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Chronic diseases such as heart disease, cancer, and diabetes are the leading causes of death and disability in the U. S. Because the central mission of state and local health departments (HDs) is to protect, promote, and improve population health, these agencies are well-positioned to address risk behaviors for chronic disease. HD-employer partnerships could enhance worksite wellness programming, but few studies have explored this topic. Building upon previously published findings, the purpose of this qualitative study was to describe the context and environment for HDs’ delivery of worksite wellness programs, including interest, barriers, facilitators, and decision-making processes. We conducted 12 interviews with directors of state chronic disease programs, 21 interviews with local directors, and three focus groups with local staff. We performed a thematic analysis of the data. Key themes include the following: (1) worksite wellness programs delivered by HDs were diverse in topic and scope and delivered both internally (at the HD for their agency) and externally (for other employers); (2) decisions made about chronic disease prevention were largely driven by funding priorities, with federal, state, and local entities playing roles in the decision-making process; and (3) HDs expressed potential interest in worksite wellness program delivery, dependent upon staff capacity, available funding, and employer buy-in. Our results suggest that funding should be increased for and reallocated towards chronic disease prevention, including worksite wellness. To overcome HD barriers to program delivery, key funders and stakeholders should prioritize and communicate the importance of worksite wellness.

IntroductionEmployers often lack data about their workers’ health risk behaviors. We analyzed state-level prevalence data among workers for 4 common health risk behaviors: obesity, physical inactivity, smoking, and missed influenza vaccination (among workers older than 50 years).MethodsWe analyzed 2007 and 2008 Behavioral Risk Factor Surveillance System data, restricting the sample to employed respondents aged 18 to 64 years. We stratified health risk behavior prevalence by annual household income, educational attainment, health insurance status, and race/ethnicity.ResultsFor all 4 health risk behaviors, we found significant differences across states and significant disparities related to social determinants of health — income, education, and race/ethnicity. Among uninsured workers, prevalence of smoking was high and influenza vaccinations were lacking.ConclusionIn this national survey study, we found that workers’ health risk behaviors vary substantially by state and by workers’ socioeconomic status, insurance status, and race/ethnicity. Employers and workplace health promotion practitioners can use the prevalence tables presented in this article to inform their workplace health promotion programs.

BackgroundWe conducted a pilot test of American Cancer Society Workplace Solutions, an intervention that takes a marketing approach to increasing employers’ adoption of evidence-based practices to prevent and control chronic diseases among their employees.ContextWe delivered the intervention and assessed the changes in practices of 8 large employers in the Pacific Northwest.MethodsWorkplace Solutions recommends 15 employer practices in 5 categories: 1) health insurance benefits, 2) policies, 3) workplace programs, 4) health-promoting communication, and 5) tracking of employee health behaviors to measure progress. The intervention includes 4 meetings with employers over 2 months and begins with a questionnaire-based assessment of employer practices. Tailored recommendations follow, along with practice-specific implementation assistance on requested topics. We tested the intervention in a before–after study without a comparison group.ConsequencesThe employers ranged in size from 7500 to 115,522 employees and included private companies and public employers. Seven of the eight employers implemented more of the recommended practices at follow-up (an average of 13 months after the intervention) than at baseline. Overall, implementation of the practices increased from 38% at baseline to 61% at follow-up (P = .02).InterpretationWorkplace Solutions is a promising new approach to bringing evidence-based best practices for preventing chronic disease to large numbers of adults.