Int. Journal of Business Science and Applied Management, Volume 6, Issue 1, 2011

Regulating employees' health behaviors: The effects of

personal health-related orientations on legitimacy

perceptions of organizational programs and policies

Hannah Klautke

Department of Communication, Michigan State University

East Lansing, MI 48824, USA

Tel: +01 (314) 814-4262

Email: klautkeh@msu.edu

Hee Sun Park

Department of Communication, Michigan State University

East Lansing, MI 48824, USA

Tel: +01 (517) 355-3480

Email: heesun@msu.edu

Abstract

The current study investigated individuals' responses and evaluations of worksite health programs and

policies. Upper level undergraduates rated the legitimacy of policies and programs exerting low,

moderate, or high levels of control over employees’ health behaviors. The findings showed that

individuals’ nutrition orientations accelerated the decrease in legitimacy ratings that accompanied

increased control over employee fitness and health risk appraisal. On the other hand, individuals’ anti-

smoking orientations slowed the decrease in legitimacy ratings that accompanied increased control over

employee smoking behavior. Implications of the findings for job counselors and human resource

personnel are discussed.

Keywords: worksite, health, smoking, fitness, health risk appraisal

Int. Journal of Business Science and Applied Management / Business-and-Management.org

1 INTRODUCTION

The growth in corporate health programs and policies constitutes one of the most pronounced

trends in business over the past 20 years, and one that is likely to continue, and even accelerate, in the

future (Goetzel & Ozminkowski, 2000; Harris, 1994). Programs range from health awareness - and

supportive environment - programs to programs aiming at behavioral change, and target areas such as

smoking cessation, fitness coaching, health risk awareness, hypertension control, stress management,

and even spiritual employee health (e.g., Kirby, 2006; O'Donnell, 1991). Motivations for organizations

to implement such programs can include demonstrating concern for employees, improving

management-labor relations, and raising employee morale, although it may be impossible to

disentangle the intermediate goal of healthier employees from the ultimate goal of cost savings (Mayer,

1991). In cases where programs are being offered on a truly voluntary basis and, more importantly,

perceptions of organizational support outweigh the restrictions that are being imposed (Dalsey & Park,

2009), individuals may well enjoy personal benefits provided by these programs rather than feel

victimized by them.

Types of health programs and policies at worksite can vary in the extent to which they regulate

individual employees' health-related behaviors. When designing and implementing health programs

and policies, companies may need to consider factors that may affect individuals' responses to the

health programs and policies. It is important to see whether individuals who will be affected by the

health programs and policies will regard the programs and policies as the legitimate and appropriate

level of organizational control. Considering that undergraduates are about to enter the workforce and

apply for jobs in near future, how they will evaluate various health programs and policies can be useful

information for companies that consider recruiting college graduates and implementing various health

programs and policies. Furthermore, undergraduates' orientations and behaviors regarding maintaining

or improving their health, nutrition, and fitness can be a factor that affects how openly they welcome

voluntary or mandatory participation in worksite health programs and policies. The current paper

focuses on health programs and policies in smoking cessation, fitness, and health risk appraisal and

investigates individual health orientation factors that are likely to affect legitimacy perceptions of low,

moderate, and high control levels of health programs and policies.

2 LITERATURE REVIEW

2.1 Health promotion in the workplace

The worksite can be an efficient place for providing public health education such as encouraging

smokers to engage in cessation techniques (Osinubi, Barbeau, Williams, & Sorensen, 2005). First, there

is the advantage of broad reach. With half of the adult population working outside of the home,

worksite programs have the potential to reach even those who traditionally lack good connections to

healthcare and health education networks (Osinubi et al., 2005). Second, there is the advantage of

exposure. The sheer amount of time individuals spend at work makes the worksite a valuable platform

for health campaigns. A third and equally important advantage lies in the opportunities for social

support, both in the form of colleagues working toward similar health goals together . Employer-based

initiatives may provide the little "nudge" that may be needed to move from good intentions to actual

healthy behaviors in order to maintain long-term changes (Mayer, 1991).

2.2 Effects on employees

As human resources strategists note, improving the company's bottom line and demonstrating true

care for employees are not mutually exclusive goals (Pfeffer, 1998). In the case of corporate health

interventions, a concern for employees’ well-being may well be an additional motive for program

implementation and employees may well appreciate ―being treated like family‖ (Hunnicutt, 2001). By

the same token, some policies can backfire and cause reactance, reduce organizational attractiveness,

and worsen the individuals' and company's well-being at the same time. This is especially true if

programs get more involved with health screenings and are perceived as intruding into employees’

privacy (Greer & Labig, 1987; Konovski & Cropanzano, 1991; McGregor, 2007; Truxillo, Baier, &

Paronto, 2002). The question is: at what point does a caring, big-brother-like company start turning into

an Orwellian version of a big brother ―watching‖ and penalizing employees for unhealthy behaviors

previously thought private?

Regarding the implementation of employee health-related interventions, more attention needs to

be paid to the perceptions of those on the receiving end of various policies formulated today (Dalsey &

Park, 2009; Konovski & Cropanzano, 1991; O'Donnell, 2000). At what point are companies' health

Hannah Klautke and Hee Sun Park

regimens perceived as "going too far," and what types of interventions are being perceived as

legitimate and/or desirable, if any? Critical voices have pointed to the paternalistic nature of these new

forms of corporate control over one's life (Kirby, 2006; Zoller, 2003), and anecdotal evidence for

employee concern over a ―slippery slope‖ exists (Jones, 2007; Park, Dalsey, Yun, Guan, & Cherry,

2008). Individuals reported the feeling of having their privacy being whittled away by attempts to

change employee behavior after five o’clock, while employers argue that it is up to the individual

whether or not they want to work under certain mandates (Jones, 2007). Although certain health issues,

such as obesity, are somewhat less amenable to employer control for legal reasons, halting behaviors

such as smoking seems to be more widely accepted; there is a move from incentive based, honor-

system approaches toward penalty-based approaches to noncompliance and more intrusive testing

(McGregor, 2007). For example, one employer started charging employees a biweekly penalty of $30

unless they meet weight, cholesterol and blood-pressure guidelines set forth by the company (Rose,

2008). For some, such intrusive health policies are overstepping sacred boundaries, and some firms

endorsing aggressive anti-smoking laws have attracted negative attention with the public both within

and outside the organization (Jones, 2007), while others are open to and even supportive of

organizational control in these areas; some may even find it desirable to work at a place where healthy

behavior is forced upon individuals.

2.3 Legitimacy perceptions of health programs and policies

Legitimacy pertains to the belief that social arrangements, institutions, authorities and their

decisions and rules are appropriate, proper and just (Tyler, 2006). Individuals’ perception of legitimacy

regarding organizational policies and programs can be important for organizations to positively

influence their members to participate in the programs and adhere to the policies. Assuming that

organizations do not prefer to simply impose a certain type of health behaviors to their members and

garner undesirable consequences, organizations may want to know how individuals will think about

legitimacy and acceptability level of organizational control when enforcing health-related regulations.

For example, when organizations change their smoking regulations from smoking allowed only in

designated break rooms to administering a mandatory pre-employment nicotine test, some individuals

may consider the new change to be much less legitimate than others may.

2.4 Types of interventions investigated in the current study

This paper focuses on three of the most common interventions: Smoke-free programs, employee

fitness programs, and health-risk appraisals (HRAs). All three approaches are well established in

organizational practice (Harris, 1994), and remain at the core of current health initiatives. For example,

the ―Wellness Management‖ program advocated by corporate healthcare provider Meritain is based on

three key initiatives labeled ―Nicotine Free,‖ ―Physically Fit,‖ and ―Managed Metrics,‖ (Meritain

Health, 2007). These programs indicate cost-saving potentials and are likely to continue to play a key

role in corporate health promotion.

Smoke-free programs: Whether in the form of incentives for quitting smoking or disincentives for

being a smoker, programs designed to eliminate or regulate smoking at the worksite do not only have a

long standing in business practice, but continue to gain in prevalence (Rose, 2008; Sofian, McAfee,

Doctor, & Carson, 1994). After all, cigarette smoking has been identified as the leading preventable

cause of illness and premature death in the U.S., increasing the risk for heart disease, stroke,

emphysema, and many cancers (CDC, 2005). It is associated with direct costs to businesses reaching

$75 billion a year in direct medical costs, $92 billion in lost productivity and $10 billion in exposure to

second-hand smoke (CDC, 2005; Meritain, 2008; Osinubi et al., 2005).

Fitness programs: After cigarette smoking, obesity is the second-leading cause of preventable

death in the U.S. A study commissioned by the AOA found that the direct healthcare costs related to

obesity reached over $102 billion in 1999 (American Obesity Association, 2002). Efforts to reduce

obesity and improve fitness are well-reflected in exercise and fitness programs pervasive in U.S.

worksites (Collingwood, 1994).

Health-risk appraisals (HRAs): Even if no immediate medical attention is needed, periodic health

reports have been found to effectively increase employees' awareness of health issues, a prerequisite for

long-term behavior modification (Dunton, 1991). While awareness and early detection are the basis for

prevention and effective treatment of most illnesses, health-risk-appraisals are one of the most

controversial elements of corporate health policies, especially if they go beyond self-report data, as in

Int. Journal of Business Science and Applied Management / Business-and-Management.org

blood chemistry analyses (Konovski & Cropanzano, 1991; McGregor, 2007; Wallston & Armstrong,

1994).

2.5 Levels of control exerted via health interventions

Canby (2007) describes the range of incentives and disincentives that may be used to encourage

compliance with corporate health programs. Rewards may range from public recognition, gift

certificates and gym memberships to days off, cash payments and reduced medical premiums. Penalties

for noncompliance, may include increased health insurance premiums, paycheck reductions, and even

termination of the employee. Some employers have elaborate calculation procedures for insurance co-

pays and deductibles in place, based on employees’ BMI, blood pressure, and even cholesterol levels

(McGregor, 2007).

The current study grouped various health initiatives into three levels of "control" based on their

intrusiveness into employees' life. Interventions labeled as low in control comprised those programs

that are implemented on a voluntary basis, are designed to raise awareness and encourage practices that

do not infringe on behaviors off the job. Examples are the limitation of smoking to designated areas,

encouragement to join the corporate fitness club membership program, and voluntary sign-ups for

health screenings. Interventions labeled as moderate in control are those that regulate employees'

behaviors on and beyond the job, such as hiring only nonsmokers (while encouraging smoking

cessation and offering support to current employees who smoke), ordering mandatory fitness regimens,

or creating annual health files for employees. Lastly, interventions labeled as high in control refer to

drastic measures such as terminating employment of smokers for their failure to quit smoking, or

denying medical benefits to high-risk individuals who fail to improve their personal fitness or reduce

health risk indicators.

2.6 Research question

Among a host of factors that can affect individuals' legitimacy ratings of various types of health

programs and policies, the current study focuses on individuals’ orientations related to health and

fitness. Individuals differ in their health and fitness related attitudes, habits, and perceived health-

related self-efficacy. These individual differences are likely to explain some variation in perceived

legitimacy and desirability of corporate health policies and programs. A match between a job

applicant’s personal values and a company’s values has been shown to positively affect the job

applicant’s evaluation of the organization (Bretz, Ash, & Dreher, 1989; Chatman, 1991; Dalsey &

Park, 2009). Similarly, a match between individuals’ health-related orientations and specific

organizational health policies that relate to these orientations is likely to increase perceptions of

legitimacy of such policies. Specifically, compared to smokers and individuals with favorable attitudes

about smoking, non-smokers and individuals with anti-smoking attitudes may be more likely to

welcome severe anti-smoking policies. Dalsey and Park (2009) showed that, compared to smokers,

non-smokers indicated higher attraction for an organization that encouraged employees to quit

smoking. Similarly, individuals with greater concern of and care for their fitness, nutrition, and

wellness can be more likely to have stronger legitimacy perceptions about higher levels of employee-

fitness and health risk appraisal interventions. The research question examined in this study is: How do

personal fitness, nutrition, anti-smoking, and wellness orientations affect the perceptions of legitimacy

of employer control of various health behaviors?

3 METHOD

3.1 Participants

Participants (n = 115, age M = 21.90, SD = 2.79, 65.3 % women) were recruited from upper

division undergraduate classes at a large Midwestern university in the U.S. The sample consisted of

84.3% Whites/Caucasians, 7.0% African Americans, 3.5% Asians, and 5.2% who indicated other

ethnicities. The majority (76.7%) was in their senior year, and 67.0 % indicated their plans to enter the

workforce within the next year. This student sample thus possessed two desirable properties for the

purpose of the current investigation: While these individuals are seriously thinking about potential

workplaces and their characteristics, they are still less concerned with an immediate need for

employment. It is likely that their personal orientations and opinions towards corporate health policies

are relatively free from practical necessity considerations that may enter the picture for long-term

unemployed job seekers, and from influences through previous corporate health promotions.

Based on considerations outlined above, but also as an induction for respondents to seriously think

about their working future, we assessed what industries, job types, and geographical regions were

sought. Answers reflected a high popularity for marketing-related jobs (26.0%), the public relations

Hannah Klautke and Hee Sun Park

industry (23.4%), health communication (11.7%), the media and entertainment industry (8.1% and

9.0%), and legal/financial/other services (7.4% each). Of the participants, 44% wished to stay in the

Midwest for their work, while 37.2% felt drawn to the West coast (19.6.2%), the East coast (17.6%), or

the South (8.8%).

3.2 Measures

All measurement items were constructed for this study, using a 7-point Likert style response

format (1 = strongly disagree, 7 = strongly agree). Appendix shows all the measurement items. Table 1

shows the reliabilities, correlations, means, and standard deviations.

Table 1: Reliabilities, Correlations, Means, and Standard Deviations

Personal health-related orientations Legitimacy ratings of interventions

Fitness

Nutrition

Anti-

smoking

Wellness

Psc

low

Psc

mod

Psc

high

Pfc

low

Pfc

mod

Pfc

high

Phc

low

Phc

mod

Phc

high

Fitness

(.87)

Nutrition

.53**

(.72)

Anti-

smoking

.13

.15

(.83)

Wellness

.47**

.52**

.18

(.82)

Psclow

.22*

.14

.30**

.18

(.81)

Pscmod

.22*

.14

.25**

.16

.41**

(.82)

Pschigh

.13

.04

.30**

.17

.32**

.71**

(.91)

Pfclow

.27**

.26**

.24**

.06

.42**

.31**

.38**

(.88)

Pfcmod

.19*

.05

.23*

.07

.18

.55**

.69**

.57**

(.83)

Pfchigh

.17

-.02

.11

.04

.19

.55**

.72**

.38**

.78**

(.91)

Phclow

.19

.25

.20*

.03

.32**

.30**

.26**

.65**

.50**

.25**

(.91)

Phcmod

.17

.09

.10

.15

.30**

.50**

.60**

.47**

.72**

.71**

.47**

(.92)

Phchigh

.06

-.06

.12

.16

.45**

.66**

.31**

.67**

.79**

.26**

.80**

(.95)

5.00

4.84

6.15

5.59

6.19

4.14

3.34

5.40

3.85

2.79

5.53

3.46

2.58

1.28

1.19

1.16

0.86

0.88

2.28

1.73

1.33

1.40

1.32

1.29

1.41

1.43

*p < .05, **p < .01. Reliabilities are reported on the diagonal.

1 = strongly disagree; 7 = strongly agree

Fitness: personal orientation placed on fitness, assessed with 3 items

Nutrition: personal orientation placed on healthy nutrition, assessed with 3 items

Anti-Smoking: anti-smoking-related orientation, assessed with 5 items

Wellness: wellness awareness orientation, assessed with 7 items

Psclow: legitimacy rating of low employer control of smoking behaviors, assessed with 7 items

Pscmod: legitimacy rating of moderate employer control of smoking behaviors, assessed with 5 items

Pschigh: legitimacy rating of high employer control of smoking behaviors, assessed with 5 items

Pfclow: legitimacy rating of low employer control of employee fitness, assessed with 6 items

Pfcmod: legitimacy rating of moderate employer control of employee fitness, assessed with 5 items

Pfchigh: legitimacy rating of high employer control of employee fitness, assessed with 8 items

Phclow: legitimacy rating of low employer control of health risk appraisals, assessed with 5 items

Phcmod: legitimacy rating of moderate employer control of health risk appraisals, assessed with 9 items

Phchigh: legitimacy rating of high employer control of health risk appraisals, assessed with 7 items

3.3 Personal health-related orientations

For this study, four categories of personal health related orientations were expected to potentially

influence perceptions of policies that related to them. These orientations were assessed through topic-

related attitudes, behaviors, and values. Fitness orientation describes personal value placed on fitness,

getting or staying in shape, and exercise habits and was assessed using three items (α = .87) such as ―I

exercise on a regular basis.‖ Nutrition orientation was measured with three items (α = .72) such as "I

Int. Journal of Business Science and Applied Management / Business-and-Management.org

maintain a well-balanced diet" and assessed respondents’ views of the importance of healthy nutrition.

Anti-smoking orientation refers to an overall tendency to be unfavorable about smoking, rather than a

simple smoker-versus-nonsmoker dichotomy. It was assessed with a continuous measure that integrated

four items (α = .83) on smoking behaviors and attitudes about being around smokers, such as ―I prefer

my environment to be smoke-free.‖ Finally, seven items (α = .82) assessed wellness orientation, or

respondents' general health awareness and behaviors regarding regular medical check-ups and taking

preventive measures (e.g., "I am interested in ways of preventing illness."). Confirmatory Factor

Analysis (CFA) showed that four-factor model (four types of orientations) fit the data well (CFI

[Comparative Fit Index] = .90, IFI [Incremental Fit Index] = .90) and was better than one-factor model

(CFI = .73, IFI = .73), Δχ

(6) = 269.78, p < .001.

3.4 Legitimacy of interventions.

Health programs and policies were grouped into three levels varying in severity for the three

general areas of interest, smoke-free programs, employee fitness programs, and health-risk-appraisals.

Legitimacy ratings were assessed by individuals indicating the extent to which they agreed or disagreed

with each program and/or policy.

For smoke-free interventions, CFA showed that three-factor models (low, moderate, and high

control) fit the data well (CFI = .95, IFI = .95) and was better than one-factor model (CFI = .87, IFI =

.87), Δχ

(3) = 305.87, p < .001. Individuals' legitimacy rating of low control of smoking behaviors

(Psclow) was assessed with seven items (α = .81) such as ―An employer has the right to limit smoking

to designated areas." Legitimacy ratings of moderate control of smoking behaviors (Pscmod) were

assessed with five items (α = .82) such as ―A company may use mandatory pre-employment nicotine

testing.‖ Legitimacy ratings of high control of smoking behaviors (Pschigh) were assessed with five

items (α = .91) such as ―One year after making a company smoke-free, an employer has the right to fire

smokers that fail to quit smoking.‖

For employee fitness interventions, CFA showed that the three-factor model fit the data well (CFI

= .91, IFI = .91) and was better than one-factor model (CFI = .83, IFI = .83), Δχ

(3) = 455.04, p < .001.

Individuals' legitimacy ratings of low control of employee fitness were assessed with six items (α = .88)

such as ―It is okay for the company to encourage regular exercise by inviting employees to a company-

wide fitness-challenge event‖ (Pfclow). Moderate control was assessed with five items (α = .83) such

as ―Depending on the employee’s fitness level, a mandatory meeting with an assigned fitness coach

may be imposed‖ (Pfcmod). High control was assessed with eight items (α = .91) such as "A company

has the right to charge higher out-of-pocket health insurance contributions of employees who fail to

improve their fitness scores substantially after one year" (Pfchigh).

Finally, for health risk appraisal interventions, CFA showed a three-factor model to be a better fit

(CFI = .95, IFI = .95) than one-factor model (CFI = .87, IFI = .87), Δχ

(3) = 897.53, p < .001. One

example of the five (α = .91) items measuring individuals' legitimacy rating of low control over

employee-health-risk appraisals (Phclow) was "A voluntary sign-up opportunity for complementary

physical check-ups is a valuable service to employees.‖ Nine items (α = .92) measured moderate

control over employee-health-risk-appraisals (Phcmod) (e.g., "An employer has the right to create

annual health reports on all employees"). Seven items (α = .95) assessed high control over employee-

health-risk appraisals (Phchigh) (e.g., "It is okay for an employer to prescribe annual blood tests to

check for cholesterol levels.").

4 RESULTS

4.1 Overview

The data were examined with Hierarchical Linear Modeling (HLM) (Raudenbush & Bryk, 2002)

because the research design involved repeated measures, and HLM allows separating the variance in

the dependent variables (i.e., legitimacy ratings) into within-individual variance and between-

individual variance. Control types (low, moderate, and high) was used to explain within-individual

level variance in the dependent variables. For between-individual level variance in the dependent

variable, individual health orientation variables (fitness, nutrition, anti-smoking, and wellness

orientations) was used to explain the variance in the extent to which individuals differ in how they

respond to each of the three control types for each health program. That is, HLM allowed for

partitioning of variance in legitimacy ratings into segments accounted for by the three types of control

(level-1 predictor) and stable individual differences (level-2 predictors). Table 2 shows HLM results.

Hannah Klautke and Hee Sun Park

Table 2: Multilevel analyses results

Coefficient

p-value

Smoke-Free Programs

For intercept 1, β

Intercept 2, γ

5.98

0.11

52.77

339

< .001

For control slope, β

Intercept 2, γ

–1.42

0.12

–12.19

110

< .001

Fitness, γ

0.13

0.09

1.44

110

.152

Nutrition, γ

–0.06

0.10

–0.61

110

.543

Anti-smoking, γ

0.26

0.08

3.06

110

.003

Wellness, γ

0.06

0.14

0.44

110

.661

Fitness Programs

For intercept 1, β

Intercept 2, γ

5.32

0.12

45.91

110

< .001

Fitness, γ

0.21

0.11

1.83

110

.070

Nutrition, γ

0.18

0.13

1.41

110

.162

Anti-smoking, γ

0.27

0.10

2.66

110

.009

Wellness, γ

–0.17

0.17

–0.95

110

.343

For control slope, β

Intercept 2, γ

–1.30

0.07

–19.43

110

< .001

Fitness, γ

0.02

0.06

0.36

110

.723

Nutrition, γ

–0.19

0.07

–2.65

110

.010

Anti-smoking, γ

–0.07

0.06

–1.09

110

.279

Wellness, γ

0.08

0.10

0.84

110

.404

Health Risk Appraisals

For intercept 1, β

Intercept 2, γ

5.33

0.11

47.06

110

< .001

Fitness, γ

0.12

0.11

1.11

110

.269

Nutrition, γ

0.26

0.12

2.08

110

.040

Anti-smoking, γ

0.18

0.10

1.78

110

.077

Wellness, γ

–0.19

0.17

–1.09

110

.278

For control slope, β

Intercept 2, γ

–1.47

0.07

–19.76

110

< .001

Fitness, γ

0.01

0.07

0.08

110

.938

Nutrition, γ

–0.25

0.08

–3.07

110

.003

Anti-smoking, γ

–0.04

0.07

–0.60

110

.553

Wellness, γ

0.19

0.11

1.74

110

.085

Note. Equations illustrating the model with grand mean centered level-2 predictors.

legitimacy of smoke-free programs

= β

+ β

(Control Type) + r

ij.

= γ

+ γ

(Fitness

) + γ

(Nutrition

) + γ

(Anti-Smoking

) + γ

(Wellness

) + u

1j,

This intercept was treated as fixed because the variance in the intercept 1 was not significant.

legitimacy of fitness programs

= β

+ β

(Control Type) + r

ij.

= γ

+ γ

(Fitness

) + γ

(Nutrition

) + γ

(Anti-Smoking

) + γ

(Wellness

) + u

= γ

+ γ

(Fitness

) + γ

(Nutrition

) + γ

(Anti-Smoking

) + γ

(Wellness

) + u

1j,

legitimacy of health risk appraisal programs

= β

+ β

(Control Type) + r

ij.

= γ

+ γ

(Fitness

) + γ

(Nutrition

) + γ

(Anti-Smoking

) + γ

(Wellness

) + u

= γ

+ γ

(Fitness

) + γ

(Nutrition

) + γ

(Anti-Smoking

) + γ

(Wellness

) + u

1j,

Int. Journal of Business Science and Applied Management / Business-and-Management.org

4.2 Smoke-Free Programs

For individuals’ legitimacy ratings of smoke-free programs, control type was a significant

predictor of the within-individual variance, coefficient = –1.42, SE = 0.09, t = –15.34, p < .001,

indicating that legitimacy ratings decreased as the control type moved from low to high. The control

type explained 61.50% of the within-individual variance. To clarify the effect of control type, paired t-

tests were conducted. Low control received higher legitimacy rating than moderate control, t (114) =

10.56, p < .001, η

= .49. Moderate control received higher legitimacy ratings than high control, t (114)

= 5.33, p < .001, η

= .20. Means are reported in Table 1.

The analysis showed that the level-1 intercept (i.e., individuals’ legitimacy ratings averaged across

the three control types) did not vary significantly across individuals, variance = 0.48, χ

(114) = 114.91,

p = .46, indicating no need for level-2 predictors. On the other hand, the level-1 slope (i.e., individual

changes from low control to high) had a significant amount of variance across individuals, variance =

0.78, χ

(114) = 364.71, p < .001, indicating that the extent to which legitimacy rating decreased from

low control to high was greater for some individuals than for others.

As shown in Table 2, individual health orientation variables (level-2 predictors) were included in

the analysis to explain between-individual variance in the extent to which legitimacy ratings changed

from low control to high (i.e., the variance in the level-1 slope). Including these level-2 predictors

explained 12.29% of the variance in the level-1 slope. Among the predictors, only anti-smoking

orientation was a significant and positive predictor, whereas fitness, nutrition, and wellness orientations

were not significant. This finding indicated that as individuals had higher anti-smoking orientations, the

slope became less negative; individuals with higher anti-smoking orientations showed less decrease in

their legitimacy ratings from low control to high. To put it differently, legitimacy rating decrease from

low control to high was more pronounced among those with lower anti-smoking orientations.

4.3 Fitness programs

For individuals’ legitimacy ratings of fitness program, the control type was a significant predictor

of the within-individual variance, coefficient = –1.30, SE = 0.07, t = –18.97, p < .001, indicating that

legitimacy ratings decreased as the control type moved from low to high. The control type explained

80.44% of the within-individual variance. To clarify the effect of control type, paired t-tests were

conducted. Low control received higher legitimacy rating than moderate control, t (114) = 13.19, p <

.001, η

= .60. Moderate control received higher legitimacy rating than high control, t (114) = 12.43, p

< .001, η

= .58. The analysis showed that the level-1 intercept (i.e., individuals’ legitimacy ratings

averaged across the three control types) varied significantly across individuals, variance = 1.33, χ

(114)

= 448.32, p < .001, indicating the need for level-2 predictors to explain the variance in the level-1

intercept. The level-1 slope (i.e., individual changes from low control to high) had a significant amount

of variance across individuals, variance = 0.30, χ

(114) = 255.15, p < .001, indicating that the extent to

which legitimacy rating decreased from low control to high was greater for some individuals than for

others.

As shown in Table 2, individual health orientation variables (level-2 predictors) were included in

the analysis to explain between-individual variance in the individual average legitimacy ratings (i.e.,

the variance in the level-1 intercept) and also in the extent to which legitimacy ratings changed from

low control to high (i.e., the variance in the level-1 slope). Including these level-2 predictors explained

14.29% of the variance in the level-1 intercept and 8.31% of the variance in the level-1 slope. Among

the predictors, only anti-smoking orientation was a significant and positive predictor of the level-1

intercept, whereas fitness, nutrition, and wellness orientations were not significant. This finding

indicated that the higher an individual's anti-smoking orientation, the higher his or her average

legitimacy ratings across the three types of control. Among the predictors, only nutrition was a

significant and negative predictor of the level-1 slope. This finding indicated that the higher an

individual's nutrition orientation, the more negative the slope became; individuals with higher nutrition

orientations showed greater decrease in their legitimacy ratings from low control to high. Put

differently, the decrease in perceived legitimacy from low control to high was less pronounced among

those with lower nutrition orientations.

4.4 Health risk appraisal programs

Finally, for individuals’ perceived legitimacy scores of health risk appraisal program, the control

type was a significant predictor of the within-individual variance, coefficient = –1.47, SE = 0.08, t = –

19.17, p < .001, again indicating that legitimacy ratings decreased as the control type moved from low

control to high. The control type explained 78.27% of the within-individual variance. To clarify the

effect of control type, paired t-tests were conducted. Low control received higher legitimacy rating than

moderate control, t (114) = 15.98, p < .001, η

= .69. Moderate control received higher legitimacy

Hannah Klautke and Hee Sun Park

ratings than high control, t (114) = 10.44, p < .001, η

= .49. The analysis showed that the level-1

intercept (i.e., individuals’ legitimacy ratings averaged across the three control types) varied

significantly across individuals, variance = 1.02, χ

(114) = 314.18, p < .001, indicating the need for

level-2 predictors to explain the variance in the level-1 intercept. The level-1 slope (i.e., individual

changes in legitimacy ratings from low control to high) had a significant amount of variance across

individuals, variance = 0.33, χ

(114) = 223.36, p < .001, indicating that the extent to which legitimacy

rating decreased from low control to high was greater for some individuals than for others.

As shown in Table 2, individual health orientation variables (level-2 predictors) were included in

the analysis to explain between-individual variance in the individual average legitimacy ratings (i.e.,

the variance in the level-1 intercept) and also in the extent to which legitimacy ratings changed from

low control to high (i.e., the variance in the level-1 slope). Including these level-2 predictors explained

11.65% of the variance in the level-1 intercept and 11.90% of the variance in the level-1 slope. Among

the predictors, only nutrition orientation was a significant and positive predictor of the level-1 intercept,

whereas fitness, anti-smoking, and wellness orientations were not significant. This finding indicated

that as individuals had higher nutrition orientations, their average legitimacy ratings across the three

types of control were higher. Among the predictors, only nutrition orientation was a significant and

negative predictor of the level-1 slope. This finding indicated that the higher individuals' nutrition

orientations, the more negative the slope became; individuals with higher nutrition orientations showed

greater decrease in their legitimacy ratings from low control to high. To put it differently, the decrease

in perceived legitimacy from low control to high was less pronounced among those with lower

nutrition orientations.

5 DISCUSSION

This study addressed how future employees would feel about different levels of workplace health

control in smoking, employee fitness, and health risk assessments. As employers are increasing to

regulate these three main areas of health, the economic benefits of corporate health initiatives will need

to show real improvements in individuals’ health and fitness, and, at the same time, should be

considered as a valuable service by employees. Otherwise, concerns can be raised about a gradual

undermining of employees’ privacy and the subtle perpetuation of managerialist ideologies (―get fit or

get fired‖) (Kirby, 2006; Park et al., 2008; Zoller, 2003). Given the powerful influence that the

implementation of health programs can have on employees’ perceptions (Zoller, 2003), this study

examined perceptions of an undergraduate sample still relatively untouched by corporate health

promotion.

Concerning whether and how perceived legitimacy of health policies and programs would change

with increasing levels of control exerted by the employer, the current findings showed that as control

increases, ratings of legitimacy decreased. There is concern for the privacy of behaviors ―off the

clock.‖ Several of the respondents in this study indicated rather strong objections to certain types of

control, and even added spontaneous and unsolicited comments such as ―None of their business!!‖ to

measurement items such as ―It is okay for the company to change employees’ general eating

behaviors.‖ The significant decrease in perceived legitimacy resulting from increases in control

level/type illustrates that even among this young, generally health conscious sample, concerns about

privacy still take precedence over the potential personal health benefits that may result from being

pressured into living healthy. Factors such as involuntariness, severe consequences of noncompliance,

and extension of control beyond the workplace and after business hours have previously been shown to

enhance the likelihood of reactance and decreased morale among employees in reaction to workplace

health promotion (Greer & Labig, 1987; Truxillo et al., 2002; Zoller, 2004).

When examining how personal health orientations, i.e. those related to fitness, nutrition, smoking,

and wellness awareness, would affect the perceptions of legitimacy of employer control of health

behaviors related to these areas, a few interesting findings emerged. For smoke-free programs, overall

legitimacy ratings did not vary across individuals, while the slope of the decrease with increasing

control did vary depending on individuals' anti-smoking orientations. Individuals with stronger anti-

smoking orientations still perceived high control as less legitimate than low control, but this reduction

was significantly less pronounced than for individuals less opposed to smoking. Other health-related

orientations did not moderate the decrease, suggesting that to a certain degree these legitimacy

perceptions are not global, but policy-specific.

For employee fitness programs, not only the slope of the decrease but also perceived overall

legitimacy across the control levels/types varied significantly across individuals, which indicates an

twofold need to understand moderating factors. Again, only a directly ―relevant‖ personal orientation,

in this case nutrition orientation, was a significant predictor. Interestingly, the pattern here was

different from the one observed for smoke-free programs: In the case of fitness programs, those

Int. Journal of Business Science and Applied Management / Business-and-Management.org

individuals with lower nutrition orientations perceived a slower decrease of legitimacy of fitness

control. One might speculate that this finding reflects a perceived value in being regulated on this issue.

It is possible that respondents who indicated low nutrition orientations perceived value in being ―forced

into shape,‖ but this speculation certainly demands further study.

Lastly, overall legitimacy of health risk appraisals across the three levels varied across individuals,

as did the slopes of the observed decrease. Analysis of the personal health orientations again revealed

nutrition orientation as a significant moderator of the decrease, in such a way that for individuals

valuing healthy nutrition more highly, legitimacy ratings decreased more steeply than for less involved

individuals. As with fitness programs, a reactance-based explanation may fit these findings: Individuals

who are more highly aware of how to take care of themselves may perceive the regulation through the

workplace as less necessary and more patronizing than individuals with lower awareness. Surprisingly,

this finding did not hold for the most closely related health-related orientation; namely, wellness

orientation which was based on the perceived value of physical check-ups and general health

awareness. It could be noted, however, that wellness orientation did produce a near-significant (p =

.085) effect on the slope of decreased legitimacy. It is possible that among young people as in the

current sample, healthy nutrition is a stronger indicator of overall health-awareness than the adherence

to check-up regimens (which tend to become more relevant to middle-aged and older individuals).

5.1 Implications of the findings

The current findings provide implications that governments, health associations, and top

managements may need to consider before implementing worksite programs and policies aiming at

employee health. Desirable outcomes of worksite programs and policies can be more likely to result

from checking the legitimacy perceptions of people who will be affected by the programs and

understanding their health-related orientations. What the governments, health associations, and/or top-

managements consider legitimate control of employee health behaviors may or may not be perceived

legitimate by the current and prospective employees. Park et al. (2008) interviewed employees of

companies that implemented a legally legitimate and highly severe smoke-free program (e.g., firing

smokers). Park et al.'s findings implied that such policies can make employees question the true

purpose of the policy and can negatively affect the organizational culture. On the other hand, people

can change their perceptions of legitimacy. As time goes by, general shifts in perceptions are likely to

occur. Cropanzano and Konovski (1995), for example, noted drastic change in perceived legitimacy of

employee drug testing between the 1960's and 1990's. When corporate control strategies are introduced

gradually, communicated skillfully, and accompanied by significant support, they may raise

individuals’ tolerance for control substantially, making repeated assessment of employee perceptions

over time a valuable basis for the assessment of such trends in the broader area of corporate health

policies.

Because the current study used a sample of undergraduates in the United States, the implications

of the findings may be limited within the national boundary. Countries differ in the public and private

coverage of health insurances and governmental regulations of health-related programs and policies at

worksites. A recent study by Klautke, Park, Lee, Hong, and Kang (2010) replicated the current study

with samples of Korean undergraduates and working adults. For one thing, Klautke et al. (2010)

examined only two of the three types of health-related programs, leaving out health risk appraisal

programs. Because health risk appraisal programs were mostly under the control of governmental

regulations, little variations existed in employer control levels. Nevertheless, some differences as well

as similarities existed between the current study and Klautke et al. (2010) in how personal health-

related orientations affected people’s legitimacy perceptions of smoke-free programs and employee

fitness programs. For example, anti-smoking and nutrition orientations were important factors affecting

people's legitimacy perceptions in both Korea and the United States. However, the effect of nutrition

orientation on legitimacy perceptions of fitness programs was different between Korea and the United

States. Unlike Americans in the current study who showed that the decrease in perceived legitimacy

from low control to high was less pronounced among those with lower nutrition orientations, Koreans

in Klautke et al (2010) showed that legitimacy decreasing from low control to high was less

pronounced among those with higher nutrition orientation. Thus, future studies may need to explore

why and how nations can differ in the way personal health-related orientations affect people’s

legitimacy perceptions of worksite health programs.

5.2 Limitations of current study and suggestions for further research

Only a very small set of factors moderating the perception of workplace health promotion was

examined in this study. Past research has shown that several elements of procedural justice can strongly

influence employees' reactions (including job satisfaction, trust in management, and performance) to

Hannah Klautke and Hee Sun Park

management actions such as drug testing (Colquitt, 2001; Cropanzano, Prehar, & Chen, 2002; Dolan,

Edlin, Tsuchiya, & Wailoo, 2007). Along similar lines, the opportunity to contribute to the shaping of

the policy as well as consistency in implementation across all levels of the organization have been

shown to not only enhance ownership of health policies, but also influence healthy behaviors directly

(Kouvonen et al., 2007). Thus, future studies focusing on varying levels of organizational support and

procedural justice features may provide additional insights to assumptions that individuals make

regarding health policies (e.g., how the policies came to be, how they were communicated, etc.).

Additional factors can be expected to play a role. The complexity of the issue is illustrated well by

anecdotal evidence indicating that policies banning smoking from the workplace led to fewer

disciplinary and employee moral problems than those that attempt to regulate, rather than eliminate,

smoking at the worksite (Sofian et al., 1994). However, the current findings and previous ones (Dalsey

& Park, 2009; Dalsey et al., 2007; Greer & Labig, 1987) show that severity of policies decreased

outcomes such as organizational attractiveness and perceived legitimacy among job candidates and

current employees.

The industry under consideration is also likely to play a role. In Zoller’s (2003) ethnographic case

study physical workers at an automobile manufacturing plant showed considerable buy-in into the

corporate ideology that ―only a healthy and fit employee is a good employee.‖ It is possible that

sedentary office workers would show more resistance to such a norm - since their immediate ability to

perform their jobs is not impacted as directly by a lack of physical fitness.

6 CONCLUSION

The rapid growth in health care expenses and the cost saving potential of workplace health

interventions are going to ensure that issues such as ―personal‖ fitness are no longer just personal. In

this context, understanding not only the return of investment, or even the best practices to generate

employee buy-in, will only give a very limited picture of this issue of workplace health promotion. For

practitioners (e.g., Goetzel & Ozminkowski, 2000; Hunnicutt, 2001) and critical observers of corporate

health programming alike (e.g. Kirby, 2006, Zoller, 2003), empirically assessing perceptions of the

recipients of the interventions will be essential.

APPENDIX: MEASUREMENT ITEMS

I. Personal Health-Related Orientations (1 = strongly disagree, 7 = strongly agree)

Fitness

1. I exercise on a regular basis.

2. I consider myself to be in "good shape."

3. I plan on being in good shape throughout my life.

Nutrition

1. I maintain a well-balanced diet.

2. I eat fast-food regularly.

3. I eat several servings of fruits and/or vegetables almost every day.

Anti-smoking

1. I smoke cigarettes a lot.

2. I am a steadfast non-smoker.

3. I prefer my environment to be smoke-free.

4. Smoking is more serious a threat than most people seem to think.

5. (As a nonsmoker) I cannot see myself smoking ever./ (As a smoker) I am motivated to quit.

Wellness

1. Health is an important topic for me.

2. I consider myself well-educated on health-matters in general.

3. I get physical check-ups in approximately the recommended intervals.

4. Overall, my lifestyle is healthier than that of most people.

5. I am interested in ways of preventing illness.

6. For the most part, people can control their health through lifestyle choices.

7. Many common diseases could be prevented through proper lifestyle choices.

Int. Journal of Business Science and Applied Management / Business-and-Management.org

II. Legitimacy of Interventions (1 = strongly disagree, 7 = strongly agree)

Low control of smoke-free programs (Psclow)

1. An employer has the right to limit smoking to designated areas.

2. An employer has the right to limit smoking to personal breaks.

3. A policy ensuring that non-smokers will not be exposed to any smoke at work is fair.

4. An employer has the right to tell employees not to smoke on the job.

5. An employer has the right to keep company premises smoke-free.

6. An employer can prohibit smoking during work hours.

7. An employer can prohibit smoking anywhere at the worksite.

Moderate control of smoke-free programs (Pscmod)

8. An employer has the right to enforce a smoke-free workforce.

9. An employer has the right to only hire non-smokers.

10. After a one-year transition period, using (announced) nicotine testing and prescribing

counseling for positively tested employees is fair.

11. A company may use mandatory pre-employment nicotine testing.

12. Mandatory nicotine testing can be a part of employment screenings.

High control of smoke-free programs (Pschigh)

13. An employer has the right to prohibit employees’ ―after work‖ cigarette.

14. One year after making a company smoke-free, an employer has the right to fire smokers that

fail to quit smoking.

15. One year after making a company smoke-free, an employer has the right to administer random

nicotine testing to make sure employees follow the new non-smoking policy.

16. Individuals who fail the random nicotine tests may be charged penalties up to $50 out of their

weekly paychecks.

17. Individuals who fail the random nicotine tests may be required to buy their own health

insurance.

Low control of employee-fitness programs (Pfclow)

1. Depending on the employee’s level of physical fitness, the company can suggest a

complementary meeting with a fitness coach.

2. It is ok for the company to discourage high-fat meals, e.g. through elimination of fatty

cafeteria foods, informational posters and materials.

3. The company may suggest a complementary meeting with a nutrition specialist.

4. It is ok for the company to discourage junk-food snacks, e.g. by eliminating vending machines

and providing informational materials on healthy alternatives.

5. It is ok for the company to encourage regular exercise inviting employees to a company-wide

fitness-challenge event.

6. It is appropriate for a company to thoroughly advertise their fitness facilities/discounted

membership program for the local gym.

Moderate control of employee-fitness programs (Pfcmod)

7. It is ok for the company to prescribe exercise regimens to employees, as long as valid medical

excuses will be considered.

8. Depending on the employee’s fitness level, a mandatory meeting with an assigned fitness

coach may be imposed.

9. ―Weight-loss-competitions‖ between departments (where no individual’s weight is disclosed

publicly) are a fun way to encourage healthy life changes.

10. Depending on the employee’s fitness level, a mandatory meeting with an assigned nutrition

specialist may be imposed.

11. A "good driver’s discount‖ with health insurance (i.e., lower out-of pocket cost for employees

meeting certain fitness standards) is a fair approach to encouraging healthy lifestyles.

High control of employee-fitness programs (Pfchigh)

12. It is okay for the company to change employees’ general eating behaviors.

13. It is fair to enforce a company-imposed exercise regimen by charging employees who are

"slacking" higher co-pays and deductibles on their health insurance.

Hannah Klautke and Hee Sun Park

14. It is okay for the company to require employees’ participation in a company-wide fitness-

challenge event.

15. A company has the right to charge higher out-of-pocket health insurance contributions of

employees that fail to improve their fitness scores substantially after one year.

16. A company may impose exercise regimens for all employees without considering any

medical excuses.

17. An employee failing to meet fitness goals prescribed by a trained coach may be required to

buy his/her own health insurance.

18. An employee refusing to comply with company-fitness regimens after a one-year grace period

can be fired.

19. An employee failing to improve any fitness scores despite significant support offered by the

company can be fired after a three year grace period.

Low control of health risk appraisal programs (Phclow)

1. A company-wide ―Health-Risk Awareness Week,‖ including speakers, information brochures

and posters on major risk factors, is a great way to improve employee health awareness.

2. A voluntary sign-up opportunity for complementary physical check ups is a valuable service

to employees.

3. A voluntary competition such as "Get your Department’s Body-Mass-Index in Shape" is a fun

way to raise awareness on the importance of maintaining a healthy weight.

4. Placing scales for personal weight-control throughout the company (e.g. in break rooms,

changing rooms) is a useful service.

5. It is appropriate for an employer to encourage participation in voluntary, company-sponsored

programs on lifestyles and habits (e.g., smoking, drinking, exercising).

6. It is appropriate for an employer to encourage participation in voluntary, company-sponsored

programs on health care practices (e.g., importance of regular pap tests/breast-self exams,

skin exams for cancer detection).

Moderate control of health risk appraisal programs (Phcmod)

7. Having all employees fill out self-reported checklists of major health indicators (e.g., height,

weight, blood pressure, level of physical activity) once a year is an appropriate way for an

employer to keep health-awareness high.

8. Having a health coach assess personal and family medical history (e.g., heart problems,

diabetes, suicide, cancer) is an appropriate way for an employer to encourage employees to

live healthier lives.

9. A personalized ―Health-Risk-Report‖ listing the individual’s top 5 causes of death in the order

of likelihood for the individual is an appropriate way for an employer to encourage

lifestyle changes.

10. Having a health coach calculate employees' ―risk age" (which may be higher than the actual

age, if key health indicators are bad) is appropriate in order to motivate employees to

improve on these indicators.

11. An employer has the right to require employees to sign up for mandatory physical check-ups.

12. An employer has the right to create annual health reports on all employees.

13. An employer can base employment decisions on pre-employment physical examinations.

14. It is legitimate for the company to keep a personal health file for every employee, including

the results of annual required physicals.

15. Employees who fail to lower their ―risk age‖ over the course of three years can be asked to

pay higher out-of-pocket costs for their health insurance.

High control of health risk appraisal programs (Phchigh)

16. High-risk employees can be required to work with a provided health coach to improve their

health scores (e.g., BMI, blood pressure, etc.).

17. High-risk employees who refuse to work with a health coach provided by the company can be

charged a monthly penalty for noncompliance.

18. It is okay for a an employer to prescribe annual blood tests to check cholesterol levels.

19. If an employee’s cholesterol levels are high, the company can make him/her pay a penalty of

$5 per period exceeded allowance—penalties up to $ 30/paycheck

20. If an employee’s cholesterol levels are high, the company can make him/her buy their own

health insurance.

Int. Journal of Business Science and Applied Management / Business-and-Management.org

21. High-risk employees who boycott programs and support offered by the company can be fired

after a grace period of 3 years.

22. High-risk employees who continue to increase their ―risk age‖ can be fired after a grace period

of 3 years.

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