Opportunities for Cancer Prevention Using Employee Wellness Programs: The Case of Kansas State Employee

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ABSTRACT

Background: The utility of employee wellness programs (EWPs) in cancer prevention and control is not well established. Purpose: This project is to determine the potential value of EWPs in preventing cancer by examining the characteristics of EWP participants and their prevalence of cancer risk factors. Methods: A secondary data analysis of health risk assessment (HRA) participants' data in the 2009 Kansas state EWE. Results: Among the 60,006 eligible participants, 9,202 (15.3%) completed an HRA. The prevalence of cancer risk factors were 59.7% for family cancer history, 7.7% for smoking, and 69.7% for overweight or obesity. Non-adherence rates in colorectal cancer screening, breast cancer screening, and cervical cancer screening were 28%, 12.2%, and 12.6%, respectively. Discussion: Overall, 94.4% of all HRA participants had at least one cancer risk factor. The majority of HRA participants were at risk for cancer, indicating the potential high impact of EWP-based cancer prevention programs. However, the low HRA participation rate and related self-selection bias of healthy workers severely undermines the utility of EWPs in cancer prevention. Translation to Health Education Practice: More health education and intervention programs should be implemented in employee communities to promote higher HRA participation rates to reduce this bias and realize the full potential impact of EWPs.

BACKGROUND

Employee wellness programs (EWPs), in this paper, are defined as organized, employer-sponsored health promotion and chronic diseases prevention programs in which annual free health risk assessments (HRA) are administered to voluntarily participating employees, and based on the results, personalized risk feedback as well as preventive care recommendations are provided to participants. Sometimes, EWPs also refer at-risk participants to prevention programs or services that address the identified risk factor(s). (1) In the past 40 years, employee wellness programs (EWPs) has become more common. In 2009, about 140 million adults in the U.S. were employed, (2) and it was estimated that nearly 90% of U.S. employers with more than 50 employees offer a health promotion program of some sort to their employees. 3 The major goals of EWPs are to: (1) improve employee health, productivity, and job satisfaction, and (2) reduce the expensive healthcare costs associated with chronic diseases. EWPs are offered to employees and their dependents as part of their health insurance plan benefits through their employers. (4)

Several studies have shown that EWPs are effective in preventing cardiovascular disease (CVD) among employees, (1,5-7) but their value in cancer prevention and control is less well-established. A recent review of worksite health promotion trials that aimed at cancer risk reduction showed a modest effect on smoking cessation, nutrition, and physical activity. However, participation rates in these trials were seldom reported and low follow-up rates may have led to biased results. (8)

In 2001, a non-profit organization led by a group of private corporation CEOs began an initiative to develop standards of an EWP-based cancer prevention program at worksites called CEO Cancer Gold Standard (www.cancergoldstandard.org). Organizations accredited by the Gold Standard must have established programs to target five key areas of health and wellness that prevent cancer in workplaces: tobacco use, diet and nutrition, physical activity, early detection of cancer, and access to quality cancer care. Although a modeling study concluded that EWP-based cancer prevention and control programs were cost-effective from employers' perspective, (9) no empirical studies have been conducted to examine the actual public health impact of these "Gold Standard" programs. As of November 21, 2011, only 111 employers in the U.S. are accredited with the "Gold Standard," and the effectiveness of these standards in cancer prevention and control still needs to be established. …

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