Promoting Wellness on the Home Front:

The Business Case for Targeting Family Health and Well-Being

Health promotion programs have traditionally focused on encouraging healthy choices and reducing risk factors among employees — but a growing body of evidence points to the strong influence of family lifestyle behaviors on employee health, indicating a new approach to cultivating a productive, thriving workforce.

Inviting family members to participate in wellness initiatives makes behavior change easier and more sustainable for employees.

To be effective in stabilizing healthcare costs, wellness initiatives in the 21st century must consider, include, and target the people who can make or break employee well-being — their families.

A focus on family health and well-being infuses workplace wellness strategies with a powerful element of social support for employees. It also addresses the health of a substantial healthcare cost-driver: dependents. And their health risks/habits affect the bottom line even if they’re not covered under the employer’s benefits — through absenteeism and lowered productivity. With better family health and a more positive home life, workers can turn their on-the-clock attention and energy back to their jobs.

Why Family Wellness MattersEncouraging family health and well-being with wellness and work-life initiatives makes good business sense:

• Each dependent costs employers $1780/year on average — and employer healthcare costs are increasing at a median annual rate of 6%.2

• According to the National Business Group on Health, approximately 33% of large employers’ employee beneficiaries are dependents under age 25.3

• Children and teens account for 14.7% of typical healthcare costs for a large employer—not including the productivity loss for working parents of sick and injured children.4

• 24 million working adults care for family members over age 50, spending an average of 19 hours/week in their care-giving roles.5

• A 2010 study reports employees who care for elderly family members incur an average of 8% more in healthcare costs than non-caregivers — with an estimated $17.1 billion-$33.6 billion lost annually to caregiving-related interruptions, absenteeism, worker replacement, and moving from full-time to part-time work.6

• Employees with jobs that positively affect their energy levels at home — and vice versa — are more likely to be engaged, feel satisfied, and plan to remain with their current employers.7

• A study of 8000 corporate leaders finds they value a supportive work environment, a challenging job and a good fit between work life and home life more than being well compensated.8

The Business Case for Targeting Family Health and Well-Being

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Promoting Wellness on the Home Front:

Productivity losses related to personal and family health problems cost US employers $1685/employee/year — or $225.8 billion annually.1

Work Life and Family Life — Inextricably Linked Managing work, life, and family is an everyday struggle for countless employees — in fact, 70% of US children live in households where both parents are employed.9 Sick family members, aging parents, financial and legal matters, relationship and parenting issues are just a few examples of personal concerns that demand workers’ time and energy on and off the job.

For many people, work plus life adds up to anxiety — and plenty of it.

High stress levels take a huge toll on physical, mental, and emotional well-being. But employees aren’t the only ones who suffer; stress affects families and even the workplace climate. In one study, 47% of adults reported being awake at night due to stress10 — a factor clearly detrimental to job performance. And work-related stress is often carried home, resulting in poor health and relationship problems.

Some people cope with stress in positive ways, such as exercising, socializing, or seeking professional help — but many turn to overeating or unhealthy foods. Others choose TV over more active leisure-time pursuits. A recent study showed that US adults watch over 5 hours/day on average,11 with kids 8-18 years watching 4 hours/day plus another 2 playing video games.12 It’s not surprising that only 49% of boys and 35% of girls ages 6-11 get 60 minutes of moderate to vigorous physical activity a day — and this age group has experienced the sharpest increase in obesity rates.13

The work environment plays a key role in how employees manage stress. Doughnuts in the break room and desktop candy bowls don’t help; instead they promote mindless junk-food grazing… a habit that easily carries over into personal time.

Because work and life are so tightly connected, both stand to benefit from employer-sponsored health promotion measures aimed at the whole family.

Promoting Wellness on the Home Front:

Helping employees and their families shift from being stressed out and sedentary to thriving is a golden opportunity for employers. For example:

• Flexible scheduling allows some families to spend more time together, participate in important events, and be more physically active while the employee still gets the work done. But rigid scheduling and job environments that promote long hours often mean missing out on family activities or special occasions — and choosing fast food over more nutritious meals.

• Offering fun, engaging wellness campaigns that get families involved together can help both employees and dependents make lasting changes that decrease long-term health risks and improve the bottom line.

An estimated 1 million workers are absent each day due to stress, at a corporate price tag of about $602/employee/year. 14

Promoting Wellness on the Home Front | 2

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Relationships CountResearch shows that close relationships have a strong influence on health behaviors. If family members have unhealthy patterns, the likelihood of employees making lasting changes is low. But the potent influence pays off when healthy habits at home support employee efforts to change:

Exercise/nutrition. Support from family, friends, and coworkers can increase exercise participation and reduce fat consumption — with the biggest improvements attributed to family support.15

Weight management. When a husband becomes obese, his wife is 44% more likely to become obese. Similarly, the husband is 37% more likely to become obese when his wife does.16 Receiving support from family and friends helps participants lower body mass index.17

Maintaining health changes. An 8-week program including family support helped study participants begin healthy behaviors and continue them at a 1-year follow-up. During the 1-year maintenance period, participants reported encouragement and participation of family members as the most important factor.18

Diabetes control. Support from family and friends boosts compliance with regular blood glucose testing recommendations,19 an essential practice for maintaining good control over diabetes and preventing complications.

Protecting teen health. Close, strong families decrease the risk of adolescents becoming victims of violence.20 Family connectedness also reduces emotional issues, incidence of eating disorders, and suicide21 while increasing adolescents’ well-being and decreasing distress.22

Dental health. When parents brush their own teeth at irregular intervals, their children are more prone to cavities — as early as 18 months of age. Using consistent parenting practices, being a positive role model, and teaching healthy lifestyle choices early are factors associated with fewer cavities at age 7.23

Self-control. Findings from a University of Georgia study indicate self-control is contagious — for better or worse. Subjects demonstrated more self-control when others around them did and when simply thinking about people who exhibit strong self-control. But when others nearby showed less self-control, so did study subjects.24, 25

Family Routines and RitualsRelationship difficulties are widely prevalent, with one study showing 59% of calls to an employee assistance program

were due to marital or other family problems.26 Families with consistent ways of relating and routine ways of doing things build an environment conducive to emotional, physical, and social well-being.27 Employers can promote a positive home life by offering a healthy work

environment, with programs and services that help families strengthen connections and develop nourishing relationships.

Eating meals together is an age-old family custom that has fallen victim to busy after-school schedules and long work hours. Encouraging employees to consistently leave work on time to share a meal with their families is a simple strategy to promote family health and well-being:

Help children develop sensible eating habits. At 9 to 14 years, children have less fried food and soda when they eat more meals with their family.28 Adolescents who eat with their parents choose more fruits, vegetables, and dairy foods; they’re also more likely to eat breakfast. Eating habits keep improving when additional meals are eaten as a family.29 Higher frequency of family dinners increases the likelihood of eating at least 5 daily servings of fruits and vegetables by 45%.28 And healthier foods — whole grains, fruits, nuts, seeds, green leafy vegetables, low-fat dairy — are associated with a 15% lower diabetes risk.30

Develop positive behaviors. Couples who coordinate efforts, affirm each other’s positions, and work together to create a family story — around the table and in daily life — have more positive emotional interactions, resulting in better child and teen behavior.31

Improve family relationships and coping skills. The more frequently families eat meals together, the greater the family unity — and better coping skills in children.32

Increase test scores. Children who spend more time eating meals with their families score higher on tests.33

Maintain weight loss. Over a 5-year period, children in a diet program with a parent lose more weight and maintain weight loss better than children alone. Factors include number of meals eaten at home and encouragement from the family.34

An Integrated Approach Workplace policies establish the framework for employer initiatives to improve family well-being — but they need strength to make things happen. Management support is a key element for the success of any business objective; employee and dependent wellness should be no exception. Drive home the expectation by involving all levels of leadership in implementing wellness campaigns and building compliance into performance evaluations.

Employers must not assume that employees are the only ones overseeing family health needs, meals, and opportunities for physical activity. While a worker may ignore or delete an email from HR, someone at home could be more apt to respond to health and wellness offerings. Therefore, a comprehensive health promotion communication plan:

• Includes the spouse or domestic partner in emails as well as telephone and direct mail messages.

• Partners with health benefit vendors (nurse advice lines, tobacco quit-lines, employee assistance programs, etc.) to coordinate messages and materials for consistent reinforcement.

Visible support by organization leaders may promote weight control. In a study of healthcare workers, greater perception of corporate commitment to employee health was associated with lower body mass index.35

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Wellness and Work/Life Initiatives to Promote Family Well-BeingPromoting employee and dependent health involves several steps. Over time, develop a comprehensive approach to meet your population’s unique needs by implementing a strategic combination of benefits, resources, and programs.

1. Engaging, team-based wellness campaigns that encourage family involvement in physical activity, good nutrition, and relationship-building

2. A culture of physical activity with walking meetings, accessible stairwells, protected break times, low or no-cost pedometers, onsite walking groups

3. Nutrition support with guidelines for food and beverages at meetings; healthy choices in vending machines; onsite farm produce delivery for subscribers; healthy take-home cafeteria dinners

4. Active transportation – encouraging bicycle and on-foot commuting with onsite showers and secure bicycle storage

5. Parenting support with coaching (online or phone), web seminars, referral to childcare resources, and childcare discounts

6. Pregnancy support with phone access to nurse case managers from pre-pregnancy through postpartum

7. Lactation support with onsite facilities, refrigerators for storage, discounts on hospital-grade breast pumps, and phone access to certified professionals

8. Eldercare resources with adult care referral, case management, and caregiver support

9. Tobacco cessation benefits; tobacco-free workplace policies

10. Flexible scheduling, part-time schedules, job-shares, telecommuting, and phased retirement

11. Adoption assistance — partial reimbursement of fees; pre- and post-adoption counseling

12. Concierge services with custom searches for household repair, summer camps, event tickets and other needs to save employees time

13. Paid time off — workplace norm that encourages employees to use vacation time and to stay home when sick

14. Employee Assistance Program for confidential relationship, mental health, financial, and legal assistance

15. Clear, enforced expectations for manager support of wellness initiatives.

Conclusions • Family support is a critical element for long-term adoption

of healthy behaviors.

• Dependent well-being affects organizations financially through healthcare costs, absenteeism, and productivity.

• Employers can have a positive influence on employee and family well-being with health promotion and work-life strategies and programs that target the whole family.

Attributes of Successful StrategiesSome of the most effective features to look for in wellness campaigns are listed below:

• Tools and evidence-based content that inspire employees to take action toward better family health and equip them to guide loved ones to healthier choices

• Focus on strengthening relationships, improving communication, and promoting physical activity, nutrition, and stress reduction

• Captivating design to engage a wide age range

• Interactive tracking that makes behavior change simpler — and fun

• Customizable features for integrating with your total rewards program

• Web-based to streamline participation across multiple worksites

• Easy to implement and manage with minimal staff time.

Endnotes/References

1 Stewart WF, Ricci JA, Chee E, Morganstein D. Lost productive work time costs from health conditions in the United States: results from the American productivity audit. J Occup Environ Med. 2003;45(12):1234-124; quoted on Partnership for Prevention website: www.prevent.org/Topics/Worksite-Health.aspx.

2 Mercer Health & Benefits Consulting, National Survey of Employer-Sponsored Health Plans: 2005 Survey Report. Mercer Health & Benefits Consulting; 2006.

3 National Business Group on Health. Maternal and child health benefits survey. Washington DC: National Business Group on Health; January 2006.

4 National Business Group on Health, Peer-Peer Solutions: Child & Adolescent Health, 6/12/2009, www.businessgrouphealth.org/benefitstopics/topics/0008.cfm?topic=0008&desc=Child%20and%20Adolescent%20Health.

5 Caregiving in the US: A Focused Look at Those Caring for Someone Age 50 or Older, National Alliance for Caregiving, November 2009, www.caregiving.org/data/FINALRegularExSum50plus.pdf.

6 The MetLife Study of Working Caregivers and Employer Health Care Costs: New Insights and Innovations for Reducing Health Care costs for Employers, National Alliance for Caregiving, University of Pittsburgh Institute on Aging, MetLife Mature Market Institute, February 2010, www.metlife.com/assets/cao/mmi/publications/studies/2010/mmi-working-caregivers-employers-health-care-costs.pdf.

7 State of Health in the American Workplace: Does Having an Effective Workplace Matter? 2008 National Study of the Changing Workplace, Families & Work Institute, www.familiesandwork.org/site/research/reports/HealthReport.pdf.

8 Leaders in a Global Economy – Finding the Fit for Top Talent, Families & Work Institute, 2008 http://familiesandwork.org/site/research/reports/globaltalentmgmt.pdf.

9 Williams J, Boushey H, The Three Faces of Work-Family Conflict: The Poor, The Professionals, and The Missing Middle, Center for American Progress, 2010, www.americanprogress.org/issues/2010/01/three_faces_report.html.

10 Stress in America 2009, American Psychological Association, www.apa.org/news/press/releases/stress-exec-summary.pdf.

11 Malone M, TVB Study, Adults Spend Twice as Much Time on TV Than Web, Broadcasting & Cable, 2010, www.broadcastingcable.com/article/453033-TVB_Study_Adults_Spend_Twice_as_Much_Time_on_TV_Than_Web.php.

12 Gavin, M, How TV Affects Your Child, 2008, http://kidshealth.org/parent/positive/family/tv_affects_child.html.

13 Brustad, R, The Role of Family in Promoting Physical Activity, President’s Council on Physical Fitness and Sports, Research Digest, March 2010, www.presidentschallenge.org/misc/news_research/research_digests/march2010digest.pdf.

14 Job Stress, American Institute of Stress, www.stress.org/job.htm.

15 Zimmerman RS, Connor C. Health Promotion in Context: The Effects of Significant Others on Health Behavior Change. Health Education & Behavior 1989;16(1):57-75.

16 Christakis NA, Fowler JH. The Spread of Obesity in a Large Social Network over 32 Years. The New England Journal of Medicine 2007;357(4):370-379.

17 Powers TA, Koestner R, Gorin AA. Autonomy Support from Family and Friends and Weight Loss in College Women. Families, Systems, & Health 2008;26(4):404-416.

18 Gardner-Ray, J. The Impact of Social Groups and Content on the Maintenance of Health Behavior Practices over a One-Year Period. Ball State University Dissertation 1996.

19 Rosland A, Kieffer E, Israel B, Cofield M, Palmisano G, Sinco B, Spencer M, Heisler M. When Is Social Support Important? The Association of Family Support and Professional Support With Specific Diabetes Self-management Behaviors. Journal of General Internal Medicine 2008;23(12):1992-1999.

20 Schreck CJ, Fisher BS. Specifying the Influence of Family and Peers on Violent Victimization. Journal of Interpersonal Violence 2004;19(9):1021-1041.

21 Resnick MD, Harris LJ, Blum RW. The Impact of Caring and Connectedness on Adolescent Health and Well-Being. Journal of Paediatrics and Child Health 1993;29(S1):S3-S9.

22 Kostelecky KL, Lempers JD. Stress, Family Social Support, Distress, and Well-Being in High School Seniors. Family and Consumer Sciences Research Journal 1998;27(2):125-145.

23 Mattila M, Rautava P, et al. Will the role of family influence dental caries among seven-year-old children? Acta Odontologica Scandinavica, 2005;63:73-84.

24 vanDellen M, Hoyle R, Regulatory Accessibility and Social Influences on State Self-Control, http://psp.sagepub.com/cgi/content/abstract/36/2/251.

25 University of Georgia (January 18, 2010). Self-control, and lack of self-control, is contagious. ScienceDaily. Retrieved July 6, 2010, from www.sciencedaily.com /releases/2010/01/100113172359.htm.

26 An Employer’s Guide to Employee Assistance Programs: Recommendations for Strategically Defining, Integrating, and Measuring Employee Assistance Programs, National Business Group on Health, 2008, www.businessgrouphealth.org/pdfs/FINAL%20NBGH%20Guide%20to%20EAPs%204%2030%2008.pdf.

27 Fiese B, et.al, A Review of 50 Years of Research on Naturally Occurring Family Routines and Rituals: Cause for Celebration? Journal of Family Psychology 2002, Vol. 16, No. 4, 381–390, www.apa.org/pubs/journals/releases/fam-164381.pdf.

28 Gillman MW, Rifas-Shiman SL, Frazier AL, Rockett, HRH, Camargo CA, Field AE, Berkey CS, Colditz GA. Family Dinner and Diet Quality Among Older Children and Adolescents. Archives of Family Medicine 2000;9(3):235-240.

29 Videon TM, Manning CK. Influences on Adolescent Eating Patterns: The Importance of Family Meals. Journal of Adolescent Health 2003;32(5):365-373.

30 Nettleton JA, Steffen LM, Ni H, Liu K, Jacobs DR. Dietary Patterns and Risk of Incident Type 2 Diabetes in the Multi-Ethnic Study of Atherosclerosis (MESA). Diabetes Care 2008;31(9):1777-1782.

31 Fiese BH, Marjinsky KAT. III. Dinnertime Stories: Connecting Family Practices With Relationship Beliefs and Child Adjustment. Monographs of the Society for Research in Child Development 1999;64(2):52-68.

32 Franko DL, Affenito SG, Thompson D, Barton BA. What Mediates the Relationship Between Family Meals and Adolescent Health Issues? Health Psychology 2008;27(2):S109-S117.

33 Hofferth SL, Sandberg JF. How American Children Spend Their Time. Journal of Marriage and Family 2001;63(2):295-308.

34 Epstein LH, Alice V, Wing RR, McCurley J. Ten-Year Outcomes of Behavioral Family-Based Treatment for Childhood Obesity. Health Psychology 1994;13(5):373-383.

35 Lemon S, Zapka J, Wenjun L, Estabrook B, Magner B, Rosal M, Perceptions of worksite support and employee obesity, activity, and diet, American Journal of Health Behavior, 2009; 33(3): 299-308.

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