Employer-sponsored Wellness Research Articles

1837-PUB: Impact of Annual Health Evaluations in a Workplace Setting—Skipping an Evaluation Is Associated with Increased Risk Factors for Chronic Disease

Objective: To evaluate the impact of skipping an annual health evaluation on biometric and blood-based metrics related to chronic disease. Methods: This longitudinal study included a cohort of adults who participated in an employer-sponsored wellness program in 2017, 2018, 2019, and 2021 but missed 2020, with metrics for body weight, BMI, blood pressure, hemoglobin A1c (HbA1c), and lipids (Table) for each year. The mean differences between 2017 and 2019 (“no evaluations missed”) were compared to the mean differences between 2019 and 2021 (“evaluation missed”) using paired t tests. To account for changes in test procedures and period effects such as Covid, individual results were normalized by subtracting a population mean of an independent cohort that was evaluated for all 5 years (2017-2021), across all metrics and years. Results: Of the 7,620 participants, 48.9% were female and the mean (standard deviation) age was 44.8 (10.9) years. Missing an annual evaluation was associated with increased BMI (0.09 kg/m2; P=0.04), HbA1c (0.03%, P=0.0006), and triglycerides (3.68 mg/dL, P=0.003), and decreased HDL-C (-1.39 mg/dL, P<0.0001), compared to not missing an evaluation. Conclusions: Missing an annual workplace health evaluation was associated with higher levels of risk factors related to chronic disease. Disclosure K.T.Van: Employee; Quest Diagnostics. L.L.Sipe: None. Z.Chen: Employee; Quest Diagnostics, Stock/Shareholder; Quest Diagnostics. M.S.Fragala: Employee; Quest Diagnostics, Stock/Shareholder; Quest Diagnostics. C.E.Birse: Employee; Quest Diagnostics.

Abstract 10732: Independent Evaluation of Effects of a Virtual Employer-Sponsored Type 2 Diabetes Management Program on Blood Glucose

Objective: To evaluate the effect of an employer-sponsored T2D management virtual program (Onduo) on blood glucose changes, via an independent data source, within the first year of participation. Methods: This retrospective pre-post study included participants with T2D who engaged in Onduo Dec 2020-Sept 2021. Participants had to have completed an employer-sponsored wellness program (independent of Onduo) with year-end biometric screening in 2019, 2020 and 2021, which included HbA1c, fasting glucose (FG), lipids, and other biometric measurements (Table). Year-to-year changes pre-intervention (2019 vs 2020 wellness screening, before Onduo) and post-intervention (2020 vs 2021) were compared using paired t-tests (significant at P ≤.05). We also assessed year-to-year changes based on use of specific Onduo telehealth tools (mobile app, blood glucose meter [BGM], health coach consultations, continuous glucose monitor [CGM], and telemedicine visits). Results: All 578 participants included (Table) used a mobile app, 84% used personalized coaching, 69% BGM, 13% telehealth visits, and 10% CGM. Seventy (12.1%) participants had HbA1c ≥9% in 2019, 79 (13.7%) in 2020, and 57 (9.9%) in 2021 (2019 vs 2020: P =.3; 2020 vs 2021: P =.01; Χ 2 tests). Within the first year of intervention, year-to-year changes in HbA1c, FG, HDL, and LDL significantly improved compared to pre-intervention changes (Table). The largest glycemic improvements post-intervention were in participants with baseline HbA1c ≥9% ( P <.001; ANOVA) or baseline FG ≥126 mg/dL ( P <.001; 2-sample t-test). Participants who used a CGM or telemedicine visits (n=81) had greater post-intervention drops (2020 vs 2021) in HbA1c than did others (-0.7 vs -0.2%, P <.01; 2-sample t-test). Conclusions: Participation in Onduo improved year-to-year trends in HbA1c, FG, HDL, and LDL. Improvements in glycemia were greater in participants with the highest baseline glycemic indices and those who used a CGM or telemedicine visits.

59-LB: Outcomes of an Employer-Sponsored Virtual Type 2 Diabetes (T2D) Reversal Program in Working-Age Adults

Objective: To evaluate short-term outcomes of an employer-sponsored virtual T2D reversal program, conducted through medically supervised nutritional intervention and provider-led telehealth, in working-age adults. Methods: This pre-post study included 119 employees with T2D and high HbA1c and/or high spending on T2D prescriptions who enrolled in the T2D reversal program October 15, 2020-January 27, 2021. HbA1c, fasting glucose (FG) , body weight, body index mass (BMI) , and waist circumference pre- and post-enrollment were assessed from annual employer-sponsored wellness screening conducted 2019-2021, independently of the T2D reversal program. Program prescriptions (insulin, DPP4, GLP1, meglitinide, sulfonylurea, TZD, SGLT2) were compared pre vs. post (Table footnote 1) . Pharmacy spending for these prescriptions was estimated from a third-party claims database. Results: The program retention rate was 82% at 6 months and 67% at 1 year. Mean levels of all outcome measures declined significantly from pre to post (Table) . The number of prescriptions decreased for 47 (39.5%) of the 119 participants and increased for 3 (2.5%) . For 89 individuals participating for 6 months or more, average monthly prescription spending declined 18% (to $449 from $547) during the first 6 months after enrollment (vs. the prior 12 months) . Conclusions: A virtual T2D reversal program helped lower HbA1c, FG, body weight, BMI, and waist circumference in employees with diabetes while reducing prescriptions and pharmacy spending. Disclosure Z. Chen: Employee; Quest Diagnostics, Stock/Shareholder; Quest Diagnostics. C. E. Birse: Employee; Quest Diagnostics. A. R. Arellano: Employee; Quest Diagnostics. M. S. Fragala: Employee; Quest Diagnostics, Stock/Shareholder; Quest Diagnostics. M. J. Mcphaul: Employee; Quest Diagnostics. L. A. Bare: Employee; Quest Diagnostics.

Rise in Blood Pressure Observed Among US Adults During the COVID-19 Pandemic

Rise in Blood Pressure Observed Among US Adults During the COVID-19 Pandemic

Case law: Learning tools for organizations

PurposeIn this paper, we examine the use of court cases as learning tools for organizations, drawing upon a case involving a workplace wellness program. The study measures employee perceptions and provides an insight into employee beliefs about wellness plan programming. Practical insights for organizations wanting to incorporate court cases into organizational learning are provided.Design/methodology/approachThis exploratory study was conducted via Amazon Mechanical Turk survey data (n= 396). We asked participants about their levels of trust in employer-sponsored wellness programs, their understanding of wellness program parameters and limitations, and their perceptions of liability by utilizing the 2017 Whitman v. Interactive Health Solutions court case.FindingsThe results of this study show that, although employees may not fully understand their employer-sponsored wellness programs, they have a high degree of trust in their employers. Additionally, employees have strong beliefs about potential employer and third-party vendor liability when unintended consequences related to wellness plan programming occur.Originality/valueThis study adds to the small, but growing body of research focused on wellness programming in the workplace. Additionally, by measuring employee perceptions of this court case, we discovered a unique approach to problem-based learning.

Employee perceptions of wellness programs in the hospitality industry

PurposeThis study aims to examine the impacts of employee wellness programs on employee and organizational outcomes in the hospitality industry.Design/methodology/approachA survey was distributed on Amazon Mechanical Turk, targeting hospitality employees who have access to employee wellness programs. Descriptive statistics, confirmatory factor analysis and structural equation modeling techniques were used.FindingsEmployee perceptions of wellness programs significantly impacted turnover intention, job stress (JS) and perceived organizational support (POS). POS had a significant mediating effect between employee perceptions of wellness programs and JS. Employee perceptions of wellness programs did not have a significant effect on emotional labor.Originality/valueEmployee wellness programs are often recommended to human resource managers, but there is little empirical evidence of their effects, particularly for hospitality industry employees. This study investigates the actual employee outcomes of employer-sponsored wellness programs.

59-LB: Risk of Type 2 Diabetes Is Reduced in the Second Year of a Digital Diabetes Prevention Program in a Workplace Setting

Background: A digital Diabetes Prevention Program (dDPP) has been shown to reduce the 8-year risk of diabetes in the first year of implementation in a workforce setting. We asked whether the dDPP reduced the risk of diabetes in a second year. Methods: Individuals were included in the study if they (i) participated in an employer-sponsored wellness program with year-end biometric screening for 4 consecutive years (2016 to 2019), (ii) had prediabetes-range fasting glucose (100 to 125 mg/dL) or Hb1Ac (5.7% to 6.4%), (iii) a BMI ≥25 kg/m2 at the end of 2017, and (iv) completed ≥9 lessons in a dDPP initiated at the beginning of 2018. In the first year of the dDPP, individuals participated in weekly online lessons. In the second year, no new content was introduced, but individuals had access to lessons delivered in year 1. Results: The baseline characteristics from the 2017 year-end screen are provided (Table). On average, participants (n=401) completed 25.1 lessons (SD: 12.3). In the second year of intervention, levels of BMI, fasting glucose, triglycerides and HDL-C, all components of the 8-year diabetes risk score, improved relative to changes observed in the year before intervention. The 8-year risk of developing diabetes was also reduced (Table). Conclusions: The risk of developing type 2 diabetes was reduced in the second year of a dDPP. Disclosure C.E. Birse: Employee; Self; Quest Diagnostics. M.S. Fragala: Employee; Self; Quest Diagnostics. A.R. Arellano: None. L.A. Bare: Employee; Self; Quest Diagnostics. C. Castro Sweet: Employee; Self; Omada Health. R.J. Lagier: Employee; Self; Quest Diagnostics. Employee; Spouse/Partner; Thermo Fisher Scientific.

Employees’ Refusals to Participate in an Employer-Sponsored Wellness Program: Barriers and Benefits to Engagement

While worksite wellness programs are generally designed to help employees realize better overall health, some employees may not see them in that light. The current study sought to better understand why employees refuse to participate in a new employer-sponsored wellness program. This study also investigated how participation in the program is related to employees’ self-perceived health, efficacy to be healthier and their perceptions toward their organization providing useful resources to engage in a healthy lifestyle. A survey of more than 1,500 employees at a large Midwest organization was conducted after their annual open-enrollment period. Open-ended responses from participants refusing to participate in the wellness program ( n = 297) indicated privacy considerations as their primary concern. They also thought participation would take too much time, conceptually thought the program was unfair or not useful and felt they were already healthy and not in need of the program. Both participants and nonparticipants had no differences in self-perceived overall health. However, participants had greater self-efficacy, and perceptions that their employer offered useful resources to engage in a healthy lifestyle, than nonparticipants. Recommendations for communicating new wellness programs to employees are discussed.

Comparison of 3 risk factor–based screening tools for the identification of prediabetes

ObjectiveTo compare risk factor–based screening tools for identifying prediabetes. MethodsParticipants in an employer-based wellness program were tested for glycosylated hemoglobin (A1C) at a regularly scheduled appointment, and prediabetes risk factor information was collected. The likelihood of having prediabetes and the need for laboratory testing were determined based on 3 risk factor–based screening tools: the Prediabetes Screening Test (PST), Prediabetes Risk Test (PRT), and 2016 American Diabetes Association guidelines (ADA2016). The results from the screening tools were compared with those of the A1C test. The predictive ability of the PST, PRT, and ADA2016 were compared using logistic regression. Results were validated with data from a secondary population. ResultsOf the 3 risk factor–based tools examined, the PRT demonstrated the best combination of sensitivity and specificity for identifying prediabetes. From July 2016 to March 2017, 740 beneficiaries of an employer-sponsored wellness program had their A1C tested and provided risk factor information. The population prevalence of prediabetes was 9.3%. Analysis of a second independent population with a prediabetes prevalence of more than 50% of confirmed PRT’s superiority despite differences in the calculated sensitivity and specificity for each population. ConclusionBecause PRT predicts prediabetes better than PST or ADA2016, it should be used preferentially.

More than step count: designing a workplace-based activity tracking system

The ‘one-size-fits-all’ approach used in current activity tracking devices such as FitBit, Jawbone, and smartwatches may not be enough to encourage healthier behaviour patterns in people, as much more considerate design is required to create meaningful experiences. This paper focuses on designing an activity tracking system that can be used in a workplace setting. We apply a grounded approach, where we aim to understand employee’s perceptions of physical activities at workplaces and the role an activity tracker can play in supporting that. We describe a three-phase design process, which involves (1) interviewing employees who participated in a large-scale employer-sponsored health and wellness programme, (2) two participatory design workshops that aimed at understanding the role of activity tracking in workplace contexts and generating ideas for activity tracking applications, and (3) studying the use of the resulting design prototype—QUTgo—as a ‘technology probe’ to gather insights into the potential of physical activity tracking in workplaces. This paper contributes to the emerging repoirtoire of studies on activity tracking by providing a user-centric perspective on how to design an engaging activity tracking system that takes into account employees’ perspectives and experiences and the dynamics of specific work settings.

The Effect of Environmental Changes on Hospital Employee Walking Duration

PURPOSE: Employee health is known to be associated with work-related physical exertion. The objectives of this study were to assess the effect on employee daily steps taken by transitioning a free-standing rehabilitation hospital to a larger facility and to compare step count differences across age, sex, and occupations. METHODS: Data from personal fitness devices linked to an employer-sponsored wellness program assessed the number of steps taken in two specific months (July and November) in the year prior to and in the year following the move to a rehabilitation facility three-times the size of the original. Participant data were only included for those enrolled in the program in these specific months pre- and post-move. Daily step counts accounted for activity both during and outside of work. RESULTS: Participants (n=70) had significantly less average daily steps for both July (9708 steps vs. 8008 p=0.02) and November (8839 vs. 7779 p=0.006) following the move to the new rehabilitation facility. Groups with significant step reduction included women compared to men (p=0.03), those aged 21-35 years (p=0.03), and the occupations of health care assistants (HCAs) and nursing (p=0.01), for both months. However, medical providers (physicians and nurse practitioners) had a trend towards increased step counts, regardless of age group or sex. CONCLUSION: Transitioning a rehabilitation facility to a larger building does not necessarily lead to increased employee work-related physical activity. In our study, the transition to a larger facility was associated with a reduction in employee daily steps taken with relation to age, gender, and occupation. These findings may reflect strategic planning within the new workspace, which optimizes efficiency specifically for nurses and HCAs, allowing occupational duties to be confined to a smaller area. This could lead to employees having less daily work-related physical exertion, although this will be investigated further in future studies.

77-LB: Digital Behavioral Counseling in a Workforce Setting Reduces 8-Year Risk of Developing Type 2 Diabetes

Background: Digital behavioral counseling has previously been shown to reduce levels of risk factors for diabetes including fasting glucose and HbA1c. We asked whether the 8-year risk of developing diabetes could be reduced within the first year of a digital counseling program. Methods: Individuals were included in the study if they (i) participated in an employer-sponsored wellness program with year-end biometric screening for 3 consecutive years (2016, 2017, and 2018), (ii) had prediabetes-range fasting glucose (100 to 125 mg/dL) or Hb1Ac (5.7% to 6.4%), (iii) a BMI ≥25 kg/m2 at the end of 2017, and (iv) completed at least 9 lessons in a digital behavioral counseling program initiated at the beginning of 2018. Paired t-Tests were used to assess changes in yearly trajectories of diabetes risk factors before and after intervention (Table). Results: The baseline characteristics of the cohort at the 2017 year-end screen are provided (Table). On average, participants (n=460) were engaged in the counseling program for 9.1 months (SD: 1.2) and completed 25.1 lessons (SD: 12.3). After participation, levels of all biometric variables included in the 8-year risk model* shifted in a favorable direction; the 8-year risk of developing diabetes was reduced (Table). Conclusions: Digital behavioral counseling was effective in reducing risk factors and the 8-year risk of diabetes during the first year of the program. Disclosure C.E. Birse: Employee; Self; Quest Diagnostics. Stock/Shareholder; Self; Quest Diagnostics. M.S. Fragala: Employee; Self; Quest Diagnostics. A. Satish: None. K.C. McNamara: Employee; Self; Omada Health, Inc. C.M. Castro Sweet: Employee; Self; Omada Health, Inc. R.J. Lagier: Employee; Self; Quest Diagnostics.

Reduction of Diabetes and Cardiovascular Risk in a Workforce after Digital Behavioral Counseling

Background: We asked whether the integration of digital behavioral counseling with employer-sponsored annual biometric screening could reduce the risk of obesity-related chronic disease in a U.S. workforce. Methods: We evaluated a cohort (n=113) who participated in an employer-sponsored annual wellness program with year-end biometric screening and enrolled in a digital behavioral counseling program. Individuals were included in the analysis if they participated in the wellness program in 2015, had prediabetes (fasting glucose (FG) 100 to 125mg/dL or Hb1Ac 5.7 to 6.4%) and a BMI ≥25 kg/m2 in 2016, and agreed to participate in a digital behavioral counseling program followed by year-end biometric screening in 2017. Results: The participants were 75% women and 61% Caucasian, 28% African American. At the 2016 year-end biometric screening, which preceded digital behavioral counseling, the characteristics of the cohort (mean± sd) were age, 50.0±9.9 years; BMI, 37.1±8.6 kg/m2; Hb1Ac, 6.1±0.6%; and FG, 106.9±24.2 mg/dL. Following behavioral counseling, 28% of the participants lost 5% or more of body weight. Hb1Ac and FG levels both fell below prediabetic thresholds for 32% of the participants. Other biometric outcome measures improved (Table). Conclusions: Digital behavioral counseling was effective in reducing risk for both diabetes and cardiovascular disease in a workforce cohort.Change in annual biometric screening resultsThe year preceding counseling (2015 to 2016)The year counseling received (2016 to 2017)P value (paired t-Test)BMI (kg/m2)+0.66-1.18<0.0001Hb1Ac (%)+0.06-0.220.001Fasting Glucose (mg/dL)+5.85-2.840.02Triglycerides (mg/dL)+12.0-17.20.0110-year ASCVD risk* (%)+1.83-0.480.01*Atherosclerotic Cardiovascular Disease risk (2013 ACC/AHA Cardiovascular Risk Guideline) Disclosure C.E. Birse: Employee; Self; Quest Diagnostics. Stock/Shareholder; Self; Quest Diagnostics. R.J. Lagier: Employee; Self; Quest Diagnostics. P. Chew: Employee; Self; Omada Health, Inc. C.B. Jasik: Employee; Self; Omada Health, Inc. E.N. Madero: Employee; Self; Omada Health, Inc..

Community pharmacist led, employer-based wellness services: A pilot study.

The emphasis that United States employers are placing on employee wellness continues to grow; however, most attention has been paid to larger firms to gauge return-on-investment from a larger pool of enrollees. With fewer resources available to fund expansive wellness programs, smaller businesses need a cost-effective mechanism to provide such benefits. As the most accessible healthcare provider, community pharmacists are in an ideal position to support certain wellness programs for smaller businesses. This research piloted a community pharmacist-led, employer-sponsored wellness program for a self-insured financial services company in Tennessee. Employees with diabetes, hypertension, hyperlipidemia, asthma, or COPD were recruited from the partnering firm to receive live, one-on-one counseling from a community pharmacist over a calendar year. Each session was tailored to individual employee's needs and goals but generally focused on medication adherence, diet, exercise, and health maintenance strategies. Fifteen employees participated in the program, and improvements in clinical measures were not realized over the course of a year. Some, albeit not statistically significant, improvements were seen in self-reported medication adherence and quality of life; however, a trend toward some weight gain was observed. Results suggest that, similar to Medicare beneficiaries, working-age adults with certain chronic conditions may benefit from pharmacist-led MTM programs but deeper investigation is needed.

Perceptions of Barriers to Effective Obesity Care: Results from the National ACTION Study.

ACTION (Awareness, Care, and Treatment in Obesity maNagement) examined obesity-related perceptions, attitudes, and behaviors among people with obesity (PwO), health care providers (HCPs), and employer representatives (ERs). A total of 3,008 adult PwO (BMI ≥ 30 by self-reported height and weight), 606 HCPs, and 153 ERs completed surveys in a cross-sectional design. Despite several weight loss (WL) attempts, only 23% of PwO reported 10% WL during the previous 3 years. Many PwO (65%) recognized obesity as a disease, but only 54% worried their weight may affect future health. Most PwO (82%) felt "completely" responsible for WL; 72% of HCPs felt responsible for contributing to WL efforts; few ERs (18%) felt even partially responsible. Only 50% of PwO saw themselves as "obese," and 55% reported receiving a formal diagnosis of obesity. Despite HCPs' reported comfort with weight-related conversations, time constraints deprioritized these efforts. Only 24% of PwO had a scheduled follow-up to initial weight-related conversations. Few PwO (17%) perceived employer-sponsored wellness offerings as helpful in supporting WL. Although generally perceived as a disease, obesity is not commonly treated as such. Divergence in perceptions and attitudes potentially hinders better management. This study highlights inconsistent understanding of the impact of obesity and need for both self-directed and medical management.

Vitamin D Status and Supplementation in Employer-Sponsored Wellness Program.

To assess the response to information about vitamin D status by participants enrolled in employer-sponsored wellness programs. A self-reported health risk assessment questionnaire was used to categorize vitamin D supplementation. A total of 50 209 participants of 12 employer-sponsored wellness programs that included vitamin D testing and services provided by Quest Diagnostics in 2014 and 2015. Vitamin D status based on laboratory testing results and responses to vitamin D supplementation in a health risk assessment questionnaire for initial and subsequent years. Among 50 209 participants, 29% had deficient and 37% had suboptimal levels of vitamin D. Many participants appeared to act counter to their informed vitamin D status by starting supplements when vitamin D level was initially optimal (20%) or discontinuing supplements when vitamin D level was initially deficient (36%). Three-quarters of participants who had deficient or suboptimal vitamin D levels and were not taking supplements in 2014 continued not taking supplements in 2015. Deficient and suboptimal vitamin D levels remain prevalent in a working-age population. Many participants do not seem to be taking appropriate actions after receiving vitamin D testing results. Accordingly, employer-sponsored wellness programs have an opportunity to better educate participants.

Obesity coverage gap: Consumers perceive low coverage for obesity treatments even when workplace wellness programs target BMI.

Evidence-based obesity treatments, such as bariatric surgery, are not considered essential health benefits under the Affordable Care Act. Employer-sponsored wellness programs with incentives based on biometric outcomes are allowed and often used despite mixed evidence regarding their effectiveness. This study examines consumers' perceptions of their coverage for obesity treatments and exposure to workplace wellness programs. A total of 7,378 participants completed an online survey during 2015-2016. Respondents answered questions regarding their health coverage for seven medical services and exposure to employer wellness programs that target weight or body mass index (BMI). Using χ2 tests, associations between perceptions of exposure to employer wellness programs and coverage for medical services were examined. Differences between survey years were also assessed. Most respondents reported they did not have health coverage for obesity treatments, but more of the respondents with employer wellness programs reported having coverage. Neither the perception of coverage for obesity treatments nor exposure to wellness programs increased between 2015 and 2016. Even when consumers have exposure to employer wellness programs that target BMI, their health insurance often excludes obesity treatments. Given the clinical and cost-effectiveness of such treatments, reducing that coverage gap may mitigate obesity's individual- and population-level effects.

Trends in Biometric Health Indices Within an Employer-Sponsored Wellness Program With Outcome-Based Incentives.

To evaluate changes in employees' biometrics over time relative to outcome-based incentive thresholds. Retrospective cohort analysis of biometric screening participants (n = 26 388). Large employer primarily in Western United States. Office, retail, and distribution workforce. A voluntary outcome-based biometric screening program, incentivized with health insurance premium discounts. Body mass index (BMI), cholesterol, blood glucose, blood pressure, and nicotine. Followed were participants from their first year of participation, evaluating changes in measures. On average, participants who did not meet the incentive threshold at baseline decreased their BMI (1%), glucose (8%), blood pressure (systolic 9%, diastolic 8%), and total cholesterol (8%) by year 2 with improvements generally sustained or continued during each additional year of participation. On average, individuals at high health risk who participated in a financially incentivized biometric assessment program improved their health indices over time. Further research is needed to understand key determinants that drive health improvement indicated here.

Using Theoretically Tailored Mobile Communications to Target Risky Drinking Among Employed Adults: Design of a Randomized Effectiveness Trial

Background: A sizeable proportion of employed adults consume alcohol at non-dependent but risky levels, which is defined by the National Institutes of Health for men as drinking more than 14 drinks per week or more than 4 in a day and for women as drinking more than 7 drinks per week or more than 3 drinks in a day. Risky levels of drinking impact the health, well-being, and productivity of employees, while driving costs to employers in lost productivity, absenteeism, and health care costs. There is a lack of evidence-based behavior change programs targeting alcohol consumption for employer-sponsored wellness programs.

Point-of-Care Tobacco Detection Testing Creates Efficiency and Reduces Costs for Employer-Sponsored Wellness Programs

Point-of-Care Tobacco Detection Testing Creates Efficiency and Reduces Costs for Employer-Sponsored Wellness Programs