Impact of Proposed Research

This project is best characterized as applied health policyresearch, where "health policy" has its more typical connotation, referring to public policy, but is also intended to connote private policy, referring to the policies and procedures of business firms. In the tradition of the literature upon which the study builds, the most immediate audience for the work is the workplace health promotion community, including both business firms and vendors of smoking cessation programs. In reading the literature and speaking with industry representatives, we have detected a genuine and substantial hunger for information. Given the lack of technical analytical expertise among the consumers of such information, this hunger is perpetually at risk of being fed by charlatans.8

In recognition of this, and reflecting an emerging appreciation of the need for alternative forms of evaluation, an expert panel of worksite wellness professionals recently called for the development and application of computer simulation models of worksite health promotion programs.35 To keep our work relevant to this community, as well as to receive technical feedback, we have secured the agreement of representatives of the Association for Fitness in Business to review and monitor ourwork. (Please see the letter in Appendix B from Dr. Robert Kaman, President-elect of the AFB.) The AFB is an organization of corporate health program officials and interested academics who focus primarily on employment-based health promotion programs. At a recent AFB conference on worksite wellness programs, the principal investigator discussed the potential of simulation as an applied research tool with other researchers and corporate officials.36 Both groups expressed considerable interest in this approach.

The research team's contacts with corporate officials responsible for health promotion programs will permit additional consultation, as well as access to data. For example, the principal investigator serves on the Senior Advisory Board of the National Center for Health Promotion, an organization that develops wellness programming for corporations throughout the country, including smoking cessation (the Smoke Stoppers program). This contact will facilitate data acquisition concerning both cessation programs and corporate benefits information. The President of the National Center, Michael Samuelson, has agreed to serve as an advisor to the project. (See his letter in Appendix B.) As a second example, based on our preliminary work during the principal investigator's sabbatical leave, the Upjohn Company offered to supply company data for use in testing the model, once the requisite developmental work has been completed. The investigators have contacts in several other major corporations that might beinterested in contributing firm- or site-specific data.

By providing the workplace health promotion community with sound understanding of the impacts of smoking cessation programs, the research should facilitate rational decision making within the business context. By emphasizing the theme of cost-effectiveness (rather than cost savings), the work might help to recast the way in which the business community approaches health promotion interventions writ large.4 Insisting on cost savings from health promotion imposes a higher, and thus unfair, standard on health promotion than is required of conventional health care. Indeed, the use of a cost-effectiveness criterion might itself represent a higher standard than is currently applied to most health care benefits.7

The proposed research differs from all that has preceded it in two critical dimensions. One is the analytic approach, the use of a simulation model rather than the standard quasi-experiment. While this is not the first simulation model developed for this purpose, as discussed above, no earlier simulation has adopted the breadth and depth of perspective proposed here. No simulation published to date, for example, has seriously examined the implications of health promotion for the health and business costs associated with the retiree population, an issue of growing urgency quite independent of further successes in health promotion.37,38

Possibly more importantly, the proposed study is unique in extending its findings to the social implications of private health promotion programs. From our preliminary work on the prototype, we can already see the potential that worksite smoking cessation programs may have dramatically different, and better, implications for the community as a whole than for the private firm that incurs the costs of helping its workers to quit smoking.

The implications of this finding, if confirmed by the research, are potentially enormous: it is conceivable, for example, that worksite health promotion could represent a highly cost-effective means of promoting public health, at the same time that it is not a particularly desirable intervention from the purely fiscal perspective of the business firm. If so, a major implication of the research, presumably of considerable interest to the health policy community in the public sector, would be the desirability of developing governmental incentives to encourage businesses to offer smoking cessation programs to employees. Such incentives might take the form of tax subsidies for employers (e.g., special deductibility provisions) or direct business-goverment collaborations. In 1988, for example, the Michigan Department of Public Health implemented a small state- legislated grants program to encourage small- and medium-sized businesses to establish health promotion interventions.39

In short, this research should have a public sector constituency that no previous worksite health promotion analysis has addressed. To assure relevant research design and dissemination of findings, we will consult regularly with healthpolicy leaders in the public sector, at both the state and federal levels. At the state level, for example, Dr. Ronald M. Davis, Chief Medical Officer of the Michigan Dept. of Public Health and former Director of the federal Office on Smoking and Health, has expressed considerable interest in the relevance of the project to possible State of Michigan initiatives, and has volunteered to consult with us on the development and execution of the research. At the federal level, Dr. J. Michael McGinnis, Deputy Assistant Secretary for Health and Director of the Office of Disease Prevention and Health Promotion, has also expressed interest in this dimension of the research and has offered to assist as a reviewer and advisor to the project. (See the letters from Drs. Davis and McGinnis in Appendix B.)

Another unique element of the proposed work is its interest in the demographic implications of workplace smoking cessation programs. With the average victim of a smoking-attributable death losing two decades of life expectancy, and 40 percent of the blue collar workforce still smoking, reducing smoking substantially within a workforce has the potential to alter the age-sex mix of the employees. While this might seem a curiosity at best, it has distinct relevance in a world in which, as described above, the character of the workforce and of entrants to the workforce is expected to undergo enormous change over the next two decades.

Finally, one hopes that the audience for this work will include a broader spectrum of professionals interested in healthpromotion and disease prevention, certainly including the subset for whom tobacco policy constitutes a central focus. If we are realistic in our (admittedly optimistic) expectations for this research, its intellectual and substantive spin-offs could be numerous and important.

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