Letters to the Editor

experimental heart-lung transplant as well as various celebrity cases of heart disease). Social issues related to health included stories on a proposed assault weapon ban, child safety (featuring McGruff the Safety Dog), community mental health after mass murder, and protesters demanding more tax money be spent on AIDS and the homeless. Nightline focused on the controversy over new "AIDS self-tests." Though health was a frequent topic on the news, health stories were not presented from a public health perspective. For example, the cystic fibrosis story featured experimental surgery, portraying the doctor as a high-tech hero, despite his protests that the new surgery was not expected to be a cure. The focus on medical technology and victims in this and other stories served to define and reinforce health problems as individual issues. A story on radon gas seeping into the nation's classrooms provides another example of the news "frame." The story highlighted the danger, equating radiation levels to "25 000 chest x-rays a year" with a health risk "equivalent to smoking three packs of cigarettes a day." While the news portrayed the Environmental Protection Agency as taking official action by alerting us to the problem, ultimately no agency was held accountable for alleviating the danger. By not asking critical questions about responsibility, the news helped to maintain the dominant news frame that government is watching out for the public's health, perhaps providing a false sense of well-being and contributing to complacency among the public. In general, health stories were presented in terms of individual behavior or responsibility. Social and economic factors external to the individual were largely ignored whereas biomedical and technological solutions to health problems were emphasized. This contributes to public health problems being understood in isolation from the larger social and political context.5 In sum, journalistic practices likely contribute to the hegemony of individual-level explanations of health issues and so may systematically inhibit a broader public health understanding of health problems. O Lwen Wafilo4 DrPH Loni 1)oeftna MPH The authors are with the School of Public

Health of the University of California at Berke-

ley. Requests for reprints should be sent to

Lawrence Wallack, DrPH, Department of So-

126 American Journal of Public Health

cial and Administrative Sciences, School of Public Health, University of California, Berkeley, CA 94720.

References 1. Rogers EM, Dearing JW. Agenda-setting research: where has it been, where is it going? Communication Yearbook 11. 1988:555-594. 2. McCombs M, Shaw D. The agenda setting function of mass media. Public Opinion Q.

1972-1973;36:176-187. 3. Iyengar S, Kinder DR. News That Matters. Chicago, Ill: University of Chicago Press; 1987. 4. Gitlin T. The Whole World Is Watching. Berkeley, Calif: University of California Press; 1980. 5. Wallack L. Improving health promotion: media advocacy and social marketing approaches. In: Atkin C, Wallack L, eds. Mass Co unication and Public Health, Complexities and Conflicts. Newbury Park, Calif: Sage Publications Inc; 1990:147-163.

Effects of Workplace Health Promotion Not Demonstrated In his article on the effects of workplace health promotion (WHP) on absenteeism and costs,1 Bertera reports that over a 2-year period disability days in program sites decreased by 0.7 days per worker per year, while mean disability days decreased by only 0.3 days at nonprogram sites. Calling the difference of 0.4 days statistically significant, Bertera multiplies this figure by daily wage costs to estimate financial savings attributable to the WHP intervention. Comparing these savings to (lower) program costs, Bertera concludes that the intervention produced a net economic benefit for the firm. He offers this study as further evidence that WHP is financially profitable for businesses. Bertera may be right. But in downplaying the important nonequivalence of the (self-selected) program and nonprogram sites, he never mentions a simple but critical observation, found in Table 2, that he himself could not conceivably have missed: disability days are identical for program and nonprogram sites at the end of the intervention. The difference of 0.4 days in the change in disability days over the course of the intervention is exactly the difference observed at baseline; that is, the self-selected program sites started out 0.4 disability days higher than the nonprogram sites. (I am using the figures presented in the text. These are not consistent with those in the table, the result, I assume, of a typo. Choice of either text or table figures does not affect the observation being made here.) If the difference is

statistically significant as a decrease over time, it is also most likely statistically significant as a difference between program and nonprogram sites prior to the initiation of the intervention. In other words, the nonprogram sites are not an adequate control for evaluating the effect of the intervention. Attainment of the same level of disability days by program sites by the end of the intervention period could simply represent regression toward the mean or some third variable related to the selfselection process. The intervention Bertera monitored may have decreased disability days; but this study offers no statistically meaningful evidence that this, in fact, occurred. Rather, Bertera's interpretation is best characterized as what Dr. Emst Wynder has labeled "wish bias" (personal communication). Ultimately, workplace health promotion may be demonstrated to be a money maker. (More importantly, perhaps, and certainly more likely, it may well prove to be an excellent vehicle to improve employee health and morale in a cost-effective manner.) The present study, like altogether too much of the relevant literature, adds little to the search for scientifically sound evidence.2 0 Kennet E. Warner, PhD Requests for reprints should be sent to Kenneth E. Warner, PhD, University of Michigan, School of Public Health, 1420 Washington Heights, Ann Arbor, MI 48109-2029.

References 1. Bertera RL. The effects of workplace health promotion on absenteeism and employment costs in a large industrial population. Am J Public Health. 1990;80:1101-1105. 2. Warner KE, Wickizer TM, Wolfe RA, Schildroth JE, Samuelson MH. Economic implications of workplace health promotion programs: review of the literature. J Occup Med. 1988;30:106-112.

Bertera Responuds Our study did not attempt to randomly assign sites or employees to the workplace health promotion interventions because of concerns about employee relations, limited staff, and an almost nonexistent research budget. As indicated in the paper, the program sites differed significantly from the nonprogram sites at the pretest on key outcome variables. This made a pretest-posttest, nonequivalent control group design the most realistic choice to guide the analysis. Once these baseline differences were acknowledged, the only valid comparisons were the pretest to posttest changes within

January 1992, Vol. 82, No. 1

Effects of workplace health promotion not demonstrated.

Letters to the Editor experimental heart-lung transplant as well as various celebrity cases of heart disease). Social issues related to health includ...
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