Community colleges as settings for promoting employee health.
Abstract: Eighty-one percent of the Presidents from the 59 campus North Carolina Community College System completed a brief survey to assess interest and current status of worksite health promotion programs. Campus tours were conducted at a convenience sample of six campuses using interviews, checklists, and environmental scans. Data were summarized using descriptive statistics. Only 27% of campuses had a wellness program in place. Campus Presidents affirmed high interest and a good fit between wellness programs and college mission. Possible barriers included limited access to healthy foods; variable access to fitness facilities; and, the challenge of accommodating part-time employees employed at geographically dispersed locations.
Article Type: Survey
Subject: Wellness programs (Health aspects)
Wellness programs (Surveys)
Community colleges (Health aspects)
Community colleges (Surveys)
Authors: Linnan, Laura
Brooks, Ashley
Haws, Susan
Benedict, Salli
Birken, Ben
French, Elizabeth
Gizlice, Ziya
Britt, Ashley
Pub Date: 03/22/2010
Publication: Name: American Journal of Health Studies Publisher: American Journal of Health Studies Audience: Professional Format: Magazine/Journal Subject: Health Copyright: COPYRIGHT 2010 American Journal of Health Studies ISSN: 1090-0500
Issue: Date: Spring, 2010 Source Volume: 25 Source Issue: 2
Topic: Event Code: 540 Executive changes & profiles
Product: Product Code: 8222000 Junior Colleges NAICS Code: 61121 Junior Colleges SIC Code: 8222 Junior colleges
Organization: Organization: University of North Carolina at Chapel Hill; University of North Carolina at Chapel Hill; American Association of Community Colleges; American Association of Community Colleges
Geographic: Geographic Scope: North Carolina Geographic Code: 1U5NC North Carolina
Accession Number: 308741499
Full Text: INTRODUCTION

Approximately 68% of U.S. adults over age 15 are employed, with full-time employees spending an average 40% of waking hours in work-related endeavors (U.S. Department of Labor, 2007). In recent years, effective worksite interventions have been shown to improve both employee health and the financial health of companies (Aldana, 2001; Goetzel, Ozminkowski, & Long, 2003; Pelletier, 2001; Pelletier & Koopman, 2007). Worksites are an important setting in which to promote adult health. Our research team investigated community colleges as potential settings for promoting health among adult employees.

Community colleges are uniquely equipped and positioned to promote adult health for the following reasons. First, community colleges are prevalent in many communities, and are found in both urban and rural settings. A total of 1,157 community colleges are located in all 50 states (American Association of Community Colleges, n.d., Community College Fact Sheet). Second, community colleges are typically part of a statewide college system. Thus, if we create effective worksite health promotion programs for community college employees, there is a built-in system for disseminating proven programs. Third, the impact of worksite health promotion programs at community colleges is likely to extend beyond employees (i.e. faculty and staff) as they serve as role models for each other and for students who attend these colleges (Jackson, Michael, & Weinstein, 1997). Finally, community colleges are settings that can accommodate comprehensive worksite health promotion programs consistent with Healthy People 2010 national guidelines (DHHS, 2000). For example, community colleges have campus facilities that could be mobilized to offer healthy and supportive social and physical environments, as well as academic programs that train individuals to provide a wide range of health and wellness-related services.

Very few research studies have taken advantage of the unique worksite setting that community colleges provide. Of those, only a handful presented information about employee health, as distinguished from student health (for exceptions see: Bucklee, 1990; Eastman, 1996; Marrow, 1993; Ness, 1997; Sink, Parkhill, & Shoemaker, 2003). Unfortunately, none of these papers provided intervention results or rigorous program evaluations, and all were limited to a single community college. Thus, in order to realize the full potential of community colleges as a setting for promoting employee health, more research is needed to understand how best to work with community colleges to offer employee health promotion programs and to clarify any potential barriers and challenges unique to this setting.

This paper describes results of formative research conducted with the 59 campuses in the North Carolina Community College System to determine the current status of their worksite health promotion efforts and to gauge the feasibility of implementing worksite health promotion programs. Implications of these results for planning, implementing and evaluating worksite health promotion programs in community college settings are discussed.

METHODS

PARTICIPANTS AND PROCEDURES

A survey and cover letter was disseminated via facsimile (FAX) to the president of all 59 community colleges in the North Carolina Community College System. The cover letter outlined the purpose of the survey, which was 1) to determine the current status of their worksite health promotion efforts; 2) to gauge the feasibility of implementing worksite health promotion programs on their campuses; and 3) to assess their interest in participating in future health promotion programming and research. Presidents completed the survey or designated a knowledgeable campus office to complete and FAX back the survey within one week. One follow-up phone call was made to non-respondents to encourage a high response rate. The survey consisted of 56 closed-ended and 5 open-ended questions. Items addressed:

1) employee demographic information; 2) campus wellness programs; 3) campus facilities/support for health promotion; and 4) computer access.

A purposive sample of six campuses was selected for onsite campus visits to a) verify data collected in written surveys; and, b) provide qualitative data that could be used for planning and implementing future worksite health promotion programs in community college settings. The six community colleges were geographically distributed throughout the state, located in both rural and urban settings, and representative of both large and small campuses. One research staff member conducted all six of the campus visits over a two month period. At each site visit, a designated campus official led a research team member on a 90-120 minute guided tour of the campus, during which the research staff member completed a brief, unstructured interview with the campus official and an environmental scan of the campus facilities including the following: presence of wellness or health promotion information; computer facilities; presence of vending machines and their contents; presence and offerings at cafeteria facilities; presence and conditions of fitness facilities; presence of walking trails; and environmental context of the campus (e.g. the immediate vicinity of the campus). Additionally, at each of the six campuses, research staff conducted an interview with the campus president and/or his designee. The interviews assessed current and past on-campus wellness activities, the respondent's level of interest in wellness, potential opportunities for faculty and staff to participate in wellness activities during work-time, faculty and staff computer access, fitness and food service facilities available on campus, and perceived barriers and supports for health promotion among faculty and staff. Written notes were summarized for each question across all six campus visits.

This study was approved by the Institutional Review Board at the University of North Carolina at Chapel Hill.

ANALYSIS

Descriptive statistics were reported on written survey results. Bivariate tests, such as chi square and t-tests, were conducted between campuses with and without a wellness program. Results of the environmental scans and interviews completed during the campus tours were summarized.

RESULTS

Forty-eight of 59 community colleges returned the survey, for an overall response rate of 81%. Figure 1 illustrates the location of the 59 campuses overall, the 48 campuses that responded to the written survey, and the 6 campuses where a site visit was conducted. Table 1 describes characteristics of the responding campuses and demographics of the employees. Overall employee turnover averaged less than 10% in the year of the survey. Responding campuses reported that 60% of employees were female, 79% were white, 17% were African-American, 2% were Hispanic, and 2% were of another race/ethnicity. In comparison, North Carolina's population in 2004 was about 68% white (non-Hispanic), 21% black (non-Hispanic), and 6% Hispanic (any race) (U.S. Census Bureau, 2008; data not shown).

[FIGURE 1 OMITTED]

Table 1 also summarizes the worksite wellness programs currently offered and the environmental and policy-related supports for employee health. For example, 27% percent of respondents (13/48) reported having a wellness program available to faculty and staff. Potential supports for worksite wellness efforts include cafeterias, at 77% of campuses, gym or fitness facilities, at 65% of campuses, and flex-time schedules, at 50% of campuses.

Table 2 compares community colleges with (n = 13) and without (n = 34) an employee wellness program. Community colleges with a wellness program were significantly more likely to have a wellness committee (61.5%); have more employees (709.5 employees/231.9 staff vs. 468.8 employees/165.1 staff); and were more likely to be located in an urban (vs. rural) county as compared to campuses without a wellness program (see Table 2). The research team assessed the feasibility of using web-based methods to offer worksite wellness programs. Importantly, 100% of campus respondents reported computer availability for staff/faculty use on their campuses; and, nearly two-thirds of both faculty and staff had access to online health programs/services during work hours (data not shown).

Campus officials at all six campuses visited expressed enthusiasm about participating in employee wellness programs and reported that they had access to staff or limited financial resources that could be utilized to develop and support worksite wellness programs. However, the onsite visits revealed several barriers to offering employee wellness programs at each campus. For example, inexpensive but high fat and high calorie food and beverage choices were prevalent at all campus visits in campus cafeterias, snack bars, bookstores, and vending machines. Easy access to many fast food restaurants was observed within a few minutes drive of all six campuses.

The most consistently reported barrier to offering traditional worksite wellness programs was low employee participation. When asked why employee participation was low, campus representatives indicated that commuting distance to campus prevented participation in activities before or after work hours. In addition, the part-time employee population presented challenges since these employees were not routinely on campus to access programs.

DISCUSSION

Community college campuses represent a largely untapped setting for promoting employee health. Community college systems are located in all US states and offer a built-in dissemination mechanism for effective health-related programming. Moreover, wellness programming is consistent with a lifelong learning mission that community colleges espouse.

We found there was both a supportive environment and infrastructure in the community colleges, as well as opportunities for intervening at multiple levels. First, although many campuses had onsite physical activity resources, such as a gym, showers, outdoor facilities, and trails, there remain opportunities for interventions to improve, promote, and facilitate employee access to fitness facilities. Secondly, the majority of campuses had cafeteria and vending facilities, but these facilities offered mostly high fat/high calorie food choices. The challenge of offering greater access to healthy food options is one that can be undertaken by working closely with contract food service providers for both cafeteria and vending machines. Health promotion interventions can focus on an increase in point of purchase advertising, labeling, and the preparation and access to healthy food options. Finally, although few colleges had an employee wellness committee, those that did were more likely to have wellness programming available for employees. Organizing an employee wellness committee and inviting representatives from key constituent groups on campus and academic program partners may be a good strategy for the long-term success of employee wellness programs and community colleges could be provided with technical assistance to support this process.

Results revealed that larger campuses, and those in urban settings, were more likely to have a wellness program in place. This finding is consistent with overall national worksite results that show that larger worksites are more likely to have all types of health promotion programming, environmental and policy supports for worksite wellness in place (Linnan, Bowling, Blakey, Lindsay, Pronk et al., 2008). Smaller, more rural campuses are likely to benefit from some specialized technical assistance to get programs underway, and employee wellness committees may be important catalysts for getting programming initiated that is tailored to the small, rural settings. Given the high percentage of part-time employees, long-commute times in rural counties, and number of satellite campuses, web-based wellness programming may be particularly well-suited to these settings. Our results indicate that virtually all faculty and staff (including maintenance and blue collar employees) have access to computers while on campus, which offers important opportunities for web-based interventions.

We also learned that several NC community colleges offer academic degree programs in health-related fields (e.g. nursing, health education, culinary arts, massage therapy, etc.) that represent important resources for campus-based wellness activities. Student nurses might offer free blood pressure screening programs for all campus employees as part of a final training or field experience. Several campus representatives were eager to discuss ways of including students and community members in planning for worksite wellness activities.

To the best of our knowledge, we have conducted one of the few studies that clarifies the challenges and opportunities of promoting health among adults employed in community colleges. Our results revealed that only 38% of participating NC community colleges in this study reported having some type of health or wellness committee in place, and only 27% reported currently having an organized wellness program for staff and faculty. Despite this limitation, the high response rate (81%) to our initial survey, our conversations with officials during campus visits, and the fact that 71% of community college presidents were willing to partner in a worksite wellness intervention, all indicate high levels of enthusiasm and support for worksite wellness programs at North Carolina community colleges.

This study had several limitations. The two-page written survey sent to all campuses was brief, consisting almost entirely of closed-ended items. A more in-depth instrument may have yielded a richer or more accurate picture of the attributes and challenges that characterize community colleges as intervention settings. To overcome this limitation, we selected a small purposive sample of six colleges and conducted a campus tour and interview with a campus official. Another study limitation is that despite having a fairly high response rate to the written survey, there remains the possibility of non-responder bias.

CONCLUSION

This study describes important formative research results to investigate the opportunities and challenges of promoting employee health in community colleges. The results suggest that community colleges have excellent potential as a place to implement comprehensive, multi-level and effective worksite health promotion programs. Community colleges are located in all US states, thus, they represent a largely untapped and under-studied worksite setting for promoting employee health. Ongoing research is needed to demonstrate how to work most effectively within these settings to promote health among employees and students.

ACKNOWLEDGEMENTS

The authors thank the UNC Center for Health Promotion Disease Prevention for support of this formative research effort. We also thank Leigh Belton (survey administration), Beth Hooten (initial data analysis) and Noel Kulik (editorial assistance). Most importantly, we thank officials at the North Carolina Community Colleges who participated in the written survey and campus tours.

REFERENCES

Aldana, S. G. (2001). Financial impact of health promotion programs: a comprehensive review of the literature. American Journal of Health Promotion, 15(5), 296-320.

American Association of Community Colleges. (n.d.). Community collegefactsheet. Retrieved December 21, 2009, from http://www2.aacc.nche.edu/research/index.htm.

Bucklee, J. (1990, May). REACH Presentation. Proceedings of the Annual Conference of the Association of Canadian Community Colleges, Charlottetown, Canada.

Eastman, W. (1996, May). Avoiding faculty burnout through the Wellness Approach. Proceedings of the Annual Conference of the Association of Canadian Community Colleges, Toronto, Canada.

Jackson, M. L., Michael, L., & Weinstein, H. M. (1997). The importance of healthy communities of higher education. Journal of American College Health, 45(6), 237-41.

Goetzel, R. Z., Ozminkowski, R. J., & Long, S. R. (2003). Development and reliability analysis of the Work Productivity Short Inventory (WPSI) instrument measuring employee health and productivity. Journal of Occupational and Environmental Medicine, 45(7), 743-762.

Linnan, L., Bowling, M., Blakey, C., Lindsay, G., Pronk, S., et al. (2008). Results of the 2004 national worksite health promotion survey. American Journal of Public Health, 98(1),1-7.

Ness, P. (1997). Understandings of health: How individual perceptions of health affect health promotion needs in organizations. American Association of Occupational Health Nurses Journal, 45(7), 330-6.

Marrow, A. J. (1993, July). The Hazard Community College "50 Mile Club." Proceedings of the Fifth Annual International Conference of the League for Innovation in the Community College and the Community College Leadership Program, Washington, D.C.

Pelletier, K. R. (2001). A review and analysis of the clinical and cost effectiveness studies of comprehensive health promotion and disease management programs at the worksite: 1995-1998 update. American Journal of Health Promotion, 16(2), 107-16.

Pelletier, K., & Koopman, C. (2003, June 15). Bringing health to the bottom line. Business and Health, 21. Retrieved December 21, 2009, from http://managedhealthcareexecutive.modernmedicine.com/mhe/ article/articleDetail.jsp?id=134250.

Research Triangle Regional Partnership. (n.d.). Research Triangle Region's Overall Major Employers. Retrieved December 21, 2009, from http://www.researchtriangle.org/data/major.html.

Sink, D. W., Parkhill, M. A., & Shoemaker, D. L. (2003). Energizing a campus: becoming a well workplace. Community College Journal, 74(1), 20-23.

U.S. Census Bureau. (n.d.). State and County QuickFacts: North Carolina. Retrieved December 21, 2009, from http://quickfacts.census.gov/qfd/states/37000.html.

U.S. Department of Health and Human Services. (2000). Healthy People 2010: Understanding and Improving Health (2nd ed.). Government Printing Office, Washington, D.C.

Laura Linnan, ScD, CHES

Ashley Brooks, MPH

Susan Haws, MPH

Salli Benedict, MPH

Ben Birken, MS

Elizabeth French, MA

Ziya Gizlice, PhD

Ashley Britt, MPA

Laura Linnan, ScD, CHES, is affiliated with the Department of Health Behavior and Health Education, School of Public Health, The University of North Carolina at Chapel Hill. Ashley Brooks, MPH, is affiliated with the Department of Health Behavior and Health Education, School of Public Health, The University of North Carolina at Chapel Hill. Susan Haws, MPH, is affiliated with the Department of Health Behavior and Health Education, School of Public Health, The University of North Carolina at Chapel Hill. Salli Benedict, MPH, is affiliated with the Center for Health Promotion and Disease Prevention, The University of North Carolina at Chapel Hill. Salli Benedict, MPH, is affiliated with the Center for Health Promotion and Disease Prevention, The University of North Carolina at Chapel Hill. Ben Birken, MS, is affiliated with the Center for Health Promotion and Disease Prevention, The University of North Carolina at Chapel Hill. Elizabeth French, MA, is affiliated with the Department of Health Behavior and Health Education, School of Public Health, The University of North Carolina at Chapel Hill. Ziya Gizlice, PhD, is affiliated with the Center for Health Promotion and Disease Prevention, The University of North Carolina at Chapel Hill. Ashley Britt, MPA, is affiliated with the Center for Health Promotion

and Disease Prevention, The University of North Carolina at Chapel Hill. Please address all correspondence to Laura Linnan, ScD, CHES, Department of Health Behavior and Health Education, CB#7440, School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7440. Tel. #: 919-963-8044. Email: linnan@email.unc.edu.
Table 1: Characteristics of North Carolina Community Colleges

Characteristics of Colleges                           Number or
                                                       Percent
                                                       (n = 48
                                                       unless
                                                       noted)

Rural (# of campuses)                                    38
Urban (# of campuses)                                    10
Number of employees (mean)                            535.7 (a)
  Full-time employees                                   221.8
  Part-time employees                                   314.0
  Faculty                                               282.4
  Staff                                                 183.9
Female (mean %)                                          60%
Turnover (2002-2003) (mean %) (n = 46)                   7%
Not covered by state health plan (mean %) (n = 47)       43%
Race/ethnicity of employees (mean %) (n = 46)
  White                                                  79%
  African-American                                       17%
  Hispanic                                               2%
  Other race                                             2%
Non-daytime (not 7am-6pm) shift workers                  28%
  (mean %) (n = 41)
Have flex-time schedule or policy                        50%
Campus based in more than one location                   69%
Have health/wellness committee                          37.5%
Have wellness program for faculty/staff                 27.1%
Cafeteria available on campus                            77%
Gym, fitness facility, or workout room on campus         65%
Walking trail (indoor or outdoor) on campus              58%
Shower/changing facilities on campus                     65%
Offered class, workshop, or event on topic
  in past 12 months?
  Heart disease                                          15%
  Nutrition                                              29%
  Blood pressure                                         33%
  Stress reduction                                       38%
  Exercise/fitness                                       42%
  Weight control                                         21%
  Cholesterol                                            27%
  Other                                                  23%
  None offered                                           25%

Note. (a) = Does not include seasonal workers.

Table 2. Characteristics of Community Colleges With/Without a
Current Wellness Program (n = 47) (a)

                                                  Current       No
Characteristics                                   Wellness   Current
                                                  Program    Wellness
                                                  (n = 13)   Program
                                                             (n = 34)

Rural (# of campuses)                               7 *         30
Number of employees (mean)                        709.5 *     468.8
Number of staff (mean)                            231.9 *     165.1
Current wellness committee (# of campuses)           8          10
Flex-time policy (# of campuses)                     9          15
Cafeteria present (# of campuses)                    12         24
Gym/fitness facility available (# of campuses)       11         19
Walking trail/track present (# of campuses)          9          18
Shower/changing facilities available (#
  campuses)                                          9          21

(a) one community college was missing data for current wellness
program

* p < 0.05
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