INTRODUCTION Systematic analyses of workplace smoking cessation programs indicate that efficacy can be enhanced by using incentives. There is variation in the type of incentives used and their effect on participation and efficacy. The aim of our study was to examine whether lowering employee health plan costs (employee contributions, co-pays) encourage employee smokers to participate in workplace smoking cessation. METHODS We conducted a 2014-2015 prospective cohort study of 415 employee smokers of Loma Linda University Health (LLUH). The employees were offered participation in a workplace smoking cessation program (LLUH BREATHE Initiative) with the incentive of enrollment in an employer-provided health plan that had a 50% lower employee monthly contribution and co-payment relative to the employer-provided health plan for non-participants. Participation rates and variables associated with participation were analyzed. RESULTS In the LLUH BREATHE cohort, we found a very high rate of participation (72.7%; 95% CI: 69-77%) in workplace smoking cessation that was encouraged by a lower out-of-pocket health plan cost for the participating employee and/or spouse. Participation did, however, vary by gender and spouse, whereby female employee households with a qualifying smoker were more than two times more likely (employee: OR=2.89, 95% CI: 1.59-5.24; or spouse: OR=2.71, 95% CI: 1.47-5.00) to participate in smoking cessation than male employee households. The point prevalence, at four months, of abstinence from smoking among the participants was 48% (95% CI: 42-54%). CONCLUSIONS Our findings indicate that a workplace smoking cessation program that uses a novel reward-based incentive of lower out-of-pocket health plan costs results in a participation rate that is much higher than US norms.

Prior research supports positive health coaching outcomes, but there is limited literature on the integration of employer-sponsored health coaching into employee wellness strategy. The aim of our mixed methods study was to assess feasibility, acceptability, and preliminary efficacy of incorporating a whole-person care model of health coaching into an employee wellness program (i.e., weight loss, smoking cessation) that is made available by an employer-sponsored health plan. For the quantitative study, eligible employees and covered spouses (n = 39) from Loma Linda University Health were recruited into a novel, 12-week, whole person care intervention that combined health coaching and health education and examined outcomes from surveys detailing the participants' experience and biometric data from the intervention and maintenance periods. For the qualitative study, data were collected through key informant interviews from three health coaches and six intervention participants who were recruited via random sampling. Health coaching was well-received by the participants, and led to a slight albeit positive behavioral change for obesity. A significant decrease in body mass index occurred over 12 weeks of intervention (−0.36 kg/m2, p = 0.016), that did not continue during the maintenance phase (−0.17 kg/m2, p = 0.218). Qualitative findings indicated improved personal health awareness, accountability, motivation, and self-efficacy along with goal setting and barrier overcoming skills among the key themes. Our pilot study findings identify positive behavior change effects of an employee health intervention based on a whole person care model of health coaching with integrated health education, and also identify the need for methods to maintain behavior change (i.e., mHealth, peer-support) post-intervention. Further investigation in randomized controlled trials is the next step in this research.

Objectives To assess the effectiveness of a program to implement long-term diet, lifestyle, and behavioral changes in bariatric surgery patients. Methods Sixteen subjects (age = 45.9 ± 11.5 years; BMI = 46.1 ± 8.3 kg/m2) participated in a comprehensive 36-week lifestyle-based program to promote weight loss before and after bariatric surgery. During the preoperative phase, baseline data on body measurements, food frequency, meal patterns and timings, miscellaneous lifestyle habits, and perceived level of self-efficacy regarding eating behaviors were collected, after which subjects underwent an intensive 24-week lifestyle program. At the end of the intervention, the same outcomes were assessed again before surgery was performed. Following surgery, the subjects completed the same program for 12 weeks, with additional data (as above) being collected at the beginning and at the end of the 12 weeks. Intra- and inter-phase comparative analyses were conducted on body measurements (weight, BMI, and waist circumference) and lifestyle habits (changes in food frequency, meal patterns and timings, miscellaneous lifestyle habits, and perceived level of self-efficacy) using Wilcoxon Signed Ranks Test. Results There was a statistically significant reduction in both preoperative (P = 0.016) and postoperative weight (P = 0.003). A reduction in waist circumference was also observed post-surgery (P = 0.027). Overall, participants lost an average of 28% of their baseline body weight (P < 0.000) and 19% of their baseline waist circumference (P < 0.000). Over the course of the program, there was a significant improvement in some diet and lifestyle-related habits, such as decreased fast-food consumption and screen time (P = 0.004 and 0.047, respectively). Self-monitoring and overall self-efficacy also improved by the end of the program (P = 0.002 and P = 0.003, respectively). Conclusions The present findings indicate that a comprehensive lifestyle-based weight loss program is beneficial for further reduction in weight and waist circumference among bariatric patients. Additionally, this program facilitated significant improvements in diet and lifestyle-related factors, as well as self-monitoring and perceived self-efficacy. Funding Sources This study was funded by Loma Linda University School of Allied Health Professions, Department of Nutrition and Dietetics.

COVID-19 is an acute infectious respiratory disease caused by SARS-CoV-2, a subtype of the coronavirus. In addition to normal levels of biometric measures, a healthy lifestyle has been considered an indispensable element in preventing complications of coronavirus infection. Demographic characteristics are also critical in determining risk levels. Aim: Investigate potential significant associations between health behaviors, biometric screenings, demographics, and COVID-19 hospitalization in Loma Linda University Health employees. Methods: Participants are employees covered under the employer-sponsored health plan at Loma Linda University Health, Loma Linda, CA, who tested positive for COVID-19. Logistic regression models were applied to analyze demographics, biometric screenings, and lifestyle factors associated with COVID-19 hospitalization. In our study, 7% of participants required hospitalization. Variables independently associated with COVID-19 hospitalization included higher age (OR = 1.05 [1.01–1.08], P = .005), non-White race compared to the White race (OR = 3.2 [1.22–8.38], P = .018), higher HbA1C levels showing a marginal association (OR = 1.31 [.99–1.72], P = .057), and lower vegetable consumption (OR = 4.39 [2.06–9.40], P < .001). Lower protein consumption decreased the Odds of hospitalization (OR = .40 [.19–.87], P = .021). Our results suggest that a diet that includes more vegetables and lower protein may confer some protection against COVID-19 hospitalization.

PurposeThe purpose of the Loma Linda University Health (LLUH) BREATHE cohort is to test the efficacy of a novel method of continuously incentivising participation in workplace smoking cessation on participation, long-term abstinence, health outcomes, healthcare costs and healthcare utilisation.ParticipantsIn 2014, LLUH—a US academic medical centre and university—incentivised participation in a workplace smoking cessation programme (LLUH BREATHE) by lowering health plan costs. Specifically, LLUH introduced a Wholeness Health Plan (WHP) option that, for the smokers, continuously incentivises participation in nicotine screening and the LLUH BREATHE smoking cessation programme by offering an ‘opt-in wellness discount’ that consisted of 50%–53% lower out of pocket health plan costs (ie, monthly employee premiums, copayments). This novel ‘continuously incentivised’ model lowers annual health plan costs for smokers who, on an annual basis, attempt or maintain cessation from tobacco use. The annual WHP cost savings for smokers far exceed the value of short-term incentives that have been tested in workplace cessation trials to date. This ongoing health plan option offered to over 16 000 employees has created an open, dynamic LLUH BREATHE cohort of current and former smokers (n=1092).Findings to dateOur profile of the LLUH BREATHE cohort indicates that after 5 years of follow-up in a prospective cohort study (2014–2019), continuously incentivised smoking cessation produced a 74% participation (95% CI (71% to 77%)) in employer-sponsored smoking cessation attempts that were occurring less than a year after the incentive was offered. The cohort can be purposed to examine the effect of continuously incentivised cessation on cessation outcomes, health plan utilisation/costs, use of electronic nicotine delivery systems, and COVID-19 outcomes.