Workplace Health Promotion in Small Businesses: What is the Evidence and Is There a Role for State Health Agencies?
Bibliographic record
Abstract
Introduction: The Affordable Care Act (ACA) of 2010 established a $200 million grant program to help small businesses develop workplace health promotion programs. The ACA specified the Secretary of Health and Human Services (HHS) shall establish guidelines for programs based on best-practices and scientific evidence. Compared to large businesses, where workplace health promotion has been more widely implemented and studied, small businesses face unique barriers and enablers. It is important that HHS develops program guidelines using small business-specific evidence. Methods: To inform guideline development, a systematic review of the literature on workplace health promotion in small businesses and a scan of state health agency activities were conducted. PubMed, PsycInfo, EMBASE, CINAHL, Web of Science (ISI), and Google Scholar were searched for evaluations of worksite health promotion interventions in small businesses in the United States, Canada, Australia, and Europe between 1982 and 2012. Articles that met inclusion criteria were evaluated to determine the extent to which interventions included program components required by the ACA, and to assess the quality of the literature. State health agency websites for each US state and Washington, DC, were examined to determine the scope of their workplace health promotion activities. Results: Of the 45 articles reviewed, sixteen met the criteria for inclusion. The health risk behaviors targeted were: physical activity and healthy eating (N=7), stress reduction (N=2), health screenings and follow-up medical evaluation (N=1), healthy eating only (N=2), physical activity only (N=2), and comprehensive programs with three or more behaviors (N=2). The majority of interventions used program components established by the ACA. Most programs produced some short-term changes in health risk behaviors, although most changes were modest. The quality of the literature was judged to be moderate overall, with few articles rated as strong. There appeared to be interest or expertise in the majority of state health agencies regarding WHP; at least eight states had experience with workplace health promotion in small businesses. Conclusions and Recommendations: The scientific literature on workplace health promotion in small businesses is limited and of moderate quality. Additional high quality evidence is needed to develop effective programs in small businesses. The Secretary of HHS should call on states with expertise for input on program guidelines, and should consider establishing an additional grant program for state health departments to evaluate the grant-funded programs in their states.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.054 | 0.217 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.004 | 0.004 |
| Bibliometrics | 0.009 | 0.014 |
| Science and technology studies | 0.002 | 0.004 |
| Scholarly communication | 0.009 | 0.010 |
| Open science | 0.003 | 0.004 |
| Research integrity | 0.006 | 0.004 |
| Insufficient payload (model declined to judge) | 0.009 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".