February 12th, 2009

Workplace Wellness Program ROI

Workplace Wellness Program ROI: Fact or Fiction? 

Workplace Wellness Programs … do they offer a strong return on investment? This is a question that we are sure goes through ever organization’s mind. HR Magazine addresses the Workplace Wellness Program ROI topic in their June 2008 issue. 

Workplace Wellness Program ROI: The Bottom Line 

According to the article, titled “Finding Wellness’ Return on Investment,” determining Workplace Wellness Program ROI is not an easy thing to do for businesses because it involves a lot of different variables and time. 

However, the businesses that have taken the time to determine the Workplace Wellness Program ROI of their Workplace Wellness Programs have found that it is quite significant. Not to mention, the Wellness program’s effect on the improvement of worker health and the slowing of the rate of their worker medical care expenses. 

Workplace Wellness Program ROI Alliance 

Workplace Wellness Program ROI is such an important part of today’s organization culture, that several large businesses have come together to form the Alliance for Wellness ROI, Inc. According to the HR Magazine article, The Alliance for Wellness ROI was specifically created to address the lack of consistency in proving the value of Workplace Wellness Programs. 

The alliance, formed by BMW of North America, Henry Ford Health System, Kraft Foods Global, MasterCard Worldwide and Schlumberger Limited, strongly believes in showing the value of Workplace Wellness Programs and want to develop a standard for how Workplace Wellness Programs are measured. 

Workplace Wellness Programs Components 

According the alliance, the following components should make up an organization-offered worker Workplace Wellness Program: 

      Employee assistance Program

      Disease Management Programs (DM)

      Fitness and exercise Programs

      Health Risk Assessments / Health Risk Appraisals

      On-Site medical care Programs

      Individual wellness profiles

      Preventive Health Testings and immunizations

      Tobacco-cessation Programs

      Telephonic Workplace Wellness Programs

      Weight loss and weight management Programs

      Self-Care Programs. 

February 11th, 2009

Summer Wellness

Wellness During the Summer 

Wellness is important year-round; however if your staff members haven’t gotten on the Wellness bandwagon, then now is the perfect time to get them there. 

Summer is an ideal season to get back into shape and enhance overall Wellness.  The weather is beautiful, staff members can get outside and they are motivated by the thought of having to wear clothes with less coverage.  Fitness, or lack of fitness, is apparent in the summer. 

Wellness in the Summer has Advantages 

There are many advantages to starting a Workplace Wellness Program in the Summer.  Employees are more likely to get outside and walk or participate in group activities during the summer than they are in the cooler months of the fall and winter.  The summer months are also a great time to begin a Wellness challenge with your staff members and celebrate the completion of the challenge with a participant picnic or cookout.  Finally, it always seems easier to eat healthy during the summer with all the fresh vegetables and fruits that are available during this time. 

Workplace Wellness Program Kick-off 

We recommend following these steps when starting a Workplace Wellness Program in your office. 

      Pick a wellness coordinator for the Workplace Wellness Program who is willing and able to see it through.

      Ensure that you have the support of organization leadership.

      Create a Wellness committee

      Use a Workplace Wellness Program survey to uncover the obstacles and goals of your Workplace Wellness Program

      Provide Health Risk Assessments / Health Risk Appraisals

      Analyze the Workplace Wellness Program and changes as needed

      Remember to stress that the Workplace Wellness Program is for the workers.  Workplace Wellness Programs have been found to prevent obesity, cancer, heart disease and hypertension.  participating in a Workplace Wellness Program that offers all that should be an easy decision for the corporation and for the staff members.

February 10th, 2009

Workplace Wellness Programs in a Depressed Economy

Workplace Wellness Programs and Health Care Costs 

Workplace Wellness Programs are more important now than ever.  According to an article in the Wall Street Journal, with the troubles in the economy it seems that the costs of business offered medical care keep continuing to grow and it doesn’t seem like it is going to change.  The article states that during the year 2008, American businesses can expect to see an increase of 10% in medical care costs. 

This increase in medical care costs is causing some small businesses to reduce their worker health benefits or get rid of them altogether. 

Workplace Wellness Programs for Healthier Lifestyles 

Workplace Wellness Programs do offer an option for small businesses.  The corporations can offer discounted co-pays and deductibles to those staff members that fully participate in the offered Workplace Wellness Program.  Full participation means getting health screens, receiving a health risk assessment, and then working with their wellness coordinator to work towards a healthier lifestyle. 

The healthier the staff members, the reduce the overall medical care costs for the corporation.  Just one lengthy hospital stay can almost deplete a small business’ medical care budget. 

Workplace Wellness Programs and Your Bottom Line 

Workplace Wellness Programs offer many advantages to a organization’s bottom-line. Workplace Wellness Program Statistics from Prudential Insurance show a benefit expense of $312 per individual enrolled in a Workplace Wellness Program compared to an expense of $574 per worker that wasn’t enrolled.  Coors Brewing Company showed a positive side-effect of participant absenteeism dropping by 18%, thus greater production and less medical care costs overall.

February 9th, 2009

Workplace Wellness Programs Result in a Healthier Bottom-lines

Workplace Wellness Programs are a fantastic investment, at least according to Lincoln industries in Nebraska.  CNN reported on this 565 employee organization their committed investment in their worker’s wellness. 

Workplace Wellness Programs are part of organization Culture 

The Workplace Wellness Programs, according the story, has been in place for 16 years at Lincoln, and it doesn’t seem to be going anywhere.  The organization has three full-time staff members dedicated to the Workplace Wellness Program and the wellness of the staff members, who receive onsite massages and a round of instructor-led stretching before they start their shifts. 

Workplace Wellness Programs Assessed

According to CNN, one of the rules of the Workplace Wellness Program, which staff members are not required to participate in, is that they receive quarterly checkups where assessments are completed on their weight, amount of body fat and flexibility.  Based on these health assessments, the staff members are then ranked from platinum all the way down to “non-medal”.  To become platinum level, where you receive a organization-paid climbing trip, you must achieve certain fitness levels and be a non-smoker.  Smoking cessation classes are part of the Workplace Wellness Program. 

Workplace Wellness Programs Result in Big Savings 

The Workplace Wellness Program has been a wise investment for Lincoln Industries.  By having healthier staff members, they have seen an average of $2 million in savings in medical care costs per year.  The savings don’t stop there, since instituting a Workplace Wellness Program, workers’ compensation claims have gone from $500,000 per year down to less than $10,000 per year.

February 8th, 2009

Advantages of Workplace Wellness Programs

Workplace Wellness Programs Becoming Increasingly Popular 

Workplace Wellness Programs are Becoming Increasingly popular outside the worksite, showing the ever-increasing importance of disease prevention and health risk management.  Private insurance businesses, as well as state Medicaid and Medicare offices are working on ways to enhance the health of the people they insure in hopes to save money in the long run.  They are finding that mini-Corporate Workplace Wellness Programs are definitely the way to go. 

Workplace Wellness Programs Aid in Early Intervention 

According to an article that recently appeared in The Indianapolis Star, businesses, insurers and government agencies are turning to “early intervention to alter the behavior of those struggling with common but dangerous health conditions, such as asthma, diabetes, heart failure and coronary heart disease.” 

The strategies that they incorporated to enhance their beneficiaries’ wellness postcard reminders for different lab tests or check-ups; and possibly even phone calls from nurses to work with the patients to make sure that they are taking their medicines properly and following the lifestyle changes that were suggested by their medical care provider. 

Workplace Wellness Programs Provide Quality Benefits 

There are more positive aspects to a Workplace Wellness Program than just the cost savings that an business or a state agency will see; there is the benefit to the actually patient.  The patient is going to get the motivation and the reward to get better or to manage their health by having to answer to someone, whether that someone is a full-time wellness worker at their organization or a nurse affiliated with their insurance organization.

February 7th, 2009

Workplace Wellness Programs: The Bottom-Line Booster

Workplace Wellness Programs are proven to improve productivity and lower medical care costs.  For a business, that makes a difference in the bottom-line. Today, more than 81 percent of America’s businesses with 50 or more workers have some form of Workplace Wellness Program with the most popular being exercise, tobaccos cessation classes, back care programs, and stress management. Most companies offer Workplace Wellness Programs simply because they think the benefit is worth the cost. Yet business leaders continue to ask themselves how to control huge annual increases in health insurance premiums and medical care costs. 

For many businesses, health costs can consume half of organization profits or more. Some employer’s look to cost sharing, cost shifting, managed care plans, risk rating, and cash-based rebates or rewards. But these methods merely shift costs. Only Workplace Wellness Programs stand out as the long-term answer for keeping workers well in the first place. 

Workplace Wellness Programs are an example of medical care reform that works. Results from America’s finest businesses, summarized here, are reason enough to consider providing Workplace Wellness Programs.  This investment in your most important asset - your workers - can have a positive impact on your bottom-line. 

Workplace Wellness Program Statistics: 

Providence Everett Medical Center, a member of the WELCOA, in Everett, Washington, saved an estimated 3 million or a cost-benefit ratio of 1 to 3.8 over 9 years of an outcomes-based Workplace Wellness Program. By providing financial rewards ($250 - $325) to workers who meet specific organizational and worker health initiatives the Workplace Wellness Program continues to meet cost containment expectations in the area of medical care use, sick time, injuries, while improving health habits and self-care practices.  

During the first 4 years of the Workplace Wellness Program there was a 28 percent average reduction in medical care utilization compared to nine other Providence hospitals that were used as a control group.  

Du Pont saw that every dollar invested in their Workplace Wellness Program returned $1.42 over two years in lower rates of absenteeism costs at Du Pont Co. (Well worksite Gold in Delaware). Absences from illness unrelated to the job among 45,000 blue-collar employees dropped 14 percent at 41 industrial sites where the Workplace Wellness Program was offered, compared with a 5.8 percent decline at 19 sites where it was not.  

The Travelers Corporation claims a $3.40 return for every dollar invested Workplace Wellness Programs, yielding total organization savings of $146 million in benefits costs. Sick leave was lowered 19 percent during the four-year study. In addition to improving the overall health of 36,000 workers and retirees by decreasing poor health habits and increasing good ones, The Travelers realized cost savings by decreasing the number of unnecessary visits to a doctor and emergency rooms. In a similar but smaller study, members of a Travelers fitness center Workplace Wellness Program were absent from work significantly fewer days than non-members.  

The Workplace Wellness Program at Reynolds Electrical & Engineering Company, located in Las Vegas, cost $76.24 per worker during the two years it has been in operation. Over half of the 1,600 workers participated in the Workplace Wellness Program. Participants significantly lowered cholesterol levels, blood pressure, and weight and experienced 21 percent lower lifestyle-related claim costs than non-participant. Resulting savings: $127.89 per participant in the Workplace Wellness Program with a benefit to cost ratio of 1.68 to 1. 

Superior Coffee and Foods, a Bensenville, Illinois-based subsidiary of Sara Lee Corporation, attributes impressive results to the success of the company’s comprehensive Workplace Wellness Program. Superior showed 22 percent fewer admissions to a hospital, 29 percent shorter hospital stays, and 42 percent lower expenses per admission when comparing costs for this division’s 1,200 workers with costs for other divisions. Long-term disability costs were down by 40 percent. 

With health costs per worker at $6,000, nearly twice the national average, Union Pacific Railroad introduced their Workplace Wellness Program to its 28,000 workers, mostly union and blue collar, in 19 Western and Southern states. Beginning with a modest health self-care initiative at an annual cost of $50 per person, the Workplace Wellness Program achieved a net savings of $1.26 million. In addition, a voluntary Workplace Wellness Program to help workers decrease health risks projected a cost-benefit ratio of 1 to 1.57 after one year. Workers in a treatment group decreaseed their risk of high blood pressure (45 percent) and high cholesterol (34 percent); others moved out of the at-risk range for weight problems (30 percent); and 21 percent stopped using tobacco.  

Average health costs of high-risk Steelcase workers- those whose lifestyles include two to four health risks such as tobacco use, little exercise, overweight- are 75 percent higher than those of low-risk workers. But high-risk workers at this Grand Rapids, Michigan-furniture manufacturing company who enhanced their health habits through the company’s Workplace Wellness Program and became low risk cut their average health claims in half thus lowering their health insurance costs by an average of $618 per year. If all high-risk workers (20 percent of the total worker population) in one location changed their lifestyles to become low risk, the projected savings could total $20 million over three years.  

Workers at Berk-Tec, a small manufacturing company in Lancaster County Pennsylvania, learned self-care techniques and decreaseed their company’s medical care costs in one year. By using a self-care guide, the 938 workers and their family members made smart health decisions and saved $21.67 per employee and dependent a nearly 18 percent reduction in costs. By combining reductions in doctor visits and emergency room use, the business saved $39.06 per employee a 24.3 percent decrease in costs over the previous year.  

A health claims-based study of 72,000 people insured through 285 Wisconsin school districts found a lower demand for health services among those with access to Workplace Wellness Programs and self-care programs. Reductions in health services results in savings for the Wisconsin Education Insurance Group of as much as $4.75 for each $1 spent, higher savings were found in the group receiving access to a 24-hour phone-based nurse advice line, a self-care reference book, and health education materials.  

CIGNA’s Healthy Babies prenatal Workplace Wellness Program delivered an average savings of $5,000 per birth by providing expectant mothers with educational materials and rewarding early and regular prenatal care. And 80 percent of participants had normal births without complications compared with 50 percent for non-participant.  

With savings estimated to be as high as $8 million, the California Public Workers’ Retirement System sent its 55,000 retirees a health risk appraisal followed, in some cases, with individualized reports and letters and self-care materials to encourage change and help reduce health risks among retirees and at the same time reduce the medical care claim costs. In another study, Bank of America retirees in California who chose the full Workplace Wellness Program and demand reduction program showed a decrease in total direct and indirect costs of 11 percent compared with a rise of 6.3 percent for those who completed only a simple health questionnaire.  

With lower medical care claims, health costs decreased 16 percent for staff members in the City of Mesa (Arizona) who participated in the comprehensive Workplace Wellness Program. The city realized a return of $3.60 for every dollar invested in the wellnss program for the city staff members.  

To prevent back injuries among its staff members, a county in California targeted white- and blue-collar employees, offered classes and fitness training. As a result, there was a significant rise in worker morale, lowered worker’s comp claims, health costs and sick days related to back injuries producing a net cost-benefit ratio of 1 to 1.79. 

Workplace Wellness Programs: Savings 

Workplace Wellness Programs offer Long-Term Savings 

Workplace Wellness Programs, according to an article in Crain’s Detroit Business, come in two varieties:  Workplace Wellness Programs or Medical Insurance products that aim to reduce costs if healthy habits are followed.  Both options are a good choice, but only one will really offer long-term health benefits for your staff members and reduce costs over the years. 

Workplace Wellness Programs offer Assistance 

Insurance-based products offer staff members the opportunity, according to the article by Jay Green, to save money on their premiums if they follow certain steps, including performing an internet-based health assessment, visiting their physician, and agree to adopt a healthy lifestyle.  These plans usually involve one coach call to the worker during the first 90 days.  We wonder if these brief wellness encounters will actually change a individual’s lifestyle. 

It is the overall change in a individual’s lifestyle, as well as disease prevention that will lead to reduce medical cots in the future. 

Workplace Wellness Programs offer convenient Health Risk Assessments / Health Risk Appraisals and screening tests for things like diabetes, cholesterol and blood pressure.  As the article states, these have initial start-up costs, but the savings accrue over time and staff members are more likely to stay active in an workplace worker Wellness Program. 

Workplace Wellness Programs Get Results 

Finally, the article states that businesses with an effective Workplace Wellness Program can expect to see “500 percent reduce absenteeism, 400 percent fewer disability claims, and 350 percent reduce medical care costs.”  These are numbers that are very hard to argue with.

February 6th, 2009

Workplace Wellness Program Tends

Corporations are no longer able to trim extra savings out of their health insurance programs, and the majority of businesses have been cost shifting, asking workers to cover more of their medical care costs. Health insurance costs continue to climb (10 percent or more per year) at 2-3 times the general inflation rate. With nowhere else to turn, companies are – more than ever – looking to get workers engaged in Workplace Wellness Programs as a means of slowing medical care costs and improving productivity. 

For example, last year 53 percent of large companies offered Health Risk Assessments / Health Risk Appraisals for their staff, up from 35 percent just two years earlier, according to a Mercer survey. Change is being driven by cost, but Workplace Wellness Programs a win-win solution for both companies and workers. 

Here are other Workplace Wellness Program trends organizations are implementing: 

More businesses are integrating Workplace Wellness Programs into their benefits plans. If they want the best plans or the lowest individual costs, they need to participate in the Workplace Wellness Program and meeting minimum goals. 

More businesses are providing workplace weight loss programs as a component of the Workplace Wellness Program, especially after Duke University’s new research showing the high cost of overweight workers and increased cost for worker’s compensation for sedentary and overweight workers. 

Corporations are providing more Workplace Wellness Programs designed to assist workers with chronic health conditions: health coaches, nurse advice lines, telephone counseling, and self-study guides 

Corporations are providing more web-based Workplace Wellness Program interventions and health information resources 

More businesses are providing regular workplace employee health screenings including cholesterol, glucose, A1c, blood pressure, weigh-ins, and other checks as a part of their Workplace Wellness Program. Some Workplace Wellness Programs even include bone-density checks and skin cancer screenings. 

Many businesses are providing fitness programs, either in the community or workplace, as a part of their Workplace Wellness Program. 

Corporations are providing more rewards, prizes and incentives getting engaged in Workplace Wellness Program activities 

Some businesses are adding emphasis to maintaining health. It’s one thing to lose weight or stop tobacco; it’s another to maintain these changes. Helping workers stay engaged and maintain their health changes is important for long-term success. 

Corporations are putting more emphasis on keeping healthy people healthy rather than just working primarily with high-risk individuals. Research shows this approach results in a greater Workplace Wellness Program ROI. 

Wellness businesses are providing great resources for businesss’ workers over the Internet – online wellness centers, monthly health and wellness newsetters, wellness challenges, web-based points tracking systems, virtual fitness programs, web-based wellness coaching or interventions, interactive health calculators, healthy recipes, even downloadable health tips for your iPod. 

Corporations who are becoming more proactive are making a big impact on their future medical care expenses and productivity. Ohio State University announced that they expect to save $30 million dollars with their comprehensive Workplace Wellness Program over the next 5 years! 

Workplace Wellness Programs and prevention are sound ideas whose time has come. Wellness is more fun and costs less than treating disease.  

References: TIME in partnership with CNN, “Businesses Help Workers Lose Weight.” Website accessed July 2007. 

February 5th, 2009

Creatinging a Workplace Wellness Program

Workplace Wellness Programs start and end with individual health. Individuals, after all, are able to make decisions about maintaining and / or improving their health and wellbeing. Employee Workplace Wellness Programs must therefore provide the tools and resources necessary to assist and motivate individuals to actively participate in the program. 

Individual health is only one part of establishing worker Workplace Wellness Programs. Below you’ll find some things to assist you in your efforts to establish a healthy atmosphere for you and your coworkers. 

Encouraging Your Employer to Create an Workplace Wellness Program 

This is the first step in establishing a Workplace Wellness Program. In recent times more and more companies are establishing to see the value of promoting and supporting the health of their workers. Partnership for Prevention, a nonprofit organization, has released a sourcebook called “Healthy Workforce 2010″ (http://www.wellnessproposals.com/pdfs/tool_kits/healthy_workforce_2010.pdf). This sourcebook is an excellent resource containing information on:

           Benefits of Workplace Wellness Programs

           Suggestions on where to start

           Tools like surveys and evaluation forms 

These resources are for both companies and workers to guide the development and determine the effectiveness of their new Workplace Wellness Program. Make available it to your employer as a place to start or read it yourself and present your ideas. 

Participating in Workplace Wellness Programs 

Once you have an worker Workplace Wellness Program established, participating fully in all facets of the program is important. Many of us know that we need to more actively engage in Workplace Wellness Programs to enhance our health, yet have difficulty finding and taking the time to do so. These simple steps can jumpstart your participation in an worker Workplace Wellness Program:

           Examine the offerings that interest you and that you need for health  improvement.

           Schedule time to go to the presentation or service.

           Actively following through with recommendations from the program.

           Make a decision now to enhance your health. You will feel better today and tomorrow and the next day for actively moving towards wellness. 

Here is a list of potential Workplace Wellness Programs that might be available to you at work:

           ergonomic evaluations and ergonomic training classes

           lactation rooms and classes

           prenatal education program

           quiet rooms for relaxation

           stress management programs

           fitnes centers

           chair massage

           nutrition education

           workplace primary medical care services

           child care facility or resources and referral service

           tobacco cessation programs parenting classes

           Elder care resources and referral service

           cholesterol, blood pressure and glucose screening programs

           influenza vaccinations

           weight management programs

           medical care consumerism programs

           work/life programs

           lifestyle coaching

           mobile mammography 

More information to follow in my next posting about Employee Workplace Wellness Programs

February 4th, 2009

Workplace Wellness Programs for Small Organizations

Studies suggest that for every $1 invested in Workplace Wellness Programs, a company saves $3 to $5 in health and safety costs. Corporations that invest in Workplace Wellness Programs reap the financial incentives through savings on medical care costs, disability pay, rates of absenteeism, turnover and safety problems. 

worksites have already proven to be a great place to promote wellness. After all, people spend more time at work than doing anything else. Eighty-two percent of the United States population is linked in some way to a worksite. Therefore, providing Workplace Wellness Programs is a great way to reach a substantial number of people in your area. 

Workplace Wellness Programs in Small Organizations 

Unlike large businesses, small businesses frequently lack the resources to provide Workplace Wellness Programs to their workers. However, they may be the most in need of such services. Small businesses are the hardest hit by health insurance costs and have the highest rates of substance abuse. Worker well-being and physical or mental illness can also be more disruptive in a small business environment. Workplace Wellness Programs in small businesses also makes sense because small firms employ the majority of working citizens. 

Regardless of the size of a business, Workplace Wellness Programs can pay. Statistically, even if there are only 100 people in a company: 

• 60 sit all day to do their work

• 50 don’t wear their safety belts regularly

• 50 feel they’re under moderate stress

• 35 are overweight by 20 percent or more

• 30 smoke

• 27 have cardiovascular disease

• 25 or more have high cholesterol (over 200 mg/dl)

• 10 are heavy drinkers

• 10 have high blood pressure

• 5 have diagnosed diabetes and another 5 have undiagnosed diabetes

• 7 use marijuana

• 1 uses cocaine 

Bottom Line Workplace Wellness Program Benefits 

At least one quarter of the medical care costs incurred by working adults can be attributed to modifiable health risks (e.g., diet, exercise, tobacco use, etc.) Fortunately, there is a way to hold back the trend. Growing research links an individual’s lifestyle behaviors to their health risk. 

The good news is Workplace Wellness Programs can: 

• Lower medical care costs

• Lower workers’ compensation claims

• Lower worker rates of absenteeism

• Increase worker productivity

• Improve worker morale 

The bottom line is that Workplace Wellness Programs can benefit any size business — small or large.

February 3rd, 2009

Why Have a Workplace Wellness Program?

There are a number of reasons why a Workplace Wellness Program is beneficial. 

1. Improved Morale - When the organizational culture begins to change as a result the Workplace Wellness Program, you and your workers may actually begin to see and feel a new level of energy within the business.  Ultimately, one of the most ambitious goals of any comprehensive Workplace Wellness Program is to attempt to sway the attitudes and actions of the business’s most valuable resource — its workers. 

2. Decreased Turnover - As we all know, worker replacement costs can be quite high for any kind of business.  The effort and expense associated with running employment ads, reading applications, checking references, interviewing qualified candidates, hiring and training a new employee can be a serious burden on any business.  In light of the challenges that high worker turnover pose, many businesses are looking to Workplace Wellness Programs as an additional perk that can help to prevent workers from jumping ship. 

3. Improved Recruitment Potential - In the midst of a very tight labor market, businesses are forced to pull out the stops in order to recruit new talent.  In some instances, Workplace Wellness Programs can prove to be a very valuable tool in sealing the deal. 

4. Decreased Absenteeism - When an employee misses work in a business environment, the entire business is forced to absorb his/her responsibilities.  Even in the event of the occasional absence caused by things like colds and the flu, work can back-up and tensions can build. 

      Even worse is a long-term absence caused by a major health event that requires hospitalization and/or rehabilitation.  By preventing certain types of illness caused by poor lifestyle habits, Workplace Wellness Programs can play an important role in decreasing rates of absenteeism. 

5. Health Care Cost Containment - Most businesses don’t begin a Workplace Wellness Program with cost containment in mind.  However, cost containment for certain health problems should be considered a viable goal by many businesses. 

6. Improved Worker Health Status - One of the greatest advantages of a well-designed Workplace Wellness Program is the promise of enhanced health.  There is a growing body of evidence that suggests well-designed Workplace Wellness Programs can successfully impact such behaviors as tobacco use, high-risk alcohol use, seatbelt use and more.