Friday, 11 February 2011 19:05

HIV/AIDS Education

Written by
Rate this item
(0 votes)

As the epidemic of HIV infection worsens and spreads, increasing numbers of workplaces, labour unions, employers and employees are being affected by the threat of HIV infection and AIDS (collectively to be termed HIV/AIDS). The effects are often particular and highly visible; they can also be insidious and somewhat hidden. Over the relatively brief lifetime of the HIV epidemic, the direct and indirect consequences of AIDS for the business sector and for the workplace in general (as distinguished from its health care aspect), remain for the most part a peripherally acknowledged component of the severity and magnitude of AIDS.

The attitudes and opinions of employees about AIDS are of pivotal importance, and must be assessed if a workplace programme is to be planned and managed effectively. Employee ignorance and misinformation can represent major obstacles to an educational programme, and if misjudged or handled poorly, can lead to distrust and disruption, and can aggravate already-prevalent biases and fears about AIDS.

In the United States, “AIDS has generated more individual lawsuits across a broad range of health issues than any other disease in history”, notes Lawrence Gostin of the HIV Litigation Project. A 1993 national survey of employee attitudes about AIDS by the National Leadership Coalition on AIDS reports that many working Americans continue to hold negative and potentially discriminatory attitudes toward HIV-infected co-workers, and the survey finds that most employees either don’t know how their employers would react to HIV- or AIDS-related situations in their workplaces, or they think that their employer would dismiss an employee with HIV infection at the first sign of illness. Discriminating against employees based solely on disability is expressly forbidden in the United States by the Americans with Disabilities Act (ADA), which includes under its protection people with HIV infection and AIDS. The Americans with Disabilities Act requires employers of more than 15 people to make “reasonable accommodations”, or adjustments in the job for their employees with disabilities, including HIV infection and AIDS.

For example, 32% of working Americans in the survey thought an employee with HIV infection would be fired or placed on disability leave at the first sign of illness. Clearly, if an employer moved to dismiss an employee with HIV infection solely on the basis of the diagnosis alone, that employer would be breaking the law. Such widespread employee ignorance of an employer’s legal responsibilities clearly makes employers—and by extension, their managers and employees—vulnerable to potentially costly discrimination lawsuits, work disruptions and employee morale and productivity problems.

Misperceptions about the epidemic can also fuel discriminatory attitudes and behaviour among managers and employees and can place an employer at risk. For example, 67% of workers surveyed thought that their colleagues would be uncomfortable working with someone with HIV infection. Left unchecked, such attitudes and the sorts of behaviour consistent with them can place an employer at considerable risk. Managers may erroneously assume that discriminatory treatment against those with HIV infection or AIDS, or those perceived as being infected, is acceptable.

HIV/AIDS Management Challenges

The medical, legal, financial, and workplace developments arising from the epidemic pose a host of challenges for people with HIV infection and AIDS, their families, their unions and their employers. Labour leaders, business executives, human resource professionals and front-line managers face increasingly complicated duties, including controlling costs, protecting the confidentiality of employees’ medical information and providing “reasonable accommodations” to their employees with HIV infection and AIDS, in addition to protecting people with HIV infection and AIDS and those perceived as having the illness from discrimination in hiring and promotion. People infected with HIV are remaining at work longer, so that employers need to plan how best to manage HIV-infected employees fairly and effectively over a longer period of time, and often with little or no training or guidance. Effectively managing employees with AIDS requires keeping abreast of emerging health care options, health insurance and health care costs, and legal and regulatory requirements, shaping effective “reasonable accommodations”, and managing concerns about confidentiality and privacy, discrimination issues, employee fears, harassment of infected workers, customer concerns, work disruptions, lawsuits, declines in worker productivity and morale—all the while maintaining a productive and profitable workplace and meeting business goals.

That is a large and somewhat complex set of expectations, a fact that underscores one of the essential needs in setting about to provide workplace education, namely, to start with managers and to train and motivate them to view AIDS in the workplace as part of long-term strategies and goals.

Amid the barrage of questions and concerns about the epidemic and how to manage its impact on the workplace, employers can take cost-effective steps to minimize risk, cut health care costs, protect their company’s future and, most important, save lives.

Step one: Establish a workplace HIV/AIDS policy

The first step toward effectively managing the workplace issues arising from the HIV epidemic is to put in place a sound workplace policy. Such a policy must set forth clearly the ways a business will deal with the host of complex but manageable challenges generated by HIV/AIDS. (“A sound workplace policy that accounts for an employer’s responsibilities to infected and affected workers will help keep a business from becoming a test case,” says Peter Petesch, a Washington, DC–based labour lawyer interested in the issue of AIDS and its workplace ramifications.)

Of course, a workplace policy itself will not remove the difficulties inherent in managing an employee with a fatal and often stigmatized illness. Nonetheless, a written workplace policy goes a long way towards preparing a company for its efforts to manage AIDS by minimizing risks and protecting its workforce. An effective written policy will include among its aims the need to

  • Set a consistent internal standard for a company’s entire HIV/AIDS programme.
  • Standardize a company’s position and communications about HIV/AIDS.
  • Establish a precedent and standards for employee behaviour.
  • Inform all employees where they can go for information and assistance.
  • Instruct supervisors how to manage AIDS in their work groups.


Effective HIV/AIDS policies should cover and provide guidance on compliance with the law, nondiscrimination, confidentiality and privacy, safety, performance standards, reasonable accommodation, co-worker concerns and employee education. In order to be effective, a policy must be communicated to employees at every level of the company. Moreover, it is crucial to have the outspoken, highly visible support of upper-level management and executives, including the chief executive, in reinforcing the urgency and importance of the messages outlined above. Without this level of commitment, a policy that exists just “on paper” runs the risk of being simply a lion with no teeth.

There are two general approaches to developing HIV/AIDS policies:

  1. The life-threatening illness approach. Some employers choose to develop their HIV/AIDS policy as part of the continuum of all life-threatening illnesses or disabilities. These policies usually state that HIV/AIDS will be handled as are all other long-term illnesses—compassionately, sensibly and without discrimination.
  2. The HIV/AIDS-specific approach. This approach to policy development specifically acknowledges and addresses HIV/AIDS as a major health issue with potential impact on the workplace. In addition to the policy statement itself, this approach often includes an educational component asserting that HIV/AIDS is not transmitted through casual workplace contact, and that employees with HIV infection or AIDS do not pose a health risk to co-workers or customers.


Step two: Train managers and supervisors

Managers and supervisors should be thoroughly familiarized with the employer’s workplace HIV/AIDS policy guidelines. One should ensure that every level of management is supplied with clear and consistent guidance on the medical facts and the minimal risk of transmission in the general workplace. In countries with anti-discrimination laws, managers must also be thoroughly familiar with their requirements (e.g., the Americans with Disabilities Act and its reasonable accommodation requirements, nondiscrimination, confidentiality and privacy, workplace safety and employee performance standards in the United States).

Also, all managers must be prepared to field questions and concerns from employees about HIV/AIDS and the workplace. Often the front-line managers are the first ones called on to provide information and referrals to other sources of information and to provide in-depth answers to employee questions about why they should be concerned about HIV infection and AIDS and about how they are expected to behave. Managers should be educated and prepared before employee education programmes are instituted.

Step three: Educate employees

Workplace-based education programmes are inexpensive and cost-effective ways to minimize risk, protect workers’ lives, save money on health care costs and save lives. MacAllister Booth, CEO of the Polaroid Corporation, recently said that the AIDS education and training for all Polaroid employees cost less than the treatment costs of one case of AIDS.

Workplace wellness programmes and health promotion are already an established part of the world of work for more and more workers, particularly among labour organizations and larger businesses. Campaigns to reduce medical costs and days missed due to preventable illnesses have focussed on the importance of stopping smoking and of exercising and following a healthier diet. Building on efforts to increase the safety of workplaces and the health of the workforce, workplace wellness programmes are already established as cost-effective and appropriate venues for health information for employees. HIV/AIDS education programmes can be integrated into these ongoing health promotion efforts.

Further, studies have shown that many employees trust their employers to provide accurate information about a broad range of topics, including health education. Working people are concerned about AIDS, many lack understanding of the medical and legal facts about the epidemic, and they want to learn more about it.

According to a study by the New York Business Group on Health (Barr, Waring and Warshaw 1991), employees generally have a positive opinion of employers who provide information about AIDS and—depending on the type of programme offered—found the employer to be a more credible source of information than either the media or the government. Further, according to the National Leadership Coalition on AIDS’ survey of working American’s attitudes about AIDS, 96% of employees who received AIDS education at work supported workplace-based HIV/AIDS education.

Ideally, attendance at employee education sessions should be mandatory, and the programme should last at least one and a half hours. The session should be conducted by a trained educator, and should present materials in an objective and nonjudgemental way. The programme should also allow for a question-and-answer period and provide referrals for confidential assistance. Initiatives taken with regard to AIDS in the workplace should be ongoing, not one-shot events, and are more effective when linked with such public acknowledgements of the importance of the problem as World AIDS Day observances. Finally, one of the most effective methods for discussing AIDS with employees is to invite a person living with HIV infection or AIDS to address the session. Hearing first-hand how someone lives and works with HIV infection or AIDS has been shown to have a positive impact on the effectiveness of the session.

A thorough workplace AIDS education programme should include a presentation of these matters:

  • the medical facts— how HIV is and is not transmitted, emphasizing that it cannot be spread through casual contact and is virtually impossible to contract in the workplace
  • the legal facts, including employer responsibilities, especially the importance of confidentiality and privacy and of providing reasonable accommodations
  • the psychosocial issues, including how to respond to a co-worker with HIV/AIDS, and what it is like to live and work with HIV/AIDS
  • guidelines on company policies, benefits and information
  • information for employees to take home to their families to teach them how to protect themselves
  • information on community resources and places to go for anonymous testing.


Studies caution that attitudes about AIDS can be negatively reinforced if an education or training session is too brief and not sufficiently thorough and interactive. Similarly, simply handing out a brochure has been shown to increase anxiety about AIDS. In a brief, cursory session, attendees have been found to absorb some of the facts, but to leave with unresolved anxieties about the transmission of HIV, anxieties which have, in fact, been aroused by the introduction of the subject. Thus it is important to allow sufficient time in a training session for in-depth discussion, questions and answers, and referrals to other sources of confidential information. Optimally, a training session should be compulsory because the stigma still associated with HIV infection and AIDS will prevent many from attending a voluntary session.

Some Union Responses to HIV/AIDS

Some leading examples of union HIV/AIDS education and policy initiatives include the following:

  1. The Seafarers International Union established an HIV/AIDS education programme as a mandatory component of the curriculum for merchant marine students at its Lundeberg School of Seamanship in Piney Point, Maryland. Individuals wishing to enter the industry may attend a 14-week training course at the school, and those already working in the industry attend no-cost classes to upgrade their skills and to obtain high-school equivalency diplomas or associate degrees. The Seafarers educational seminars about HIV/AIDS last two hours, and this comprehensive approach is based on the recognition that a thorough training is necessary to meet the needs of a workforce which travels abroad and operates in a self-contained environment. The HIV prevention course is part of a programme that covers employment practices, workplace health and safety, and the containment of health care costs. The education is supplemented by the showing of a variety of AIDS videotapes in the closed circuit television system in the Lundeberg school, publication of articles in the school newspaper and the distribution of brochures at Union Halls in each port. Free condoms are also made available.
  2. The Service Employees International Union (SEIU) became involved in AIDS-related activities in 1984 when fear of AIDS transmission first arose among its members working at San Francisco General Hospital. To assure that health care workers would be able to continue to provide compassionate care to their patients, it was critically important that irrational fear be confronted with factual information and that adequate safety precautions be implemented at the same time. This crisis led to the establishment of the SEIU’s AIDS Program, a model for peer-oriented efforts, in which members work with each other to resolve educational and emotional support needs. The programme includes monitoring infection control procedures in hospitals, responding to individual requests from union members to design and conduct AIDS training programmes and encouraging hospital management coordination with the SEIU on AIDS-related concerns.
  3. A significant benefit of the SEIU approach to HIV/AIDS has been the development of scientifically-based policies and member education programmes that demonstrate genuine concern for all involved in the epidemic, including the health care worker, the patient and the public. The union actively promotes AIDS awareness on the national and international levels at conferences and meetings, a focus which has positioned the SEIU at the forefront of educating newly arrived immigrant workers about HIV prevention and about workplace safety with respect to all blood-borne pathogens. This educational effort takes into account the primary or preferred languages and cultural differences among its target audience.



Although the unions and companies responding constructively to the day-to-day workplace challenges of HIV/AIDS are in the minority, many have provided the models and a growing body of knowledge that is readily available to help others effectively address HIV as a workplace concern. The insight and experience gained over the past ten years demonstrate that well-planned AIDS policies, workplace standards and practices, leadership and ongoing labour, management and employee education are effective methods for addressing these challenges.

As trade unionists, industry groups and business associations recognize the growing consequences of AIDS for their sectors, new groups are forming to address the particular relevance of AIDS to their interests. The Thai Business Coalition on AIDS was launched in 1993, and appears likely to stimulate similar developments in other Pacific Rim countries. Several business and trade groups in Central and Southern Africa are taking the initiative in providing workplace education, and similar undertakings have become visible in Brazil and in the Caribbean.

The World Development Report (1993) was devoted to “Investing in Health” and examined the interplay between human health, health policy and economic development. The report provided a number of examples of the threat which AIDS poses to development strategies and accomplishments. This report indicates that there is a growing opportunity to utilize the skills and resources of global finance and development, working in closer harmony with public health leaders around the world, to form more effective action plans for confronting the economic and business challenges stemming from AIDS (Hammer 1994).

Unions and employers find that implementing AIDS policies and employee education programmes before confronting a case of HIV helps reduce workplace disruptions, saves money by protecting the health of the workforce, averts costly legal battles, and prepares managers and employees to respond constructively to the challenges of AIDS in the workplace. The tools needed to manage the multiple and complex day-to-day issues associated with the disease are readily accessible and inexpensive. Finally, they can save lives and money.



Read 1982 times Last modified on Thursday, 16 June 2011 12:00

" DISCLAIMER: The ILO does not take responsibility for content presented on this web portal that is presented in any language other than English, which is the language used for the initial production and peer-review of original content. Certain statistics have not been updated since the production of the 4th edition of the Encyclopaedia (1998)."


Part I. The Body
Part II. Health Care
First Aid & Emergency Medical Services
Health Protection & Promotion
Occupational Health Services
Part III. Management & Policy
Part IV. Tools and Approaches
Part V. Psychosocial and Organizational Factors
Part VI. General Hazards
Part VII. The Environment
Part VIII. Accidents and Safety Management
Part IX. Chemicals
Part X. Industries Based on Biological Resources
Part XI. Industries Based on Natural Resources
Part XII. Chemical Industries
Part XIII. Manufacturing Industries
Part XIV. Textile and Apparel Industries
Part XV. Transport Industries
Part XVI. Construction
Part XVII. Services and Trade
Part XVIII. Guides

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.
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.