The costs of health risks and the effects of a health promotion program designed to reduce these risks

Health promotion programs (HPP's) have become increasingly popular with corporations seeking to control rapidly increasing health care expenditures. These programs promise to reduce expenditures by reducing health risks that lead to illness and injury. Although the costs associated with health risks have been documented, proof that HPP's can reduce these risks and the costs associated with them is lacking.; This work analyzed the relationships between health risks and health care expenditures and the effects of a HPP on these relationships in several ways. First, the effects of participation in the StayWell HPP on health risks were assessed. Next, this work analyzed the associations between thirteen health risks, and changes therein, and health care expenditures. Finally, the effects of participation in the StayWell HPP on health care expenditures were estimated.; This work furthered the science behind health promotion by incorporating advanced econometric techniques and by introducing a procedure for estimating the selection effects associated with HPP participation. The annual costs associated with various health risks were estimated using two-part models. Generalized estimating equations with an exchangeable error structure were used in these models to control for the numerous unmeasured, individual-specific factors that affect health care expenditures. Standard errors for the estimates of the overall effect of each risk factor were determined using bootstrap analysis. These modeling techniques were also used to estimate the effects of the StayWell HPP on health care expenditures.; Participation in activities related to eating habits and exercise was associated with slight improvements in the associated risks. Depression ({dollar}642), back pain ({dollar}438), stress ({dollar}424), obesity ({dollar}346), and smoking ({dollar}284) were the most costly health risks. Reductions in depression, back pain, and stress risks were associated with reductions in the costs of these risks. For heavy smokers, smoking cessation was associated with a {dollar}560 increase in expenditures. Participation in the StayWell program was not correlated with a reduction in health care expenditures in the general population.; This work clearly demonstrated that modifiable health risks were associated with significantly increased health care expenditures. However, the HPP was only marginally effective at reducing health risks and ineffective at reducing costs.