Chapter One
Building a Workplace Wellness Program
What is wellness?
Wellness is more than just the absence of illness. Over the years, the term
evolved and has been re-defined many times. Now, definitions of wellness vary
widely. We choose to use the following:
Wellness is an intentional choice of lifestyle characterized by personal responsibility,
balance, and maximum personal enhancement of mind, body and spirit.
In the not-so-distant past, pneumonia, tuberculosis, and diarrhea were the
major threats to our lives and health. Public health measures and the discovery
of antibiotics reduced both the prevalence – and the seriousness – of these
diseases. Today's major killers (heart disease, cancer and stroke – along with
accidents for younger folks), have proved resistant to these traditional solutions.
In fact, there are no simple cause and effect relationships between these diseases
and bacterial, viral, and/or environmental conditions. The chart to the right
indicates, lifestyle – the simple, everyday choices, made about how we eat, sleep,
relax, exercise, drive, smoke, etc. – is the largest single contributor to present day
illnesses and untimely deaths.
Causes of illness and
untimely deaths
Lifestyle
51%
Heredity
& Other
Biological
Causes
20%
Environment
19%
What is health risk?
The wellness approach to health is, in fact, based on the “health risk” approach
to disease. The concept of health risk comes from the scientific observation
that most of our major illnesses are associated with factors that predispose an
individual to developing a particular disease or dying from a particular cause.
While some health risk factors are outside of an individual’s control (like age,
gender, ethnicity, family history, and certain other environmental factors) many,
in fact most, are the result of individual choice (like tobacco use, physical activity,
food choices, and other preventative measures like regular health screenings).
Inadequate
Health Care
10%
AWC’s 2004 claims analysis has identified exercise, weight, and stress as the
top 3 risk factors for the AWC population at-large for each of the three years
2001 – 2003, (all highly modifiable risk factors). To position wellness programs to
have the greatest impact, it is important to understand the risks of the employee
population. The aim is to increase the percentage of low risk employees to drive
health care spending down as health risks drive health costs.
May 2010
Chapter 1 Workplace Workplace Wellness Planner
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In addition, wellness programs help to prevent the migration of low risk
employees from becoming high risk. The chart below depicts how risk factors
translate to health care costs by comparing the average spending for an individual
at high risk for each risk factor.
Health care costs increase for individuals at high risk
3000
$3000
Annual health care spending
$2500
2500
$2535
2001 – 2003
$2000
2000
$2085
$1747
$1500
1500
$1263
$1000
1000
$1256
$1116
$837
500
$500
0$0
$568
Depression
Blood
Pressure
Stress
Diabetes
Exercise
Cholesterol Tobacco
Weight
$496
Nutrition
Source: AWC Claims Analysis, 2004, Summex Health Management
An Overall Wellness Score is calculated from risk factors and health behaviors
for each individual who completes the health risk assessment questionnaire.
A person with a score of 80 or below is considered to be at elevated risk for
developing chronic disease that can greatly affect health care spending and quality
of life. The Overall Wellness Score is based strictly on modifiable lifestyle habits.
As the graph below indicates, 55% of participants have a wellness score placing
them at elevated risk for one or more risk factors.
Overall wellness score shows
elevated risk for 55% of participants
100%
90%
80%
70%
60%
50%
40%
33%
30%
21%
20%
10%
0%
14%
11%
Under 75
75 – 79
80 – 84
85 – 89
Overall Wellness Score
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Association of Washington Cities
20%
90 – 100
Risk factors for the top three causes of death
Controllable risk factors:
Non-controllable risk factors:
Cardiovascular • Cigarette smoke
• High blood pressure
Disease
• High blood cholesterol levels
• Physical inactivity
• Other contributing risk factors: diabetes, obesfty.
stress
•
•
•
•
Heredity – family history of heart disease
Ethnicity
Gender
Age
Selected Cancers
Lung Cancer
Controllable risk factors:
• Smoking
• Exposure to: asbestos, arsenic, certain organic
chemicals, radiation, radon, side stream cigarette
smoke
Controllable risk factors:
Non-controllable risk factors:
Colon and Rectum Controllable risk factors:
• Inflammatory bowel disease
Cancers
• High-fat and/or low-fiber diet
Non-controllable risk factors:
Controllable risk factors:
Non-controllable risk factors:
Controllable risk factors:
Non-controllable risk factors:
Breast Cancer
• Never had children or late age at first birth
• Higher education and socioeconomic status
• Diet – especially high fat intake
Skin Cancer
•
•
•
•
• Heredity – family history of cancer or
polyps of the colon or rectum
• Excessive exposure to ultraviolet radiation
• Occupational exposure to coal tar. pitch, creosote,
arsenic compounds, or radium
Prostate Cancer
• High dietary fat intake
Uterus and Cervix
Cancers
Controllable risk factors:
Accidents
Controllable risk factors:
•
•
•
•
Over age 40, increases with age
Heredity – family history
Early age at menarche
Late age at menopause
• Fair complexion
• Incidence increases with age – over 80% of
all prostate cancers are diagnosed in men
over 65
• More common in northwestern Europe and
North America
• African Americans have the highest
incidence rate in the world
Early age at first intercourse
Multiple sex partners
Cigarette smoking
Certain sexually transmitted diseases
• Lack of or improper use of seat belts or child
restraints
• Drinking while driving
• Speed over 50 mph
• Cigarette smoking
• Chronic medical condition
• Miles driven
Non-controllable risk factors:
• Age – experience
Chapter 1 Workplace Workplace Wellness Planner
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“America can only be
as strong and healthy
as its people.”
Ronald Reagan
Lifestyle does make a difference
Studies show certain lifestyle habits turn up over and over again as risk factors
(major or minor) for a number of serious diseases and medical conditions.
Research also shows evidence that lifestyle can be changed, and that the changes
reduce risks of premature death and disability. Major controllable risk factors and
how they can be controlled have been identified as follows:
Smoking
Smoking is the single most preventable cause of death in Americans and 17.1% of
adults in Washington smoke. (CDC’s Behavioral Risk Factor Surveillance System,
2006)* Smoking harms nearly every organ in the body, causing many diseases and
reduced quality of life and life expectancy. (CDC, 2004) Not smoking and staying
away from people who are smoking are the easiest way to eliminate health risks
associated with this habit.
High blood pressure
Uncontrolled high blood pressure (hypertension) is a major risk factor for
heart attack and stroke. Because there are no symptoms, only blood pressure
measurement can detect hypertension. Although there is no known cure, once
detected, high blood pressure can be controlled through diet, exercise, and, if
needed, medication.
High blood cholesterol
An elevated blood cholesterol level increases risk of heart disease: the higher
the blood cholesterol level, the greater the risk. A simple blood test can identify
high blood cholesterol levels. Cholesterol levels can be controlled through diet,
exercise, and, if needed, medication.
Physical inactivity
Lack of exercise and physical fitness is associated with obesity, heart disease,
stress, depression, digestive disorders, osteoporosis, and a number of other
health conditions. Studies show that although regular, moderate-intensity exercise
is most beneficial to one’s health, even intermittent activity provides substantial
health benefits. Out of all of AWC’s health risk assessment participants in 2007,
76.4% reported physical activity less than 4 times per week, with 13.6% reporting
no exercise at all.
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Association of Washington Cities
Stress
High level, prolonged stress is closely linked with leading causes of death and
illness, including heart attack, stroke, cancer, diabetes, back pain, accidental injuries,
alcoholism, obesity, and depression. In addition, chronic unrelieved stress, or the
inability to manage stress effectively, aggravates nearly every health condition.
According to a study by the Health Enhancement Research Organization (HERO),
stress and depression were the two risk factors associated with the greatest
medical costs. Stress can not be eliminated completely from one’s life, but a
lot can be done to prevent, manage, and control stress through exercise, good
nutrition habits, relaxation, adequate sleep, and time management.
Alcohol/substance abuse
Alcoholism is the leading cause of cirrhosis of the liver and a major risk factor
for motor vehicle injuries, depression, and suicide. Any drug that is misused will
cause health risks of some sort. Eliminating abuse will eliminate health risks
involved with using them.
Failure to wear seat belts
For individuals who drive or ride in a motor vehicle, the failure to “buckle up”
greatly increases the risk of dying or suffering major injury from a motor vehicle
accident. The simple task of putting on a seat belt and properly using child safety
restraints can greatly reduce this risk. More than 90% of adults in Washington
report wearing their seat belts most of the time. (Source: CDC’s Behavioral Risk
Factor Surveillance System, 2006)
Obesity
Recent estimates indicate that 60.7% of adults in Washington State are
overweight (36.5%) or obese (24.2%). (Source: CDC’s Behavioral Risk Factor
Surveillance System, 2006) * In 2007, 64% of AWC’s health risk assessment
participants were overweight or obese. Also, there has been an increase in body
fat levels in children and youth over the past 20 years. After infancy and early
childhood, the earlier the onset of obesity, the greater the likelihood of remaining
obese. Obesity is associated with heart disease, diabetes, hypertension, back
problems, arthritis and cancer. Maintaining appropriate weight through proper
nutrition and exercise will reduce or eliminate the risk.
Chapter 1 Workplace Workplace Wellness Planner
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Statistically, if there are 100 people in
your city or department . . .
These figures have
been calculated using
AWC’s 2007 health risk
assessment aggregate
4 have diagnosed diabetes
8 have depression
11 have high blood
pressure
11 have anxiety
report.
12 use tobacco
20 engage in high risk
alcohol behaviors
23 have allergies
26 have moderate or
severe symptoms of
depression
28 have elevated
cholesterol levels
30 are at elevated risk for
cardiovascular disease
44 are considered prediabetic
57 are at risk for stress
related disorders
64 are overweight or
obese (BMI greater than
25)
76 are inactive
= 5 people
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Association of Washington Cities
93 do not meet
recommended nutritional
guidelines
Building the case for wellness
Total disability lost-time
The cost of poor health
In 2005, the AWC State of the Cities Report cited health care costs as one of the
top issues impacting city budgets. Concern continues today as health care costs
for Washington cities rose by 168% from 1997 – 2007. Even though health care
trends have relaxed in recent years, the reality is that projected healthcare trends
of 9 – 12% annually for the next several years is still 4 – 5 times the rate of
general inflation (2.4% as of July 2007).
costs exceeded medical
costs by 58%
Other direct costs to the employer associated with unhealthy
employees include salaries to the absent employees – as well as added
stress to coworkers and the cost of temporary replacement and administrative
costs during their absence. The nation experienced a 25% increase in worker
absenteeism in the 1990’s, a trend that is expected to continue, according to Total
Health Advocacy Partners (2002), providers of employee health management
programs for large employers.
Another disturbing trend for employers is disability lost-time, which
exceeded medical care costs in 2000. Base on data accumulated by the Centers
for Disease Control and Prevention (CDC) National Health Interview Survey,
the Work Loss Data Institute completed a benchmarking evaluation of disability
costs to U.S. employers. The study revealed that for all conditions combined, total
disability lost-time costs exceeded medical costs by 58%.
More difficult to measure are the indirect costs resulting from reduced
productivity, diminished work quality, accuracy and safety, or presenteeism.
Workers are at work by not fully engaged in their jobs due to a host of reasons
such as being sick, fatigued, in pain, stressed or distracted by personal issues.
Presenteeism is viewed as the opposite of absenteeism; employees being at work
when they should be at home.
Using a Worker Productivity Index to measure the indirect costs to
employers, one research group was able to demonstrate statistically that the
more health risks employees have, the lower their productivity (Burton, et
al., 1999). In a comparison of low-risk coworkers at ten companies, high-risk
employees cost more in medical claims, disability and workers’ compensation.
They have a higher ratio of absenteeism and lower rate of productivity (UM/
HMRC, 2000). In AWC’s 2004 analysis of HealthCheck Plus participants,
absenteeism rates decreased as health risk decreased.
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Examples of the cost of poor health in workers:
• The Centers for Disease Control (CDC) reported in 2002 that a smoking
employee will cost employers on average $1,760 in lost productivity and
$1,623 in excess medical costs per year.
• The absenteeism rate for smoking employees is on average 50% more than
for nonsmoking coworkers.
• Estimates indicate that stress costs approximately $200 billion annually
in decreased productivity, higher health care costs and higher absenteeism
(Brown, 1998)
• Heart disease accounted for 61% of all health care spending in 2001, an
estimated $498 billion (CEC, 2002)
• The indirect cost of lost productivity related to heart disease is projected to
exceed $129 billion in 2002 when tabulated (American Heart Association).
• The average annual per capita increase in medical expenditures and
absenteeism associated with obesity ranges between $460 and $2,500
per obese employee, with costs increasing as body mass index increases.
(American Journal of Health Promotion 2005)
• Back injuries cost business $10 – $14 billion in workers’ compensation
expenses and approximately 100 million work days each year, according to the
National Institute for Occupational Safety and Health (2002).
• Worksite injuries due to alcohol and drug abuse are associated with 40%
of industrial fatalities (HR Focus, 1997).
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Association of Washington Cities
Workplace wellness makes an impact
Employers are being forced to get involved in medical cost management. Cities
in Washington encourage more healthy behavior by employees and many are
considering options for incentives that encourage employees to make cost
effective health care choices.
The cost savings of workplace health promotion have been well documented in
many studies. The overwhelming result: Changes in cost follow changes in risk.
Medical costs decrease with increasing wellness score
$2817
Annual medical costs
$2700
$2508
$2369
$2200
$2087
$1800
$1643
$1700
$1415
$1200
Research conducted at General
Motors by the University of Michigan
has demonstrated the inverse
relationship between a health risk
assessment’s “wellness score” and
annual medical expenditures. As the
“wellness score” increase, the health
care costs decreased.
Source:Yen L, McDonaldT, Hirschland
D, Edington, DW. Association between
wellness score from a health risk appraisal and prospective medical claim costs. J Occup
Environ Med. 2003; 45(10):1049-1057
65
70
75 80
85
Wellness score
90
95
A review of 73 published studies of worksite health promotion programs
documents an average $3.50 – $1 saving-to-cost ratio in reduced absenteeism
and health care costs. (Aldana, American Journal of Health Promotion, 2001)
A meta-review of 42 published studies of worksite health promotion programs
(Chapman,The Art of Health Promotion, 2003):
• Average 28% reduction in sick leave absenteeism
• Average 26% reduction in health costs
• Average 30% reduction in workers’ compensation and disability management
claims costs
• Average $5.93-to-$1 savings-to-cost ratio
Chapter 1 Workplace Workplace Wellness Planner
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Savings per dollar invested in worksite
health promotion programs
Each $1 invested bought the following returns:
From AWC’s 6-year returnon-investment analysis on the
HealthCheck Plus program
$4.50 was saved in excess health costs
and reduced absenteeism
A comprehensive health
management program at
Citibank
$4.56-$4.73 to $1 in savings-to-cost
ratio in
reduced total health care costs
From a review of 13 studies of
worksite health enhancement
programs
$3.48 to $1 (average) in reduced
health care costs
A blood pressure control
program at General Motors
$3.10 to $1 in savings-to-cost ratio in
reduced absenteeism (year 2)
$5.82 to $1 (average) in lower
absenteeism costs
A medical self-care (demand
management) program offered at
Union Pacific Railroad
$2.78 to $1 in savings-to-cost ratio in
reduced outpatient costs (non-chronic
conditions)
$3.90 to $1 in savings-to-cost ratio in
reduced absenteeism (year 3)
A comprehensive mass
communication program
with field coordinators at The
Travelers
$4.50 to $1 saving-to-cost ratio
in health care savings, decreased
absenteeism, and increased
productivity
Disease management
interventions
$1.25 to $2.94 in savings-to-cost ratio
in reduced medical care costs
Sources: AWC 2004 Claims Analysis; Partnership for Prevention, Leading By Example,
Executive Summary, www.prevent.org.
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Association of Washington Cities
Nationally, the move towards worksite health is being recognized as imperative;
here in Washington State, cities are a major part of that movement. Since the
mid-80’s, each year, more cities initiate worksite wellness programs. In 2006,
88% of AWC Employee Benefit Trust member cities participate at some level in
employee wellness programs.
From the 2002 study by Hewitt Associates (Health and Productivity Programs
Continue to Grow in Popularity as Health Care Costs Rise, 7/02), here are
the types of activities that a growing number of employers are offering their
employees:
• 72% provide education or training through seminars and counseling for
lifestyle habits.
• 42% offer financial incentives for program participation: or disincentives
(e.g., higher premiums for smokers, or a lower payout for not using a seatbelt
while in an accident).
• 28% administer health risk appraisals to analyze individual health and
promote early detection of preventable conditions (online applications make
this process relatively easy and affordable).
“The City of Bainbridge
Island Wellness Program
offers a point-based
incentive system for
employees that exercise
regularly or quit
smoking.”
Marja J. Preston, AICP, Planner and Wellness
Coordinator, City of Bainbridge Island.
• 75% use health screenings primarily to detect high blood pressure,
cholesterol, breast cancer and other conditions through health plans, fairs or
mobile units.
• 79% offer special programs, such as flu vaccinations, education in prenatal
care and well-baby/child care, and disease and medical management (e.g.,
diabetes, asthma, arthritis).
• 81% sponsor additional activities designed to heighten awareness of
health behaviors. These activities include a smoke-free workplace (57%), onsite
fitness facility (35%), company sports teams (30%) and health club discounts
(23%).
Chapter 1 Workplace Workplace Wellness Planner
11
Wellness benefits everyone
High level city
wellness program
equals lower costs
$4000
Wellness programs can present many benefits for employees, employers and
their community.
$3785
$3500
$3349
$3374
$3142
$3000
$2522
$2311
2001
l
2002
• Increased knowledge about the
relationship between lifestyle and
health
• Increased opportunity to take
control of their health and medical
treatment
$2500
$2000
Benefits for employees:
2003
High level program u Low-moderate
Cities with a high level of wellness
programming show health costs
markedly below cities with low-tomoderate wellness programming
efforts; the average savings over
the study period was nearly $300
per person per year.
• Improved health and quality of life
through reduction of risk factors
• Fewer on-the-job accidents
• Reduced premature retirement
• Decreased health care
utilization
• Stabilized health benefit costs
Benefits for community:
• Increased opportunity for support
from co-workers and environment
• Complements and reinforces
national and regional public health
initiatives
• Reduced absences
• Reduced illness and accidents
• Reduced medical costs
Benefits for employers:
• Increased worker productivity
• Informed, health care costconscious workforce
• Positive public relations
• Recruitment tool
Association of Washington Cities
• Reduced disability claims
• Increased morale via management's
interest in their health and wellbeing
• Increased worker morale
12
• Opportunity for cost savings via:
• Reduced absenteeism
• Contributes to establishing health
as a norm
• Provides a model for other area
organizations
• Improves quality of life of citizenry
• Helps control (and possibly reduce)
the economic and social burden on
all tax payers of premature death
and disability
The worksite is also an ideal location for wellness activities from the perspective
of program effectiveness. Since adults spend most of their waking hours at work,
what better place to reach them? Lifestyle change is a slow, incremental process.
It requires information, commitment, and support – over time – to be effective
for most people. Among the many documented advantages of offering wellness
programs to people where they work are:
“The commitment of
the City Council and
members of management
has made the City’s
• The high rate of voluntary participation
program active and alive
• The ability to work with large groups of people over an extended period of
time
with great potential for
• The presumption by employees that if their employer sponsors a program it
must be valuable
future growth and an
• The perception of the programs by employees as an additional employee
benefit
ever-increasing level of
• The opportunities for mass communication
participation.”
• The opportunities to create social support for behavior change on an
individual and group basis
Karen Sires, Human Resources Manager and
• The potential for economic return to the employer and the employee – a
healthier employee spends less out of pocket.
Wellness Coordinator, City of Pullman
It's clear that wellness at the worksite is a trend that has yet to reach its full
potential. It's also clear that wellness at work is a win/win situation. Employers
win employee appreciation, an enhanced community and professional reputation
and a healthier bottom line. Employees win better health and an overall higher
quality of life.
Chapter 1 Workplace Wellness Planner
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What is a workplace wellness program?
Workplace wellness programs are an organized effort intended to foster
awareness, influence attitudes, and identify alternatives, so that individuals can
make informed choices and change their behavior to reach an optimal level of
wellness. (Remember that wellness is an intentional choice of lifestyle characterized
by personal responsibility, balance and maximum personal enhancement of mind, body
and spirit.)
Dr. Bill Hettler, co-founder of the National Wellness Institute has identified six
dimensions of wellness which extend far beyond the well-known physical aspects
of health. The six dimensions are described below.
• The physical dimension covers the most commonly understood
aspects of health including physical activity, diet, nutrition, smoking, drugs,
and alcohol consumption. Physical wellness is characterized by the belief that
it is better to consume foods and beverages that enhance good health rather
than those which impair it.
• The spiritual dimension recognizes our search for meaning and
purpose in human existence. Spiritually well people believe it is better to
live each day in a way that is consistent with their values and beliefs than to do
otherwise and feel untrue to themselves.
• The intellectual dimension explores issues of problem-solving,
creativity and learning. People who are intellectually well feel it is better to
stretch and challenge their minds with intellectual and creative pursuits than
to become self-satisfied and unproductive.
• The social dimension encourages contributing to one’s environment
and community. Social wellness is modeled by living in harmony with
others and our environment rather than in conflict with them.
• The emotional dimension recognizes awareness and acceptance of
one’s feelings. It includes the degree to which a person feels positive and
enthusiastic and is able to cope with stress.
• The occupational dimension recognizes the need for personal
satisfaction and enrichment in one’s life through work. Occupational
wellness may be found by choosing a career which is consistent with personal
values, interests and beliefs.
What should your wellness program look like?
It is natural to look around at other programs and wonder, “What should our
program look like?” and “What is a successful program?” It would be nice if there
were perfect, straight forward answers to these questions. However, nothing is
ever that simple. The process for developing a successful program is the same for
everyone, but no two programs will ever end up looking exactly the same.
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Association of Washington Cities
To achieve the kind of success documented in the studies referenced earlier in
this chapter, a wellness program needs the following elements:
• Detailed plan with a committed leader
• Senior-management and elected official commitment to make it work
• Coordinated effort among departments
• Solid foundation of policies, programs, and an environment that provides
health awareness, education and behavior change opportunities for employees
Program planning
Wellness programs can include anything that helps people identify their personal
health risks to support lifestyle changes. Since the range of potential wellness
programs is enormous, it helps to have a systematic way to think about program
planning. The figure on the right provides a conceptual program planning model
that illustrates the structural components of the planning process.
Program
Planning Model
Components of the Planning Process
Foundation
• Gain management support
• Create supportive work
environment
• Form a wellness committee
• Set policies
• Create a mission statement
• Involve employees
Assessment
Design
• Inventory your internal resources
• Locate other wellness program
coordinators
• Explore AWC resources
• Inventory your external resources
• Review data
• Identify needs, interests & risks
DELIVERY
ASSESSMENT
DESIGN
FOUNDATION
• Establish program goals and
objectives
• Document a plan
• Know your audience
• Develop a means of evaluation
• Select activities & interventions
• Establish a budget
• Create a timeline and schedule
• Select vendors and materials
• Delegate responsibilities
Delivery
• Promote the program
• Provide incentives
• Launch the program
• Facilitate the activities
• Evaluate progress and outcomes
Chapter 1 Workplace Wellness Planner
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“Health is obviously so
much more than a diseasefree interlude. To be
healthy is to have a body
toned to its maximum
performance potential,
a clear mind exploding
with wonder and curiosity,
and a spirit happy and at
peace with the world.”
The AWC Well City Standards
AWC has identified nine steps that are necessary to building a workplace
wellness program that has impact. They are expressed as the AWC WellCity
Standards and serve as chapter headings for the remaining nine chapters in this
Planner. If you follow these standards as guidelines, you will see your program
take shape as you build upon a strong foundation with careful assessment and
design steps before moving on to implementation and delivery.
Keep in mind that as you build your program, you may not move through the
chapters sequentially, one at a time. Some chapters build on each other, while
others work together simultaneously. As you explore each element of the
program planning process you find yourself moving back and forth through the
chapters.
AWC WellCity Standards
1. Developing Policies & Procedures
2. Gaining Management Support
3. Creating a Wellness Committee
Dr. Patch Adams
4. Weaving Your Wellness Network
5. Assessing Program Needs
6. Building an Infrastructure of Health
7. Forming an Operating Plan
8. Planning Activities and Interventions
9. Evaluating Progress & Outcomes
These standards cover the four components of AWC’s program planning model
which is highlighted at the beginning of each chapter.You’ll notice some chapters
play a roll in multiple components. Within each chapter you’ll find instructions,
assessments, guidelines, resources, and worksheets designed to help you create a
successful workplace wellness program.
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Association of Washington Cities
Exhibit 1-1
Workplace Wellness Program Resources
Leadership for Healthy Communities
www.activelivingleadership.org
Centers for Disease Control Healthier Worksite Initiative
Policies, toolkits, resources, program design.
www.CDC.gov/hwi
National Wellness Institute
www.nationalwellness.org
Professional Assisted Cessation Therapy (PACT)
Employers’ Smoking Cessation Guide: Practical Approaches to a Costly Workplace Problem
www.endsmoking.org
Partnership for Prevention
www.prevent.org
Wellness Councils of America
www.welcoa.org
Chapter 1 Workplace Wellness Planner
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Association of Washington Cities