The objective of the project is to understand how best to help mid-size employers adopt evidence-based chronic disease prevention practices that improve employee health behaviors.

Employers have the incentive and the means to play a key role in chronic disease prevention. The incentive - employers need to control the costly and growing burden of chronic diseases among their employees. The means - employers purchase 94% of private health insurance, and employees spend one third of their lives in the workplace, where they often eat, move, socialize, and smoke. Over the past 5 years, the CDC and the Task Force on Community Preventive Services have recommended a number of chronic disease prevention practices. Among these, we have identified 17 practices that employers should adopt. These practices include health insurance benefits, workplace policies, and workplace programs, and aim at increasing employees' disease screening, healthy eating, influenza immunization, physical activity and tobacco cessation. Unfortunately, employer surveys reveal low adoption of these practices.

Working with the American Cancer Society, our research team from the University of Washington has developed and pilot-tested an innovative consulting intervention to increase adoption of these practices. Our two-stage intervention is comprehensive yet tailored by employer feedback.

The intervention:

• markets the "business case" that employers can help control health-care costs and productivity losses through adoption of these practices
• enables implementation by providing tools for each practice.

In this proposal, our primary aim is to test this intervention in a randomized, controlled trial among 48 medium-sized employers with a high proportion of socioeconomically disadvantaged employees in the Puget Sound area. Our primary outcome is change in employer practices as measured by survey and validated by audit and contract and policy review.

Our secondary aims include:

• development and pilot-testing of an employee-level health risk behavior survey
• cost analysis and assessment of feasibility of our intervention
• assessment of employees' preference for different message sources and message appeals.

Our multidisciplinary research team includes business, communication, and public health faculty and has more than 10 years of experience in both chronic disease prevention and working with business. If successful, our team's approach has broad applicability to other public health problems.

Inclusion Criteria:

• Corporate size equal to 100 to 999 part-time and full-time employees (excluding seasonal and temporary workers)
• Headquarters located in King County, Washington, and in a zip code within a 30 mile radius of the research center
• Within an industry with an average annual salary below the median annual salary for King County, Washington (defined by 3-digit NAICS code)
• 50% or more employees are age 35 or older

Exclusion Criteria:

• Do not offer health insurance to full-time employees
• In existence for less than 3 years
• No physical address to which employees report
• Current or previous participation in other workplace health promotion study
• Recent refuser or non-responder for other current workplace health promotion study
• Current participant in other American Cancer Society employer program
• Not willing to be randomized to intervention or comparison group