Presenteeism According to Healthy Behaviors,Physical Health,and Work Environment

Abstract

The objective of this study is to identify the contribution that selected demographic characteristics, health behaviors, physical health outcomes, and workplace environmental factors have on presenteeism (on-the-job productivity loss attributed to poor health and other personal issues). Analyses are based on a cross-sectional survey administered to 3 geographically diverse US companies in 2010. Work-related factors had the greatest influence on presenteeism (eg, too much to do but not enough time to do it, insufficient technological support/resources). Personal problems and financial stress/concerns also contributed substantially to presenteeism. Factors with less contribution to presenteeism included physical limitations, depression or anxiety, inadequate job training, and problems with supervisors and coworkers. Presenteeism was greatest for those ages 30–49, women, separated/divorced/widowed employees, and those with a high school degree or some college. Clerical/office workers and service workers had higher presenteeism. Managers and professionals had the highest level of presenteeism related to having too much to do but too little time to do it, and transportation workers had the greatest presenteeism because of physical health limitations. Lowering presenteeism will require that employers have realistic expectations of workers, help workers prioritize, and provide sufficient technological support. Financial stress and concerns may warrant financial planning services. Health promotion interventions aimed at improving nutrition and physical and mental health also may contribute to reducing presenteeism. (Population Health Management 2012:15:293–301)

Introduction

C ompanies must account for loss of employee productivity because of sick days, vacation days, and other forms of employee absence. Likewise, companies need to consider loss of employee productivity for individuals who come to work but perform below par because of health problems and/or personal issues.^1
–3 Human resource professionals refer to less-than-optimal work performance because of illness or other personal issues as presenteeism.^4

–7

Presenteeism exists at high levels among workers in various settings and according to different work tasks.^8

–13 Not only does presenteeism negatively affect the productivity of a worker, but coworkers may have poorer than normal performance because of distraction and/or the spread of illness.^14,15 It is estimated that the cost associated with presenteeism is 2 to 3 times greater than annual health care expenses.¹⁶ However, presenteeism does not register on the worksite radar screen because it is not a tangible expense tracked in a typical financial report. Nevertheless, if one were able to sum all the lost employee productivity, presenteeism would account for 77% of the total and absenteeism would account for 23%.¹⁷

Despite the size of the presenteeism problem, little research has focused on this important component of employer productivity loss. As literature expands in this area, better understanding of how to manage presenteeism will assist companies to save money, as well as contribute to a more engaged and productive workforce.¹⁸ Some of what we have learned about presenteeism is that it exists at lower levels among employees who view their work as important and interdependent with other tasks, and at higher levels among workers with greater perceived job security, equity in the company, legitimacy in the absence from work, and negative emotional states.¹⁹ Chronic health conditions such as arthritis, allergies, and high body mass also frequently contribute to presenteeism.^8,9,20,21 In general, research has shown that work-related factors may contribute as much or more to presenteeism compared to personal circumstances.¹¹

Addressing presenteeism involves identifying its potential causes, designing and implementing interventions to prevent or reduce it, and then monitoring and evaluating those interventions. The focus of the current study is to identify the potential causes of presenteeism, including demographic factors, health behaviors, physical health, and workplace environment.

Methods

Population and survey

In January 2008, Healthways, a well-being improvement company, and Gallup, a behavioral research firm, formed a partnership to monitor well-being among employees and other individuals in communities throughout the United States. A validated cross-sectional survey called the Well-Being Assessment was developed to measure a comprehensive picture of employee health and well-being. The survey instrument captures information from 6 major domains including: life evaluation (how an individual rates their overall life), emotional health, physical health, healthy behaviors, work environment, and basic access (ability to access and afford basic essentials including health care). Employees from 3 companies participated in the current study. The first company is a large, geographically distributed general insurance company with business in multiple US states. A portion of their business also includes some inbound call center staff. The second company is a large, geographically distributed health insurance company. The third company is geographically distributed and employs health care professionals. The survey was administered in 2010. All employees of these 3 companies were eligible to complete the survey.

The number of employee participants from the first company was 15,605; the second company had 2245 participants, and the third company had 2264 participants. Of the 20,114 employee participants, 311 (1.5%) failed to answer any questions about presenteeism. These individuals were excluded from the current study. Thus, analyses are based on 19,803 employees. Employees were made aware of and asked to complete the survey as a part of their benefits enrollment process. Employers used e-mail communication, printed materials, and reminders, as well as incentives such as random drawings for prizes or cash, to encourage participation. Each employer was allowed to tailor specific messaging and communication about the program in order to optimize engagement in their specific workforce.

Variables

Demographic variables included age, sex, marital status, education, and job type. Income was not included because roughly one third of respondents had missing information on this variable. Health behaviors considered in this study consisted of smoking status, dietary habits, and physical activity. Physical health indicators included body mass index (BMI); whether the individual had ever been told by a physician or nurse that he or she had a history of high blood pressure, high cholesterol, diabetes, depression, heart attack, asthma, and/or cancer; or whether he or she had chronic neck and back conditions that cause pain, or knee or leg conditions that cause pain.

Validated measures of presenteeism from the Health and Work Performance Questionnaire and the Work Productivity and Activity Limitations Questionnaire were incorporated into the survey.^22,23 Twelve selected questions on presenteeism were assessed in the current study. The stem of the question read, “During the past four weeks (28 days), how often have you been at work but had trouble concentrating or doing your best because of…?” The 12 extensions to the question were (1) your health or physical condition, (2) your responsibilities taking care of someone else, (3) lack of resources (people, material, or information), (4) issues with coworkers, (5) having too much to do and not enough time, (6) issues with supervisor(s), (7) lack of sufficient training, (8) personal problems or worries, (9) depression or anxiety, (10) regulatory or legal requirements, (11) technology issues, or (12) financial stress/concerns. Possible responses for each of the 12 questions were a lot (=1), some (=0.5), not at all (=0), and don't know (=0.5). Item scores were transformed to a 100-point scale by multiplying these responses by 100. An overall 100-point presenteeism index score also was calculated for each individual by summing the 12 transformed responses and dividing by 12.

Institutional Review Board approval to analyze these data was granted by Brigham Young University in August 2011.

Statistical techniques

Data were summarized using means and proportions. Regression analysis was used to compare presenteeism mean scores, adjusting for age, sex, marital status, education, and job type. Statistical significance was based on the F test. In addition, adjusted presenteeism prevalence ratios were calculated across the levels of the demographic variables and adjusted for these demographic variables, selected health behaviors, health risks, and workplace environment factors. Statistical significance was assessed using 95% confidence intervals. Analyses were performed using Statistical Analysis System (SAS) software version 9.2 (SAS Institute Inc., Cary, NC).

Results

Employee respondents ranged in age from 18 to 83 (mean=43.5, standard deviation [SD]=11.0); 38% were men, 70% were married, and 76% had greater than a high school education. The most common job classifications were professional workers (41%), clerical or office workers (21%), managers or executives (17%), service workers (4%), and sales workers (3%).

Responses to 12 selected items related to having trouble concentrating or doing one's best work in the past 28 days are presented in Figure 1. The item most commonly identified as a barrier to concentrating or doing one's best was having too much to do and not enough time to do it. Regulatory or legal issues had the least association with difficulty concentrating or doing one's best.

FIG. 1.

Level of agreement with 12 selected items related to having trouble concentrating or doing one's best work in the past 28 days.

Selected presenteeism measures are presented according to demographic factors in Table 1. For each of the presenteeism measures, there was a tendency to increase in the younger age groups, peak in the age groups 30–39 and 40–49, and then decrease. Women had significantly greater prevalence for each of the measures, except for financial stresses/concerns. Employees who were separated/divorced/widowed had consistently higher prevalence for each of the measures. Higher prevalence was associated with high school and some college education for personal problems/worries, financial stresses/concerns, physical health, and depression/anxiety. Higher prevalence for having too much to do but not enough time to do it was associated with having a college degree or postgraduate work or degree. Managers or executives and professional workers had the highest level of too much to do but not enough time; clerical or office and service workers had the highest level of personal problems/worries, financial stresses/concerns, physical health, and depression/anxiety. In addition, high levels of financial stresses/concerns were associated with business owners and sales workers, and high levels of physical health limitation were associated with transportation workers.

Table 1.

Selected Presenteeism Measures by Demographic Factors

	No.	Too much to do, too little time %	Personal problems/worries %	Financial stresses/concerns %	Physical health limitation %	Depression/anxiety %
Age
18–29	2,621	34	24	25	12	13
30–39	4,606	38	25	27	13	14
40–49	6,014	39	23	25	13	13
50–59	5,227	37	20	21	12	12
60+	1,335	30	15	15	11	10
Sex
Men	7,515	33	20	22	11	11
Women	12,288	38	23	23	14	14
Marital Status
Single/never married	3,201	33	21	21	13	12
Married	13,641	34	18	18	11	10
Separated/Divorced/Widowed	2,635	36	26	28	14	16
Missing	326	38	20	22	11	12
Education
< High school	2,273	35	22	23	12	13
High school	2,255	35	26	28	13	16
Technical/vocational school	1,194	36	20	21	12	12
Some college	4,706	34	25	27	15	15
College graduate	6,494	38	21	21	12	12
Postgraduate work or degree	2,628	37	20	29	13	12
Missing	253	33	16	18	9	7
Primary Job Category
Manager or executive	3,296	46	21	19	9	11
Professional	7,784	41	22	21	11	13
Sales worker	667	29	23	25	10	13
Clerical or office	4,007	37	26	27	13	15
Manufacturing or production	183	38	20	16	10	10
Business owner	269	37	22	30	11	13
Service	696	37	27	26	14	18
Construction	146	30	17	24	11	7
Transportation	78	25	23	21	18	11
Installation or repair	104	36	14	20	12	8
Farming, fishing, or forestry	58	40	16	14	11	8
Other	1,909	32	24	25	13	15
Missing	606	33	24	26	17	18

Note: Mean percentages were simultaneously estimated, adjusting for the other variables in the table. Bolded percentages were statistically significant, based on the F-statistic, P<0.05.

The average 12-item presenteeism index score, scaled from 0 to 100, differed significantly by age, sex, marital status, and education: 17.0 (SD=14.6) for ages younger than 50, and 15.3 (SD=13.9) for those age 50 and older (F=65.1, P<0.001); 14.8 (SD=13.7) for men and 17.5 (SD=14.7) for women (F=161.0, P<0.001); 15.6 (SD=13.9) for married, 17.6 (SD=14.9) for never married, and 19.4 (SD=15.4) for previously married (F=61.8, P<0.001); and 15.6 (SD=13.9) for<high school/technical or vocational school, 16.2 (SD=13.8) for college graduate or postgraduate degree, and 17.3 (SD=15.3) for high school/some college. For job type, after adjusting for age, sex, marital status, and education, employees involved in farming, forestry or fishing and construction or mining had the lowest presenteeism scores (mean=11.2, 12.8, respectively) and clerical or office workers and service workers had the highest presenteeism scores (mean=17.1, 18.4, respectively).

The prevalence of presenteeism in the top quintile (ie, poorest 20%) was greater for age groups 30–39 and 40–49 compared to the 18–29 age group, women compared to men, separated/divorced/widowed compared to single/never married, high school graduates or some college experience compared to those having less than a high school degree, and clerical or office workers or service workers compared to managers or executives (Table 2). Significantly lower presenteeism occurred for those aged 60 years and older compared with 18–29-year-olds, married compared with single/never married, and construction workers compared with managers or executives.

Table 2.

Presenteeism According to Selected Demographic Variables

	Presenteeism Index Score Top Quintile (Poorest 20%)
	No.	%	Prevalence Ratio ¹	95% CI ¹
Age
18–29	499	19	1.00
30–39	1,041	23	1.25	1.13, 1.38
40–49	1,277	21	1.17	1.06, 1.29
50–59	970	19	1.00	0.90, 1.11
60+	198	15	0.77	0.66, 0.90
Sex
Men	1,257	17	1.00
Women	2,728	22	1.18	1.11, 1.26
Marital Status
Single/never married	710	22	1.00
Married	2,467	18	0.83	0.77, 0.90
Separated/Divorced/ Widowed	720	27	1.19	1.08, 1.32
Missing	88	27	1.20	0.97, 1.50
Education
< High school	418	18	1.00
High school	484	22	1.16	1.03, 1.31
Technical/vocational school	192	16	0.90	0.77, 1.05
Some college	1,103	23	1.20	1.09, 1.33
College graduate	1,232	19	1.04	0.94, 1.15
Postgraduate work or degree	506	19	1.09	0.97, 1.23
Missing	50	20	0.77	0.57, 1.04
Primary Job Category
Manager or executive	562	17	1.00
Professional	1,516	20	1.09	1.00, 1.19
Sales worker	114	17	0.96	0.81, 1.15
Clerical or office	952	24	1.19	1.07, 1.32
Manufacturing or production	31	17	0.98	0.71, 1.37
Business owner	45	17	1.07	0.81, 1.41
Service	167	24	1.30	1.12, 1.52
Construction	13	9	0.56	0.33, 0.94
Transportation	14	18	1.12	0.69, 1.80
Installation or repair	10	10	0.62	0.34, 1.12
Farming, fishing, or forestry	4	7	0.42	0.16, 1.08
Other	400	21	1.17	1.04, 1.31
Missing	157	26	1.43	1.21, 1.69

Prevalence ratios and confidence intervals (CI) adjusted for all the variables in the table.

Selected healthy behavior variables are presented in Table 3. Nonsmokers were 28% less likely than smokers to have presenteeism scores in the top quintile. Those who did not eat healthy all day the previous day, those who did not eat 5 or more servings of fruits and vegetables on 4 or more days in the past week, and those who did not exercise for 30 minutes or more on 3 days in the past week were all more likely to have presenteeism scores in the top quintile.

Table 3.

Presenteeism According to Healthy Behaviors

	Presenteeism Index Score Top Quintile (Poorest 20%)
	No.	%	Prevalence Ratio ¹	95% CI ¹
Do you smoke?
Yes	487	29	1.00
No	3,476	19	0.72	0.66, 0.78
Don't know/Missing	22	37	1.21	0.86, 1.69
Did you eat healthy all day yesterday?
Yes	1,610	15	1.00
No	2,030	26	1.66	1.56, 1.76
Don't know/Missing	345	22	1.37	1.24, 1.53
In the last 7 days, had 5 or more servings of fruit and vegetables on 4 or more days?
Yes	1,451	16	1.00
No	2,326	23	1.39	1.31, 1.48
Don't know/Missing	208	24	1.41	1.24, 1.60
In the last 7 days, exercised for 30 or more minutes on 3 or more days?
Yes	1,575	16	1.00
No	2,353	25	1.50	1.42, 1.59
Don't know/Missing	57	26	1.57	1.25, 1.97

Adjusted for age, sex, education, and primary job type.

CI, confidence interval.

Those in the overweight and obese BMI ranges were significantly more likely than those in the normal weight range to have presenteeism scores in the top quintile (Table 4). Having been told by a physician or nurse that one had high blood pressure, high cholesterol, diabetes, depression, heart attack, asthma, and neck or back pain or knee or leg pain were each significantly associated with a greater risk of having a presenteeism score in the top quintile.

Table 4.

Presenteeism According to Physical Health

	Presenteeism Index Score Top Quintile (Poorest 20%)
	No.	%	Prevalence Ratio ¹	95% CI ¹
Body Weight
Normal weight (<25)	1200	17	1.00
Overweight (25≤BMI<30)	1269	19	1.17	1.08, 1.25
Obese 1 (30≤BMI<40)	1184	24	1.40	1.30, 1.51
Obese 2 (BMI ≥40)	323	27	1.44	1.29, 1.60
Missing	9	15	0.83	0.46, 1.53
High Blood Pressure²
No	3,014	19	1.00
Yes	968	23	1.23	1.15, 1.31
Don't know/Missing	3	25	1.40	0.53, 3.69
High Cholesterol²
No	3,002	20	1.00
Yes	971	21	1.16	1.09, 1.24
Don't know/Missing	12	52	2.17	1.55, 3.05
Diabetes²
No	3,700	20	1.00
Yes	275	23	1.19	1.07, 1.32
Don't know/Missing	10	43	2.14	1.37, 3.36
Depression or Anxiety²
No	2,862	17	1.00
Yes	1,111	42	2.31	2.18, 2.45
Don't know/Missing	12	35	2.06	1.31, 3.22
Heart Attack²
No	3,944	20	1.00
Yes	35	24	1.34	1.01, 1.78
Don't know/Missing	6	46	2.39	1.34, 4.26
Asthma²
No	3,429	19	1.00
Yes	551	27	1.39	1.29, 1.50
Don't know/Missing	5	33	1.50	0.74, 3.04
Cancer²
No	3,808	20	1.00
Yes	171	21	1.07	0.93, 1.22
Don't know/Missing	6	50	2.55	1.46, 4.46
Neck or back conditions causing pain³
No	2,376	17	1.00
Yes	1,563	30	1.79	1.69, 1.89
Don't know/Missing	46	36	2.10	1.67, 2.64
Knee or leg condition causing pain³
No	2,835	18	1.00
Yes	1,111	30	1.72	1.62, 1.83
Don't know/Missing	39	41	1.99	1.59, 2.50

Adjusted for age, sex, education, and primary job type.

Previously told by a physician or nurse that they had this condition.

Whether had this condition in the past 12 months.

CI, confidence interval.

Selected workplace conditions that affect presenteeism are shown in Table 5. Those participants who perceived their workplace as making it difficult to adopt healthy behaviors (eg, exercise) or as not being supportive of physical or emotional health were more likely to have presenteeism scores in the top quintile.

Table 5.

Presenteeism According to Selected Workplace Conditions

	Presenteeism Index Score Top Quintile (Poorest 20%)
	No.	%	Prevalence Ratio ¹	95% CI ¹
Difficult or easy to exercise during the workday
Easy	1,567	14	1.00
Difficult	2,129	28	1.96	1.85, 2.08
Don't know/Missing	289	27	1.86	1.67, 2.08
Difficult or easy to eat fresh fruits, vegetables, and other low-fat foods at work
Easy	2,801	17	1.00
Difficult	903	33	1.93	1.81, 2.05
Don't know/Missing	281	37	2.12	1.92, 2.34
Workplace would support you in becoming physically healthier
Yes	2,687	17	1.00
No	431	37	2.23	2.06, 2.42
Don't know/Missing	867	31	1.80	1.69, 1.92
Workplace would support you in becoming emotionally healthier
Yes	1,712	13	1.00
No	973	42	3.20	3.00, 3.41
Don't know/Missing	1,300	30	2.26	2.12, 2.41

Adjusted for age, sex, education, and primary job type.

CI, confidence interval.

Discussion

Although on-the-job productivity loss attributed to poor health and other personal issues (presenteeism) costs companies more than health care expenditures and absenteeism combined, presenteeism has received little attention in the literature and is poorly understood. To reduce presenteeism requires that we first understand why it exists. The current study provides new information about the contributing factors of presenteeism and the job types most prone to its influence.

The employees in this study represented a wide range of demographic characteristics and job types. The most commonly identified item contributing to presenteeism in this diverse group was having too much to do and not enough time to do it, which is consistent with previous studies identifying time pressure and job stress as primary contributors to presenteeism.^11,12,23,24 Personal problems, financial stresses and concerns, and a lack of resources also were primary contributors to presenteeism, again consistent with other studies.^13,21,26 These factors all contributed more to trouble concentrating or doing one's best at work than did physical health limitations or depression/anxiety.

The lower relative contribution of personal physical health to presenteeism may be surprising given past research reporting a strong contribution of chronic conditions (eg, allergies, arthritis, high body mass) to presenteeism.^8,9,20,21,27 Yet the much higher contribution from employees' having too much to do and not enough time to do it is consistent with another study identifying work-related factors as the most important contributors to presenteeism.¹¹ Additionally, while not related to presenteeism as strongly as constant time pressure, physical health conditions were associated with increases in presenteeism of between 16% for elevated cholesterol and 79% for neck/back pain.

As shown in previous research, depression/anxiety and comorbid mental disorders were shown to contribute to presenteeism.^26,28
–30 One study found that 75% of employees with mood and anxiety disorders reported interference with their work, while only 13% of those without these disorders reported interference with their work.²⁹ Using the Work Limitations Questionnaire, researchers identified a dose-response relationship between depression severity and presenteeism.³⁰ In another study, different dimensions of job performance were compromised by depression and persisted even after the depressive symptoms improved.²⁸ Because depression and anxiety are easily recognized, perhaps more than other factors contributing to presenteeism, these mental disorders may be more likely to lead to unemployment.³¹ On the other hand, they also may be treated more easily as a result, which this and past research suggests could result in significantly reduced levels of presenteeism.

Other factors that contribute to presenteeism, albeit at a lower level, involve personal work-related training and interpersonal relationships with supervisors, trainees, and coworkers. Proper training may be associated with a greater appreciation for and interest in one's work, which, in turn, may lower presenteeism.¹⁹ Consistent with our findings, previous research has linked poor relationships with coworkers and managers and ineffective leadership with presenteeism.^21,32 Thus, identifying ways to improve interpersonal relationships among workers and promote more effective leadership should be an important part of managing presenteeism.

Presenteeism tended to decrease in older age groups, was greater among women than men, and was greater among separated/divorced/widowed than among married individuals. Two previous studies associated older age with lower presenteeism.^21,26 The current study demonstrated that employees in their 30s and 40s had the greatest personal problems or worries, financial stresses or concerns, personal health limitations, and depression or anxiety. Pregnancy may contribute to the higher levels of presenteeism in women if pregnant women are less likely to take sick leave when warranted, as shown in a recent study.³³ Women also may have a greater level of distraction because of responsibilities for children or aging parents, which is consistent with their having a higher level of personal problems or worries (Table 1). Further, a greater percentage of women may have less control over their work because of being employed part time and, thus, may be under greater pressure to attend work while sick.³⁴ Finally, the higher contribution of being separated/divorced/widowed to presenteeism was seen consistently for measures involving too much to do in too little time, personal problems or worries, financial stresses or concerns, physical health limitations, and depression or anxiety. Previous research has associated major changes in marital status and related financial stress, work/life imbalance, and life dissatisfaction with higher presenteeism.^12,21,26

Those with a high school degree or some college had higher presenteeism. These employees were most likely to have clerical positions (41%, 36%, respectively). The sedentary nature of the job and less direct interest in the work may contribute to greater presenteeism. We also observed that physical labor or outdoor type jobs had the lowest presenteeism scores.

Poor health behaviors and health problems were associated with greater levels of presenteeism. Studies have shown that worksite nutrition policies can improve productivity.^32,35 In addition, physical activity can lower body weight and help manage stress, which, in turn, may help ameliorate presenteeism.^32,36 Smoking may be positively associated with presenteeism independently or because of its association with poor nutrition, less physical activity, and worse general physical health.

Employees who indicated it was difficult to exercise during the workday, those who said it was difficult to eat fresh fruits, vegetables, and other low-fat foods at work, those who did not believe the workplace would support them in becoming physically healthier, and those who did not believe the workplace would support them in becoming emotionally healthier all had higher levels of presenteeism. These results are consistent with the need for managers to promote nutrition and physical activity in order to help reduce presenteeism.^32,35 The need to create supportive policies and environments is a fundamental aspect of health promotion efforts and, as indicated by the particularly strong associations of presenteeism levels with workplace support for physical and mental health in the current study, for reducing presenteeism.

This study may be limited by self-reporting bias. However, we believe this bias is minimal because the survey questions did not require extensive recall or involve highly sensitive questions. There may have been some selection bias, albeit minimal because of the broad range of participation across age, education, and job types. Participants were surveyed from only 3 organizations in insurance and health care, which may not provide a representative sample of other industry groups. Additionally, the population includes a larger than average proportion of female and professional workers. Additional research is needed to assess the external validity of the study findings.

Conclusion

Work-related issues (eg, requiring too much of one's employees, not having sufficient technological support and resources) have the greatest influence on presenteeism. Company leadership may see a decrease in presenteeism by having more realistic expectations for employees, matching employee expertise with their job responsibilities, and assuring that employees have the necessary technological support and resources. Personal problems and financial stress/concerns also are primary contributors to presenteeism. Providing counseling and educational material with respect to managing problems and financial concerns may be an effective approach to lowering presenteeism.

Physical health limitations and depression/anxiety are important contributors to presenteeism. It is well established that properly implemented worksite wellness programs have the potential to improve employee health behaviors and physical and emotional health status, thereby lowering presenteeism. These programs should include aspects that require support from company leadership, such as policies and environments making it feasible for employees to exercise during the day, eat healthily at work, and feel that their employer has interest in their physical and mental health.

Other factors contributing to presenteeism include inadequate training and challenging relationships with supervisors and between coworkers. Assuring that workers are adequately trained may help improve challenging relationships. Likewise, dealing with other work-related and personal health issues as suggested may improve challenging relationships with supervisors and between coworkers.

Clerical or office, service, and transportation are occupations with the highest level of presenteeism. Among all occupations considered, clerical or office and service workers tended to experience the highest levels of personal problems/worries, financial stress/concern, and depression/anxiety. Transportation workers had the highest level of physical limitations. Company leadership should consider such information in order to develop tailored policies and programs to lower presenteeism.

Footnotes

Disclosure Statement

Drs. Merrill, Aldana, Pope, Anderson, and Coberley, and Mr Whitmer disclosed no conflicts of interest with regard to the research, authorship, and/or publication of this article. The authors disclosed that they did not receive funding for the research, authorship, and/or publication of this article.

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