Encouraging stair use: stair-riser banners are better than posters

Choice architecture interventions to change physical activity and sedentary behavior: a systematic review of effects on intention, behavior and health outcomes during and after intervention

BACKGROUND

Choice architecture interventions, which subtly change the environment in which individuals make decisions, can be used to promote behavior change. This systematic review aimed to summarize studies on micro-environmental choice architecture interventions that encouraged physical activity or discouraged sedentary behavior in adults, and to describe the effectiveness of those interventions on these behaviors - and on related intentions or health outcomes - in presence of the intervention and after removal of the intervention (i.e. post-intervention, regardless of the time elapsed).

METHODS

We systematically searched PubMed, Embase, PsycINFO and the Cochrane Library for (quasi) experimental studies published up to December 2019 that evaluated the effect of choice architecture interventions on physical activity and sedentary behavior, as well as on intentions and health outcomes related to physical activity/sedentary behavior. Studies that combined choice architecture techniques with other behavior change techniques were excluded. All studies were screened for eligibility, relevant data was extracted and two independent reviewers assessed the methodological quality using the QualSyst tool.

RESULTS

Of the 9609 records initially identified, 88 studies met our eligibility criteria. Most studies (n = 70) were of high methodologic quality. Eighty-six studies targeted physical activity, predominantly stair use, whereas two studies targeted sedentary behavior, and one targeted both behaviors. Intervention techniques identified were prompting (n = 53), message framing (n = 24), social comparison (n = 12), feedback (n = 8), default change (n = 1) and anchoring (n = 1). In presence of the intervention, 68% of the studies reported an effect of choice architecture on behavior, whereas after removal of the intervention only 47% of the studies reported a significant effect. For all choice architecture techniques identified, except for message framing, the majority of studies reported a significant effect on behavioral intentions or behavior in presence of the intervention.

CONCLUSIONS

The results suggest that prompting can effectively encourage stair use in adults, especially in presence of a prompt. The effectiveness of the choice architecture techniques social influence, feedback, default change and anchoring cannot be assessed based on this review. More (controlled) studies are needed to assess the (sustained) effectiveness of choice architecture interventions on sedentary behavior and other types of physical activity than stair use.

Motivational signage increases stair usage on a Hispanic serving institution

Objective: Stair climbing is considered a good physical activity. Motivational signage has been successful in promoting stair usage in various settings. This study was to investigate the effects of motivational signage on stair usage in a Hispanic serving institution. Participants: A total of 31,067 pedestrians were observed from February to March 2013. Methods: Stair usage was monitored for 9 h per day each week at phase 1 (baseline), 2 (intervention), and 3 (post-intervention). Results: Overall, participants' stair usage was higher during phase 2 (49.0%) and phase 3 (48.0%), compared with phase 1 (39.7%). The participants during phase 2 and 3 were more likely to use the stairs compared to participants during phase 1, regardless of floor level (3-story or 4-story building), status (student or staff/faculty), and time of day (7:30-10:29, 10:30-13:29, or 13:30-16:30) (p < .001). Conclusion: Motivational signage can effectively encourage more stair usage, and hence promote healthy behavior in a predominantly Hispanic-serving institution.

Nudging to move: a scoping review of the use of choice architecture interventions to promote physical activity in the general population

Background

Nudges are used to alter lifestyles and thus curb the rise of non-communicable diseases. Physical activity is a core prevention strategy to reduce the burden of non-communicable diseases. This paper aims to (1) give an overview of the scope of interventions using choice architecture techniques to promote physical activity at the population levels and (2) identify research gaps by analysing the different approaches in terms of class and type of intervention used.

Methods

A systematic electronic database search was combined with snowball citation sampling of a starter set of publications to search for studies published through October 2018 reporting interventions to promote physical activity at the population level using choice architecture techniques. The methodology of the Joanna Briggs Institute for Scoping Reviews was applied.

Results

In all, 35 publications were included. Most of the interventions used point-of-choice prompts tested at railway stations, shopping malls and airports (N = 27). Eight studies were online studies. While all studies were aimed at the general population, details, if reported at all, were vague and basic. All studies focused on individual-level lifestyle behaviour. None of the studies attempted to alter population-based lifestyle behaviour. Online and “real-world” approaches were rarely combined. Neither, interventions targeting meso- and macro-level structures nor combinations of individual-level and specific meso- or macro-level interventions were found.

Conclusion

Nudging is in principle an effective approach to promote physical activity within the general population. However, there are large gaps in research. Available opportunities have not yet been exhausted. Further research is needed that is explicitly based on behavioural insights and covering the full range of nudging approaches, particularly focussing on theoretical developments, practical feasibility tests and scale-up activities.

Electronic supplementary material

The online version of this article (10.1186/s12966-019-0844-z) contains supplementary material, which is available to authorized users.

Learnt effects of environmental cues on transport-related walking; disrupting habits with health promotion?

Background

In Ecological models, physical environments can be important determinants of transport-related walking. With repeated exposure to the same environment, learning of a linkage between the cues in the environment and walking should occur. Subsequent encounters with the cues can prompt the behaviour relatively automatically. No studies have experimentally tested the potential learning of this linkage between cues and behaviour. Choices between stairs and escalators in public access settings were employed to test this premise for transport-related walking.

Methods

Three studies investigated the effects of visual cues on stair/escalator choices (combined n = 115,062). In quasi-experimental, interrupted time-series designs, observers audited choices in public access settings. Design alone phases with art or coloured backgrounds were compared with design plus message phases in which verbal health promotion messages were superimposed on the visual cues. Analyses used bootstrapped logistic regression.

Results

In initial studies, the design alone phases had no effect whereas subsequent design plus message phases reduced escalator choice. In two further studies, a 5–6 week design plus message phase that reduced escalator choice preceded a design alone phase. The visual background behind the successful health promotion message was reintroduced four weeks after the intervention was removed. The visual cue of design alone reduced escalator choice after it had been paired with the verbal health promotion message. There were no differences between art and coloured backgrounds.

Conclusion

These studies demonstrate for the first time a learnt linkage between transport-related walking and environmental cues. Discussion focuses on the mechanisms that may underlie this learning and cues in the environment that are relevant to transport-related walking.

A Systematic Review of Interventions to Increase Stair Use

CONTEXT

Stair climbing is an accessible activity that can be incorporated into one's daily lifestyle to increase physical activity levels and provide health benefits. This review summarizes the effectiveness of stair interventions and explores key differences that may influence intervention effectiveness.

EVIDENCE ACQUISITION

Interventions to increase stair use published from January 1990 to July 2015 were identified in PubMed, Sport Discus, Web of Science, Environment Complete, CINAHL, Trial Register of Promoting Health Interventions, Embase, Scopus, and PsycINFO. Eligibility criteria included original studies, published in peer-reviewed journals, targeting adult samples, and clearly describing intervention design and results. Studies were also required to measure the use of stairs compared with an elevator, escalator, or moving stairway at baseline and during at least one timepoint when the intervention was in effect. Studies were required to provide data to determine if the intervention resulted in significant changes in stair use/climbing.

EVIDENCE SYNTHESIS

The search results yielded 2,136 articles in total; 54 articles met the criteria, which resulted in a final sample of 67 studies included in the analyses. Interventions settings included public sites (75%), worksites (21%), or a combination of both (4%). For Phase 1 results, 72% of studies reported significant improvements in stair use (n=10 of 14) and stair climbing (n=38 of 53).

CONCLUSIONS

Evidence from the review demonstrates support for the effectiveness of interventions to increase stair use and stair climbing. Although evidence supports the effectiveness of stair interventions in public settings, less support is provided for worksites.

Effects of Environmental Changes in a Stair Climbing Intervention: Generalization to Stair Descent

Purpose.

Visual improvements have been shown to encourage stair use in worksites independently of written prompts. This study examined whether visual modifications alone can influence behavior in a shopping mall. Climbing one flight of stairs, however, will not confer health benefits. Therefore, this study also assessed whether exposure to the intervention encouraged subsequent stair use.

Design.

Interrupted time-series design.

Settings.

Escalators flanked by a staircase on either side.

Subjects.

Ascending and descending pedestrians (N = 81,948).

Interventions.

Following baseline monitoring, a colorful design was introduced on the stair risers of one staircase (the target staircase). A health promotion message was superimposed later on top. The intervention was visible only to ascending pedestrians. Thus, any rise in descending stair use would indicate increased intention to use stairs, which endured after initial exposure to the intervention.

Measures.

Observers inconspicuously coded pedestrians' means of ascent/descent and demographic characteristics.

Results.

The design alone had no meaningful impact. Addition of the message, however, increased stair climbing at the target and nontarget staircases by 190% and 52%, respectively. The message also produced a modest increase in stair descent at the target (25%) and nontarget (9%) staircases.

Conclusions.

In public venues, a message component is critical to the success of interventions. In addition, it appears that exposure to an intervention can encourage pedestrians to use stairs on a subsequent occasion.

Promoting Stair Climbing: Intervention Effects Generalize to a Subsequent Stair Ascent

Purpose.

Studies report a significant increase in stair use when message prompts are introduced at the “point of choice” between stairs and escalators. Climbing one set of stairs, however, will not confer meaningful health dividends. Therefore, this study examined whether exposure to point of choice prompts also encouraged individuals to climb the next set of stairs that they encountered.

Design.

Interrupted time-series design.

Settings.

Two separate stair/escalator pairings within a U.K. shopping mall (the “intervention” site and the “generalization” site), separated by a 25-m long atrium.

Subjects.

Ascending pedestrians (intervention site n = 29,713; generalization site n = 47,553).

Interventions.

Two weeks of baseline monitoring were followed by a 13-week intervention in which banners carrying health promotion messages were introduced at the intervention site only.

Measures.

At both sites observers inconspicuously recorded pedestrians' methods of ascent, along with their gender, age, ethnicity, and baggage.

Results.

Banners increased stair climbing at the intervention site by 161%. Results also suggested a simultaneous increase of up to 143% at the generalization site, where no prompt was in place. At both sites stair use remained significantly elevated 5 weeks after the banners were removed.

Conclusions.

It appears that exposure to point of choice prompts can encourage pedestrians to climb stairs when they are encountered in a subsequent setting. Consequently stair-climbing interventions are likely to engage the public in more physical activity than previously realized.

Stair-use interventions in worksites and public settings - a systematic review of effectiveness and external validity

OBJECTIVE

We performed a literature review with the main aims to propose an updated overview of the effectiveness of stair-use interventions and to determine the most effective type of intervention.

METHODS

We systematically searched stair-use interventions performed in worksites or public settings, published up to mid 2013. We used a harvest plot approach to visualize the findings in addition to a quantitative synthesis. We also assessed external validity using the Reach, Efficacy, Adoption, Implementation, Maintenance (RE-AIM) framework.

RESULTS

Of 8571 articles identified, 50 were included. In worksites (25 studies) and public settings (35 studies), an increase in stair climbing was found during the intervention period in 64% and 76% of studies, respectively. Combining motivational and directional signs in worksites or conducting a second intervention phase in public settings increased stair climbing in 83% and 86% of studies, respectively. Elements of external validity were overall largely under-reported.

CONCLUSION

There is evidence that stair-use interventions are effective to increase stair climbing in public settings, but evidence of such effect is limited in worksites. Issues regarding the best sequencing of interventions or the potential importance of environmental interventions should be addressed in future studies. Process evaluation should be an integral part of interventions.

Is there any Proffitt in stair climbing? A headcount of studies testing for demographic differences in choice of stairs

The apparent slope of a hill, termed geographical slant perception, is overestimated in explicit awareness. Proffitt (2006) argued that overestimation allows individuals to manage their locomotor resources. Increasing age, fatigue, and wearing a heavy back pack will reduce the available resources and result in steeper reports for a particular hill. In contrast, Durgin and colleagues have proposed an alternative explanation for these effects based on experimental design—particularly, the potential effects of experimental demand. Proffitt’s resource-based model would predict that pedestrians with reduced resources should avoid climbing a hill that would further deplete their resources if the opportunity arose. Within the built environment, stairs are the man-made equivalent of relatively steep hills (20°–30°). In many public access settings, pedestrians can avoid climbing the stairs by opting for an adjacent escalator. Observations of pedestrian behavior in shopping malls reveal that 94.5 % do so. This article summarizes the effects of demographic grouping on avoidance of stairs in public health research. Observations in shopping malls (n = 355,069) and travel contexts (n = 711,867) provide data consistent with Proffitt’s resource model. Women, the old, and those carrying excess body weight or large bags avoid the stairs more than do their comparison groups. Discussion focuses on differences in physiology that may underlie avoidance of stair climbing in order to highlight the pedestrian behavior that psychology needs to explain.

Systematic review of incidental physical activity community interventions

BACKGROUND

Increasing incidental physical activity (IPA) such as active transport has substantial public health potential.

OBJECTIVE

This systematic review describes community-based and community-wide IPA interventions and assesses their effectiveness.

METHOD

Data sources (Medline, Embase, PsycINFO and CINAHL) were searched along with the reference lists of identified systematic reviews and included articles. Eligibility criteria; 4+ weeks in duration; 20+ participants; community-based or community-wide; stated aim to increase IPA.

RESULTS

Forty three studies were identified from 42 original articles; more than half (60%) aimed to increase stair use compared to escalator and/or lift use; a quarter (23%) aimed to increase active transport; and, 16% to increase playground energy expenditure. More than two-thirds of studies reported a significant increase in IPA. Accurate comparisons between studies were not possible due to substantial heterogeneity in study design. Critical appraisal of studies revealed that the level of bias was moderate-high in most of the studies (77%).

CONCLUSION

Due to the heterogeneity and bias of included studies, only limited conclusions can be drawn about the effectiveness of IPA interventions. However, this systematic review provides a timely summary of current evidence that can be used to inform decision-makers in designing IPA interventions in the community.

Environmental modifications and 2-year measured and self-reported stair-use: a worksite randomized trial

Environmental modifications have been shown to increase short-term stair use, longer-term success is unclear. This study assessed the 2-year effectiveness of an environmental intervention promoting worksite stair use. We assessed stair use at work by means of self-reports and infrared beam counters (which send a safe and invisible beam of infrared light from one side of a stairwell to a reflector on the other side; when an individual uses the stairs, the infrared beam is disrupted and an instance of stair use is recorded) at six worksites (three intervention, three control) in a group randomized, controlled worksite weight-gain prevention trial in Minneapolis/St. Paul, MN. Intervention modifications were signs encouraging stair use, music, and art posters in stairwells. We collected data before environmental modifications (2006-2007) and at the end of the 2-year intervention (2008-2009). The intervention had a significant positive effect on stair use measured both objectively and via self-report, with greatest increases reported among those participants who used the stairs least at baseline. Following 2-years of continuously-maintained stairwell modifications, increases in both objectively-measured and self-reported stair use were significantly larger at intervention than control worksites. Study findings suggest that the positive impact of environmental modifications on stair use persist over a longer time period than has been previously demonstrated. Results also indicate that infrequent stair users may be most amenable to the behavior changes encouraged by these environmental enhancements.

Study protocol title: a prospective cohort study of low back pain

BACKGROUND

Few prospective cohort studies of workplace low back pain (LBP) with quantified job physical exposure have been performed. There are few prospective epidemiological studies for LBP occupational risk factors and reported data generally have few adjustments for many personal and psychosocial factors.

METHODS/DESIGN

A multi-center prospective cohort study has been incepted to quantify risk factors for LBP and potentially develop improved methods for designing and analyzing jobs. Due to the subjectivity of LBP, six measures of LBP are captured: 1) any LBP, 2) LBP ≥ 5/10 pain rating, 3) LBP with medication use, 4) LBP with healthcare provider visits, 5) LBP necessitating modified work duties and 6) LBP with lost work time. Workers have thus far been enrolled from 30 different employment settings in 4 diverse US states and performed widely varying work. At baseline, workers undergo laptop-administered questionnaires, structured interviews, and two standardized physical examinations to ascertain demographics, medical history, psychosocial factors, hobbies and physical activities, and current musculoskeletal disorders. All workers' jobs are individually measured for physical factors and are videotaped. Workers are followed monthly for the development of low back pain. Changes in jobs necessitate re-measure and re-videotaping of job physical factors. The lifetime cumulative incidence of low back pain will also include those with a past history of low back pain. Incident cases will exclude prevalent cases at baseline. Statistical methods planned include survival analyses and logistic regression.

DISCUSSION

Data analysis of a prospective cohort study of low back pain is underway and has successfully enrolled over 800 workers to date.

The Changing Environment and Population Obesity in the United States

The recent unexpected increases in the prevalence of obesity in the United States are widely agreed to be the result of changes in environmental conditions. This paper reviews the available data from diverse sources on environmental factors and obesity. Coverage includes descriptive data on temporal trends in the environment, cross-sectional and longitudinal studies of the association between environmental exposures and body weight, and experimental trials that have related environmental factors thought to be potentially important in influencing energy intake and expenditure and body weight. Over the period covered by the "obesity epidemic," a variety of environmental factors have changed dramatically. Some would seem to favor increased body weight (e.g., increased availability of convenience foods and increased use of automobiles and televised entertainment), and others would seem to favor decreased body weight (e.g., a lower-fat food supply and the increased availability of some forms of physical activity). Definitive conclusions about the relative contributions of energy intake and expenditure to increasing body weight or about the contribution of specific environmental exposures to increasing body weight are far from clear. Increased sophistication in methods for making valid inferences from existing environmental data would be helpful. Even more important, given the urgency of the problem, is experimental research on the question of what environmental changes would be necessary to reverse the obesity epidemic.

Population approaches to improve diet, physical activity, and smoking habits: a scientific statement from the American Heart Association

BACKGROUND

Poor lifestyle behaviors, including suboptimal diet, physical inactivity, and tobacco use, are leading causes of preventable diseases globally. Although even modest population shifts in risk substantially alter health outcomes, the optimal population-level approaches to improve lifestyle are not well established.

METHODS AND RESULTS

For this American Heart Association scientific statement, the writing group systematically reviewed and graded the current scientific evidence for effective population approaches to improve dietary habits, increase physical activity, and reduce tobacco use. Strategies were considered in 6 broad domains: (1) Media and educational campaigns; (2) labeling and consumer information; (3) taxation, subsidies, and other economic incentives; (4) school and workplace approaches; (5) local environmental changes; and (6) direct restrictions and mandates. The writing group also reviewed the potential contributions of healthcare systems and surveillance systems to behavior change efforts. Several specific population interventions that achieved a Class I or IIa recommendation with grade A or B evidence were identified, providing a set of specific evidence-based strategies that deserve close attention and prioritization for wider implementation. Effective interventions included specific approaches in all 6 domains evaluated for improving diet, increasing activity, and reducing tobacco use. The writing group also identified several specific interventions in each of these domains for which current evidence was less robust, as well as other inconsistencies and evidence gaps, informing the need for further rigorous and interdisciplinary approaches to evaluate population programs and policies.

CONCLUSIONS

This systematic review identified and graded the evidence for a range of population-based strategies to promote lifestyle change. The findings provide a framework for policy makers, advocacy groups, researchers, clinicians, communities, and other stakeholders to understand and implement the most effective approaches. New strategic initiatives and partnerships are needed to translate this evidence into action.

Lumbar bone mass predicts low back pain in males

STUDY DESIGN

Longitudinal study of lumbar bone mass as predictor of low back pain (LBP).

OBJECTIVE

To investigate whether low bone mineral content (BMC) and bone mineral density (BMD) values at the age of 36 years are associated with the prevalence of LBP at the age of 42 years among the study population of the Amsterdam Growth and Health Longitudinal Study.

SUMMARY OF BACKGROUND DATA

Results of epidemiological, clinical, and in vitro studies indicate that spinal injuries, caused by mechanical loading, might be a cause of LBP. BMC and BMD are determinants of spinal strength. We therefore hypothesized that BMC and BMD are associated with LBP.

METHODS

At the age of 36 years, the lumbar BMC and BMD were determined by dual-energy x-ray absorptiometry in 140 men and 152 women. At the age of 42 years, the participants were asked whether they had experienced LBP in the previous 12 months. Logistic regression analyses were performed to determine odds ratios (ORs)-adjusted for stature, body weight, physical activity, and smoking-for the relationship of BMC and BMD with LBP.

RESULTS

BMC and BMD at the age of 36 years were significantly associated with the reported 12-month prevalence of LBP at the age of 42 years. This association, however, was observed only for men and not for women. Men within the quartile with the lowest BMC or BMD values had higher odds for LBP with ORs of 4.78 (95% confidence interval, 1.52-15.00) and 3.48 (95% confidence interval, 1.23-9.85), respectively.

CONCLUSION

For a male population that is not characterized by osteoporosis or old age, lower lumbar BMC and BMD values at the age of 36 years are associated with an increased risk of reporting to have had LBP in the previous 12 months at the age of 42 years.

Investigating behavioural mimicry in the context of stair/escalator choice

OBJECTIVES

We investigated whether individuals mimic the stair/escalator choices of preceding pedestrians. Our methodology sought to separate cases where the 'model' and 'follower' were acquaintances or strangers.

DESIGN

Natural experiment.

METHODS

Infrared monitors provided a second-by-second log of when pedestrians ascended adjacent stairs/escalators in a mall. Manual timings established that stair climbers spent ≥ 7 s on ascent, during which time they could act as models to following pedestrians. Thus, individuals who mounted the stairs/escalator ≤ 7 s after the previous stair climber were assigned to a 'stair model' condition. A 'no stair model' condition comprised individuals with a gap to the previous stair climber of ≥ 60 s. The stair model condition was subdivided, depending if the gap between model and follower was 1-2 s or 3-7 s. It was hypothesized that the former cohort may know the model.

RESULTS

Percentage stair climbing was significantly higher in the 'stair model' versus 'no stair model' condition (odds ratio [OR]= 2.08). Subgroup analyses showed greater effects in the '1-2 s' cohort (OR = 3.33) than the '3-7 s' cohort (OR = 1.39).

CONCLUSIONS

Individuals appear to mimic the stair/escalator choices of fellow pedestrians, with more modest effects between strangers. People exposed to message prompts at stair/escalator sites are known to take the stairs unprompted in subsequent situations. Our results suggest that these individuals could recruit a second generation of stair climbers via mimicry. Additionally, some of the immediate behavioural effects observed in interventions may be a product of mimicry, rather than a direct effect of the messages themselves.

Worksite physical activity interventions and obesity: a review of European studies (the HOPE project)

OBJECTIVE

Our aim was to review the effectiveness of physical activity promotion interventions in the worksite setting in Europe in order to identify those studies that had measured obesity-related outcomes and to evaluate how external validity of the findings had been assessed.

METHODS

We conducted a review of studies conducted in Europe, published up to December 2009. We assessed levels of evidence regarding effectiveness and analysed external validity using the RE-AIM framework.

RESULTS

Studies included (n = 33) were divided in 6 intervention categories. Moderate evidence of effectiveness was found for physical fitness outcomes with exercise training interventions and for physical activity outcomes with active commuting interventions. There was no or inconclusive evidence for obesity-related outcomes for all intervention categories. For external validity, elements receiving the least attention (<20%) were representativeness of participants, setting-level inclusion/exclusion criteria and representativeness, characteristics regarding intervention staff, implementation of intervention, costs, long-term effects and programme sustainability.

CONCLUSIONS

Active commuting and exercise training appear as promising approaches to promote physical activity or fitness in the workplace. The effect of interventions on obesity-related outcomes remains to be further investigated. There is a need to better report elements of generalizability and dissemination for translation into practice of worksite physical activity interventions.

An informational stair climbing intervention with greater effects in overweight pedestrians

Previous interventions have successfully increased levels of stair climbing in public-access settings (e.g. malls). This study used robust methods to establish the magnitude of intervention effects among a specific target group-the overweight. Ascending stair/escalator users (N = 20 807) were observed in a mall. A 2-week baseline was followed by a 5-week intervention in which message banners, promoting stair climbing, were attached to the stair risers. Standardized silhouettes were used to code individuals as normal/overweight. Logistic regression analyses were conducted with stair/escalator choice as the outcome variable and weight status entered as a moderator alongside condition, gender, ethnicity and 'pedestrian traffic volume'. Overall, the intervention significantly increased the rate of stair climbing [odds ratio (OR) = 1.28, 95% confidence intervals (CI) = 1.08-1.53], with the effects sustained over 5 weeks. There were differential effects between weight categories, with greater increases in overweight (OR = 1.95, CI = 1.34-2.83) versus normal weight individuals (OR = 1.29, CI = 1.09-1.53). In conclusion, message prompts produced larger effects among overweight individuals, who could benefit most from stair climbing. The public health value of these interventions may, therefore, be greater than realized. The heightened effects among the overweight were likely due to the salience of the current message, which linked stair climbing with the target of weight control.

Promotion of physical activity using point-of-decision prompts in Berlin underground stations

To evaluate point-of-decision prompts in the promotion of stair use in Germany, motivational posters were placed at three underground stations in Berlin. The proportion of passengers using stairs or stairways was counted before, during installation, and two weeks after removal of posters. In total, 5,467 passersby were counted. Stair use increased significantly in women, but not in men. The present pilot study thereby shows that the use of point-of-decision prompts is also feasible in Germany and it provides some evidence of effectiveness. Methodologically rigorous studies are warranted to confirm these findings.

Point-of-decision prompts to increase stair use. A systematic review update

In 2000, the Guide to Community Preventive Services (Community Guide) completed a systematic review of the effectiveness of various approaches to increasing physical activity including informational, behavioral and social, and environmental and policy approaches. Among these approaches was the use of signs placed by elevators and escalators to encourage stair use. This approach was found to be effective based on sufficient evidence. Over the past 5 years the body of evidence of this intervention has increased substantially, warranting an updated review. This update was conducted on 16 peer-reviewed studies (including the six studies in the previous systematic review), which met specified quality criteria and included evaluation outcomes of interest. These studies evaluated two interventions: point-of-decision prompts to increase stair use and enhancements to stairs or stairwells (e.g., painting walls, laying carpet, adding artwork, playing music) when combined with point-of-decision prompts to increase stair use. This latter intervention was not included in the original systematic review. According to the Community Guide rules of evidence, there is strong evidence that point-of-decision prompts are effective in increasing the use of stairs. There is insufficient evidence, due to an inadequate number of studies, to determine whether or not enhancements to stairs or stairwells are an effective addition to point-of-decision prompts. This article describes the rationale for these systematic reviews, along with information about the review process and the resulting conclusions. Additional information about applicability, other effects, and barriers to implementation is also provided.

Changing behavioral patterns to promote physical activity with motivational signs

OBJECTIVES

We have evaluated the effectiveness of motivational signs in promoting stair use instead of escalators, in terms of gender and age, at a train station with a 37-step staircase. We also examined whether a newspaper article, or booster, had any effect on augmenting the impact of the signs.

METHODS

In a serial cross-sectional survey with prompted signs, the subjects were coded by gender and age (over 65 years, under 65 years), and students (13-18 years old and school uniforms). We used a 2-week baseline period, followed by a 4-week intervention in which a total of 45 posters and banners with motivational messages were used to encourage stair use. As a booster, we published a news release of this study on a web site and in a local newspaper during the intervention period.

RESULTS

A total of 43,241 escalator/stair-choice observations were made. Stair use increased significantly from 3.58 to 4.93% during the intervention period of 1-2 weeks for all subjects. In addition, stair use had a significantly high value of 5.80% during the intervention period of 3-4 weeks. Stair use also increased in subgroups during the intervention periods with the exception of women 65 and older. Attempts to publicize the study had no effect on the increase in stair use.

CONCLUSIONS

The use of signs was effective in changing behavior during the period of sign use, but this effectiveness was limited by gender, age, and the physical ability (e.g., muscle strength) and energy required to climb the stairs. The possible synergistic effects of publicity were inconclusive but are worthy of further investigation.

Promoting stair climbing: stair-riser banners are better than posters... sometimes

OBJECTIVE

Stair-riser banners are twice as effective as posters in encouraging stair climbing in shopping centres. This study tested the effectiveness of stair-riser banners in an English train station in 2006-2007.

METHOD

The train station had a 39-step staircase and an adjacent escalator. Baseline observations (3.5 weeks) were followed by 10.5 weeks of a banner intervention supplemented with 3 weeks of a poster intervention. Both poster and banner featured the message 'Stair climbing burns more calories per minute than jogging. Take the stairs'. Ascending escalator and stair users (N=36,239) were coded for gender.

RESULTS

Analyses, controlling for effects of gender and pedestrian traffic volume, revealed no significant change in stair climbing between baseline (40.6%) and the banner intervention (40.9%; p=0.98). Addition of the poster increased stair climbing (44.3%; OR=1.36, 95% CIs 1.16-1.60, p<0.001), with the effect reduced at higher pedestrian traffic volumes.

CONCLUSION

While stair-riser banners had no effect, the poster intervention increased stair climbing. The high pedestrian volumes as the wave of disembarking passengers seek to leave the station would have obscured the visibility of the banner for many commuters. Thus stair-riser banners appear unsuitable point-of-choice prompts in stations where pedestrian traffic volume is high.

JCQ scale reliability and responsiveness to changes in manufacturing process

BACKGROUND

The job content questionnaire (JCQ) was administered to automobile manufacturing workers in two interviews, 5 years apart. Between the two interviews, the company introduced substantial changes in production technology in some production areas. The aims were: (1) to describe the impact of these changes on self-reported psychosocial exposures, and (2) to examine test-retest reliability of the JCQ scales, taking into account changes in job assignment and, for a subset of workers, physical ergonomic exposures as assessed through field observations.

METHODS

The study population included 790 subjects at the first and 519 at the second interview, of whom 387 were present in both. Differences in demand and control scores between interviews were analyzed by Wilcoxon matched-pairs signed-rank test. Test-retest reliability of these scales was evaluated by the intraclass correlation coefficient (ICC) and the Spearman's rho coefficient.

RESULTS

The introduction of more automated technology produced an overall increase in job control but did not decrease psychological demand. The reliability of the control scale was low overall but increased to an acceptable level among workers who had not changed job. The demand scale had high reliability only among workers whose physical ergonomic exposures were similar on both survey occasions.

CONCLUSIONS

These results show that 5-year test-retest reliability of self-reported psychosocial exposures is adequate among workers whose job assignment and ergonomic exposures have remained stable over time.

A poster-based intervention to promote stair use in blue- and white-collar worksites

OBJECTIVE

Previous studies have generally shown the effectiveness of prompts to promote stair use in worksites that mainly consist of white-collar workers. The present study tested whether an intervention using prompts is effective in stimulating stair use in two types of worksites: one consisting mainly of white-collar workers and one mainly of blue-collar workers.

METHOD

In 2005, elevator and stair use (stair climbing and descent) was monitored in two types of worksites in the Netherlands, namely one office building (n=150 white-collar workers) and one paper factory (n=800 blue-collar workers). The study used a simple time-series design of collecting data in three waves: before, during and after implementation of posters containing prompts stimulating stair use.

RESULTS

A total of 6771 choices between stairs and elevator were observed. There was a significant difference between stair use at baseline and during the poster intervention in both types of worksites. There was no worksite-by-intervention interaction, implying that the prompts were equally effective in both types of worksites. After removal of the posters stair use decreased significantly to a level that was not significantly different from baseline.

CONCLUSION

Stair use can be positively influenced in both blue- and white-collar workers by a short-term low-cost intervention using prompts on posters.

Factors associated with back problems among emergency medical technicians

INTRODUCTION

Back problems are a common complaint among emergency medical technicians (EMTs). It is hypothesized that the likelihood of reporting back problems will be associated with the individual and work-related characteristics of a national sample of EMTs.

METHODS

A case-control analysis was performed on 579 EMTs wherein cases were the 104 subjects who reported new back problems in 2004. Controls were 475 subjects who reported no back problems in 2003 and 2004.

RESULTS

EMTs dissatisfied with their current assignment were significantly more likely to report back problems (OR = 9.33; 95% CI = 3.04-28.67), as were EMTs reporting good or fair fitness when compared to excellent fitness (OR = 3.39; 95% CI = 1.54-7.45, OR = 3.43; 95% CI = 1.37-8.56).

CONCLUSIONS

Results from this analysis suggest that there are two modifiable factors associated with self-reported back problems among EMTs, satisfaction with current assignment and self-reported physical fitness.

Measuring stair use in two office buildings: a comparison between an objective and a self-reported method

INTRODUCTION/PURPOSE

Measuring stair use reliably and objectively is complicated and difficult. In this study, stair use was measured at an individual level by using an innovative registration system and was compared with self-reported data. The purpose of this study was to gain an insight into the comparability of self-reported stair use vs objectively measured stair use.

METHODS

Self-reported and objective stair use was measured in two worksites and was operationalized as how often a subject uses the stairs per week (i.e., stair-use frequency) and the number of floors covered (up or down) in a week with each use. Analyses were performed by means of the intraclass correlation coefficients (ICCs).

RESULTS

A number of significant differences in stair use between worksites were found. ICCs of 0.55 and 0.24 for stair-use frequency were found in worksites 1 and 2, respectively. The ICCs for the number of floors covered were lower at 0.39 and 0.19 for worksites 1 and 2, respectively.

CONCLUSION

The comparability of self-reported and objectively measured stair use is moderate to poor, and given the independent measurement errors of both methods, this might have been expected. Comparability seemed to be dependent on worksite characteristics.

The association of socioeconomic status and psychosocial and physical workplace factors with musculoskeletal injury in hospital workers

BACKGROUND

The combined effect of socioeconomic, organizational, psychosocial, and physical factors on work-related musculoskeletal disorders (WRMSDs) were studied in a heterogeneous, socioeconomically diverse sample (cases and their matched referents) of hospital workers.

METHODS

Cases were defined by a new acute or cumulative work-related musculoskeletal injury; referents were matched by job group, shift length, or at random. Information was obtained through telephone interviews and on-site ergonomics observation. Questionnaire items included sociodemographic variables, lost work time, work effectiveness, health status, pain/disability, and psychosocial working conditions using Effort Reward Imbalance (ERI) and Demand-Control (DC) models. Two multivariate models were tested: Model 1 included occupation as a predictor; Model 2 included education-income as a predictor.

RESULTS

Cases reported greater pain, disability, lost time, and decreased work effectiveness than the referents. Model 1 was statistically significant for neck/upper extremity injury (Chi-square = 19.3, P = 0.01), back/lower extremity injury (Chi-square = 14.0, P = 0.05), and all injuries combined (Chi-square = 25.4, P = 0.001). "Other Clinical" occupations (34% mental health workers) had the highest risk of injury (OR 4.5: 95%CI, 1.7-12.1) for all injuries. The ERI ratio was a significant predictor for neck and upper extremity (OR 1.5: 95%CI, 1.1-1.9) and all injuries (OR 1.3; 95%CI, 1.04-1.5), per SD change in score.

CONCLUSIONS

In this study, the risk of WRMSDs was more strongly influenced by specific psychosocial and physical job-related exposures than by broad socioeconomic factors such as education and income.

Key factors in back disability prevention: a consensus panel on their impact and modifiability

STUDY DESIGN

Modified Delphi panel using Q-methodology.

OBJECTIVE

To reach consensus on the relative impact and modifiability of factors that might prevent participation restrictions in people with back pain as defined by the WHO International Classification of Functioning, Disability and Health.

SUMMARY OF BACKGROUND DATA

Back disability prevention should focus on factors with large impact that are relatively easy to change and supported by most stakeholders. An evidence-based consensus panel can provide interim direction until definitive evidence is available.

METHODS

Evidence summaries for 32 factors were used by 33 researchers and stakeholders in a 3-round Delphi process to rank the factors' relative impact and modifiability. Consensus was judged as strong (>85% of panel members), moderate (50%-84%), or low (33%-49%).

RESULTS

Most available research focused on return to work and often left unexplored other participation domains and environmental factors at home. The panel had substantial disagreements, particularly on the impact of changes to physical functioning and activities required at work. After 3 rounds, there was strong consensus that care provider reassurance had a high impact. There was moderate consensus that expectation of recovery and decreased fears had a high impact. Back supports, care provider reassurance, and patient knowledge were deemed most modifiable.

CONCLUSIONS

Until definitive evidence is available, back disability prevention interventions will likely need to address multiple factors simultaneously and emphasize efforts to improve care provider reassurance. Consensus findings may vary depending on the panel. Research on nonoccupational participation, environmental factors at home, and reasons for discordant interpretation of evidence is needed.

The impact of psychosocial factors on low back pain: longitudinal results from the Belstress study

STUDY DESIGN

An epidemiological cohort study.

OBJECTIVE

To describe the impact of psychosocial factors, both work and nonwork-related, on the prevalence of low back pain (LBP) after 6.6 years on average.

SUMMARY OF BACKGROUND DATA

There is growing consensus that psychosocial factors play a role in the development of LBP, although results are not consistent across studies.

METHODS

Within a sample of 2556 middle-aged men and women from the Belstress study, baseline psychosocial factors were measured through self-administered questionnaires and related to prevalent cases of LBP after a mean time interval of 6.6 years through Cox regression analysis.

RESULTS

After adjustment for individual and physical risks, including occasional back pain at baseline, the prevalence rate of LBP in men is significantly related to baseline low decision latitude and low social support at work, and nonsignificantly to high job strain, low wage and job satisfaction, feeling stressed at work, and feeling depressed. High job insecurity, feeling stressed at work, and feeling depressed nonsignificantly increase the relative risks for LBP in women.

CONCLUSIONS

Based on the results of this study, psychosocial factors (both work and nonwork-related) constitute nonnegligible risks for the development of LBP.

Promoting stair use by modeling: an experimental application of the Behavioral Ecological Model

PURPOSE

This study evaluated the effect of behavioral modeling and social factors promoting stair use.

DESIGN

Alternating baseline and intervention phase experimental design.

SETTING

San Diego International Airport, San Diego, California.

SUBJECTS

Stair use was coded for 15,574 filmed participants.

INTERVENTION

This study compared the effects of three types of behavioral modeling: natural models (i.e., passersby), single experimental model (i.e., confederate), and confederate model pairs providing verbal prompts.

MEASURES

Variables were coded based on systematic observation of videotapes, including demographics, day and time, and the following indicators of physical and social reinforcement contingencies: dress, luggage, children, social group, and speed. Reliability ranged from .64 to .88.

ANALYSIS

Bivariate and logistic regression models stratified by gender.

RESULTS

Stair use increased over baseline by 102.6% with no model present and by 61.8% in the presence of natural models for men and women (p < .001). Controlling for multiple covariates, the odds ratios for stair use ranged from 1.76 to 2.93 for men and from 1.82 to 2.54 for women across the levels with natural and confederate models present (all p < .001).

CONCLUSION

Modeling can prompt stair use, and findings for social and environmental reinforcement contingencies support the Behavioral Ecological Model. Modeling may explain partial maintenance of stair use in public areas after removal of prompts (e.g., signs, banners). Results inform interventions for increasing physical activity as part of daily routines.

A workplace intervention to promote stair climbing: greater effects in the overweight

OBJECTIVE

Stair climbing is a lifestyle physical activity that uses more calories per minute than jogging. This study tested an intervention designed to promote stair climbing in a workplace. Because previous studies provide only equivocal evidence of the effects of increased stair climbing in worksites, a formal comparison of the effects of the intervention on stair ascent and descent was made.

RESEARCH METHODS AND PROCEDURES

In a five-story public sector building, a 2-week baseline was followed by 6 weeks of an intervention involving a 23(1/2)- x 16(1/2)-inch poster in the lobby, the same poster and six messages affixed to the stair risers between floors, and an 11(3/4)- x 8(1/4)-inch point-of-choice prompt at the elevators. Stair and elevator choices (n = 26,806) were videotaped throughout and subsequently coded for direction of travel, traveler's sex, and traveler's load. Weight status was coded using silhouettes beside the computer monitor.

RESULTS

A significant effect of the intervention on stair climbing was greater in those coded as overweight (+5.4%; odds ratio = 1.33) than in individuals of normal weight (+2.5%; odds ratio = 1.12). Although stair descent was more common than ascent, the intervention had similar effects for both directions of travel.

DISCUSSION

Stair climbing at work has few barriers and seems to be a type of physical activity that is acceptable to overweight individuals. The relatively weak effect of workplace interventions compared with results for public access staircases may reflect uncontrolled effects such as the immediate availability of the elevator for the traveler.

Evidence-based approaches to dissemination and diffusion of physical activity interventions

With the increasing availability of effective, evidence-based physical activity interventions, widespread diffusion is needed. We examine conceptual foundations for research on dissemination and diffusion of physical activity interventions; describe two school-based program examples; review examples of dissemination and diffusion research on other health behaviors; and examine policies that may accelerate the diffusion process. Lack of dissemination and diffusion evaluation research and policy advocacy is one of the factors limiting the impact of evidence-based physical activity interventions on public health. There is the need to collaborate with policy experts from other fields to improve the interdisciplinary science base for dissemination and diffusion. The promise of widespread adoption of evidence-based physical activity interventions to improve public health is sufficient to justify devotion of substantial resources to the relevant research on dissemination and diffusion.

The impact of workplace risk factors on the occurrence of neck and upper limb pain: a general population study

Background

Work-related neck and upper limb pain has mainly been studied in specific occupational groups, and little is known about its impact in the general population. The objectives of this study were to estimate the prevalence and population impact of work-related neck and upper limb pain.

Methods

A cross-sectional survey was conducted of 10 000 adults in North Staffordshire, UK, in which there is a common local manual industry. The primary outcome measure was presence or absence of neck and upper limb pain. Participants were asked to give details of up to five recent jobs, and to report exposure to six work activities involving the neck or upper limbs. Psychosocial measures included job control, demand and support. Odds ratios (ORs) and population attributable fractions were calculated for these risk factors.

Results

The age-standardized one-month period prevalence of neck and upper limb pain was 44%. There were significant independent associations between neck and upper limb pain and: repeated lifting of heavy objects (OR = 1.4); prolonged bending of neck (OR = 2.0); working with arms at/above shoulder height (OR = 1.3); little job control (OR = 1.6); and little supervisor support (OR = 1.3). The population attributable fractions were 0.24 (24%) for exposure to work activities and 0.12 (12%) for exposure to psychosocial factors.

Conclusion

Neck and upper limb pain is associated with both physical and psychosocial factors in the work environment. Inferences of cause-and-effect from cross-sectional studies must be made with caution; nonetheless, our findings suggest that modification of the work environment might prevent up to one in three of cases of neck and upper limb pain in the general population, depending on current exposures to occupational risk.

An uphill struggle: Effects of a point-of-choice stair climbing intervention in a non-English speaking population

BACKGROUND

Increases in lifestyle physical activity are a current public health target. Interventions that encourage pedestrians to choose the stairs rather than the escalator are uniformly successful in English speaking populations. Here we report the first test of a similar intervention in a non-English speaking sample, namely the Hong Kong Chinese.

METHODS

Travellers on the Mid-Levels escalator system in Hong Kong were encouraged to take the stairs for their health by a point-of-choice prompt with text in Chinese positioned at the junction between the stairs and the travelator. Gender, age, ethnic origin, and walking on the travelator were coded by observers. A 2 week intervention period followed 2 weeks of baseline monitoring with 57 801 choices coded. Specificity of the intervention was determined by contrasting effects in Asian and non-Asian travellers.

RESULTS

There was no effect of the intervention on stair climbing and baseline rates (0.4%) were much lower than previous studies in Western populations (5.4%). Nonetheless, a modest increase in walking up the travelator, confined to the Asian population (OR = 1.12), confirmed that the intervention materials could change behaviour.

CONCLUSIONS

It would be unwise to assume that lifestyle physical activity interventions have universal application. The contexts in which the behaviours occur, e.g. climate, may act as a barrier to successful behaviour change.

Worksite interventions to increase stair climbing; reasons for caution

Point-of-choice prompts to use the stairs rather than the escalator consistently increase physical activity at public access staircases such as those in shopping malls. More recently, exercise promoters have targeted stair climbing in the worksite. A review of interventions in worksites reveals little hard evidence of successful increases in stair climbing, though the increases in stair usage are encouraging. The contrast between the worksites and public access staircases, however, is not simply one of location. In a worksite, the choice is between the stairs and an elevator rather than an escalator. We reason that the availability of the elevator or the stairwell may be the major immediate determinant of stair climbing in worksites and dilute any possible effects of an intervention.

Mapping stairwell accessibility in Vancouver's downtown core

BACKGROUND

The increase in obesity is due in part to changes in the environment that affect behaviours such as physical activity. Stairwells in buildings present an opportunity to increase physical activity in the workplace. We characterized the stairwell accessibility in business buildings in the downtown core of Vancouver.

METHODS

Characteristics of the stairwells in business buildings with two or more floors were obtained. Stairwells were characterized based on their visibility from the main entrance, signage, presence of physical door, and interior lighting and space. Building completion year was obtained from the Vancouver City Hall.

RESULTS

A total of 138 buildings in the pre-designated area were eligible for characterization. Due to security concerns, only 123 were assessed. Of those assessed, 54% had stairwells visible from the main entrance, 33% had locked doors and only 18% had signs on the stairwell doors. Of the 83 stairwells that were accessible, 54% and 36% were considered brightly lit and spacious enough for two people, respectively. Only 11% of the buildings studied had accessible stairwells that met all of our accessibility criteria. More recently built buildings tended to have a higher proportion of locked stairwell doors; otherwise, building completion year was not associated with any of the accessibility criteria.

INTERPRETATION

Based on their environmental characteristics, very few buildings were set up in a way that encouraged stair use. For the work environment to be conducive to increased physical activity, building policy will need to consider the implications of design on activity patterns.

Risk factors for recurrent episodes of work-related low back disorders in an industrial population

STUDY DESIGN

An observational longitudinal design.

OBJECTIVES

To characterize the rate of and risk factors for recurrent episodes of work-related low back disorder in industrial workers.

SUMMARY OF BACKGROUND DATA

Little data exist on risk factors for recurrent episodes of work-related low back disorders in employed persons.

METHODS

A total of 352 active hourly union employees who were diagnosed with a recent work-related low back disorder and who had at least one follow-up visit within 12 months enrolled for participation in a rehabilitation intervention study at the workplace. Information on clinical and job factors was obtained at each study visit. Job risk for low back disorder was quantified using the Lumbar Motion Monitor. The main outcome measure, recurrence of work-related low back pain, was derived from a computerized file of administrative records of visits to the plant's medical department.

RESULTS

The rate of repeated episodes was 24.4%; an additional episode occurred in 2.3%. Adjusting for age, gender, health status and job exposures, lower levels of physical health, increasing back pain disability, spinal deformity, high stress, and increasing number of different jobs worked at the same plant were risk factors for a recurrent episodes of low back pain.

CONCLUSIONS

Early identification of risk factors for a work-related low back disorder may signal the need for early and intense rehabilitation to prevent recurrent episodes. Because these findings were based on jobs with medium risk of low back disorders, other factors may be significant in higher risk jobs.

Mapping stairwell accessibility in Vancouver's downtown core

BACKGROUND

The increase in obesity is due in part to changes in the environment that affect behaviours such as physical activity. Stairwells in buildings present an opportunity to increase physical activity in the workplace. We characterized the stairwell accessibility in business buildings in the downtown core of Vancouver.

METHODS

Characteristics of the stairwells in business buildings with two or more floors were obtained. Stairwells were characterized based on their visibility from the main entrance, signage, presence of physical door, and interior lighting and space. Building completion year was obtained from the Vancouver City Hall.

RESULTS

A total of 138 buildings in the pre-designated area were eligible for characterization. Due to security concerns, only 123 were assessed. Of those assessed, 54% had stairwells visible from the main entrance, 33% had locked doors and only 18% had signs on the stairwell doors. Of the 83 stairwells that were accessible, 54% and 36% were considered brightly lit and spacious enough for two people, respectively. Only 11% of the buildings studied had accessible stairwells that met all of our accessibility criteria. More recently built buildings tended to have a higher proportion of locked stairwell doors; otherwise, building completion year was not associated with any of the accessibility criteria.

INTERPRETATION

Based on their environmental characteristics, very few buildings were set up in a way that encouraged stair use. For the work environment to be conducive to increased physical activity, building policy will need to consider the implications of design on activity patterns.

Delayed trunk muscle reflex responses increase the risk of low back injuries

STUDY DESIGN

Prospective observational study with a 2- to 3-year follow-up.

OBJECTIVES

To determine whether delayed muscle reflex response to sudden trunk loading is a result of or a risk factor for sustaining a low back injury (LBI).

SUMMARY OF BACKGROUND DATA

Differences in motor control have been identified in individuals with chronic low back pain and in athletes with a history of LBI when compared with controls. However, it is not known whether these changes are a risk for or a result of LBI.

METHODS

Muscle reflex latencies in response to a quick force release in trunk flexion, extension, and lateral bending were measured in 303 college athletes. Information was also obtained regarding their personal data, athletic experience, and history of LBI. The data were entered into a binary logistic regression model to identify the predictors of future LBI. RESULTS.: A total of 292 athletes were used for the final analysis (148 females and 144 males). During the follow-up period, 31 (11%) athletes sustained an LBI. The regression model, consisting of history of LBI, body weight, and the latency of muscles shutting off during flexion and lateral bending load releases, predicted correctly 74% of LBI outcomes. The odds of sustaining LBI increased 2.8-fold when a history of LBI was present and increased by 3% with each millisecond of abdominal muscle shut-off latency. On average, this latency was 14 milliseconds longer for athletes who sustained LBI in comparison to athletes who did not sustain LBI (77 [36] vs. 63 [31]). There were no significant changes in any of the muscle response latencies on retest following the injury.

CONCLUSIONS

The delayed muscle reflex response significantly increases the odds of sustaining an LBI. These delayed latencies appear to be a preexisting risk factor and not the effect of an LBI.

Promoting stair use: single versus multiple stair-riser messages

Message banners attached to stair risers produced a significant increase in pedestrian stair use, exceeding effects previously reported for conventional posters. Multiple instances of the same message banner, however, were as effective as banners featuring different messages. Therefore, greater visibility, rather than message variety, appears to account for the superiority of the banner format. Our findings indicate the feasibility of simple stair-use promotion campaigns based around the repetition of a single message.

Worksite health promotion programs with environmental changes: a systematic review

BACKGROUND

It is now widely believed that health promotion strategies should go beyond education or communication to achieve significant behavioral changes among the target population. Environmental modifications are thought to be an important addition to a worksite health promotion program (WHPP). This review aimed to systematically assess the effectiveness of WHPPs with environmental modifications, on physical activity, dietary intake, and health risk indicators.

METHODS

Online searches were performed for articles published up to January 2004 using the following inclusion criteria: (1) (randomized) controlled trial (RCT/CT); (2) intervention should include environmental modifications; (3) main outcome must include physical activity, dietary intake, and health risk indicators; and (4) healthy working population. Methodologic quality was assessed using a checklist derived from the methodologic guidelines for systematic reviews (Cochrane Back Review Group), and conclusions on the effectiveness were based on a rating system of five levels of evidence.

RESULTS

Thirteen relevant, mostly multicenter, trials were included. All studies aimed to stimulate healthy dietary intake, and three trials focused on physical activity. Follow-up measurements of most studies took place after an average 1-year period. Methodologic quality of most included trials was rated as poor. However, strong evidence was found for an effect on dietary intake, inconclusive evidence for an effect on physical activity, and no evidence for an effect on health risk indicators.

CONCLUSIONS

It is difficult to draw general conclusions based on the small number of studies included in this review. However, evidence exists that WHPPs that include environmental modifications can influence dietary intake. More controlled studies of high methodologic quality need to be initiated that investigate the effects of environmental interventions on dietary intake and especially on physical activity in an occupational setting.

Predictors of work-related repetitive strain injuries in a population cohort

OBJECTIVES

We assessed predictors of work-related repetitive strain injuries using data from 4 waves of the Canadian National Population Health Survey.

METHODS

Participants were 2806 working adults who completed an abbreviated version of the Job Content Questionnaire in 1994-1995 and did not experience repetitive strain injuries prior to 2000-2001. Potential previous wave predictors of work-related repetitive strain injuries were modeled via multivariate logistic regression.

RESULTS

Female gender (odds ratio [OR] = 1.98; 95% confidence interval [CI]=1.24, 3.18), some college or university education (OR=1.98; 95% CI=1.06, 3.70), job insecurity (OR=1.76; 95% CI=1.07, 2.91), high physical exertion levels (OR = 2.00; 95% CI = 1.29, 3.12), and high levels of psychological demands (OR = 1.61; 95% CI = 1.02, 2.52) were all positively associated with work-related repetitive strain injuries, whereas working less than 30 hours per week exhibited a negative association with such injuries (OR=0.2; 95% CI=0.1, 0.7).

CONCLUSIONS

Modifiable job characteristics are important predictors of work-related repetitive strain injuries.

Integrating Qualitative Research into Occupational Health: A Case Study Among Hospital Workers

OBJECTIVE

We sought to better use qualitative approaches in occupational health research and integrate them with quantitative methods.

METHODS

We systematically reviewed, selected, and adapted qualitative research methods as part of a multisite study of the predictors and outcomes of work-related musculoskeletal disorders among hospital workers in two large urban tertiary hospitals.

RESULTS

The methods selected included participant observation; informal, open-ended, and semistructured interviews with individuals or small groups; and archival study. The nature of the work and social life of the hospitals and the foci of the study all favored using more participant observation methods in the case study than initially anticipated.

CONCLUSIONS

Exploiting the full methodological spectrum of qualitative methods in occupational health is increasingly relevant. Although labor-intensive, these approaches may increase the yield of established quantitative approaches otherwise used in isolation.