Health crimes and punishments: Employers -- and employees -- can decide

Turns out, those employer wellness programs are not the benignly helpful initiatives that some Americans might have perceived them to be. Sure, they encourage workers to act in their own best health interests, but they're now also having an impact on those who don't. Ultimately, they could ... well, who knows.

And that's the point of today's Los Angeles Times story on healthcare overhaul. It begins:

"Who could object to rewarding people who quit smoking, lose weight or start to exercise? The American Cancer Society and the American Heart Assn., for starters.

"Some companies are charging lower insurance premiums to workers who meet benchmarks for healthy living. The Senate's healthcare overhaul legislation would expand the trend.

"But instead of cheering the proposal, some patient advocacy and health groups are worried that it could mean higher rates for less-fit Americans, possibly pricing them out of their employers' insurance plans."

That story: Insurance discounts for healthy habits spur debate in Washington

But it's open enrollment time, and the debate is more than theoretical. It's personal and now faced by millions of Americans of varying states of health. Another recent L.A. Times story notes that some companies won't let workers sign up for health insurance until they sign up for risk assessments that were once optional. It says:

"If the assessment discovers manageable problems, you may be encouraged to join a fitness or smoking cessation program. Do that and you're likely to get bigger financial incentives -- somewhere in the neighborhood of $100 to $500 annually.

"But if you don't, your employer might restrict your health insurance choices to plans that demand higher deductibles and offer fewer services and benefits, which could cost you hundreds of dollars."

That story: This open enrollment period, expect rewards and penalties

Don't like the approach? You could take a stand. And pay for it, of course.

Not wild about helping to pay, in a roundabout way, for your smoking colleague's medical costs? Here's your chance to get just a little bit even and benefit from your own, perhaps wiser, choices.

Either way, the trend's increasing prominence suggests each of us should ask what such "incentives" might ultimately entail -- for good or ill.

Here's a recent Washington Post look at the issue. And an NPR story on Safeway's incentive programs.

-- Tami Dennis

Photo: Stop smoking -- or you might face limited healthcare choices.

Credit: John MacDougall / AFP / Getty Images

Meth use among L.A. workforce twice the national average

Drug use by employees continues to be a major problem for employers. But new statistics show the picture is changing in Los Angeles.

Data from Quest Diagnostics show that cocaine use has decreased in recent years while amphetamine use is up. In particular, the rate of positive workplace drug tests for methamphetamine in Los Angeles is more than twice the national average: 23 positive tests per 10,000 people versus 11 per 10,000 nationwide.

Positive tests for cocaine were found in 27 per 10,000 workers in Los Angeles compared with 39 per 10,000 workers nationwide. Overall, screening shows a decline in positive drug tests in Los Angeles from 320 per 10,000 workers in 2006 to 269 per 10,000 last year. Nationwide, 380 per 10,000 workers tested positive for drug in 2006 compared with 360 per 10,000 last year.

The data are from the annual Quest Diagnostics Drug Testing Index, based on 5.7 million urine drug tests performed by the company.

-- Shari Roan

Photo: A pipe used to smoke crystal meth. Credit: Ann Heisenfelt / AP
 

You can retire from the job, but not necessarily its effects

It matters whether someone spends his or her working years as a manager or a person to be managed. And it matters long after the job becomes a description tacked onto the word "retired."

UC Davis researchers assessed the connection. From the news release:

"Retirement-aged Americans who held higher-status jobs — such as chief executives, financial managers and management analysts — tend to have the lowest rates of hypertension, while those who had lower-status jobs tend to have the highest rates."

We suspected as much. 

Here's the abstract from the study, published in the June issue of Journal of Occupational and Environmental Medicine.

-- Tami Dennis

Photo: If you're worried about your blood pressure, a promotion or two might be the way to go. Credit: Los Angeles Times

Barring smokers from employment isn't right, researchers say

Smoking bans in public buildings, workplaces, even at some outdoor venues are now commonplace. And becoming more common is the practice of barring smokers from employment. But this approach is unfair and may have unintended consequences that do more harm than good, say researchers in an essay published today in the journal Tobacco Control.

Policies prohibiting the hiring of smokers have become much more popular in the past year, a co-author of the report, Dr. Michael Siegel, said today in an interview. One U.S. company, for example, has stopped hiring smokers, has made smoking outside the workplace a fireable offense and even has extended its smoking ban to employees' spouses. Siegel, a professor at Boston University School of Public Health, is a tobacco-control advocate. But he and co-author Brian Houle, of the University of Washington, fear the widespread adoption of such policies may make smokers nearly unemployable, cause them to lose their health insurance and affect their health and that of their families.

Moreover, they say, refusing to hire smokers is discriminatory and may lead to the adoption of other selective employment practices, such as not hiring people who are overweight or who have high cholesterol.

"People have thought about the positive benefits of these programs," says Siegel, such as the fact that they may reduce absenteeism and increase productivity. "But we don't think people have thought through the negative consequences. We're looking at this from a broader public-health perspective."

Tobacco-control advocates are divided over the merits of barring smokers from the workplace. Some fear that speaking out against the employment bans will get them branded as "traitors to the cause," Siegel said.

"Smoking is a very powerful addiction," he said. "Tobacco-control practitioners have naturally become very frustrated that it's so difficult to get people to quit. The problem is that we can't let that frustration cloud our vision about what is appropriate and what is not appropriate. This represents employment discrimination. And I believe, from a public-health perspective, we need to shun that."

Employers typically favor positive approaches to encourage healthy employee behavior, such as free smoking-cessation classes. But Siegel predicts that workplace bans will become more popular as employers look for every approach to cut healthcare costs. About half of all states have laws that protect employees from being fired or not hired because they smoke. But other states have no such protections.

-- Shari Roan

Photo credit: Karen Bleier/AFP/Getty Images

More academic wisdom on the workplace

On Tuesday we wrote about a study that found that employees who worked for bad bosses were more likely to suffer from angina and heart attacks than those who worked for good bosses. Not good news!

Some other workplace psychology tidbits:

From the University of Alberta, as per a university news release: "Secret to workplace happiness? Remember what you love about the job." The study, published in the Journal of Gerontological Nursing, tested a "Spirit at Work" program aimed at fostering morale and sense of purpose in a healthcare setting. "Urging employees to simply rethink their jobs was enough to drop absenteeism by 60% and turnover by 75%," the news release states.

"Employees will feel -- and act -- engaged when their employer creates conditions that permit them to do so," states another release, this one from the journal Industrial and Organizational Psychology. No kidding! It's a thumb-sucker enough of a subject to warrant, in addition to the paper, "a set of 13 commentaries taking differing positions on the issue."

One more workplace finding -- from the Psychology of Women Quarterly -- reports (again from a release) that "employees who are sexually harassed experience less job satisfaction and lower job performance." Who would have imagined that?

All of these items may have a -- may we say obvious? -- flavor to them -- until you stop to consider how many organizations appear to ignore the obvious. In any case, they're more thoughtful than that: The harassment paper quantifies the effect of harassment, for example -- that's what you have to do sometimes to get people to act -- and the "Spirit" one actually tests a program. (Just because something looks good on paper doesn't mean it will work.)

And the creating-engagement-at-work paper discusses the precise factors that contribute to a feeling of engagement. Engagement is not the same as satisfaction, the researchers note. Certainly that makes sense to me. There have been days when I would be quite satisfied to sit around making pigs out of pushpins and pink erasers and checking L.A. Observed every hour or so.

But -- uh -- they were rare, of course. Aberrations, really. And very long ago.

-- Rosie Mestel

Bad boss? Your heart may feel the heat

Anyone who's been in the job market long enough has sooner or later worked for a bad boss -- the kind, perhaps, who makes you start awake at 3 in the morning to fret about the day ahead or the horrible day that just happened.

A new study suggests such bosses may increase the risk of a heart attack among employees, a finding that fits with other research on the effect of stress and powerlessness on physical health. (See, for example, the famous Whitehall II study.)

The latest study, published online today in the journal Occupational and Environmental Medicine, tracked 3,122 working Swedish men ages 19 and 70 at the study's start. Their health was checked between 1992 and 1995 and their heart health outcomes tracked all the way up to 2003. At the start of the study the men were also asked to rate their managers' leaderships skills for such issues as -- per the paper -- "consideration for individual employees, provision of clarity in goals and role expectations, supplying information and feedback, ability to carry out changes at work successfully, and promotion of employee participation and control."

During the period of time that was monitored, there had been 74 cases of ischemic heart disease (problems caused by narrow heart arteries, such as angina and heart attacks). Higher leadership scores were associated with a lower heart disease risk -- and the longer an employee worked at the same job with a good manager the lower his risk became. And vice versa.

The researchers do note the possibility that the heart outcomes may have more to do with the personality of the people doing the rating -- after all, the bad-boss-good-boss perceptions were made by the employees themselves.

But, they write in their paper, "if the association is causal, this study suggests that interventions aimed at improving the psychosocial work environment and preventing ischaemic heart disease among employees could focus on concrete managerial behaviors, such as the provision of clear work objectives, information and sufficient control in relation to responsibilities."

Of course, one can think of other good reasons management might want to improve workforce leadership skills -- such as making a workplace more pleasant (even if people aren't going to have heart attacks) and enhancing team performance. 

-- Rosie Mestel