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Stress Management Programmes

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The essential mission of occupational health and safety is to protect and enhance the health, well-being and productivity of workers, individually and collectively. That mission cannot be accomplished without an understanding of stress and the mechanisms through which it affects individuals and organizations, and without a well-planned programme that will both alleviate its deleterious effects and, more important, prevent them.

Stress is an inescapable ingredient of the lives of all people everywhere. It stems from—and simultaneously affects—individuals’ inner sense of well-being; their relationships with family, friends, co-workers and strangers; and their capacity to function in the home, the workplace and the community. When excessive, it leads to physical or psychological symptoms and, when prolonged, it may lead to disability and disease. It modifies individuals’ perceptions, feelings, attitudes and behaviour and affects the organizations whose activities they direct or carry out. The subject of stress is covered extensively elsewhere in this Encyclopaedia.

Designing a Stress Management Programme

The effective workplace stress management programme will contain a number of overlapping elements operating concurrently. Some are formalized under the designation of a stress management programme while others are simply part of general organizational management even when they are explicitly aimed at controlling stress. Some of these are aimed at employees individually and in groups; others are aimed at stressors arising in the workplace; and still others address the stressors impinging on the organization as an entity in itself which inevitably filter down to affect some or all of the employees. The elements of a workplace stress management programme will be examined under the following headings.

1. Managing stress-related symptoms. This element deals with individuals already suffering from the effects of stress. Labelled the “medical model,” it attempts to identify individuals with signs and symptoms and to persuade them to come forward voluntarily or accept referral to professionals able to evaluate their problems, diagnose the causes and offer appropriate treatment. It may be based in the employee health service or in the employee assistance programme, or it may be associated with any other counselling services provided by the organization. The services may cover a broad range extending from one-on-one interviews and examinations to telephone “hot-lines” for emergency situations to comprehensive centres with multidisciplinary staffs of qualified professionals. It may be served by full- or part-time professionals or by contractual or casual referral arrangements with professionals who come to the worksite or are based in nearby facilities in the community. Some units deal with any and all problems, while others may more or less focus on such specific stress-related syndromes as hypertension, backache, alcoholism, drug abuse or family problems. The contributions of these service elements to the stress management programme are based on the following capabilities:

  • An awareness that many recurrent or persistent somatic complaints such as muscular aches and pains, backache, headache, gastrointestinal upsets, and so on, are attributable to stress. Instead of simply providing palliative medications and advice, the alert health professional or counsellor will recognize the pattern and direct attention to the stressors that are actually responsible.
  • Recognition that when a number of employees in a particular unit or area of the workplace present such functional complaints, a search should be initiated for a causative factor in the work environment which may prove to be a controllable stressor.
  • Reaching out to individuals involved in or witnessing a cataclysmic occurrence such as a fatal accident, or an episode of violence.
  • Seizing the opportunity to stay a disciplinary action faced by an employee because of inadequate performance or aberrant behaviour pending an opportunity to lower the stress level and restore his or her normal equanimity and work capacity.

 

2. Reducing individual vulnerability. The most common elements in stress management programmes are those that help individuals to cope with stress by reducing their vulnerability. These include series of seminars and workshops, supplemented by audiotapes or videotapes and pamphlets or other publications that educate employees to cope with stress more effectively. Their common denominators are these:

  • Training in self-awareness and problem analysis to detect signs of increasing stress and identify the stressors that are responsible
  • Assertiveness training enabling workers to become more dynamic in dealing with them
  • Techniques that will reduce stress to more tolerable levels

 

Some of the tools they employ are listed in figure 1. For those not familiar with the term, “rap sessions” are meetings of groups of employees, with or without supervisors being present, in which experiences and problems are discussed and complaints freely ventilated. They are analogous to the shop meetings held under union auspices.

Figure 1. Some approaches to reducing vulnerability.

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3. Interpersonal relations in the workplace. Organizations are being increasingly made aware of stressors emanating from the diversity of the workforce and the interpersonal problems they often present. Prejudice and bigotry do not stop at the gates of the worksite and are often compounded by insensitive or discriminatory behaviour on the part of managers and supervisors. Sexual and racial bias may take the form of harassment and may even be expressed in or evoke acts of violence. When rampant, such attitudes demand prompt correction through enunciation of an explicit policy that includes disciplinary actions against those who are guilty, coupled with protecting victims emboldened to complain against reprisals.

 

4. Managing job-related stressors. It is the organization’s responsibility to minimize job-related stressors that may have an adverse effect on employees’ capacity to function effectively. It is most important to ensure that supervisors and managers on all levels receive appropriate training to recognize and to deal promptly and effectively with the “people problems” that will inevitably arise in the workplace.
 

5. Managing the organization’s stress. The organization as an entity is exposed to stressors which, if not properly managed, filter down through the workforce, inevitably impinging on employees on all levels. This state of affairs requires the establishment of challenging but attainable goals and objectives, early identification and assessment of potential stressors that may thwart those plans, coordination of the organization’s capacities to deal with them and the communication of the results of those efforts to the workforce. The last-mentioned need is particularly critical at times of economic stringency, when employee collaboration and optimal productivity are especially important in dealing with such crises as changes in top management, threatened mergers and takeovers, plant closings or relocations. and downsizing.
 

6. Helping to manage personal stressors. While the management of stressors arising in the home and in the community is fundamentally a problem for the individual, employers are discovering that the stress they generate is inevitably brought into the workplace where, either on their own or in conjunction with job-related stressors, they often affect employees’ well-being and compromise their work performance. Accordingly, employers are finding it expedient (and in some instances, necessary) to establish programmes designed to assist employees to cope with stressors of this sort. A list of the most common personal stressors and workplace programmes aimed at them is presented in figure 2.

Figure 2. Stressors in the workplace and workplace programmes to help with them.

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Basic Principles of the Programme

In establishing a worksite stress management programme, some basis principles must be emphasized.

First, it must be remembered that there are no boundaries between stress arising in the workplace, in the home and in the community. Each individual presents a unique composite of all of the factors which are carried wherever he or she may go. This means that while the programme must focus on those problems arising in the workplace, it must recognize that these continue to affect the worker’s outside life, nor can it ignore those originating off the job. Indeed, it has been shown that work itself and the support derived from co-workers and the organization may have a therapeutic value in dealing with personal and family problems. In fact, the loss of this support probably accounts for much of the disability associated with retirement, even when it is voluntary.

Second, stress is highly “contagious”. It not only affects particular individuals but also those about them with whom they must relate and collaborate. Thus, dealing with stress is simultaneously therapeutic and preventive.

Third, coping with stress is inherently an individual responsibility. Troubled employees can be identified and offered counselling and guidance. They can be given support and encouragement and taught to improve their coping skills. When necessary, they can be referred to qualified health professionals in the community for more intensive or prolonged therapy. But, in the last analysis, all this requires the consent and participation of the individual which, in turn, depends on the structure of the programme, its status in the organization, the competence of its staff and the reputations they earn, and its accessibility. Perhaps the most important determinant of programme success is the establishment of and strict adherence to a policy of observing the confidentiality of personal information.

Fourth, control of workplace stress is fundamentally a managerial responsibility. The programme must be based on an explicit organizational policy that places high value on employee’s health and well-being. And that policy must be reflected in the day-to-day operations by the attitudes and behaviour of managers on all levels,

Fifth, employee involvement in the programme’s design and operation and, particularly, in identifying stressors and devising ways to control them is an important ingredient of programme success. This is facilitated in many workplaces where safety and health joint labour-management committees function or where worker participation in managerial decision-making is encouraged.

Finally, a successful stress management programme requires an intimate understanding of the employees and the environment in which they work. It is most successful when stress-related problems are identified and resolved before any damage is done.

Conclusion

The essential mission of occupational health and safety is to protect and enhance the health, well-being and productivity of workers, individually and collectively. That mission cannot be accomplished without an understanding of stress and the mechanisms through which it affects individuals and organizations, and a well-planned programme that will both alleviate its deleterious effects and, more important, prevent them.

 

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Health Protection and Promotion References

Adami, HG, JA Baron, and KJ Rothman. 1994. Ethics of a prostate cancer screening trial. Lancet (343):958-960.

Akabas, SH and M Hanson. 1991. Workplace drug and alcohol programmes in the United States. Working paper given at Proceedings of the Washington Tripartite Symposium on Drug and Alcohol Prevention and Assistance Programmes at the Workplace. Geneva: ILO.

American College of Obstetricians and Gynecologists (ACOG). 1994. Exercise during Pregnancy and the Postpartum Period. Vol. 189. Technical Bulletin. Washington, DC: DCL.

American Dietetic Association (ADA) and Office of Disease Prevention and Health Promotion. 1994. Worksite Nutrition: A Guide to Planning, Implementation, and Evaluation. Chicago: ADA.

American Lung Association. 1992. Survey of the public’s attitudes toward smoking. Prepared for the Gallup Organization by the American Lung Association.

Anderson, DR and MP O’Donnell. 1994. Toward a health promotion research agenda: “State of the Science” reviews. Am J Health Promot (8):482-495.

Anderson, JJB. 1992. The role of nutrition in the functioning of skeletal tissue. Nutr Rev (50):388-394.

Article 13-E of the New York State Public Health Law.

Baile, WF, M Gilbertini, F Ulschak, S Snow-Antle, and D Hann. 1991. Impact of a hospital smoking ban: Changes in tobacco use and employee attitudes. Addict Behav 16(6):419-426.

Bargal, D. 1993. An international perspective on the development of social work in the workplace. In Work and Well-Being, the Occupational Social Work Advantage, edited by P Kurzman and SH Akabas. Washington, DC: NASW Press.

Barr, JK, KW Johnson, and LJ Warshaw. 1992. Supporting the elderly: Workplace programs for employed caregivers. Milbank Q (70):509-533.

Barr, JK, JM Waring, and LJ Warshaw. 1991. Employees’ sources of AIDS information: The workplace as a promising educational setting. J Occup Med (33):143-147.

Barr, JK and LJ Warshaw. 1993. Stress among Working Women: Report of a National Survey. New York: New York Business Group on Health.

Beery, W, VJ Schoenbach, EH Wagner, et al. 1986. Health Risk Appraisal: Methods and Programs, with Annotated Bibliography. Rockville, Md: National Center for Health Services Research and Health Care Technology Assessment.

Bertera, RL. 1991. The effects of behavioral risks on absenteeism and healthcare costs in the workplace. J Occup Med (33):1119-1124.

Bray, GA. 1989. Classification and evaluation of the obesities. Med Clin North Am 73(1):161-192.

Brigham, J, J Gross, ML Stitzer, and LJ Felch. 1994. Effects of a restricted worksite smoking policy on employees who smoke. Am J Public Health 84(5):773-778.

Bungay, GT, MP Vessey, and CK McPherson. 1980. Study of symptoms of middle life with special reference to the menopause. Brit Med J 308(1):79.

Bureau of National Affairs (BNA). 1986. Where There’s Smoke: Problems and Policies Concerning Smoking in the Workplace. Rockville, Md: BNA.

—. 1989. Workplace smoking, corporate practices and developments. BNA’s Employee Relations Weekly 7(42): 5-38.

—. 1991. Smoking in the workplace, SHRM-BNA survey no. 55. BNA Bulletin to Management.

Burton, WN and DJ Conti. 1991. Value-managed mental health benefits. J Occup Med (33):311-313.

Burton, WN, D Erickson, and J Briones. 1991. Women’s health programs at the workplace. J Occup Med (33):349-350.

Burton, WN and DA Hoy. 1991. A computer-assisted health care cost management system. J Occup Med (33):268-271.

Burton, WN, DA Hoy, RL Bonin, and L Gladstone. 1989. Quality and cost effective management of mental health care. J Occup Med (31):363-367.

Caliber Associates. 1989. Cost-Benefit Study of the Navy’s Level III Alcohol Rehabilitation Programme Phase Two: Rehabilitation vs Replacement Costs. Fairfax, Va: Caliber Associates.

Charafin, FB. 1994. US sets standards for mammography. Brit Med J (218):181-183.

Children of Alcoholics Foundation. 1990. Children of Alcoholics in the Medical System: Hidden Problems, Hidden Costs. New York: Children of Alcoholics Foundation.

The City of New York. Title 17, chapter 5 of the Administration Code of the City of New York.

Coalition on Smoking and Health. 1992. State Legislated Actions On Tobacco Issues. Washington, DC: Coalition on Smoking and Health.

Corporate Health Policies Group. 1993. Issues of Environmental Tobacco Smoke in the Workplace. Washington, DC: National Advisory Committee of the Interagency Committee on Smoking and Health.

Cowell, JWF. 1986. Guidelines for fitness-to-work examinations. CMAJ 135 (1 November):985-987.

Daniel, WW. 1987. Workplace Industrial Relations and Technical Change. London: Policy Studies Institute.

Davis, RM. 1987. Current trends in cigarette advertising and marketing. New Engl J Med 316:725-732.

DeCresce, R, A Mazura, M Lifshitz, and J Tilson. 1989. Drug Testing in the Workplace. Chicago: ASCP Press.

DeFriese, GH and JE Fielding. 1990. Health risk appraisal in the 1990s: Opportunities, challenges, and expectations. Annual Revue of Public Health (11):401-418.

Dishman, RH. 1988. Exercise Adherence: Its Impact On Public Health. Champaign, Ill: Kinetics Books.

Duncan, MM, JK Barr, and LJ Warshaw. 1992. Employer-Sponsored Prenatal Education Programs: A Survey Conducted By the New York Business Group On Health. Montvale, NJ: Business and Health Publishers.

Elixhauser, A. 1990. The costs of smoking and the effectiveness of smoking-cessation programs. J Publ Health Policy (11):218-235.

European Foundation for the Improvement of Living and Working Conditions.1991. Overview of innovative action for workplace health in the UK. Working paper no. WP/91/03/EN.

Ewing, JA. 1984. Detecting alcoholism: The CAGE questionnaire. JAMA 252(14):1905-1907.

Fielding, JE. 1989. Frequency of health risk assessment activities at US worksites. Am J Prev Med 5:73-81.

Fielding, JE and PV Piserchia. 1989. Frequency of worksite health promotion activities. Am J Prev Med 79:16-20.

Fielding, JE, KK Knight, RZ Goetzel, and M Laouri. 1991. Utilization of preventive health services by an employed population. J Occup Med 33:985-990.

Fiorino, F. 1994. Airline outlook. Aviat week space technol (1 August):19.

Fishbeck, W. 1979. Internal Report and Letter. Midland, Michigan: Dow Chemical Company, Corporate Medical Dept.

Food and Agriculture Organization of the United Nations (FAO) and World Health Organization (WHO). 1992. International Conference on Nutrition: Major Issues for Nutrition Strategies. Geneva: WHO.

Forrest, P. 1987. Breast Cancer Screening 1987. Report to the Health Ministers of England, Wales, Scotland, and Ireland. London: HMSO.

Freis, JF, CE Koop, PP Cooper, MJ England, RF Greaves, JJ Sokolov, D Wright, and Health Project Consortium. 1993. Reducing health care costs by reducing the need and demand for health services. New Engl J Med 329:321-325.

Glanz, K and RN Mullis. 1988. Environmental interventions to promote healthy eating: A review of models, programs, and evidence. Health Educ Q 15:395-415.

Glanz, K and T Rogers. 1994. Worksite nutrition programs in health promotion in the workplace. In Health Promotion in the Workplace, edited by MP O’Donnell and J Harris. Albany, NY: Delmar.

Glied, S and S Kofman. 1995. Women and Mental Health: Issues for Health Reform. New York: The Commonwealth Fund.

Googins, B and B Davidson. 1993. The organization as client: Broadening the concept of employee assistance programs. Social Work 28:477-484.

Guidotti, TL, JWF Cowell, and GG Jamieson. 1989. Occupational Health Services: A Practical Approach. Chicago: American Medical Association.

Hammer, L. 1994. Equity and gender issues in health care provision: The 1993 World Bank Development Report and its implications for health service recipients. Working Paper Series, no.172. The Hague: Institute of Social Studies.

Harris, L et al. 1993. The Health of American Women. New York: The Commonwealth Fund.

Haselhurst, J. 1986. Mammographic screening. In Complications in the Management of Breast Disease, edited by RW Blamey. London: Balliere Tindall.

Henderson, BE, RK Ross, and MC Pike. 1991. Toward the primary prevention of cancer. Science 254:1131-1138.

Hutchison, J and A Tucker. 1984. Breast screening results from a healthy, working population. Clin Oncol 10:123-128.

Institute for Health Policy. October, 1993. Substance Abuse: The Nation’s Number One Health Problem. Princeton: Robert Wood Johnson Foundation.

Kaplan, GD and VL Brinkman-Kaplan. 1994. Worksite weight management in health promotion in the workplace. In Health Promotion in the Workplace, edited by MP O’Donnell and J Harris. Albany, NY: Delmar.

Karpilow, C. 1991. Occupational Medicine in the Industrial Workplace. Florence, Ky: Van Nostrand Reinhold.

Kohler, S and J Kamp. 1992. American Workers under Pressure: Technical Report. St. Paul, Minn.: St. Paul Fire and Marine Insurance Company.

Kristein, M. 1983. How much can business expect to profit from smoking cessation? Prevent Med 12:358-381.

Lesieur, HR and SB Blume. 1987. The South Oaks Gambling Screen (SOGS): A new instrument for the identification of pathological gamblers. Am J Psychiatr 144(9):1184-1188.

Lesieur, HR, SB Blume, and RM Zoppa. 1986. Alcoholism, drug abuse and gambling. Alcohol, Clin Exp Res 10(1):33-38.

Lesmes, G. 1993. Getting employees to say no to smoking. Bus Health (March):42-46.

Lew, EA and L Garfinkel. 1979. Variations in mortality by weight among 750,000 men and women. J Chron Dis 32:563-576.

Lewin, K. [1951] 1975. Field Theory in Social Science: Selected Theoretical Papers by Kurt
Lewin, edited by D Cartwright. Westport: Greenwood Press.

Malcolm, AI. 1971. The Pursuit of Intoxication. Toronto: ARF Books.
M
andelker, J. 1994. A wellness program or a bitter pill. Bus Health (March):36-39.

March of Dimes Birth Defects Foundation. 1992. Lessons Learned from the Babies and You Program. White Plains, NY: March of Dimes Birth Defects Foundation.

—. 1994. Healthy Babies, Healthy Business: An Employer’s Guidebook on Improving Maternal and Infant Health. White Plains, NY: March of Dimes Birth Defects Foundation.

Margolin, A, SK Avants, P Chang, and TR Kosten. 1993. Acupuncture for the treatment of cocaine dependence in methadone-maintained patients. Am J Addict 2(3):194-201.

Maskin, A, A Connelly, and EA Noonan. 1993. Environmental tobacco smoke: Implications for the workplace. Occ Saf Health Rep (2 February).

Meek, DC. 1992. The impaired physician programme of the Medical Society of the District of Columbia. Maryland Med J 41(4):321-323.

Morse, RM and DK Flavin. 1992. The definition of alcoholism. JAMA 268(8):1012-1014.

Muchnick-Baku, S and S Orrick. 1992. Working for Good Health: Health Promotion and Small Business. Washington, DC: Washington Business Group on Health.

National Advisory Council for Human Genome Research. 1994. Statement on use of DNA testing for presymptomatic identification of cancer risk. JAMA 271:785.

National Council on Compensation Insurance (NCCI). 1985. Emotional Stress in the Workplace—New Legal Rights in the Eighties. New York: NCCI.

National Institute for Occupational Safety and Health (NIOSH). 1991. Current Intelligence Bulletin 54. Bethesda, Md: NIOSH.

National Institutes of Health (NIH). 1993a. National High Blood Pressure Education Program Working Group Report on Primary Prevention of Hypertension. National High Blood Pressure Education Program, National Heart, Lung, and Blood Institute. NIH publication No. 93-2669. Bethesda, Md: NIH.

—. 1993b. Second Report of the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (ATP II). National Cholesterol Education Program, National Institutes of Health, National Heart, Lung, and Blood Institute. NIH publication no. 93-3095. Bethesda, Md: NIH.

National Research Council. 1989. Diet and Health: Implications for Reducing Chronic Disease Risk. Washington, DC: National Academy Press.

New York Academy of Medicine. 1989. Drugs in the workplace: Proceedings of a symposium. B NY Acad Med 65(2).

Noah, T. 1993. EPA declares passive smoke a human carcinogen. Wall Street J, 6 January.

Ornish, D, SE Brown, LW Scherwitz, JH Billings, WT Armstrong, TA Ports, SM McLanahan, RL Kirkeeide, RJ Brand, and KL Gould. 1990. Can lifestyle changes reverse coronary heart disease? The lifestyle heart trial. Lancet 336:129-133.

Parodi vs. Veterans Administration. 1982. 540 F. Suppl. 85 WD. Washington, DC.

Patnick, J. 1995. NHS Breast Screening Programmes: Review 1995. Sheffield: Clear Communications.

Pelletier, KR. 1991. A review and analysis of the cost effective outcome studies of comprehensive health promotion and disease prevention programs. Am J Health Promot 5:311-315.

—. 1993. A review and analysis of the health and cost-effective outcome studies of comprehensive health promotion and disease prevention programs. Am J Health Promot 8:50-62.

—. 1994. Getting your money’s worth: The strategic planning programme of the Stanford Corporate Health Programme. Am J Health Promot 8:323-7,376.

Penner, M and S Penner. 1990. Excess insured health costs from tobacco-using employees in a large group plan. J Occup Med 32:521-523.

Preventive Services Task Force. 1989. Guide to Clinical Preventive Services: An Assessment of the Effectiveness of 169 Interventions. Baltimore: Williams & Wilkins.

Richardson, G. 1994. A Welcome for Every Child: How France Protects Maternal and Child Health-A New Frame of Reference for the United States. Arlington, Va: National Center for Education in Maternal and Child Health.

Richmond, K. 1986. Introducing heart healthy foods in a company cafeteria. J Nutr Educ 18:S63-S65.

Robbins, LC and JH Hall. 1970. How to Practice Prospective Medicine. Indianapolis, Ind: Methodist Hospital of Indiana.

Rodale, R, ST Belden, T Dybdahl, and M Schwartz. 1989. The Promotion Index: A Report Card on the Nation’s Health. Emmaus, Penn: Rodale Press.

Ryan, AS and GA Martinez. 1989. Breastfeeding and the working mother: A profile. Pediatrics 82:524-531.

Saunders, JB, OG Aasland, A Amundsen, and M Grant. 1993. Alcohol consumption and related problems among primary health care patients: WHO collaborative project on early detection of persons with harmful alcohol consumption-I. Addiction 88:349-362.

Schneider, WJ, SC Stewart, and MA Haughey. 1989. Health promotion in a scheduled cyclical format. J Occup Med 31:482-485.

Schoenbach, VJ. 1987. Appraising health risk appraisal. Am J Public Health 77:409-411.

Seidell, JC. 1992. Regional obesity and health. Int J Obesity 16:S31-S34.

Selzer, ML. 1971. The Michigan alcoholism screening test: The quest for a new diagnostic instrument. Am J Psychiatr 127(12):89-94.

Serdula, MK, DE Williamson, RF Anda, A Levy, A Heaton and T Byers. 1994. Weight control practices in adults: Results of a multistate survey. Am J Publ Health 81:1821-24.

Shapiro, S. 1977. Evidence of screening for breast cancer from a randomised trial. Cancer:2772-2792.

Skinner, HA. 1982. The drug abuse screening test (DAST). Addict Behav 7:363-371.

Smith-Schneider, LM, MJ Sigman-Grant, and PM Kris-Etherton. 1992. Dietary fat reduction strategies. J Am Diet Assoc 92:34-38.

Sorensen, G, H Lando, and TF Pechacek. 1993. Promoting smoking cessation at the workplace. J Occup Med 35(2):121-126.

Sorensen, G, N Rigotti, A Rosen, J Pinney, and R Prible. 1991. Effects of a worksite smoking policy: Evidence for increased cessation. Am J Public Health 81(2):202-204.

Stave, GM and GW Jackson. 1991. Effect of total work-site smoking ban on employee smoking and attitudes. J Occup Med 33(8):884-890.

Thériault, G. 1994. Cancer risks associated with occupational exposure to magnetic fields among electric utility workers in Ontario and Quebec, Canada, and France. Am J Epidemiol 139(6):550-572.

Tramm, ML and LJ Warshaw. 1989. Screening for Alcohol Problems: A Guide for Hospitals, Clinics, and Other Health Care Facilities. New York: New York Business Group on Health.

US Department of Agriculture: Human Nutrition Information Service. 1990. Report of the Dietary Guidelines Advisory Committee On Dietary Guidelines for Americans. Publication no. 261-495/20/24. Hyattsville, Md: US Government Printing Office.

US Department of Health, Education and Welfare. 1964. Smoking and Health Report of the Advisory Committee to the Surgeon General of the Public Health Service. PHS Publication No. 1103. Rockville, Md: US Department of Health, Education, and Welfare.

US Department of Health and Human Services (USDHHS). 1989. Reducing the Health Consequences of Smoking: 25 Years of Progress. A Report of the Surgeon General. USDHHS publication no.10 89-8411.Washington, DC: US Government Printing Office.

—. 1990. Economic Costs of Alcohol and Drug Abuse and Mental Illness. DHHS publication no. (ADM) 90-1694. Washington, DC: Alcohol, Drug Abuse, and Mental Health Administration.

—. 1991. Environmental Tobacco Smoke in the Workplace: Lung Cancer and Other Effects. USDHHS (NIOSH) publication No. 91-108. Washington, DC: USDHHS.
US Food and Drug Administration (FDA). 1995. Mammography quality deadline. FDA Med Bull 23: 3-4.

US General Accounting Office. 1994. Long-Term Care: Support for Elder Care Could Benefit the Government Workplace and the Elderly. GAO/HEHS-94-64. Washington, DC: US General Accounting Office.

US Office of Disease Prevention and Health Promotion. 1992. 1992 National Survey of Worksite Health Promotion Activities: Summary Report. Washington, DC: Department of Health and Human Services, Public Health Service.

US Public Health Service. 1991. Healthy People 2000: National Health Promotion and Disease Prevention Objectives—Full Report With Commentary. DHHS publication No. (PHS) 91-50212. Washington, DC: US Department of Health and Human Services.

Voelker, R. 1995. Preparing patients for menopause. JAMA 273:278.

Wagner, EH, WL Beery, VJ Schoenbach, and RM Graham. 1982. An assessment of health hazard/health risk appraisal. Am J Public Health 72:347-352.

Walsh, DC, RW Hingson, DM Merrigan, SM Levenson, LA Cupples, T Heeren, GA Coffman, CA Becker, TA Barker, SK Hamilton, TG McGuire, and CA Kelly. 1991. A randomized trial of treatment options for alcohol-abusing workers. New Engl J Med 325(11):775-782.

Warshaw, LJ. 1989. Stress, Anxiety, and Depression in the Workplace: Report of the NYGBH/Gallup Survey. New York: The New York Business Group on Health.

Weisman, CS. 1995. National Survey of Women’s Health Centers: Preliminary Report for Respondents. New York: Commonwealth Fund.

Wilber, CS. 1983. The Johnson and Johnson Program. Prevent Med 12:672-681.

Woodruff, TJ, B Rosbrook, J Pierce, and SA Glantz. 1993. Lower levels of cigarette consumption found in smoke-free workplaces in California. Arch Int Med 153(12):1485-1493.

Woodside, M. 1992. Children of Alcoholics At Work: The Need to Know More. New York: Children of Alcoholics Foundation.

World Bank. 1993. World Development Report: Investing in Health. New York: 1993.

World Health Organization (WHO). 1988. Health promotion for working populations: Report of a WHO expert committee. Technical Report Series, No.765. Geneva: WHO.

—. 1992. World No-Tobacco Day Advisory Kit 1992. Geneva: WHO.

—. 1993. Women and Substance Abuse: 1993 Country Assessment Report. Document No. WHO/PSA/93.13. Geneva: WHO.

—. 1994. A Guide On Safe Food for Travellers. Geneva: WHO.

Yen, LT, DW Edington, and P Witting. 1991. Prediction of prospective medical claims and absenteeism for 1,285 hourly workers from a manufacturing company, 1992. J Occup Med 34:428-435.