Employers are charged with assisting employees in retirement planning, and now they are recognizing the need to educate employees regarding those lifestyle factors which are most likely to assure their reaching their retirement years in good health.
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There is increasing evidence that health promotion and wellness programs have proven successful for many companies and employees. Most chronic diseases are associated with lifestyle practices. Among these are heart disease, cancer, and other chronic debilitating diseases such as arthritis and diabetes. Contemporary lifestyle may be an associated factor in the development and progression of these diseases.
Education regarding prevention and management of these diseases may reduce loss of life, improve quality of life, and better utilize financial resources. Additionally, screening programs for early detection and assessment of risk factors for these diseases may prove a valuable component of the educational program. Early detection reduces absenteeism, often reduces cost of treatment, and improves the prognosis.
Early in the development of a comprehensive wellness program it is necessary for a company to assess its needs. Such an assessment can be accomplished by evaluating accident and Workers Compensation records and illness reports as well as medical records, particularly those associated with insurance records for medical conditions. The needs of employees can be evaluated through questionnaires, risk assessments, and medical screening programs.
After a company recognizes the need for a health promotion program, an administrator or director is essential. Resources which could be used by the program must be identified. Financial commitment to the program should be evaluated and a budget determined. Many companies are probably already doing more than they may realize. For example, some employers provide worksite screening programs for vision and hearing, or perhaps they are actually engaged in some form of education regarding health-related topics such as blood pressure control or smoking cessation.
Creating awareness is a vital part of developing a worksite health promotion program. The program must be visible if it is to be successful. Involvement of employees is necessary for a successful program.
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Employee risk assessment is also beneficial to program development. This can be accomplished through monitoring cholesterol levels, blood pressure, and weight, and by providing employees with health risk appraisals or assessments so that they can evaluate their own personal health based upon family history and current health practices.
Increasing employee knowledge is essential to bring about lifestyle changes. Lectures, programs, printed information, and other activities can increase employees' awareness of positive health practices and critical issues such as recognition of symptoms which should be reported to a physician.
It is also beneficial for any wellness program to have follow-up and evaluation of effectiveness in order to assure that it meets the needs of both the employer and the employees. Lifestyle changes are a process, and sustaining positive lifestyle changes is often more difficult than making the changes in the first place.
Individuals require support and assistance following acquisition of knowledge in order to make and sustain positive lifestyle behavioral choices. Wellness or health promotion programs are often strengthened by activities. The size of the employee population, socio-economic background, age, education, and gender are useful factors to be evaluated when developing program activities. Some popular activities used in wellness programs include awareness and information programs, behavioral change projects, and screening programs.
Stress reduction activities may include provision of relaxation tapes or a relaxation room, support groups, stress management and relaxation training, flex-time, psychological counseling, reduction of environmental stressors, training in time management, exercise activities, and assertiveness training courses or courses for dealing with difficult persons or situations. Of course, there are no clear boundaries between situations in which the government attempts to compel citizen action and situations in which it relies on voluntary action. When recommendations for voluntary hurricane evacuation are ignored, for example, residents may be ordered to leave their homes.
Similarly, states can set standards for indoor radon levels and require home builders, home sellers, or even homeowners to prove that the standards are met. But at least with respect to existing housing not involved in real-estate transactions, the states have so far chosen to rely on voluntary action, putting themselves in the role of communicator rather than regulator.
Environmental agencies have much less experience with the former role and may be less adept at playing it. Government communicators see themselves as responsible for providing people at risk with the information they need to cope effectively with the problem. But is information alone sufficient? If people use the information to arrive at accurate assessments of their risk, to make appropriate decisions about the need for remedial action, and, when necessary, to choose suitable remedial measures, an information-only strategy is enough. However, this strategy may fail for a variety of reasons.
People may not seek out or attend to information; they may misunderstand the information; or they may prove unable to use the information to arrive at a decision.
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Furthermore, if the course of action they select is at all complex, they may need additional assistance in carrying out their plans. When information programs are unsuccessful, communicators may have to be more aggressive in distributing information, may need to examine the comprehensibility of the materials provided, and may have to refocus communication efforts on issues people seem to misunderstand such as who is and who is not at risk.
Nevertheless, experience with a wide range of hazards has shown that even well-designed information and education programs are seldom adequate to bring about appropriate protective behavior Weinstein Communicators who wish to promote self-protective action may have to consider approaches that are not primarily informational and use the power of interpersonal influence, incentives, vivid hazard images, repeated reminders, and the like.
They may have to develop messages offering explicit recommendations or warnings to convince those who are at risk that they should act, and they may need parallel messages to reassure those whose risks are minimal. In the remainder of this article, we assess the efficacy of an information program in promoting appropriate individual responses to a specific hazard — geological radon.
We focus on a target audience of special interest: citizens who have voluntarily monitored their homes for radon and have found nontrivial levels, and who now face the decision of what if anything to do to reduce the problem. The data presented concern the accuracy of judgments such people make about the radon in their homes, and provide insight into the problems they encounter in their decision-making efforts. Finally, we raise the question of whether the needs of individuals exposed to the threat of radon were met by the information strategy employed. Geological radon is a radioactive gas produced by the decay of naturally occurring uranium.
This gas seeps into the basements of houses built over uranium-bearing soil or rock and becomes trapped. Since about two million people in this country die each year, these figures suggest that between one in and one in deaths are caused by radon. Since , when radon was first recognized as a serious home pollution problem in the United States, government agencies have been faced with the task of ensuring that residents have the information they need to cope with this hazard.
It is tempting to suppose that the only real communication task is to encourage people to test their homes to find out if they are at risk. Since a good deal is known about radon risks more than is known about most environmental carcinogens , one might expect that once individuals have monitored, their decisions should follow logically from their test results. Individuals with negligible radon concentrations, for example, should not waste time and money trying to achieve still lower levels.
Those with higher levels should weigh their risk against the cost and feasibility of mitigation in deciding whether to take action. It is true that encouraging citizens to monitor their homes is itself a formidable communication task. However, the results presented in the remainder of this article indicate that communicators cannot count on appropriate responses following radon monitoring. Officials in New Jersey, while desiring to reduce the risk faced by state residents, were also concerned about avoiding panic.
Past research indicates that panic is not a common response to hazards Drabek and is usually found only in situations in which time is thought to he running out Lazarus But panic seemed possible in this case because radon involved high risk levels, radiation, cancer, and a difficult remediation problem — hazard characteristics that have produced fear among members of the public in the past. In an effort to forestall panic while still educating residents, DEP the state agency given principal responsibility for dealing with radon in New Jersey adopted a strategy characterized by passive diffusion of information.
A radon hot line was set up to answer questions residents might have about radon pollution and radon testing. When requested by local authorities, DEP and DOH representatives spoke about radon at public meetings, but no attempt was made to distribute information directly to residents in areas of the state where radon was thought to be a problem.
Note: 2 Copies of EPA radon information sheets were also available to hot-line callers on request. Note: 3 Another fact sheet prepared by the Pennsylvania Department of Health contained mortality probabilities for different radon levels and different lengths of exposure. It was available from DEP and from some commercial testing companies and was also distributed in large numbers to homeowners in high-risk areas of New Jersey by an elected official.
For this communication strategy to prove successful, concerned individuals would need to seek out information and share what they learned with friends and neighbors. These steps would lead to the eventual dissemination of information throughout the population at risk, and to widespread individual decisions to monitor and to take remedial action, where appropriate. If they wished to confirm their initial test results, these individuals could obtain a second measurement from the state at no charge.
Note: 4 This was part of a research program to guide DEP radon communication efforts. Other parts included a general survey of the population at risk and a comparison of the effectiveness of different ways of explaining radon risk levels. If we found evidence that even those who had monitored and found a problem still failed to understand the nature of the radon risk or were responding inappropriately, the results would suggest strongly.
The individuals who had requested confirmatory monitoring of their radon levels from the DEP as of June were invited to participate in the survey. Because the identities of residents in the monitoring program were confidential, we could not recruit them directly. Instead, a letter describing the project was mailed by DEP to all program participants, along with a postcard they could return to us indicating their willingness to take part.
This method of recruitment, although necessary for ethical reasons, resulted in a relatively low response rate; Had we been able to contact potential participants directly or to send them reminders, the return rate probably would have been higher.
These differences suggest that, compared to the average New Jersey homeowner, survey respondents were probably more aware of radon and more concerned about its risks, more interested in seeking additional information about radon and their own risk levels, and more trusting of the ability of government and academe to provide appropriate help while maintaining confidentiality.
Although the participants in the confirmatory monitoring program were not a representative sample of the population at risk, they were an important group to study for two reasons. First, because members of this sample were more knowledgeable about radon than the remaining population and because they had demonstrated their willingness to deal with the radon issue by getting initial and follow-up measurements, they can he viewed as a best-case indicator of the effectiveness of communications available at that time.
If members of this group were misinformed or had difficulty responding in a manner appropriate for their radon levels, the adequacy of the available information for the rest of the public would be doubtful. Questionnaires were mailed to the eligible volunteers, and returned completed forms. We also conducted lengthy face-to-face interviews in the homes of 16 survey participants between October and December Although the number of these interviews is small, they proved enlightening, and will be discussed where appropriate.
A major goal of radon communication efforts is for individuals to understand the risk they face, so that those with low levels will relax and those with high levels will remediate. Consequently, an indicator of the effectiveness of radon communication is the degree of association between the objective risk — indicated by home radon levels — and mitigation actions.
Strong, positive correlations between radon levels and these response measures would indicate that communications were accurately explaining the magnitude of the risk and that people were able to use this risk information in judging their need for action. As the results presented in Table 1 show, however, strong correlations were not found.
Correlations between radon levels self-reported for basement and first floor and responses to a variety of survey questions were sometimes statistically significant, but were modest in size. The remainder of this article explores some of the factors that diminish the size of these correlations and the implications of these findings for communication. Survey participants had acquired a good deal of information about radon. They were less familiar with its health effects e. The high scores on the radon quiz are not surprising, given that the sample was restricted to people who had both monitored their homes and contacted the state for a confirmatory test.
Indeed, members of this sample were unusual in their fervor for radon information. Nevertheless, the radon quiz results do show that factual information was available to people who sought it out. Other research indicates that the general population in New Jersey was also absorbing this information, although at a somewhat slower pace Weinstein, Sandman, and Klotz The acquisition of general information, however, did not improve decision making.
Multiple regression equations containing knowledge as measured by the radon quiz , radon level, and the interaction of these two variables were no better at predicting actions, plans, and risk perceptions than equations containing the radon level alone. The personal interviews shed some light on the lack of association between knowledge and reactions to radon. Many respondents we interviewed expressed frustration with their search for information, especially for information that would help them evaluate their levels and make decisions about remediation.
There are several possible reasons for their dissatisfaction. First, at the time of this survey the radon problem was still so new that detailed information was not generally available, especially information regarding remediation procedures and companies able to carry out these procedures. Second, many people lacked the background needed to make use of the rather technical information that was available, a situation that can lead people to misunderstand or even to disregard information Friedman ; Hanley For example, the units in which radon levels are usually reported, picocuries of radiation per liter of air, were unfamiliar to residents.
Many of the people we interviewed found their test results virtually meaningless. Furthermore, explanations of the risk associated with various levels were often presented in terms of probabilities, which many people find hard to understand Tversky and Kahneman Finally, some people felt that the available information was inadequate because it offered too little guidance.
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The desire for help in choosing remediation strategies was especially strong. Many of the people we interviewed wanted a prescribed course of action, not an explanation of the various options available to them. It may be that the technical nature of the problem, the uncertainty associated with both risk assessment and remediation, and the high stakes involved in terms of both money and health combined to make the situation too taxing for the average homeowner to deal with without expert help.
Respondents were quite concerned about, but not distraught over, the level of radon in their homes. Six 5-point scales asked about the amount of concern, worry, fear, depression, helplessness, and anger experienced e. When ratings of these six adjectives were summed to yield a single index of distress, its correlation with home radon levels was not significant see Table 1. Several other variables did prove to be associated with distress: concern about health effects appeared to be the major force behind negative emotional reactions.
Furthermore, the nonsignificant correlations between distress and radon levels indicate that people with low levels were as likely to become upset as those with high levels. The interviews we conducted suggest an additional caveat. Several individuals indicated that they had forgotten about radon over the summer months when the house was open, but were experiencing increased anxiety with the onset of winter, when windows are kept closed and radon levels are higher.
One person remarked that he became alarmed each time he heard his forced-air heating system come on bringing contaminated air up from the basement. Since the survey was conducted in July, ratings of negative affect might have been attenuated temporarily by the decreased salience of the radon problem. Although they did not deny the presence of radon in their homes — only The correlation between the perceived seriousness of their radon problem and the basement radon level, although significant, was only moderate in size, and the correlation with the first-floor radon level which is a better indicator of the actual risk was not significantly different from zero.
Associations between radon levels and other variables that indicate the perceived seriousness of the radon threat, such as beliefs about the likelihood of effects on health and the size of effects on property values, were modest in size see Table 1. Clearly, the belief that radon poses a serious home problem did not accurately reflect actual radon test results. In a similar study conducted in Maine, Johnson and Luken found no relationship between perceived and actual risk. Discrepancies between actual and perceived risk were not totally random; people were more likely to underestimate than overestimate the hazard Weinstein, Klotz, and Sandman In fact, responses to several questions in this survey indicate an optimistic bias, a common finding in research on risk perception.
Note: 7 For example, respondents were asked how serious it would be if someone in their families became ill because of radon. Participants were also asked to compare the risk from their radon levels with the risk from other common health hazards. They judged whether the risk from their own level of radon was less than, the same as, or greater than the risks from smoking, not wearing a seat belt, eating a high-cholesterol diet, exposure to hazardous waste, and being 20 pounds overweight.
Very few respondents perceived their radon concentrations to be more risky than these other hazards. Furthermore, as radon levels go up, survey participants should more often judge that their risk is greater than that presented by the comparison risk, but all the correlations between radon levels and these comparative risk judgments were nonsignificant see Table 1. Save to Library. Create Alert. Share This Paper.
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Tables from this paper. References Publications referenced by this paper. Douthitt , Lydia Zepeda. Food safety: An application of the health belief model Robert B. Schafer , Elisabeth Schafer , Gordon L.