CME A VAILABLE FOR THIS ARTICLE AT ACOEM.ORG Seven-Year Trends in Employee Health Habits From a Comprehensive Workplace Health Promotion Program at Vanderbilt University Daniel W. Byrne, MS, Ron Z. Goetzel, PhD, Paula W. McGown, MSN, MAcc, RN, FNP-BC, CPA, Marilyn C. Holmes, MS, RD, LDN, Meghan Short Beckowski, MPH, Maryam J. Tabrizi, MS, Niranjana Kowlessar, PhD, and Mary I. Yarbrough, MD, MPH, FACOEM, FACPM Objective: To assess long-term changes in health risks for employees partici- pating in Vanderbilt University’s incentive-based worksite wellness program. Methods: Descriptive longitudinal trends were examined for employees’ health risk profiles for the period of 2003 to 2009. Results: The majority of risk factors improved over time with the most consistent change occurring in physical activity. The proportion of employees exercising one or more days per week increased from 72.7% in 2003 to 83.4% in 2009. Positive annual, monotonic changes were also observed in percentage for nonsmokers and seat belt usage. Although the largest improvements occurred between the first two years, improvements continued without significant regression to- ward baseline. Conclusions: This 7-year evaluation, with high participation and large sample size, provides robust estimates of health improvements that can be achieved through a voluntary incentive-based wellness program. I n the past three decades, US employers sought ways to stem the growth in health care costs, which were often at double-digit annual inflationary rates and incompatible with viable long-term business models. 1 This steep rise in health care spending changed the role of the employer from passively purchasing services for the treatment of disease to actively engaging in programs and benefit plan designs in attempts to control unnecessary utilization. 1 More specifically, employers have redirected their efforts at population health management and incorporating health promotion and disease prevention programs alongside more traditional case and disease management. Tools used by employers for population health manage- ment typically include extensive awareness building through health education, health risk assessments (HRAs), in-person risk reduction interventions, telephonic health coaching, Web-enabled communi- cations, social networking, and establishment of data warehouses. 2–4 From Health & Wellness, Division of Administration (Mr Byrne, Ms McGown and Holmes, and Dr Yarbrough), the Division of General Internal Medicine and Public Health, Department of Medicine (Mr Byrne and Dr Yarbrough), the Department of Biostatistics (Mr Byrne), Vanderbilt University, Nashville, Tenn; the Institute for Health and Productivity Studies (Dr Goetzel), Emory University, Atlanta, Ga; and Thomson Reuters (Drs Goetzel and Kowlessar and Ms Beckowski and Tabrizi), Washington, DC. Authors Byrne, Yarbrough, McGown, Holmes, Short Beckowski, Tabrizi, Kow- lessar, and Goetzel have no financial interest related to this study. Funding for this study was provided in part by Vanderbilt University Clinical and Translational Science Award grant UL1 RR024975 from NCRR/NIH. The contents are the sole responsibility of the authors and do not necessarily represent the official views of Vanderbilt University, Emory University, or Thomson Reuters. The JOEM Editorial Board and planners have no financial interest related to this research. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and is provided in the HTML and PDF versions of this article on the journal’s Web site (www.joem.org). Address correspondence to: Mary I. Yarbrough, MD, MPH, FACOEM, FACPM, Health & Wellness, Department of Administration, Vanderbilt University, 1211 21st Avenue South, Suite 640, Medical Arts Building, Nashville, TN 37212 (mary.yarbrough@vanderbilt.edu). Copyright C  2011 by American College of Occupational and Environmental Medicine DOI: 10.1097/JOM.0b013e318237a19c Learning Objectives  Discuss the characteristics of Vanderbilt University’s work- place health promotion program, “Go For The Gold” (GFTG).  Identify long-term effects on health risk factors such as physical activity, smoking, and seat belt use.  Discuss factors leading to the overall health improvement and risk reduction among GFTG participants. When implemented appropriately, these tools are effective in three areas: risk identification; behavioral change facilitation; and creation of knowledgeable health care consumers. While some employers have adopted these programs with en- thusiasm, others are looking critically at the evidence that expanded primary prevention can improve outcomes. For individual employers, assessing this evidence can be challenging because of the difficulty in establishing a stable, unbiased cohort within the workforce that has experienced consistent programming from which outcomes can be determined. Although the general consensus is that workplace well- ness programs can help individuals improve modifiable risk factors, 5 the current literature is often limited to data collected at two time periods (before and after a health promotion program intervention), with the second period suffering from high attrition and low partici- pation levels, many of which are less than 50%, 6 making it difficult to assess the true long-term trends in risk factors. The analysis described here attempts to overcome some of these limitations by tracking the experience of Vanderbilt Univer- sity employees participating in an incentive-based wellness program called “Go for the Gold” (GFTG) over a 7-year period. The GFTG Program, initiated in 2003, aimed to engage faculty and staff at the university in identifying their lifestyle risks and maintaining or improving those risks through dynamic programming. The pro- gram, now in its eighth year of existence, has continued with sta- ble management and consistent data collection. The longitudinal trends in lifestyle risks of faculty and staff who participated in this incentive-based program during the 7 years since its inception have been tracked and benchmarked against national and state results. The high annual participation rate in GFTG (averaging 75.5%) pro- vides a valuable database to investigate changes in risk factors and healthy lifestyle characteristics over time and to compare the results to benchmark norms. METHODS Setting and Population This is a longitudinal descriptive analysis of Vanderbilt Uni- versity employees’ health risk data for an aggregate and cohort pop- ulation during the period of 2003 to 2009. Located on a 330-acre Copyright © 2011 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited. 1372 JOEM  Volume 53, Number 12, December 2011