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Suggested Citation:"4 Workplaces." National Academies of Sciences, Engineering, and Medicine. 2019. Implementing Strategies to Enhance Public Health Surveillance of Physical Activity in the United States. Washington, DC: The National Academies Press. doi: 10.17226/25444.
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4

Workplaces

INTRODUCTION

On average, adults in the United States who are employed fulltime spend a majority of their waking hours working and doing work-related activities, whether at a traditional worksite or office environment, at home or another location for telework situations, or at an offsite location for non-office jobs (e.g., truck driver or construction worker) (DOL, 2018). Thus, the workplace is an important environment to conduct physical activity surveillance. Workplace physical activity surveillance can capture the amount of time an individual engages in physical activity or sedentary behaviors throughout the day, job-specific physical activity or sedentary behavior, an employee’s level of physical fitness, physical activity or sedentary time during commuting, availability and use of workplace programs that support physical activity, and the types of policies that encourage physical activity such as paid time off to be active or promotion of active commuting to and from work.

Physical activity surveillance in the workplace is not straightforward to implement. First, there are questions about the level at which physical activity surveillance should occur—organizationally (including worksite design and culture, leadership role modeling, and programs that promote physical activity) or individually (an employee’s physical activity or fitness level). Second, because physical activity is only one component of health assessment within the broad scope of worksite health promotion, it is rare that employers consider physical activity surveillance independent of other health metrics such as body weight, blood pressure, cholesterol, or tobacco use (Bailey et al., 2018). Third, goals for surveillance raise questions about

Suggested Citation:"4 Workplaces." National Academies of Sciences, Engineering, and Medicine. 2019. Implementing Strategies to Enhance Public Health Surveillance of Physical Activity in the United States. Washington, DC: The National Academies Press. doi: 10.17226/25444.
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which employers and employees are included in the surveillance system and which are not. Inclusion can vary based on employer prioritization of workplace health promotion, labor union contracts, or resource limitations, and has implications for equitable implementation of surveillance efforts. These questions are particularly important in light of the changing U.S. workforce, which increasingly includes teleworking opportunities and independent employment as part of the fast growing “gig economy,” which refers to workers who are loosely connected to organizations as independent contractors or selling directly to the market place (Petriglieri et al., 2019). For example, how are workers captured by surveillance systems when they are not at a physical workplace each day? Moreover, understanding which employers and employees are captured in surveillance systems is important for future analysis of disparities in rates of physical activity or sedentary behavior, as well as underlying inequities in workplace practices. Fourth, several factors are considered crucial to supporting a culture of health and well-being at work, including workplace policies, benefit design, work conditions, and the built and psychosocial environments within the walls of the workplace, in the case of a brick-and-mortar building, as well as while traveling to and from a workplace. If these factors influence physical activity, how are they captured in surveillance efforts?

The geography, size, industry, and demographics of workplaces are also important to consider, as it is preferred for surveillance systems to include a diverse sample of workplaces and employees. Related to the changing nature of the workplace are the changing demographics of the workforce. The U.S. workforce is aging and becoming more racially and ethnically diverse, which raises questions about how surveillance systems capture different employee groups.

In addition to these questions about which employers and employees are included in the surveillance system, there is a fundamental belief that a robust workplace physical activity surveillance system can occur only with buy-in from employers and employees. Any effort to implement physical activity surveillance should consider how surveillance outcomes are tied to value on investment, so that they are relevant for employers and employees and clearly described as such. It is also important to secure appropriate consumer protections for employees to ensure data privacy and adequate engagement.

The following strategies and actions for implementation of physical activity surveillance in workplaces were informed by a discussion paper, Pate et al. (2018), and with input from a group of experts representing government, academia, not-for-profit organizations, and the private sector. These individuals were engaged in discussions to prioritize implementation strategies, and an in-person meeting that occurred in November 2018 (as described in Chapter 1).

Suggested Citation:"4 Workplaces." National Academies of Sciences, Engineering, and Medicine. 2019. Implementing Strategies to Enhance Public Health Surveillance of Physical Activity in the United States. Washington, DC: The National Academies Press. doi: 10.17226/25444.
×

STRATEGIES AND ACTIONS FOR IMPLEMENTATION OF PHYSICAL ACTIVITY SURVEILLANCE IN WORKPLACES

Strategy 13

Background

Several workplace surveillance initiatives exist, including the Workplace Health in America Survey; the Bureau of Labor Statistics’ data collection efforts (e.g., American Time Use Survey [ATUS]), which measures the amount of time people spend doing various activities such as paid work; the Occupational Requirements Survey, which assess the physical demands of different occupations (DOL, 2019); organizational scorecards (e.g., Centers for Disease Control and Prevention [CDC] Worksite Health ScoreCard, the Health Enhancement Research Organization [HERO] Scorecard, the American Heart Association Workplace Health Achievement Index); employer-based surveys/tools; and other measures of the built environment and building design standards (e.g., Fitwel, a certification system that optimizes buildings to support health).

In addition to these workplace surveillance initiatives, there are other well-known national surveillance systems, such as the Behavioral Risk Factor Surveillance System, as well as many other lesser-known state and local surveillance systems, that capture valuable data about physical activity in the workplace and active commuting to and from work.

Findings

It would be beneficial to create a compendium of current workplace surveillance efforts, which would help identify gaps. A comprehensive analysis of existing efforts could serve as the foundation for future programmatic, policy, systems, and environmental change work and advocacy efforts.

The process for adding new questions to existing surveillance systems is unclear. Moreover, there is a lack of information on the exact costs

___________________

1Chapter 5, Community Supports for Physical Activity, provides guidance on potential opportunities to capture physical activity during travel to and from work.

Suggested Citation:"4 Workplaces." National Academies of Sciences, Engineering, and Medicine. 2019. Implementing Strategies to Enhance Public Health Surveillance of Physical Activity in the United States. Washington, DC: The National Academies Press. doi: 10.17226/25444.
×

to modify existing surveillance questions and analyze data pertaining to workplace physical activity. The cost for adding new surveillance measures and/or questions will be influenced by the surveillance system into which they are inserted, the timetable for their addition, and whether they are included longitudinally or at only one point in time. Securing information on these administrative and financial implications is important for the federal appropriations process and fundraising efforts related to expanding surveillance efforts.

Supporting Actions for Implementation

The committee recommends the following actions to support this strategy:

Suggested Citation:"4 Workplaces." National Academies of Sciences, Engineering, and Medicine. 2019. Implementing Strategies to Enhance Public Health Surveillance of Physical Activity in the United States. Washington, DC: The National Academies Press. doi: 10.17226/25444.
×

Strategy 14

Background

The workplace sector has identified the need to develop consistent, reliable, and validated criteria for physical activity, physical fitness, and sedentary behavior assessment in worksite health promotion (Pate et al., 2018). An expert group was convened to identify such criteria, and published its consensus recommendations in early 2019 (Whitsel et al., 2019).

Findings

The current measures that stakeholders use in the field to assess workplace physical activity, physical fitness, and sedentary behavior are inconsistent. Standardizing the measures would support consistency in the physical activity surveillance that informs outcome evaluation, benchmarking, and individually tailored, evidence-based programming across the worksite health promotion field.

Supporting Actions for Implementation:

The committee recommends the following actions to support this strategy:

___________________

2 Described in Whitsel et al., 2019.

Suggested Citation:"4 Workplaces." National Academies of Sciences, Engineering, and Medicine. 2019. Implementing Strategies to Enhance Public Health Surveillance of Physical Activity in the United States. Washington, DC: The National Academies Press. doi: 10.17226/25444.
×

Strategy 15

Background

The measures of workplace designs and operations, policies, programs, culture, and climate that foster physical activity promotion are not

Suggested Citation:"4 Workplaces." National Academies of Sciences, Engineering, and Medicine. 2019. Implementing Strategies to Enhance Public Health Surveillance of Physical Activity in the United States. Washington, DC: The National Academies Press. doi: 10.17226/25444.
×

standardized nor developed for different types of workplaces. It is well documented that organizational culture is strongly associated with health outcomes, with research showing that organizations with cultural support, such as the presence of worksite policies or statements supporting healthy behaviors or policies that support physical activity breaks, reported greater improvements in health behaviors compared to organizations with little or no cultural support (Allen, 2017). There is also evidence regarding the role of supportive leadership in creating and promoting opportunities for physical activity (Bailey et al., 2018).

Findings

Achieving consensus on measures that can be consistently used and applied to different types of workplaces would generate critical data on workplace supports for physical activity.

Supporting Actions for Implementation

The committee recommends the following actions to support this strategy:

Suggested Citation:"4 Workplaces." National Academies of Sciences, Engineering, and Medicine. 2019. Implementing Strategies to Enhance Public Health Surveillance of Physical Activity in the United States. Washington, DC: The National Academies Press. doi: 10.17226/25444.
×

Strategy 16

Background

The federally funded Workplace Health in America (WHA) survey, conducted in 2016–2017, is the most comprehensive national survey of employers’ workplace health promotion offerings (CDC, 2017). The WHA is also the first national survey to capture the status of workplace health and safety programming, the implementation of evidence-based strategies, and the description of key components of a comprehensive workplace health promotion program (Linnan et al., 2019). The last nationally representative, federally funded survey of employers’ workplace health promotion offerings was conducted in 2004 and indicated that 19.6 percent of employers offered physical activity–related programming (Linnan et al., 2008). The latest WHA survey compared some of its findings with the 2004 results, presenting a wider array of data on evidence-based physical activity programs and policies, and documenting existing worksite health programs, benefits, policies, and supports (Linnan et al., 2019). Ideally, surveillance measures identified in the previous supporting actions would be integrated into the WHA survey working in close partnership with CDC.

Findings

Data for the WHA were collected from November 2016–December 2017, after a 12-year gap, due to budget limitations. Securing funding to support regular administration of this survey is important for national physical surveillance efforts in workplaces.

Supporting Actions for Implementation

The committee recommends the following actions to support this strategy:

Suggested Citation:"4 Workplaces." National Academies of Sciences, Engineering, and Medicine. 2019. Implementing Strategies to Enhance Public Health Surveillance of Physical Activity in the United States. Washington, DC: The National Academies Press. doi: 10.17226/25444.
×

CONCLUSION

Employed adults spend many of their waking hours on the job, which makes workplaces an important environment for promoting physical activity and conducting physical activity surveillance. The heterogeneity of U.S. workplaces calls for a variety of approaches to implementing surveillance, and there are a variety of corresponding challenges as well. Buy-in from employers and employees can help overcome some of the challenges, and this buy-in can be achieved in part by clarifying the value and return on investment of surveillance outcomes. The 4 strategies and 12 implementation actions described in this chapter will help coordinate longitudinal data collection and data analysis to promote more comprehensive physical activity surveillance across workplaces and create opportunities to examine inequities in physical activity and physical fitness outcomes across work settings and employee populations.

REFERENCES

Allen, J. 2017. Transforming organizational cultures to support good health. In M. P. O’Donnell (Ed.), Health promotion in the workplace, 5th ed. Troy, MI: Art & Science of Health Promotion Institute. Pp. 633-648.

Bailey, M. M., R. K. Coller, and K. M. Pollack Porter. 2018. A qualitative study of facilitators and barriers to implementing worksite policies that support physical activity. BMC Public Health 18(1):1145. doi: 10.1186/s12889-018-6045-x.

CDC (Centers for Disease Control and Prevention). 2017. Workplace health promotion data & surveillance. https://www.cdc.gov/workplacehealthpromotion/data-surveillance/index.html (accessed January 25, 2019).

Suggested Citation:"4 Workplaces." National Academies of Sciences, Engineering, and Medicine. 2019. Implementing Strategies to Enhance Public Health Surveillance of Physical Activity in the United States. Washington, DC: The National Academies Press. doi: 10.17226/25444.
×

DOL (Department of Labor). 2018. American Time Use Survey—2017 results (USDL-18-1058). https://www.bls.gov/news.release/pdf/atus.pdf (accessed January 25, 2019).

DOL. 2019. Occupational Requirements Survey. https://www.bls.gov/ors (accessed February 15, 2019).

Linnan, L., M. Bowling, J. Childress, G. Lindsay, C. Blakey, S. Pronk, S. Wieker, and P. Royall. 2008. Results of the 2004 national worksite health promotion survey. American Journal of Public Health 98(8):1503-1509.

Linnan, L. A., L. Cluff, J. E. Lang, M. Penne, and M. S. Leff. 2019. Results of the Workplace Health in America survey. American Journal of Health Promotion 1-14. https://doi.org/10.1177/0890117119842047.

Pate, R. R., D. Berrigan, D. M. Buchner, S. A. Carlson, G. Dunton, J. E. Fulton, E. Sanchez, R. P. Troiano, J. Whitehead, and L. P. Whitsel. 2018. Actions to improve physical activity surveillance in the United States. NAM Perspectives. Discussion Paper, National Academy of Medicine, Washington, DC. doi: 10.31478/201809f.

Petriglieri, G., S. J. Ashford, and A. Wrzesniewski. 2019. Agony and ecstasy in the gig economy: Cultivating holding environments for precarious and personalized work identities. Administrative Science Quarterly 64(1):124-170. https://doi.org/10.1177/0001839218759646.

Whitsel, L. P., R. Arena, L. A. Kaminsky, D. Berrigan, P. T. Katzmarzyk, C. Calitz, and N. P. Pronk. 2019. Assessing physical activity, sedentary behavior, and cardiorespiratory fitness in worksite health promotion. American Journal of Health Promotion 33(2):318-326. https://doi.org/10.1177/0890117118816750e.

Suggested Citation:"4 Workplaces." National Academies of Sciences, Engineering, and Medicine. 2019. Implementing Strategies to Enhance Public Health Surveillance of Physical Activity in the United States. Washington, DC: The National Academies Press. doi: 10.17226/25444.
×
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Suggested Citation:"4 Workplaces." National Academies of Sciences, Engineering, and Medicine. 2019. Implementing Strategies to Enhance Public Health Surveillance of Physical Activity in the United States. Washington, DC: The National Academies Press. doi: 10.17226/25444.
×
Page 64
Suggested Citation:"4 Workplaces." National Academies of Sciences, Engineering, and Medicine. 2019. Implementing Strategies to Enhance Public Health Surveillance of Physical Activity in the United States. Washington, DC: The National Academies Press. doi: 10.17226/25444.
×
Page 65
Suggested Citation:"4 Workplaces." National Academies of Sciences, Engineering, and Medicine. 2019. Implementing Strategies to Enhance Public Health Surveillance of Physical Activity in the United States. Washington, DC: The National Academies Press. doi: 10.17226/25444.
×
Page 66
Suggested Citation:"4 Workplaces." National Academies of Sciences, Engineering, and Medicine. 2019. Implementing Strategies to Enhance Public Health Surveillance of Physical Activity in the United States. Washington, DC: The National Academies Press. doi: 10.17226/25444.
×
Page 67
Suggested Citation:"4 Workplaces." National Academies of Sciences, Engineering, and Medicine. 2019. Implementing Strategies to Enhance Public Health Surveillance of Physical Activity in the United States. Washington, DC: The National Academies Press. doi: 10.17226/25444.
×
Page 68
Suggested Citation:"4 Workplaces." National Academies of Sciences, Engineering, and Medicine. 2019. Implementing Strategies to Enhance Public Health Surveillance of Physical Activity in the United States. Washington, DC: The National Academies Press. doi: 10.17226/25444.
×
Page 69
Suggested Citation:"4 Workplaces." National Academies of Sciences, Engineering, and Medicine. 2019. Implementing Strategies to Enhance Public Health Surveillance of Physical Activity in the United States. Washington, DC: The National Academies Press. doi: 10.17226/25444.
×
Page 70
Suggested Citation:"4 Workplaces." National Academies of Sciences, Engineering, and Medicine. 2019. Implementing Strategies to Enhance Public Health Surveillance of Physical Activity in the United States. Washington, DC: The National Academies Press. doi: 10.17226/25444.
×
Page 71
Suggested Citation:"4 Workplaces." National Academies of Sciences, Engineering, and Medicine. 2019. Implementing Strategies to Enhance Public Health Surveillance of Physical Activity in the United States. Washington, DC: The National Academies Press. doi: 10.17226/25444.
×
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Physical activity has far-reaching benefits for physical, mental, emotional, and social health and well-being for all segments of the population. Despite these documented health benefits and previous efforts to promote physical activity in the U.S. population, most Americans do not meet current public health guidelines for physical activity.

Surveillance in public health is the ongoing systematic collection, analysis, and interpretation of outcome-specific data, which can then be used for planning, implementation and evaluation of public health practice. Surveillance of physical activity is a core public health function that is necessary for monitoring population engagement in physical activity, including participation in physical activity initiatives. Surveillance activities are guided by standard protocols and are used to establish baseline data and to track implementation and evaluation of interventions, programs, and policies that aim to increase physical activity. However, physical activity is challenging to assess because it is a complex and multidimensional behavior that varies by type, intensity, setting, motives, and environmental and social influences. The lack of surveillance systems to assess both physical activity behaviors (including walking) and physical activity environments (such as the walkability of communities) is a critical gap.

Implementing Strategies to Enhance Public Health Surveillance of Physical Activity in the United States develops strategies that support the implementation of recommended actions to improve national physical activity surveillance. This report also examines and builds upon existing recommended actions.

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