title: Does Skin in the Game Matter if You Aren't Playing? Examining Participation in Oregon's Public Employee Health Engagement Model.
abstract: OBJECTIVE
  Employers are increasingly exploring health benefits that incentivize lifestyle change for employees. We used early data from an ongoing study of one such model-the Health Engagement Model (HEM), which Oregon implemented for all public employees in 2012-to analyze variation in employee participation and engagement.
  
  
  METHODS
  A survey was designed to assess program engagement, opinions of the program, and self-reported lifestyle changes.
  
  
  METHODS
  Data were collected in 2012, about 9 months after HEM launched.
  
  
  METHODS
  A representative random sample of 4500 state employees served as the study subjects.
  
  
  METHODS
  Primary measures included whether employees signed up for the program, completed its required activities, and reported making lifestyle changes.
  
  
  METHODS
  Logistic regression was used to analyze survey results.
  
  
  RESULTS
  Most employees (86%) chose to participate, but there were important socioeconomic differences: some key target populations, including smokers and obese employees, were the least likely to sign up; less educated employees were also less likely to complete program activities. Despite mostly negative opinions of the program, almost half of participants reported making lifestyle changes.
  
  
  CONCLUSIONS
  Oregon's HEM launch was largely unpopular with employees, but many reported making the desired lifestyle changes. However, some of those the program is most interested in enrolling were the least likely to engage. People involved with implementing similar programs will need to think carefully about how to cultivate broad interest among employees.
authors.affiliation: 1 Center for Outcomes Research & Education, Providence Health & Services, Portland, Oregon.
authors.forename: Bill J
authors.initials: BJ
authors.lastname: Wright
authors.affiliation: 1 Center for Outcomes Research & Education, Providence Health & Services, Portland, Oregon.
authors.forename: Kristen
authors.initials: K
authors.lastname: Dulacki
authors.affiliation: 2 Mark O. Hatfield School of Government, Portland State University, Portland, Oregon.
authors.forename: Jill
authors.initials: J
authors.lastname: Rissi
authors.affiliation: 3 School of Community Health, Portland State University, Portland, Oregon.
authors.forename: Leslie
authors.initials: L
authors.lastname: McBride
authors.affiliation: 1 Center for Outcomes Research & Education, Providence Health & Services, Portland, Oregon.
authors.forename: Sarah
authors.initials: S
authors.lastname: Tran
authors.affiliation: 1 Center for Outcomes Research & Education, Providence Health & Services, Portland, Oregon.
authors.forename: Natalie
authors.initials: N
authors.lastname: Royal
mesh_terms: D000328:Adult; D005260:Female; D006293:Health Promotion / Q000379:methods* / Q000458:organization & administration; D006801:Humans; D008297:Male; D008875:Middle Aged; D017146:Models, Organizational; D009042:Motivation; D009765:Obesity / Q000517:prevention & control / Q000523:psychology; D016272:Occupational Health; D009922:Oregon; D040242:Risk Reduction Behavior; D012907:Smoking / Q000523:psychology; D000074606:Smoking Prevention / Q000379:methods; D013219:State Government; D000074824:Work Engagement
keywords: Health Behavior; Health Promotion; Health focus: fitness/physical activity; Lifestyle; Occupational Health; Outcome measure: behavioral; Prevention Research. Manuscript format: research; Program Evaluation; Research purpose: intervention testing/program evaluation; Setting: workplace; Strategy: education; Study design: quasiexperimental; Target population age: adults; Target population circumstances: education/income level; and weight control; geographic location; incentives; nutrition; race/ethnicity; skill building/behavior change; smoking control