ImageThere is an old saying –real men don’t wear pink.  On Saturday, October 26, the manly members of the Ohio State football team and over 90,000 other real men and women wore pink in honor of Breast Cancer Awareness Month, also raising awareness about programs at The Ohio State University Comprehensive Cancer Center and the Stefanie Spielman Comprehensive Breast Center.  It’s not often you see a football team, much less an entire stadium, drenched in pink.  It was a very visual reminder of breast cancer awareness.

Breast Cancer Awareness Month may be coming to a close, but breast cancer won’t stop at the end of the month. I would imagine you know someone who has been affected by breast cancer. You may wonder what can you do besides wear pink? You can start by taking steps to detect the disease in its early stages and encourage others to do the same.  Yes, men DO wear pink and CAN encourage the women they love to get breast cancer screenings.

The importance of finding breast cancer early

The goal of screening exams for early breast cancer detection is to find cancers before they start to cause symptoms. Most doctors feel that early detection tests for breast cancer save thousands of lives each year, and that many more lives could be saved if even more women and their health care providers took advantage of these tests.

Women age 40 and older should have a mammogram every year and should continue to do so for as long as they are in good health.

  • Despite their limitations, mammograms are still a very effective and valuable tool for decreasing suffering and death from breast cancer.

Women in their 20s and 30s should have a clinical breast exam (CBE) as part of a periodic (regular) health exam by a health professional preferably every 3 years. Starting at age 40, women should have a CBE by a health professional every year.

  • CBE is done along with mammograms and offers a chance for women and their doctor or nurse to discuss changes in their breasts, early detection testing, and factors in the woman’s history that might make her more likely to have breast cancer.

Breast self-exam (BSE) is an option for women starting in their 20s. Women should report any breast changes to their health professional right away.

  • Sometimes, women are so concerned about “doing it right” that they become stressed over the technique. Doing BSE regularly is one way for women to know how their breasts normally look and feel and to notice any changes. The goal, with or without BSE, is to report any breast changes to a doctor or nurse right away.

There are additional tests to be considered if you are at high risk.   Talk with your doctor to determine if you are at high risk and if an MRI makes sense for you.

Valorie Bender CWPM

Source:  American Cancer Society (last updated 09/17/2013). Breast Cancer, Early Detection. Retrieved October 16, 2013, from

This headline caught my eye in the NBC Health News “Smoking employees cost $6,000 a year more, study finds.” Is it no wonder why there are more and more employersCost of smoking seeking to put smoking policies into the workplace?

The study by Micah Berman of Ohio State University, was a culmination of reviewing studies on health care costs, presenteeism – “when people are at work but not putting in full effort” states Berman. In addition, Berman and his colleagues, reviewed studies that calculated the cost of more sick days by smokers and the cost of employee smoke breaks. Smoke breaks were included in lost productivity of smokers taking longer breaks due to the smoking ban within the workplace.

In the booklet Save Lives, Save Money, Make your Business Smoke-Free by the Center for Disease Control and Prevention (CDC),  have a few unexpected reasons why a smoke-free work place is good for the bottom line.

  • Going smoke-free reduces the risk of fires and accidental injuries
  • Going smoke-free reduces cleaning and maintenance costs
  • Going smoke-free reduces potential legal liability for legal suits from non-smokers

Here are a few tips from the CDC if you want to implement a workplace smoking policy:

  • Give yourself six months to a year to plan the new policy
  • Set up a task force to oversee the process, include top management, smokers, non-smokers
  • Gather information to educate the task force. Survey your employees to understand their needs and concerns.
  • Write the policy. Keep it clear, simple and straightforward. Address how the policy will work and how it will enforced.
  • Announce the policy. Several months before the start date send out a letter from top management to introduce policy.
  • Offer support to all employees who want to quit smoking, such as free or reimbursed cessation programs on-site or through local providers, and nicotine replacement therapy.
  • Start policy
  • Monitor the policy and continue to get feedback from both employees and other stakeholder groups.

Implementing a smoke-free workplace policy will create both healthier employees as well as a healthier business bottom line.

Perhaps you’ve had an experience similar to one I had, one of those life lessons that you never forget. I was working in a rather intense client situation with a large New York City financial services company. The company I was working foImager at the time was delivering a highly customized service, something we had never done before. And at that particular moment, we weren’t doing a great job for the client. I remember the client saying to me ‘If you can’t measure it, you can’t manage it.” Seems pretty basic, right? But it served as that slap upside the head that told me I needed to focus on ways to measure what we were doing so we could tell the story of the services we were providing and how the client was benefiting.

Many years later, I think of this often in the work we do with worksite health promotion programs. Measuring and evaluating wellness programs is a critical success factor and a best practice.

Why measure and evaluate?

Measuring and evaluating your wellness program serves to:

  • Assist in improving the present program.  Getting regular and consistent feedback from participants allows you to make immediate adjustments to improve on meeting the needs of participants.
  • Demonstrate program value and magnitude of impact to senior management. With this information, the program coordinator is in an excellent position to use the results to educate senior management on the benefits of the workplace wellness program, and to secure their support for future program growth.
  • Justifying proposed budgets at budget planning sessions in the organization.  Without the data provided by evaluation efforts, securing future budget increases may be more difficult.
  • Planning future programming changes, it may be necessary to compare the efficacy of different interventions – the success of one intervention vs. another.  New approaches are always being developed and having comparative data will help in making decisions about which intervention is best for your population.

How to measure and evaluate?

When developing your plan for evaluation, think about measuring in three different areas: process, impact, and outcomes.

Process Evaluation

This type of evaluation is best used to assess the intervention content by looking at methods, program materials, instructors and participation rates. Evaluate how the process worked in developing the program

  • How the program is structured
  • How it is promoted
  • How it is funded
  • How decisions are made.

This is useful identifying a need to modify the marketing strategy, identifying how participants are targeted and how program facilitators are utilized and the effectiveness of materials used.

Impact Evaluation

This type of evaluation assesses the impact of the interventions on the population targeted.  It measures:

  • Have participants demonstrated any behavioral or biometric changes using objective measures such as blood pressure readings, HRAs and changes in the numbers of smokers.
  • Are there changes in knowledge, attitudes and behavior can also be measured using pre and post participation questionnaires.
  • Combine with biometric data for complete picture.
  • The results from impact evaluation may be used to guide program planning moving forward

Outcomes Evaluation

Every once in a while, we have to step back and look at the big picture. Outcomes evaluation helps us do this. The outcomes results we hope to measure are:

  • Have there been any changes in the organization such as cost-effectiveness, cost benefit and return on investment.
  • The variables to examine are productivity, absenteeism, employee moral and utilization of health care.
  • If it’s not feasible to do, existing literature may be used as support for the organizational benefits from program outcomes.
  • Typically outcome evaluation takes place yearly with a snapshot of the organization taken in the beginning compared to the snapshot a year later.

Where to start?

Start by taking the time to develop an evaluation strategy and plan. Use the same business planning processes you use for other aspects of your business to:

  • Determine evaluation objectives.
  • Identify the programmatic components to be evaluated.
  • Identify proposed evaluation methods for each program objective.
  • Identify evaluation tools.
  • Identify how the evaluation results will be used.

In the long run, when you are asked ‘is your program working and providing results’, your evaluation efforts will help you answer the question.



To create a meaningful wellness program that will align with the specific health needs of your company and engage employees in a culture of wellness, it is important to create a Wellness Committee made up of volunteers from all areas of your workforce.

A Wellness Committee represents all stakeholder groups who will ultimately participate in your wellness program, from management to shift workers and is led by an appointed “Wellness Champion,” who should be someone who has the ability to develop agendas, keep the team on task , define priorities, and effectively communicate with, and motivate others. The Wellness Committee members are the advocates for workplace policies and environment changes that support the wellness program. Most importantly, they serve as champions and role models for the program by actively participating in the Wellness Program and encouraging fellow employees to do the same.

Managerial support of the Wellness Committee and its recommendations is paramount to the success of any wellness program. The responsibilities of the Wellness Committee must be considered by management to be a part of their job descriptions and, thus, should be fully supported and subject to performance review.

The reason a Wellness Committee is so important to the sustainability of a worksite wellness program is that it makes it personal. Rather than presenting a pre-packaged set of activities that any company could do, it creates a sense of ownership for the wellness program and allows it to form into something unique to your company and your employees.

 ImageDubai recently launched an initiative to pay chunky citizens real gold to lose weight, as part of the United Arab Emirates’ efforts to curb the obesity epidemic.  I would guess they will have some success in the short term, but I would be curious to see if contestants keep the weight off.

Various monetary incentives are becoming a larger and larger part of the wellness culture.  Wellness professionals would love employees to be motivated by a desire to not become sick.  However, for most people the possibility of maybe getting sick somewhere in the future causes their motivation to also move to “sometime in the future”. The prospect of an immediate reward is much more motivating.

I am not against incentives.  They can be used successfully. However, before going down that road it is important to understand the plusses and minuses of using incentives.

Plus side

  • Incentives have been shown to be powerful tools for short term, easy to accomplish behavior (flu shot, complete a health assessment).
  • Incentives often increase participation.  Participation can be a first step toward lasting behavior change.

But their usefulness may be limited in regard to more complex, deep-seated behaviors.


  • Paying incentives may become economically unsustainable over long periods of time.
  • Incentives are not shown to work for long-term maintenance of behavior change.
  • Incentives can encourage the potential for unintended negative consequences (cheating, short cuts and unethical behavior).
  • Incentives may be construed as an entitlement and potentially reduce motivation and appreciation for the wellness program.

Incentives should be one element, among many, in driving engagement, participation and sustained behavior change.  It should not be the primary mechanism to drive outcomes. 

If not incentives, then what?

  • Create a supportive culture.  Provide opportunities to give and receive social support (promote team challenges, buddy systems).
  • Provide an environment where the healthy choice is the easy choice (such as, healthy vending and cafeteria food, walking paths or exercise classes at the workplace).
  • Provide comprehensive communications: tell them, tell them, and tell them again.
  • Implement relevant programs.  Use a needs and interest survey to find out what is of interest to your employees.
  • Use recognition as a reward.
  • Make the wellness program part of the culture.  It should be part of recruitment, onboarding, safety, community affairs, productivity, etc.

The true cost of making something as deeply personal as health choices about money, is a culture where it’s more difficult for people to want to do something good for themselves (just tell me what I need to do to get the money).  According to positive psychology research, one of the key elements for true happiness or well being, is pursuing items for their own sake, not merely to get anything else.

Valorie Bender, CWPM


NY Daily News (last updated July 22, 2013). Dubai paying citizens gold to lose weight in fight against obesity.  Retrieved July 22, 2013, from

Terry, P.E. PhD, Serxner, S.A., PhD, MPH, Moller, A. PhD, Spring, B.A. PhD. The Motivation Issue.  The Art of Health Promotion, March/April, 2013.

Witherspoon, Reese, How to Create an Environment Where Intrinsic Motivation Can Flourish. Last updated July 17, 2013. Health Enhancement Systems. Retrieved July 22, 2012 from

Seligman, Martin E. (2011).  Flourish A Visionary New Understanding of Happiness and Well Being. New York, N.Y.: Free Press.


Many companies have random and intermittent wellness activities, which are usually independent of each other and are short puzzle1term oriented. Far fewer companies have sustainable wellness programs resulting in changing behavior, lowering health risks and providing a positive economic return.

The key to having the later is making the effort to have an Administrative Infrastructure in place for the wellness program.  Administrative Infrastructure refers to the assortment of personnel, policies, procedures, and resources in place to support the wellness program.  This type of structure is required to bring about long-term cultural and organizational change.

Think of the infrastructure as the core pieces of your program. There are 16 key components, which make up a complete administrative infrastructure.

Program Design

–       A design team is established to help create the initial design of the program.

–       Budget planning

–       Proposals

–       Vendors

–       Wellness program work plan (what are the activities, who is responsible)

–       Program Brand (should include a logo and tag line)

–       Program Goals

–       Program Objectives

–       Ongoing evaluation

Program Operations


–       Wellness Program Coordinator or Manager

–       Wellness Advisory group (to make decisions, approve budgets)

–       Support Staff (admin, health coaches, educators etc.

–       Employees wellness network (the feet on the ground to help coordinate)

–       Ad hoc teams (as needed for special projects)

Internal System Support

–       Email support

–       Wellness Website

Not all organizations will have all components.  The larger the organization, the more complete the infrastructure will need to be.  Regardless of the size of your organization, if your wellness program is not achieving measurable results, take a hard look and ask the question – Do you have only wellness activities or do you have a solid plan and the pieces in place to implement that plan?  Then take a look at each of the 16 elements, and see what is missing and can be incorporated into your program. The good news is you don’t have to implement everything at once.  Infrastructure should be built in phases and should change over time.  As your wellness program matures the infrastructure should mature right along with it.

Source: Chapman, L. (2009). Building a Sustainable Administrative Infrastructure for Worksite Health Programs. The Art of Health Promotion, November/December 2009



Depression. The topic few like to discuss. However, this disease affects many lives and businesses. Depression as defined in the Merriam Webster dictionary:

(1) : a state of feeling sad : dejection (2) : a psychoneurotic or psychotic disorder marked especially by sadness, inactivity, difficulty in thinking and concentration, a significant increase or decrease in appetite and time spent sleeping, feelings of dejection and hopelessness, and sometimes suicidal tendencies

With a definition like this, is it any wonder few discuss this topic. However, opening discussion and creating awareness about depression is necessary for the health of employees and the business’ bottom line. The Journal of the American Medical Association draws the sobering conclusion, that depression costs employers $44 billion a year in lost productivity. Those are strictly indirect costs; and do not begin to reflect medical costs.

Work is a big part of our lives. Depression can affect employees’ abilities to perform their jobs efficiently. The inability to concentrate fully or make decisions can lead to safety risks, accidents or costly mistakes. Other problems can include absenteeism, alcohol and drug abuse, or morale issues.

If five or more of the following symptoms persist for more than two weeks, medical attention may be called for:

  • Sleeping too little, or too much, difficulty falling or staying asleep
  • A persistent sad, anxious, or empty feeling
  • Markedly diminished interest or pleasure in almost all activities
  • Reduced appetite or weight loss or increase appetite and weight gain
  • Fatigue or low energy
  • Difficulty concentrating or remembering things, indecisiveness
  • Feeling of worthlessness or excessive guilt
  • Restlessness, irritability

Fortunately, depression is not a life sentence. It is a very treatable condition.

If you suspect an employee is depressed, approach the employee and offer your support:

  • Confront the situation quickly in a caring and gentle way.  Express genuine concern.
  • Be empathetic and non-judgmental.
  • Listen.  Everyone has a story and wants to be heard. Do not try to solve the problem.
  • Provide a solution.  Refer the employee to the Employee Assistance Professional or have a referral to counselors available.
  • Follow up and provide a supportive environment.

In eighty percent of cases, successful treat is possible for people with clinical depression. With recognition, intervention and support, most employees can overcome their depression and push forward with renewed energy.

Vicki Prussak B.A., CWPM, ACE

Certified Wellness Coach


Sources:  Depression. 2013. In  Retrieved April 2, 2013, from

Stewart WF, Ricci JA, Chee E, Hahn SR, Morganstein D. Cost of lost productive work time among US workers with depression. JAMA. 2003 Jun 18;289(23):3135-3144.  Retrieved from




I’m lucky. Or at least I consider myself lucky. I have help with the small tasks in life that I don’t always want to do. For me that task is grocery shopping. In my household, I get lots of help when it comes to the grocery shopping. That is a good thing, since I’d rather do 100 other things than grocery shop. But it also has its drawbacks. As a result of someone else doing the shopping, all sorts of foods end up in the refrigerator and cabinets that I would not normally buy (think: chips, hot dogs, salami, pickles, ice cream). And even though I wouldn’t buy them, once they appear within arm’s reach, it is tempting to eat these things. Well, maybe not the hot dogs!

Without realizing it, our families, friends and others we interact with regularly have significant impact on our health behaviors. The way our families come together, the way we talk together as family and friends about our health choices and they way we support and encourage each other, all work to influence our health behaviors.

In my recently published article “Family Wellness: The Power Is in Being Healthy Together” in the American Journal of Health Promotion, these key points address the impact of how we can work together as families to be healthy together:

  • A sense of community. Some family members may have grown apart. Where this is the case, wellness could be a mechanism for getting reacquainted. Wellness initiatives could be organized in such a way that family members have opportunities to help one another. While family members may not share the same lifestyle goals, they can be an important source of mutual support.
  • A shared vision. Many families could benefit from a sense of broader meaning and purpose. Health and wellExtended Family Group In Parkbeing could be that purpose. A family might be inspired by the aspirations of individual family members to, for example, be a competitive athlete, recover from an illness, or do well in school. The high costs associated with medical care and lost work may make wellness an economic necessity within the family system. Other inspirational family goals are likely to have a lifestyle component. For example, the family might join together to promote peace, social justice, or a healthier planet.
  • A positive outlook. A family wellness initiative could be the catalyst for a “can do” philosophy within a family. An emphasis on achieving wellness goals makes it possible to better appreciate achievements. In addition, wellness activities offer ready opportunities for families to enjoy time together.

A family does not necessarily mean the traditional nuclear family of our past. Your family may be the people you live with, your team at work, or a group of people with whom you regularly socialize.

Bring your family together and be well.



When employers develop work-site health promotion programs they often begin with healthy eating or physical activity campaigns.  While exercise and eating right will always be standard programs, organizations forget to promote current benefits. These benefits can have an impact on their employee population’s health; specifically, dental benefits.  There is a proven connection between oral health and medical cost savings.

After analyzing five years of health claims, a 2008 study by the University of Michigan School of Dentistry and the Blue Cross Blue Shield Foundation of Michigan showed that for people with diabetes, getting regular periodontal services can lower overall medical and pharmacy costs by more than 10% and Diabetes-related medical costs could be lowered by as much as 19%.

Other studies have indicated a person with periodontal disease is up to four times more likely to develop heart disease and have twice the prevalence for diabetes than those without periodontal disease. Pregnant women with periodontal disease are at an increased risk for preterm births and low birth weight babies.

So in addition to starting new programs, consider promoting current benefits. Most dental problems do not become painful or visible until they are highly advanced.  At that point treatment can be time consuming and expensive. In comparison, the cost of basic oral hygiene is low.  It benefits all to encourage employees to have regular preventative visits to keep problems at bay.

Consider these options to encourage dental visits.

  • Advertise your dental benefits. 
  • Educate your employees about the link between oral health and other health issues.
  • Bring dentists on site.
  • Award a new electric toothbrush to employees who get their annual check up.
  • Promoting your existing dental benefits is a low cost, easy campaign, which can result in measurable results.




We’ve all heard of the 99 percent, but what about the 80 percent? 80 percent of the US adult population has some form of periodontal disease. [1] Periodontal disease, which is defined as an inflammation of the tissues supporting the teeth, can be easily prevented or managed through performing good oral health habits.

Although our dental care may seem like a less integral aspect of our physical health, the truth is quite the opposite. Our mouths are at the center of our lives, allowing us to eat, drink and speak. Although our mouths are essential for living fulfilling lives, our care for our oral health often falls behind other elements on our master checklist.

Not only is it important to participate in preventive oral health so that the normal functions of our mouth are not disturbed, it is also important to brush twice a day, floss, and visit the dentist regularly to prevent other health complications such as heart disease and stroke.

Heart disease and stroke? That’s right, oral health is indeed tied to the health of the rest of the body. People with periodontal disease are almost twice as likely to suffer from coronary artery disease. [2] Bacteria and plaque build up in our mouths can cause build-up in our blood as well, contributing to clot formation and inflammation of arteries.

We can take care of our oral health by brushing our teeth twice a day, and flossing regularly. Visiting a dentist frequently is essential for preventing infections, and other costly complications. Eating a balanced diet is important for maintaining good oral health just as it is for the rest of our body. Monitoring sugar intake and staying away from sugary drinks, such as sodas reduces the risk of cavities and leads to healthier teeth.

Although these things may seem less important than getting in your daily amount of physical activity, a few minutes brushing and flossing each day will go a long way. An investment in your oral health not only guarantees a brighter smile, but an overall healthier you. So start giving your mouth the attention it deserves.

[1] American Dental Association, 211 East Chicago Ave, Chicago, IL 60611

[2] American Academy of Periodontology. 737 N. Michigan Ave., Suite 800, Chicago, IL 60611

Kay Monks

Kay is a senior at American University in Washington, D.C, where she is enrolled in the Health Promotion Education program. Kay has been an intern with AdvancingWellness since early 2011.