But when implemented, programs can improve worker health

Employees at small businesses are less likely to have access to work-site wellness programs, according to a research review in the June Journal of Occupational and Environmental Medicine, official publication of the American College of Occupational and Environmental Medicine (ACOEM).

But smaller companies that can overcome the barriers and implement wellness programs can realize achieve meaningful improvements in employee health, report Kira McCoy, BA, of Hampshire College, Amherst, Mass., and colleagues.

They write, "Preventative health initiatives and disease management receive less attention in small business, yet are equally important for clinical implications of working American's health."

The researchers analyzed the findings of 19 studies of work-site wellness programs in small business. A 2008 study suggested that less than 5% of small work-sites offered comprehensive wellness programs, compared to nearly one-fourth of larger businesses. More than half of the U.S. workforce is employed by small companies with less than 500 employees.

Costs were identified as a key barrier to starting wellness programs in small business: not only direct program costs but also indirect costs such as time and staff. Smaller companies are also less likely to offer health insurance, and thus don't have the financial incentive of lowering employee insurance premiums by improving employee health. There may also be issues related to employee privacy and perceived "meddling" in workers' private lives at smaller companies.

But the few studies that have evaluated wellness programs at smaller companies have shown reported improvements in employee health. Those studies reported improvements in outcomes including diet, physical activity, and emotional health.

McCoy and coauthors call for more into how best to disseminate effective health promotion programs to smaller companies. The availability of technical assistance and incentives for workplace wellness programs under the Affordable Care Act, "reinforces the urgent need for more high quality research that specifically addresses adoption, implementation, efficacy and sustainability of work-site wellness within small business settings."

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