy as opposed to reducing energy drain, and increasing resilience as opposed to reducing rigidity.
I hope you would have figured out the meaning of a celebrative approach by now –it is about embracing your positive health factors and celebrating them.
I wish you all a healthy year ahead.
Sudhakar Sathayanarayanan, PhD
Data Analyst
University of Michigan
Health Management Research Center |
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The University of Michigan - Health Management Research Center invites you to attend the 31st Annual Wellness in the Workplace Conference, "The Future of Worksite Wellness in the 21st Century", on March 14th and 15th, 2012 in Ann Arbor, MI. Registration is open now and discounts are avai lable to all who register before January 31st, 2012 by visiting the Conferences at UM-HMRC webpage or calling (734) 764-8179.
We are also pleased to announce that the 2012 Edington Next Practice
Awards will be presented at the Conference. The awards are co-sponsored by Edington Associates, CBIZ and the UM - Health Management Research Center, and recognize organizations that are actively engaged in the pursuit of a healthy, high-performing workplace and workforce. To find out more information or to apply, please visit the CBIZ Wellness Solutions page.
Due to the overwhelming success of last conference's "Conversation with Dee Edington and Friends", we will again be featuring the two-hour evening Q&A session with Dee Edington, the founder of the UM - Health Management Research Center, following the first day of the conference. This session is open for all attendees and promises to be an engaging discussion.
Conference attendees will be able to:
Discover 21st century tools to assess your company. Learn ways to calculate your financial concerns. Get a sneak preview of our new Healthy Life Assessment. Discuss community activation for a healthy city. Find ways to evaluate your company's environment and culture. Network with over 200 workplace professionals. Attend a Special Session for all registered attendees the evening of March 14: A two-hour open conversation with Dee Edington and Friends.
This year's speakers will include:
Steven Aldana, PhD - CEO, WellSteps Susan Bailey, MS, CHES, IC® - Manager, Wellness & Health Promotion, DTE Energy Jack Bastable - National Practice Leader, Employee Health & Productivity, CBIZ Benefits & Insurance Services, Inc. Joel Bender, PhD, MD, FACOEM - Global Medical Director, U.S. Preventive Medicine, Inc. Wayne Burton, MD - Global Corporate Medical Director, American Express Company Ed Casper - Group Health & Safety Leader, Bendix Commercial Vehicle Systems LLC L. Casey Chosewood, MD - Senior Medical Officer for Total Worker Health, NIOSH at CDC Lee Dukes - President, Principal Wellness Company Tom Gilliam, PhD - President, Move It. Lose It. Live Healthy, LLC and Industrial Physical Capability Services, Inc. Melanie King - National Wellness Manager, American Express Company Rick Maursetter - Duininck Companies (American Construction Benefits Group) Randy G. Millard - Vice President, Human Resources, ME Global, Inc. Nicoletta Morin, CEBS, MBA - Product Director, Wellness and Health Coaching, CIGNA Shirley Musich, PhD - Senior Research Director, Advanced Analytics Group, OptumInsight UnitedHealth Group Ron Ozminkowski, PhD - Vice President, Research and Development, Advanced Analytics Group, OptumInsight UnitedHealth Group Michael Parkinson, MD, MPH, FACPM - Senior Medical Director, Health & Productivity, UPMC Health Plan and WorkPartners Neal Sofian - Director, Member Engagement, Premera Blue Cross Elliot Sternberg, MD - Executive Vice President, Wellness & Health Improvement, St. Joseph Health System
The conference will be held at the newly-renovated Sheraton Ann Arbor (formerly FOUR POINTS by Sheraton). For more information on the hotel or to book your rooms, please visit http://www.sheratonannarbor.com/ or call (734) 996-0600. Please continue to check back with us on Facebook and our website, http://www.hmrc.umich.edu/, for the latest on this year's speakers and presentations. |
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