Support for Food and Beverage Worksite Wellness Strategies and Sugar-Sweetened Beverage Intake Among Employed U.S. Adults

PURPOSE

Sugar-sweetened beverage (SSB) consumption is high among U.S. adults and is associated with obesity. Given that more than 100 million Americans consume food or beverages at work daily, the worksite may be a venue for interventions to reduce SSB consumption. However, the level of support for these interventions is unknown. We examined associations between workday SSB intake and employees' support for worksite wellness strategies (WWSs).

DESIGN

We conducted a cross-sectional study using data from Web-based annual surveys that gather information on health-related attitudes and behaviors.

SETTING

Study setting was the United States.

SUBJECTS

A total of 1924 employed adults (≥18 years) selected using probability-based sampling.

MEASURES

The self-reported independent variable was workday SSB intake (0, <1 or ≥1 times per day), and dependent variables were employees' support (yes/no) for the following WWSs: (1) accessible free water, (2) affordable healthy food/drink, (3) available healthy options, and (4) less available SSB.

ANALYSIS

Multivariable logistic regression was used to control for sociodemographic variables, employee size, and availability of cafeteria/vending machine.

RESULTS

About half of employees supported accessible free water (54%), affordable healthy food/drink (49%), and available healthy options (46%), but only 28% supported less available SSB. Compared with non-SSB consumers, daily SSB consumers were significantly less supportive of accessible free water (adjusted odds ratio, .67; p < .05) or less available SSB (odds ratio, .49; p < .05).

CONCLUSION

Almost half of employees supported increasing healthy options within worksites, although daily workday SSB consumers were less supportive of certain strategies. Lack of support could be a potential barrier to the successful implementation of certain worksite interventions.

Telephone-Based Coaching

PURPOSE

Many Americans continue to smoke, increasing their risk of disease and premature death. Both telephone-based counseling and in-person tobacco cessation classes may improve access for smokers seeking convenient support to quit. Little research has assessed whether such programs are effective in real-world clinical populations.

DESIGN

Retrospective cohort study comparing wellness coaching participants with two groups of controls.

SETTING

Kaiser Permanente Northern California, a large integrated health care delivery system.

SUBJECTS

Two hundred forty-one patients who participated in telephonic tobacco cessation coaching from January 1, 2011, to March 31, 2012, and two control groups: propensity-score-matched controls, and controls who participated in a tobacco cessation class during the same period. Wellness coaching participants received an average of two motivational interviewing-based coaching sessions that engaged the patient, evoked their reason to consider quitting, and helped them establish a quit plan.

MEASURES

Self-reported quitting of tobacco and fills of tobacco cessation medications within 12 months of follow-up.

ANALYSIS

Logistic regressions adjusting for age, gender, race/ethnicity, and primary language.

RESULTS

After adjusting for confounders, tobacco quit rates were higher among coaching participants vs. matched controls (31% vs. 23%, p < .001) and comparable to those of class attendees (31% vs. 29%, p = .28). Coaching participants and class attendees filled tobacco-cessation prescriptions at a higher rate (47% for both) than matched controls (6%, p < .001).

CONCLUSION

Telephonic wellness coaching was as effective as in-person classes and was associated with higher rates of quitting compared to no treatment. The telephonic modality may increase convenience and scalability for health care systems looking to reduce tobacco use and improve health.

Advancing School and Community Engagement Now for Disease Prevention (ASCEND)

PURPOSE

To compare two intensity levels (standard vs. enhanced) of a nutrition and physical activity intervention vs. a control (usual programs) on nutrition knowledge, body mass index, fitness, academic performance, behavior, and medication use among elementary school students.

DESIGN

Quasi-experimental with three arms.

SETTING

Elementary schools, students' homes, and a supermarket.

SUBJECTS

A total of 1487 third-grade students.

INTERVENTION

The standard intervention (SI) provided daily physical activity in classrooms and a program on making healthful foods, using food labels. The enhanced intervention (EI) provided these plus additional components for students and their families.

MEASURES

Body mass index (zBMI), food label literacy, physical fitness, academic performance, behavior, and medication use for asthma or attention-deficit hyperactivity disorder (ADHD).

ANALYSIS

Multivariable generalized linear model and logistic regression to assess change in outcome measures.

RESULTS

Both the SI and EI groups gained less weight than the control (p < .001), but zBMI did not differ between groups (p = 1.00). There were no apparent effects on physical fitness or academic performance. Both intervention groups improved significantly but similarly in food label literacy (p = .36). Asthma medication use was reduced significantly in the SI group, and nonsignificantly (p = .10) in the EI group. Use of ADHD medication remained unchanged (p = .34).

CONCLUSION

The standard intervention may improve food label literacy and reduce asthma medication use in elementary school children, but an enhanced version provides no further benefit.

Active8! Technology-Based Intervention to Promote Physical Activity in Hospital Employees

PURPOSE

Increase physical activity in health care employees using health messaging, and compare e-mail with mobile phone short-message service (SMS) as delivery channels.

DESIGN

Randomized controlled trial Setting. U.K. hospital workplace.

SUBJECTS

Two hundred ninety-six employees (19-67 years, 53% of study Web site visitors).

INTERVENTION

Twelve-week messaging intervention designed to increase physical activity and delivered via SMS (n =147) or e-mail (n =149); content tailored using theory of planned behavior (TPB) and limited to 160 characters.

MEASURES

Baseline and 6, 12, and 16 weeks. Online measures included TPB constructs, physical activity behavior on the Global Physical Activity Questionnaire, and health-related quality of life on the Short-Form 12.

ANALYSIS

General linear models for repeated measures.

RESULTS

Increase in duration (mean h/d) of moderate work-related activity and moderate recreational activity from baseline to 16 weeks. Short-lived increase in frequency (d/wk) of vigorous recreational activity from baseline to 6 weeks. Increase in duration and frequency of active travel from baseline to 16 weeks. E-mails generated greater changes than SMS in active travel and moderate activity (work and recreational).

CONCLUSION

Minimal physical activity promotion delivered by SMS or e-mail can increase frequency and duration of active travel and duration of moderate intensity physical activity at work and for leisure, which is maintained up to 1 month after messaging ends. Both channels were useful platforms for health communication; e-mails were particularly beneficial with hospital employees.

Perceived workplace health support is associated with employee productivity

PURPOSE

To examine the relationship between perceived workplace health support and employee productivity.

DESIGN

A quantitative cross-sectional study.

SETTING

Washington State agencies.

SUBJECTS

A total of 3528 employees from six state agencies were included in this analysis.

MEASURES

Perceived workplace health support was assessed by two questions that queried respondents on how often they felt supported by the workplace for healthy living and physical activity. The Work Productivity and Activity Impairment Questionnaire was used to measure health-related absenteeism and presenteeism in the past 7 days.

ANALYSIS

Multivariate linear regression was used to estimate the mean differences in productivity by levels of perceived health support.

RESULTS

Most participants were between 45 and 64 years of age and were predominantly non-Hispanic white. Presenteeism varied significantly by the level of perceived workplace health support, with those who felt least supported having higher presenteeism than those who felt most supported. The difference in presenteeism by perceived workplace support remained significant in models adjusting for sociodemographic and health characteristics (mean difference: 7.1% for support for healthy living, 95% confidence interval: 3.7%, 10.4%; 4.3% for support for physical activity, 95% confidence interval: 1.7%, 6.8%). Absenteeism was not associated with perceived workplace health support.

CONCLUSION

Higher perceived workplace health support is independently associated with higher work productivity. Employers may see productivity benefit from wellness programs through improved perceptions of workplace health support.

Life stage influences on U.S. South Asian women's physical activity

PURPOSE

South Asian (SA) women in the United States report extremely low rates of leisure time physical activity (PA) compared with women in other ethnic minority groups. This study explored SA women's perspectives on PA during different life stages.

DESIGN

This is a community-based participatory research study that used focus groups.

SETTING

The study setting was a community-based organization that provides social services to SA immigrants in Chicago, Illinois.

PARTICIPANTS

The study team conducted six focus groups (in English and Hindi) with 42 SA women, ages 18 to 71 years.

METHOD

A semistructured interview guide was used to foster discussion about perceptions of, barriers to/facilitators of, and suggestions for PA programs. Discussions were transcribed and independently coded by two reviewers using thematic content analysis and guided by a coding scheme that was developed a priori.

RESULTS

Participants said that different life stages strongly influenced their PA. PA decreased after marriage and having children. Chronic diseases constrained older women from more vigorous PA. Barriers to PA among younger women were family disapproval and perceptions that PA is unnecessary if you are "skinny." Women agreed that PA is not a priority within the culture, and that interventions must take into account cultural, religious, and family context.

CONCLUSION

Sociocultural norms, family constraints, and lack of awareness about the benefits of PA strongly influenced PA among SA women. Culturally salient intervention strategies might include programs in trusted community settings where women can exercise in women-only classes with their children, and targeted education campaigns to increase awareness about the benefits of PA across life stages.

A cluster randomized trial of alcohol prevention in small businesses: a cascade model of help seeking and risk reduction

PURPOSE

The current study adapted two workplace substance abuse prevention programs and tested a conceptual model of workplace training effects on help seeking and alcohol consumption.

DESIGN

Questionnaires were collected 1 month before, 1 month after, and 6 months within a cluster randomized field experiment.

SETTING

Texas small businesses in construction, transportation, and service industries.

SUBJECTS

A total of 1510 employees from 45 businesses were randomly assigned to receive no training or one of the interventions.

INTERVENTION

The interventions were 4-hour on-the-job classroom trainings that encouraged healthy lifestyles and seeking professional help (e.g., from the Employee Assistance Program [EAP]). The Team Awareness Program focused on peer referral and team building. The Choices in Health Promotion Program delivered various health topics based on a needs assessment.

MEASURES

Questionnaires measured help-seeking attitudes and behavior, frequency of drinking alcohol, and job-related incidents.

ANALYSIS

Mixed-model repeated-measures analyses of covariance were computed.

RESULTS

Relative to the control group, training was associated with significantly greater reductions in drinking frequency, willingness to seek help, and seeking help from the EAP. After including help-seeking attitudes as a covariate, the correlation between training and help seeking becomes nonsignificant. Help-seeking behavior was not correlated with drinking frequency.

CONCLUSION

Training improved help-seeking attitudes and behaviors and decreased alcohol risks. The reductions in drinking alcohol were directly correlated with training and independent from help seeking.

The impact of incentives on intrinsic and extrinsic motives for fitness-center attendance in college first-year students

PURPOSE

A criticism of incentives for health behaviors is that incentives undermine intrinsic motivation. The objective of this study was to determine the impact of monetary incentive provision on participation motives for exercise in first-year college students at a northeastern public university.

DESIGN

Randomized-controlled trial.

SETTING

Public university in the Northeastern United States.

SUBJECTS

One hundred seventeen first-year college students.

INTERVENTION

Participants were randomized to one of three conditions: a control condition receiving no incentives for meeting fitness-center attendance goals; a discontinued-incentive condition receiving weekly incentives during fall semester 2011, and no incentives during spring semester 2012; or a continued-incentive condition receiving weekly incentives during fall semester, and incentives on a variable-interval schedule during spring semester.

MEASURES

The Exercise Motivation Inventory 2 measured exercise participation motives at baseline, end of fall semester, and end of spring semester. Fitness-center attendance was monitored by using ID-card check-in/check-out records.

ANALYSIS

Repeated-measures analyses using linear mixed models with first-order autoregressive covariance structures were run to compare motive changes in the three conditions.

RESULTS

Participation motives of Enjoyment and Revitalization associated with intrinsic motivation did not decrease significantly over time in any of the conditions, F(4, 218) = 2.25, p = .065 and F(4, 220) = 1.67, p = .16, respectively.

CONCLUSION

Intrinsically associated participation motives for exercise did not decrease with incentive provision. Therefore, incentives may encourage fitness-center attendance without negatively impacting participation motives for exercise.

Effect of two jumping programs on hip bone mineral density in premenopausal women: a randomized controlled trial

PURPOSE

To determine the effect of two jumping programs on hip bone mineral density (BMD) in women.

DESIGN

Randomized controlled trial.

SETTING

Approximately 20 cities in the Mountain West.

SUBJECTS

Sixty premenopausal women, aged 25 to 50 years, completed the intervention.

INTERVENTION

Subjects were randomly assigned to a control group or one of two jumping groups. The Jump 10 group performed 10 jumps with 30 seconds rest between jumps, twice daily for 16 weeks, while the Jump 20 group performed the same protocol but with 20 jumps.

MEASURES

Hip BMD was measured by using dual-energy x-ray absorptiometry.

ANALYSIS

Analysis of variance and covariance.

RESULTS

At 8 weeks, unadjusted percentage change in hip BMD was significantly different among groups (F = 5.4, p = .0236). Specifically, compared with controls, the Jump 20 women had significantly greater gains in hip BMD and the Jump 10 women had marginally greater improvements. Following 16 weeks of jumping, differences between the Jump 10 and the Jump 20 groups compared with controls were significant (F = 4.2, p = .0444), especially after adjusting for the covariates (F = 7.3, p = .0092).

CONCLUSION

After 16 weeks of high-impact jump training, hip BMD can be improved in premenopausal women by jumping 10 or 20 times, twice daily, with 30 seconds of rest between each jump, compared with controls.

Neighborhood Attributes Associated With the Social Environment

PURPOSE

To examine the association between specific attributes of neighborhood environments and four social environment measures.

DESIGN

Data were collected as part of a baseline survey among participants enrolling in a walking intervention.

SETTING

Participants were recruited from a metropolitan area in a Southeastern state.

SUBJECTS

Participants (n = 294) were predominantly African-American (67%) and female (86%), with some college education (79%) and a mean age of 49.

MEASURES

The International Physical Activity Questionnaire Environment Module assessed perceptions about neighborhood attributes. The social environment was assessed using three distinct scales: social cohesion, social interactions with neighbors, and social support for physical activity from family and friends.

ANALYSIS

Multiple regression models examined associations between neighborhood attributes and social environment measures, adjusting for demographic variables.

RESULTS

Having walkable destinations and having access to amenities and transit stops were associated with increased interactions with neighbors (b = 1.32, 1.04, and 1.68, respectively, p < .05). Attributes related to structural support for physical activity (sidewalks, street connectivity, recreation facilities) were associated with increased interactions with neighbors (b = 1.47, 1.34, and 1.13, respectively, p < .05). Bicycling facilities that were maintained (i.e., bike lanes, racks) were associated with social support for physical activity from family and friends (b = .43 and .30, respectively, p < .05).

CONCLUSION

The study highlights key attributes of neighborhood environments that may be associated with the social context of such settings.

Promoting Influenza Vaccination to Restaurant Employees

PURPOSE

To evaluate an evidence-based workplace approach to increasing adult influenza vaccination levels applied in the restaurant setting

DESIGN

We implemented an intervention and conducted a pre/post analysis to determine effect on vaccination.

SETTING

Eleven Seattle-area restaurants.

SUBJECTS

Restaurants with 25+ employees speaking English or Spanish and over 18 years.

INTERVENTION

Restaurants received influenza vaccination promotion materials, assistance arranging on-site vaccination events, and free influenza vaccinations for employees.

MEASURES

Pre/post employee surveys of vaccination status with direct observation and employer interviews to evaluate implementation.

ANALYSIS

We conducted descriptive analysis of employee survey data and performed qualitative analysis of implementation data. To assess intervention effect, we used a mixed-effects logistic regression model with a restaurant-specific random effect.

RESULTS

Vaccination levels increased from 26% to 46% (adjusted odds ratio 2.33, 95% confidence interval 1.69, 3.22), with 428 employees surveyed preintervention, 305 surveyed postintervention, and response rates of 73% and 55%, respectively. The intervention was effective across subgroups, but there were restaurant-level differences.

CONCLUSION

An access-based workplace intervention can increase influenza vaccination levels in restaurant employees, but restaurant-level factors may influence success.

Differences in Weight-Related Behavioral Profiles by Sexual Orientation Among College Men: A Latent Class Analysis

PURPOSE

To identify and describe homogenous classes of male college students based on their weight-related behaviors (e.g., eating habits, physical activity, and unhealthy weight control) and to examine differences by sexual orientation.

DESIGN

Study design was a cross-sectional sample of 2- and 4-year college students.

SETTING

Study setting was forty-six 2- and 4-year colleges in Minnesota.

SUBJECTS

Study subjects comprised 10,406 college males.

MEASURES

Measures were five categories of sexual orientation derived from self-reported sexual identity and behavior (heterosexual, discordant heterosexual [identifies as heterosexual and engages in same-sex sexual behavior], gay, bisexual, and unsure) and nine weight-related behaviors (including measures for eating habits, physical activity, and unhealthy weight control).

ANALYSIS

Latent class models were fit for each of the five sexual orientation groups, using the nine weight-related behaviors.

RESULTS

Overall, four classes were identified: "healthier eating habits" (prevalence range, 39.4%-77.3%), "moderate eating habits" (12.0%-30.2%), "unhealthy weight control" (2.6%-30.4%), and "healthier eating habits, more physically active" (35.8%). Heterosexual males exhibited all four patterns, gay and unsure males exhibited four patterns that included variations on the overall classes identified, discordant heterosexual males exhibited two patterns ("healthier eating habits" and "unhealthy weight control"), and bisexual males exhibited three patterns ("healthier eating habits," "moderate eating habits," and "unhealthy weight control").

CONCLUSION

Findings highlight the need for multibehavioral interventions for discordant heterosexual, gay, bisexual, and unsure college males, particularly around encouraging physical activity and reducing unhealthy weight control behaviors.

A Multicomponent Intervention Helped Reduce Sugar-Sweetened Beverage Intake in Economically Disadvantaged Hispanic Children

PURPOSE

This study aimed to examine the effect of a multicomponent intervention program on consumption of sugar-sweetened beverages (SSBs), and lifestyle factors associated with SSB intake, in Hispanic children from low-income families.

DESIGN

A five-wave longitudinal study using a quasi-experimental design was conducted.

SETTING

Five elementary schools in West Texas served as the setting.

SUBJECTS

Participants included 555 predominantly Hispanic children (ages 5-9 years) from low-income families and their parents (n = 525).

INTERVENTION

A multicomponent intervention program was implemented.

MEASURES

Children's anthropometric measures were obtained. Their weight status was determined based on body mass index for age and gender. Parents responded to a demographic questionnaire, a shelf inventory, an acculturation scale, and a family survey.

ANALYSIS

Growth curve analyses were used to test differences between intervention and comparison participants' SSB intake and to examine potential covariates.

RESULTS

Comparison group children's daily SSB intake significantly increased over time (B = 1.06 ± .40 ounces per month, p < .01), but this linear increase of SSB was slowed down by the intervention (B = -.29 ± .12, p < .05). More daily TV time, more fast food intake, and more types of SSBs available at home were associated with higher SSB intake.

CONCLUSION

Risk factors of childhood obesity were associated with each other. The intervention program produced a modest reduction in SSB consumed by economically disadvantaged and predominantly Hispanic children.

The Effects of Tai Chi on Cardiovascular Risk in Women

PURPOSE

This study examined the effects of tai chi (TC) on biobehavioral factors associated with cardiovascular disease (CVD) risk in women.

DESIGN

A randomized trial used a wait-list control group, pretest-posttest design. Data were collected immediately before, immediately after, and 2 months following the intervention.

SETTING

The study was community based in central Virginia.

SUBJECTS

Women aged 35 to 50 years at increased risk for CVD.

INTERVENTION

The 8-week intervention built on prior work and was designed to impact biobehavioral factors associated with CVD risk in women.

MEASURES

Biological measures included fasting glucose, insulin, and lipids as well as C-reactive protein and cytokines. Behavioral measures included fatigue, perceived stress, depressive symptoms, social support, mindfulness, self-compassion, and spiritual thoughts and behaviors.

ANALYSIS

A mixed effects linear model was used to test for differences between groups across time.

RESULTS

In 63 women, TC was shown to decrease fatigue (∂ [difference in group means] = 9.38, p = .001) and granulocyte colony stimulating factor (∂ = 12.61, p = .052). Consistent with the study model and intervention design, significant changes observed 2 months post intervention indicated that TC may help down-regulate proinflammatory cytokines associated with underlying CVD risk, including interferon gamma (∂ = 149.90, p = .002), tumor necrosis factor (∂ = 16.78, p = .002), interleukin (IL) 8 (∂ = 6.47, p = .026), and IL-4 (∂ = 2.13, p = .001), and may increase mindfulness (∂ = .54, p = .021), spiritual thoughts and behaviors (∂ = 8.30, p = .009), and self-compassion (∂ = .44, p = .045).

CONCLUSION

This study contributes important insights into the potential benefits and mechanisms of TC and, with further research, may ultimately lead to effective strategies for reducing CVD risk in women earlier in the CVD trajectory.

Making Healthy Eating Policy Practice: A Group Randomized Controlled Trial on Changes in Snack Quality, Costs, and Consumption in After-School Programs

PURPOSE

The aim of this study was to evaluate an intervention designed to assist after-school programs (ASPs) in meeting snack nutrition policies that specify that a fruit or vegetable be served daily and sugar-sweetened beverages/foods and artificially flavored foods eliminated.

DESIGN

The study used a 1-year group-randomized controlled trial.

SETTING

The study took place in ASPs operating in South Carolina, United States.

SUBJECTS

Twenty ASPs serving over 1700 children were recruited, match-paired postbaseline on enrollment size and days fruits/vegetables were served per week, and randomized to either intervention (n = 10) or control (n = 10) groups.

INTERVENTION

The study used Strategies To Enhance Practice for Healthy Eating (STEPs-HE), a multistep adaptive intervention framework that assists ASP leaders and staff to serve snacks that meet nutrition policies while maintaining cost.

MEASURES

Direct observation of snacks served and consumed and monthly snack expenditures as determined by receipts were used.

ANALYSIS

The study used nonparametric and mixed-model repeated measures.

RESULTS

By postassessment, intervention ASPs increased serving of fruits/vegetables to 3.9 ± 2.1 vs. 0.7 ± 1.7 d/wk and decreased serving sugar-sweetened beverages to 0.1 ± 0.7 vs. 1.8 ± 2.4 d/wk and sugar-sweetened foods to 0.3 ± 1.1 vs. 2.7 ± 2.5 d/wk compared to controls, respectively. Cost of snacks increased by $0.02/snack in the intervention ASPs ($0.36 to $0.38) compared to a $0.01 per snack decrease in the control group ($0.39 to $0.38). Across both assessments and groups, 80% to 100% of children consumed FVs.

CONCLUSIONS

The STEPs-HE intervention can assist ASPs in meeting nationally endorsed nutrition policies with marginal increases in cost.

Early Childhood Disadvantage for Sons of Mexican Immigrants: Body Mass Index Across Ages 2-5

PURPOSE

To distinguish the origins of higher weight status and determine when and why intra- and interracial/ethnic disparities emerge.

DESIGN

The study used a longitudinal analysis of the Early Childhood Longitudinal Study-Birth Cohort (ECLS-B).

SETTING

The study was conducted in the United States.

SUBJECTS

Participants were children of non-Hispanic white mothers and children of U.S.- and foreign-born mothers of Mexican origin from a nationally representative sample of children born in the year 2001 (N ≈ 3700).

MEASURES

The Centers for Disease Control and Prevention growth charts determined sex- and age-specific weight status. Covariates were obtained from birth certificate records and parent interviews.

ANALYSIS

Frequencies, growth curve trajectories, and ordinary least squares regression examined body mass index (BMI) and obesity across survey waves.

RESULTS

Compared to their peers with non-Hispanic white mothers, children of Mexican-heritage mothers have higher average BMI and greater rates of obesity. The BMI of boys with Mexican-born mothers is higher relative to whites and children of U.S.-born Mexican mothers across early childhood, increasing sharply at about age 4.5 years. This divergence is driven by increases in the BMI of boys, as girls do not show the same growth. A number of measures, including descriptors of children's nutritional intake, lifestyle factors, and acculturation, do not explain the increased obesity rates among sons of Mexican mothers.

CONCLUSION

Despite favorable perinatal health and weight, Mexican-American sons of foreign-born mothers show disadvantages in BMI that emerge close to the start of kindergarten.

A Reach, Effectiveness, Adoption, Implementation, Maintenance Evaluation of Weekend Backpack Food Assistance Programs

PURPOSE

The purpose of this study was to evaluate an ongoing statewide weekend backpack program through the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework.

DESIGN

Mixed-methods inquiry was used to explore the reach, effectiveness, adoption, implementation, and maintenance of backpack programs within Montana.

SETTING

Study participants completed audio-recorded one-on-one phone interviews.

PARTICIPANTS

Key informants (e.g., managers at food banks, staff at participating schools, policy makers) were purposively sampled (N = 20).

METHOD

Semistructured interviews were conducted to gather data to describe each RE-AIM dimension. Interviews were transcribed verbatim and deductively (i.e., using RE-AIM as themes) coded for meaning units, placed into higher-order categories, and summarized in narrative. Supporting quantitative data (e.g., the proportion of eligible students that joined the program, rate of school-level adoption) were calculated using descriptive statistics.

RESULTS

Backpack programs with a broad reach and evidenced effect may be appealing to adopt. Weekend food bags cost an average $3.87 (SD ± .94) and there were some positive (i.e., ease, protecting participants' privacy) and very few negative (logistical) components of implementation. Collaborators and community partners are necessary for long-term sustainability.

CONCLUSION

Backpack programs are widespread and have potential to relieve weekend hunger; however, more efforts need to be made to end childhood hunger.

Exploring Perceptions of Barriers, Facilitators, and Motivators to Physical Activity Among Female Bariatric Patients: Implications for Physical Activity Programming

PURPOSE

To explore barriers, facilitators, and motivators to adopting and maintaining regular physical activity among women with obesity who have undergone bariatric surgery.

APPROACH

Individual interviews with women 3 to 24 months post-bariatric surgery.

SETTING

Participants were recruited from a bariatric clinic in Montreal, Canada.

PARTICIPANTS

Twelve women were recruited (mean age = 47 ± 9 years) using poster advertisements and word of mouth. Participants were on average 15 months postsurgery.

METHOD

Each woman was interviewed once using a semistructured interview protocol. Recruitment was conducted until data saturation (i.e., no new information emerged). The interviews were transcribed, coded, and analyzed using inductive thematic analysis.

RESULTS

Three interrelated themes emerged: the physical body, appraisal of the physical and social self, and the exercise environment. Barriers included weight-restricted mobility, side effects of surgery, body dissatisfaction, compromised psychological health, competing responsibilities, a lack of exercise self-efficacy and social support, reduced access to accommodating facilities, lack of exercise knowledge, and northern climate. Participants reported postsurgical weight loss, weight and health maintenance, enjoyment, body image, and supportive active relationships, as well as access to accommodating facilities and exercise knowledge, as facilitators and motivators.

CONCLUSION

Suggested physical activity programming strategies for health care professionals working with this unique population are discussed. Physical activity and health promotion initiatives can also benefit from a cultural paradigm shift away from weight-based representations of health.

Effects of Smoking Cessation Media and Community Campaigns in Taiwan

PURPOSE

To examine the effects of a smoking cessation campaign.

DESIGN

Data from the 2010-2011 Taiwan Adult Tobacco Surveys were analyzed.

SETTING

The study was set among a nationally representative sample of adults in Taiwan.

SUBJECTS

The surveys included 16,282 and 16,886 adults in 2010 and 2011, respectively, while our analyses focused on current smokers, 2518 and 2507 adults in 2010 and 2011, respectively.

INTERVENTION

In 2010 the Taiwanese government launched a national smoking cessation campaign through mass media in conjunction with community-based smoking cessation programs throughout the nation.

MEASURES

Outcome variables include awareness of cessation services, quit attempts, intention to quit, and use of quitting method.

ANALYSIS

Multivariate logistic regressions were used to analyze data.

RESULTS

The implementation of the national smoking cessation campaign was associated with an increase in awareness of cessation services (odds ratio [OR] = 1.36; 95% confidence interval [CI] = 1.20-1.53), in quit attempts (OR = 1.12; 95% CI = 1.01-1.25), in use of unassisted quitting methods (OR = 1.39; 95% CI = 1.13-1.72), and in intention to quit smoking (OR = 1.15; 95% CI = 1.02-1.30).

CONCLUSION

The implementation of the national smoking cessation campaign through media and community programs was effective in increasing smokers' awareness of cessation services, quit attempts, and intention to quit.

Improvements in Health Behaviors, Eating Self-Efficacy, and Goal-Setting Skills Following Participation in Wellness Coaching

Purpose . This project examined potential changes in health behaviors following wellness coaching. Design . In a single cohort study design, wellness coaching participants were recruited in 2011, data were collected through July 2012, and were analyzed through December 2013. Items in the study questionnaire used requested information about 11 health behaviors, self-efficacy for eating, and goal-setting skills. Setting . Worksite wellness center. Participants . One-hundred employee wellness center members with an average age of 42 years; 90% were female and most were overweight or obese. Intervention . Twelve weeks of in-person, one-on-one wellness coaching. Method . Participants completed study questionnaires when they started wellness coaching (baseline), after 12 weeks of wellness coaching, and at a 3-month follow-up. Results . From baseline to week 12, these 100 wellness coaching participants improved their self-reported health behaviors (11 domains, 0- to 10-point scale) from an average of 6.4 to 7.7 (p < .001), eating self-efficacy from an average of 112 to 142 (on a 0- to 180-point scale; p < .001), and goal-setting skills from an average of 49 to 55 (on a 16- to 80-point scale; p < .001). Conclusion . These results suggest that participants improved their current health behaviors and learned skills for continued healthy living. Future studies that use randomized controlled trials are needed to establish causality for wellness coaching.

Perspectives on Workplace Health Promotion Among Employees in Low-Wage Industries

PURPOSE

Study goals were to (1) understand the attitudes of employees in low-wage industries toward workplace health promotion, including views on appropriateness of employer involvement in employee health and level of interest in workplace health promotion overall and in specific programs, and (2) determine the potential for extending workplace health promotion to spouses and partners of these employees.

APPROACH

The study used 42 interviews of 60 to 90 minutes.

SETTING

Interviews were conducted with couples (married or living together) in the Seattle/King County metropolitan area of Washington State.

PARTICIPANTS

Study participants were forty-two couples with one or more members working in one of five low-wage industries: accommodation/food services, education, health care/social assistance, manufacturing, and retail trade.

METHOD

The study employed qualitative analysis of interview transcripts using grounded theory to identify themes.

RESULTS

Employees consider workplace health promotion both appropriate and desirable and believe it benefits employers through increased productivity and morale. Most have little personal experience with it and doubt their employers would prioritize employee health. Employees are most interested in efforts focused on nutrition and physical activity. Both employees and their partners support extending workplace health promotion to include partners.

CONCLUSION

Employees and their partners are interested in workplace health promotion if it addresses behaviors they care about. Concern over employer involvement in their personal health decisions is minimal; instead, employees view employer interest in their health as a sign that they are valued.

The Association of Meal Practices and Other Dietary Correlates With Dietary Intake Among High School Students in the United States, 2010

PURPOSE

To examine behavioral and environmental factors that may be related to dietary behaviors among U.S. high school students.

DESIGN

Data were obtained from the 2010 National Youth Physical Activity and Nutrition Study, a cross-sectional study.

SETTING

The study was school-based.

SUBJECTS

Study subjects were a nationally representative sample of students in grades 9 to 12 (n = 11,458).

MEASURES

Variables of interest included meal practices, in-home snack availability, and intakes of healthful foods/beverages (fruits, vegetables, water, and milk) and less healthful foods/beverages (fried potatoes, pizza, and sugar-sweetened beverages).

ANALYSIS

Sex-stratified logistic regression models were used to examine associations of meal practices and snack availability with dietary intake. Odds ratios (ORs) were adjusted for race/ethnicity and grade.

RESULTS

Eating breakfast daily, frequent family dinners, and bringing lunch from home were associated with higher odds of consuming at least three healthful foods or beverages. High fast-food intake was associated with lower odds of healthful dietary intake and higher odds of sugar-sweetened beverage intake (female OR = 3.73, male OR = 4.60). Students who mostly/always had fruits and vegetables available at home had increased odds of fruits (female OR = 3.04, male OR = 2.24), vegetables (female OR = 2.12, male OR = 1.65), water (female OR = 1.82, male OR = 1.85), and milk intake (female OR = 1.45, male OR = 1.64).

CONCLUSION

Encouraging daily breakfast consumption, frequent family dinners, and fruit and vegetable availability at home may lead to higher intakes of healthful foods among high school students.

The Role of Age in Moderating the Association Between Disability and Light-Intensity Physical Activity

PURPOSE

There's a lack of evidence on the association between light-intensity physical activity and disability. This study examines the relationships in activity by self-reported physical function in five domains (i.e., activities of daily living [ADL], instrumental ADL, leisure activities, lower extremity, and general activities), and whether this association varies by age.

DESIGN

Cross-sectional.

SETTING

Data from National Health and Nutrition Examination Survey 2003-2004 and 2005-2006 waves.

SUBJECTS

Participants included 5700 men and women ages 20 to 85 years.

MEASURES

Difficulty with various activities was measured with the Physical Functioning Questionnaire, accelerometer-measured physical activity, demographics, and self-rated health.

ANALYSIS

Ordinary least squares regression models were run to examine the relationship between physical function in each domain, light-intensity activity, and the moderating effect of age. Analyses controlled for body mass index, moderate-to-vigorous-intensity activity, self-reported health, accelerometer wear time, and gender.

RESULTS

Little variation was seen in light-intensity physical activity among younger adults regardless of disability status. Older adults reporting difficulty with activities engaged in significantly less light-intensity physical activity compared to those with no disability (271.8 vs. 316.5 minutes). Age significantly moderated the association between light-intensity physical activity and leisure activities (p = .048), and lower extremity mobility (p = .039). Age did not moderate other domains of disability.

CONCLUSION

Younger age may be protective regarding the influence of disability on light-intensity activity. In addition, disability may be more debilitating for some older individuals. Interventions to increase light-intensity activity should aim to address disability at all ages, with increased attention for older adults.

Child and Caregiver Attitudes About Sports Drinks and Weekly Sports Drink Intake Among U.S. Youth

PURPOSE

To examine caregiver and youth attitudes about sports drinks (SDs) and the association of those attitudes with youth SD intake.

DESIGN

Study design was cross-sectional. The online YouthStyles survey was sent to youth (ages 12-17 years) whose caregivers completed the online Summer ConsumerStyles survey for adults.

SETTING

The 2011 Styles survey data comprised the setting.

SUBJECTS

The sample was composed of 815 U.S. caregiver-youth dyads.

MEASURES

The outcome variable is youth SD consumption, and exposure variables are youth and caregivers' attitudes that SDs are healthy for children, and caregivers' attitude that children need SDs for hydration. Covariates are youth demographic and physical activity variables.

ANALYSIS

Multivariable logistic regression was used to estimate adjusted odds ratios (ORs) for youth SD consumption one or more times per week after controlling for covariates.

RESULTS

About one in five youth consumed SDs one or more times per week. Caregiver attitudes about the healthfulness of SDs and children's need of SDs for hydration both significantly differed by race and caregiver education level. The odds of youth SD consumption one or more times per week were significantly higher among youth of caregivers who agreed that SDs are good, healthy drinks for children (OR, 2.72 vs. disagreed) and among youth of caregivers who agreed that children need SDs for hydration (OR, 3.15 vs. disagreed). Youth attitude about SD healthfulness was not associated with intake.

CONCLUSION

Caregivers, particularly minority and less educated caregivers, may need more education about SD use.

Understanding small business engagement in workplace violence prevention programs

PURPOSE

Worksite wellness, safety, and violence prevention programs have low penetration among small, independent businesses. This study examined barriers and strategies influencing small business participation in workplace violence prevention programs (WVPPs).

APPROACH

A semistructured interview guide was used in 32 telephone interviews.

SETTING

The study took place at the University of North Carolina Injury Prevention Research Center.

PARTICIPANTS

Participating were a purposive sample of 32 representatives of small business-serving organizations (e.g., business membership organizations, regulatory agencies, and economic development organizations) selected for their experience with small businesses.

INTERVENTION

This study was designed to inform improved dissemination of Crime Free Business (CFB), a WVPP for small, independent retail businesses.

METHODS

Thematic qualitative data analysis was used to identify key barriers and strategies for promoting programs and services to small businesses.

RESULTS

Three key factors that influence small business engagement emerged from the analysis: (1) small businesses' limited time and resources, (2) low salience of workplace violence, (3) influence of informal networks and source credibility. Identified strategies include designing low-cost and convenient programs, crafting effective messages, partnering with influential organizations and individuals, and conducting outreach through informal networks.

CONCLUSION

Workplace violence prevention and public health practitioners may increase small business participation in programs by reducing time and resource demands, addressing small business concerns, enlisting support from influential individuals and groups, and emphasizing business benefits of participating in the program.

Small Convenience Stores and the Local Food Environment: An Analysis of Resident Shopping Behavior Using Multilevel Modeling

PURPOSE

Local food environments can influence the diet and health of individuals through food availability, proximity to retail stores, pricing, and promotion. This study focused on how small convenience stores, known in New York City as bodegas, influence resident shopping behavior and the food environment.

DESIGN

Using a cross-sectional design, 171 bodegas and 2118 shoppers were sampled.

SETTING

Small convenience stores in New York City.

SUBJECTS

Any bodega shopper aged 18+ who purchased food or beverage from a participating store.

MEASURES

Data collection consisted of a store assessment, a health and behavior survey given to exiting customers, and a bag check that recorded product information for all customer purchases.

ANALYSIS

Descriptive statistics were generated for bodega store characteristics, shopper demographics, and purchase behavior. Multilevel models were used to assess the influence of product availability, placement, and advertising on consumer purchases of sugar-sweetened beverages (SSBs), water, and fruits and vegetables.

RESULTS

Seventy-one percent of participants reported shopping at bodegas five or more times per week, and 35% reported purchasing all or most of their monthly food allotment at bodegas. Model results indicated that lower amounts of available fresh produce were significantly and independently associated with a higher likelihood of SSB purchases. A second, stratified multilevel model showed that the likelihood of purchasing an SSB increased with decreasing varieties of produce when produce was located at the front of the store. No significant effects were found for water placement and beverage advertising.

CONCLUSIONS

Small convenience stores in New York City are an easily accessible source of foods and beverages. Bodegas may be suitable for interventions designed to improve food choice and diet.

Associations Between Physical Activity and Metabolic Syndrome: Comparison Between Self-Report and Accelerometry

PURPOSE

To assess the relationship between self-reported and objectively measured physical activity (PA) and metabolic syndrome and its risk factors in U.S. adults.

DESIGN

A cross-sectional design was used for this study.

SETTING

The study was set among a nationally representative sample of U.S. adults.

SUBJECTS

Adults, ages 20 years and older, from the National Health and Nutrition Examination Survey (NHANES) 2003-2006 (n = 5580) participated in the study.

MEASURES

PA measures included minutes per week of moderate plus vigorous PA estimated by self-report (MVPAsr), total 7-day accelerometry (MVPAa), and accelerometer-based MVPA performed in 10-minute bouts (MVPAb). Risk factors for metabolic syndrome included blood pressure, high-density lipoprotein cholesterol, triglycerides, glucose, and waist circumference.

ANALYSIS

Odds ratios (ORs) for having metabolic syndrome were calculated for men and women who met the Physical Activity Guidelines for Americans compared to those who did not.

RESULTS

Women who did not meet the PA guidelines had significantly greater odds of having metabolic syndrome according to MVPAsr (OR = 2.20; 95% confidence interval [CI] = 1.65-2.94), MVPAa (OR = 4.40; 95% CI = 2.65-7.31), and MVPAb (OR = 2.91; 95% CI = 1.42-5.96). Men had significantly higher odds of having metabolic syndrome according to MVPAa (OR = 2.57; 95% CI = 1.91-3.45) and MVPAb (OR = 2.83; 95% CI = 1.55-5.17), but not MVPAsr. These ORs remained significant after adjusting for all potential confounders except body mass index, after which only MVPAsr in women and MVPAb in men remained significant.

CONCLUSION

Individuals who do not meet the PA guidelines exhibited greater odds of having metabolic syndrome. This relationship tended to be stronger for objective PA measures than for self-report.

Validity of self-reported fitness across black and white race, gender, and health literacy subgroups

PURPOSE

To compare concurrent criterion validity of the Self-Reported Fitness (SRFit) Survey, a new fitness measure, between black and white race, gender, and health literacy groups.

DESIGN

Cross-sectional.

SETTING

Midwest urban primary care center and commercial fitness center.

SUBJECTS

One hundred one black, white, male, and female primary care patients aged ≥40 years.

MEASURES

Measures included demographics, the Rapid Estimate of Adult Literacy in Medicine, the SRFit Survey, and the Rikli and Jones Senior Fitness Test battery of physical tests. The BodPod determined percentage of body fat. Body mass index was calculated.

ANALYSIS

Concurrent validity was assessed using Pearson and Spearman rank order correlations between corresponding physical tests and SRFit survey items.

RESULTS

Correlations between physical tests and SRFit items ranged from r = .52 to .76 (ρ = .41-.85) in males, r = .40 to .79 (ρ = .33-.80) in females, r = .45 to .79 (ρ = .53-.82) in blacks, and r = .49 to .77 (ρ = .33-.82) in whites. Correlations were r = .58 (ρ = .58) to r = .77 (ρ = .79) in persons with low health literacy and r = .50 to .79 (ρ = .39-.85) among persons with moderate to high health literacy.

CONCLUSION

SRFit shows similar concurrent validity across race, gender, and health literacy subgroups.

Environmental Correlates of Recreational Walking in the Neighborhood

PURPOSE

To assess environmental correlates of neighborhood recreational walking.

DESIGN

The study used a cross-sectional survey.

SETTING

The study was conducted in the local community.

SUBJECTS

Participants were adults who recently relocated and walk for recreation in their current neighborhood.

MEASURES

The outcome measure was participant-reported neighborhood recreational walking in participants' prior neighborhood. Exposure measures were (1) participant-reported social and environmental characteristics of the prior neighborhood and (2) geographic information system-derived environmental characteristics assessed within a buffer around participant's prior address.

ANALYSIS

Participants reporting current neighborhood recreational walking (n = 231) were characterized by whether they walked for recreation in their prior neighborhood. Associations between neighborhood characteristics and neighborhood recreational walking were assessed using logistic regression.

RESULTS

Neighborhood recreational walking was associated with perceptions of the presence of recreational facilities (odds ratio [OR] = 2.49, 95% confidence interval [CI] = 1.29-4.84), interesting things to see (OR = 2.82, 95% CI = 1.46-5.45), and others being active (OR = 3.56, 95% CI = 1.80-7.05), and was inversely associated with concerns about crime (OR = .40, 95% CI = .20-.77) and traffic (OR = .43, 95% CI = .22-.87). This behavior was associated with objectively measured presence of walking trails (OR = 3.58, 95% CI = 1.07-4.46), percentage of street length with speed limits ≤25 mph (OR = 1.31 for 10% increase, 95% CI = 1.08-1.61), and percentage of tree canopy coverage (OR = 1.55 for 10% increase, 95% CI = 1.12-2.14).

CONCLUSION

Recreational walking may be influenced by environmental factors that support a safe, enjoyable, and social experience, attributes that are not necessarily prioritized in transportation walking. Outcome and exposure specificity are important when studying recreational walking.

Municipal Officials' Participation in Built Environment Policy Development in the United States

PURPOSE

This study examined municipal officials' participation in built environment policy initiatives focused on land use design, transportation, and parks and recreation.

DESIGN

Web-based cross-sectional survey.

SETTING

Eighty-three municipalities with 50,000 or more residents in eight states.

SUBJECTS

Four hundred fifty-three elected and appointed municipal officials.

MEASURES

Outcomes included self-reported participation in land use design, transportation, and parks and recreation policy to increase physical activity. Independent variables included respondent position; perceptions of importance, barriers, and beliefs regarding physical activity and community design and layout; and physical activity partnership participation.

ANALYSIS

Multivariable logistic regression models.

RESULTS

Compared to other positions, public health officials had lower participation in land use design (78.3% vs. 29.0%), transportation (78.1% vs. 42.1%), and parks and recreation (67.1% vs. 26.3%) policy. Perceived limited staff was negatively associated with participation in each policy initiative. Perceptions of the extent to which physical activity was considered in community design and physical activity partnership participation were positively associated with participation in each. Perceived lack of collaboration was associated with less land use design and transportation policy participation, and awareness that community design affects physical activity was associated with more participation. Perceived lack of political will was associated with less parks and recreation policy participation.

CONCLUSION

Public health officials are underrepresented in built environment policy initiatives. Improving collaborations may improve municipal officials' policy participation.

Predictors for Persistent Overweight, Deteriorated Weight Status, and Improved Weight Status During 18 Months in a School-Based Longitudinal Cohort

PURPOSE

To examine predictors for persistent overweight/obesity, deteriorated weight status, and improved weight status among students who participated in a school-based obesity prevention intervention from fall 2009 to spring 2011.

DESIGN

Longitudinal assessment of a school-based cohort was conducted to determine the characteristics of students who remained overweight/obese, improved their weight status, or showed deteriorated weight status during an 18-month period.

SETTING

Eleven schools in southern Indiana, northwestern Kentucky, and southeastern Illinois.

SUBJECTS

N = 5309 students in 4th through 12th grade.

MEASURES

Weight, height, and self-reported physical activity and nutrition behaviors of students were measured at baseline and 6, 12, and 18 months.

ANALYSIS

SAS 9.3 was employed to examine predictors for the three different weight categories using logistic regression.

RESULTS

Low socioeconomic status (SES) (adjusted odds ratio [AOR] = 1.56 and p < .001, AOR = 1.35 and p = .0069, respectively) and higher soda intake (AOR = 1.07 and p = .0016, AOR = 1.08 and p = .0278, respectively) increased the odds of belonging to persistent overweight/obesity (30.6%) and deteriorated weight status (6.9%), compared to the persistent nonoverweight status group.

CONCLUSION

While SES is an important determinant of weight category change, students' screen time and soda consumption may be important factors. Schools and families may be able to successfully focus on these modifiable risk factors, decreasing the burden of childhood obesity.

Screening and Counseling for Tobacco Use in Student Health Clinics: Reports of Health Care Providers

PURPOSE

To assess tobacco screening and counseling in student health clinics, including facilitators, barriers, and associations with campus- and state-level variables.

DESIGN

We conducted a mixed-methods study with an online survey and qualitative interviews.

SETTING

Study setting was student health clinics on college campuses.

SUBJECTS

Subjects included 71 clinic directors or designees from 10 Southeastern states (quantitative survey) and 8 directors or designees from 4 Southeastern states (qualitative interviews).

MEASURES

Quantitative measures included demographics, screening and counseling practices, clinic-level supports for such practices, perceptions of tobacco on campus, institution size, public/private status, state tobacco farming revenue, and state tobacco control funding. Qualitative measures included barriers and facilitators of tobacco screening and counseling practices.

ANALYSIS

Logistic and linear regression models assessed correlates of screening and counseling. Qualitative data were analyzed using multistage interpretive thematic analysis.

RESULTS

A total of 55% of online survey respondents reported that their clinics screen for tobacco at every visit, whereas 80% reported their clinics offer counseling and pharmacotherapy. Barriers included lack of the following: time with patients, relevance to chief complaint, student self-identification as a tobacco user, access to pharmacotherapy, and interest in quitting among smokers. In multivariable models, more efforts to reduce tobacco use, student enrollment, and state-level cash receipts for tobacco were positively associated with clinic-level supports.

CONCLUSION

This study highlights missed opportunities for screening. Although reports of counseling were higher, providers identified many barriers.

Association between Physical Activity and Inflammatory Markers among U.S. Adults with Chronic Obstructive Pulmonary Disease

Purpose.

Chronic obstructive pulmonary disease (COPD) may cause not only inflammation in the lungs but also systemic effects. One potential strategy to reduce systemic inflammation and attenuate disease progression is physical activity (PA). However, no nationally representative studies, to our knowledge, have examined the association between objectively measured physical activity and inflammation among those with COPD.

Design.

Cross-sectional.

Setting.

National Health and Nutrition Examination Survey 2003–2006.

Subjects.

Two hundred thirty-eight former or current smokers with self-reported COPD who had complete data on study variables.

Measures.

Participants wore an accelerometer for ≥4 days to assess light-intensity PA (LPA), moderate-to-vigorous PA (MVPA), and total physical activity (TPA); completed questionnaires to assess self-reported COPD and smoking status; and had their blood taken to assess white blood cell (WBC) and neutrophil levels.

Analysis.

Multivariable linear regression analysis was used.

Results.

LPA (β = –.0004), MVPA (β = –.04), and TPA (β = –.0004) were significantly inversely associated with WBC level. Similarly, LPA (β = –.001) and TPA (β = –.001) were significantly inversely associated with neutrophils; however, MVPA was marginally associated with neutrophils (β = –.05; p =.06).

Conclusion.

These analyses demonstrate an inverse association between objectively measured PA and inflammation among current or former smokers with COPD. If these findings are confirmed elsewhere, then PA among those with COPD may serve as an anti-inflammatory strategy to possibly decrease cardiovascular and metabolic disease occurrence.

Time perspective and exercise, obesity, and smoking: moderation of associations by age

PURPOSE

Time perspective, a psychological construct denoting subjective orientation to either present or future concerns, has been inconsistently associated with healthy behaviors in adults. We hypothesized that associations would be stronger in young adults, who are first developing independent attitudes, than in older adults.

DESIGN

Cross-sectional survey.

SETTING

The study was conducted in three cities in the Mid-Atlantic region.

SUBJECTS

Subjects were 790 patrons of barber and beauty shops.

MEASURES

Measures used were the Zimbardo Time Perspective Inventory future, present-fatalistic, and present-hedonistic subscales and current smoking, days per week of recreational exercise, and height and weight, by self-report.

ANALYSIS

We tested if associations between time perspective and exercise, obesity, and current smoking differed by age group (18-24 years, 25-34 years, and 35 years and older) using analysis of variance and logistic regression.

RESULTS

Higher future time perspective scores, indicating greater focus on future events, was associated with more frequent exercise, whereas higher present-fatalistic time perspective scores, indicating more hopelessness, was associated with less frequent exercise in 18- to 24-year-olds, but not in older individuals. Lower future time perspective scores, and higher present-hedonistic time perspective scores, indicating interest in pleasure-seeking, were also associated with obesity only in 18- to 24-year-olds. Current smoking was not related to time perspective in any age group.

CONCLUSION

Time perspective has age-specific associations with exercise and obesity, suggesting stages when time perspective may influence health behavior decision making.

Patterns and predictors of health behaviors among racially/ethnically diverse residents of low-income housing developments

PURPOSE

To examine behavioral patterns and sociodemographic predictors of diet, inactivity, and tobacco use among a diverse sample of residents from low-income housing developments.

DESIGN

In this cross-sectional survey study, households and residents were randomly selected using multistage cluster sampling. Setting . The study was conducted in 20 low-income housing developments in the Boston, Massachusetts, metropolitan area.

SUBJECTS

Subjects were 828 residents who completed the survey (response rate = 49.3%). Forty-one percent of participants were Hispanic and 38% were non-Hispanic Black. Measures . Outcomes measured were diet, inactivity, and tobacco use. Predictors measured were age, race/ethnicity, gender, education, country in which the subject was born, language spoken, and financial hardship. Analysis . Logistic regression analyses were conducted to examine the association of three health behaviors with sociodemographic factors.

RESULTS

Age, gender, language spoken, and financial hardship showed significant relationships with all three behaviors. For example, those who reported less financial hardship (odds ratio [OR] = 1.75) were more likely to eat healthier. Residents who spoke no English, or at least one language in addition to English, were significantly more likely to report healthier eating (OR = 2.78 and 3.30, respectively) than those who spoke English only. Men were significantly more likely to report less healthy eating (OR = 0.65) than were women. Similar trends emerged for inactivity and tobacco use.

CONCLUSION

Effective health promotion interventions in low-income housing developments that leverage protective factors while addressing risk factors have the potential to reduce income-related health disparities in these concentrated resource-deprived neighborhoods.

Predictors of the Existence of Congregational HIV Programs: Similarities and Differences Compared With Other Health Programs

PURPOSE

Identify and compare predictors of the existence of congregational human immunodeficiency virus (HIV) and other health programs.

DESIGN

Cross-sectional study.

SETTING

United States.

SUBJECTS

A nationally representative sample of 1506 U.S. congregations surveyed in the National Congregations Study (2006-2007).

MEASURES

Key informants at each congregation completed in-person and telephone interviews on congregational HIV and other health programs and various congregation characteristics (response rate = 78%). County-level HIV prevalence and population health data from the Robert Wood Johnson Foundation's 2007 County Health Rankings were linked to the congregational data.

ANALYSIS

Multinomial logistic regression was used to assess factors that predict congregational health programs relative to no health programs; and of HIV programs relative to other health activities.

RESULTS

Most congregations (57.5%) had at least one health-related program; many fewer (5.7%) had an HIV program. Predictors of health vs. HIV programs differed. The number of adults in the congregation was a key predictor of health programs, while having an official statement welcoming gay persons was a significant predictor of HIV programs (p < .05). Other significant characteristics varied by size of congregation and type of program (HIV vs. other health).

CONCLUSION

Organizations interested in partnering with congregations to promote health or prevent HIV should consider congregational size as well as other factors that predict involvement. Results of this study can inform policy interventions to increase the capacity of religious congregations to address HIV and health.

Development and Validation of the Cognitive Behavioral Physical Activity Questionnaire

PURPOSE

Develop and demonstrate preliminary validation of a brief questionnaire aimed at assessing social cognitive determinants of physical activity (PA) in a college population.

DESIGN

Quantitative and observational.

SETTING

A midsized northeastern university.

SUBJECTS

Convenience sample of 827 male and female college students age 18 to 24 years.

MEASURES

International Physical Activity Questionnaire and a PA stage-of-change algorithm.

ANALYSIS

A sequential process of survey development, including item generation and data reduction analyses by factor analysis, was followed with the goal of creating a parsimonious questionnaire. Structural equation modeling was used for confirmatory factor analysis and construct validation was confirmed against self-reported PA and stage of change. Validation analyses were replicated in a second, independent sample of 1032 college students.

RESULTS

Fifteen items reflecting PA self-regulation, outcome expectations, and personal barriers explained 65% of the questionnaire data and explained 28.6% and 39.5% of the variance in total PA and moderate-to-vigorous-intensity PA, respectively. Scale scores were distinguishable across the stages of change. Findings were similar when the Cognitive Behavioral Physical Activity Questionnaire (CBPAQ) was tested in a similar and independent sample of college students (40%; R (2) moderate-to-vigorous-intensity PA = .40; p < .001).

CONCLUSION

The CBPAQ successfully explains and predicts PA behavior in a college population, warranting its incorporation into future studies aiming at understanding and improving on PA behavior in college students.

Moving the Barricades to Physical Activity: A Qualitative Analysis of Open Streets Initiatives Across the United States

PURPOSE

Ciclovía, or Open Streets initiatives, are events where streets are opened for physical activity and closed to motorized traffic. Although the initiatives are gaining popularity in the United States, little is known about planning and implementing them. The goals of this paper are to explore the development and implementation of Open Streets initiatives and make recommendations for increasing the capacity of organizers to enhance initiative success.

APPROACH

Phenomenology with qualitative analysis of structured interviews was used.

SETTING

Study setting was urban and suburban communities in the United States.

PARTICIPANTS

Study participants were organizers of Open Streets initiatives in U.S. cities.

METHOD

Using a list of 47 events held in 2011, 27 lead organizers were interviewed by telephone about planning, implementation, and lessons learned. The interviews were digitally recorded and transcribed. A phenomenologic approach was used, an initial coding tool was developed after reviewing a sample of transcripts, and constant comparative coding methodology was applied. Themes and subthemes were generated from codes.

RESULTS

The most common reasons for initiation were to highlight or improve health and transportation. Most initiatives aimed to reach the general population, but some targeted families, children, or specific neighborhoods. Getting people to understand the concept of Open Streets was an important challenge. Other challenges included lack of funding and personnel, and complex logistics.

CONCLUSION

These initiatives democratize public space for citizens while promoting physical activity, social connectedness, and other broad agendas. There are opportunities for the research community to contribute to the expanse and sustainability of Open Streets, particularly in evaluation and dissemination.

A Mixed-Methods Evaluation of the Choose Less, Weigh Less Portion Size Health Marketing Campaign in Los Angeles County

PURPOSE

To assess the impact of the Choose Less, Weigh Less portion size health marketing campaign.

DESIGN

A mixed-methods, cross-sectional evaluation.

SETTING

A quantitative Internet panel survey was administered through an online sampling vendor and qualitative interviews were conducted by street intercept.

SUBJECTS

The panel survey included 796 participants, weighted to represent Los Angeles County. Street intercept interviews were conducted with 50 other participants.

INTERVENTION

The Choose Less, Weigh Less campaign included print media on transit shelters, bus and rail cars, and billboards; radio and online advertising; and Web site content and social media outreach.

MEASURES

The panel survey measured self-reported campaign exposure and outcomes, including knowledge of recommended daily calorie limits, attitudes toward portion sizes, and intent to reduce calories and portion size. Intercept interviews assessed campaign appeal, clarity, and utility.

ANALYSIS

Weighted survey data were analyzed using logistic regression to assess the association between campaign exposure and outcomes. Interview data were analyzed for themes.

RESULTS

The campaign reached 19.7% of the Los Angeles County population. Significant differences were seen for 2 of the 10 outcomes assessed. Participants who saw the campaign were more likely than those who did not to report fast-food portion sizes as being too large (adjusted odds ratio [Adj. OR]: 1.89; 95% confidence interval [CI]: 1.16, 3.07) and intention to choose a smaller portion (Adj. OR: 1.99; 95% CI: 1.20, 3.31). Qualitative data revealed three themes about appeal, clarity, and utility.

CONCLUSION

Health marketing efforts targeting portion size can have relatively broad reach and limited but positive impacts on consumer attitudes and intent to select smaller portions.

Environmental Intervention in Carryout Restaurants Increases Sales of Healthy Menu Items in a Low-Income Urban Setting

PURPOSE

To investigate how a pilot environmental intervention changed food sales patterns in carryout restaurants.

DESIGN

Quasi-experimental.

SETTING

Low-income neighborhoods of Baltimore, Maryland.

SUBJECTS

Seven carryouts (three intervention, four comparison).

INTERVENTION

Phase 1, menu board revision and healthy menu labeling; phase 2, increase of healthy sides and beverages; and phase 3, promotion of cheaper and healthier combination meals.

MEASURES

Weekly handwritten menu orders collected to assess changes in the proportion of units sold and revenue of healthy items (entrée, sides and beverages, and combined).

ANALYSIS

Logistic and Poisson regression models with generalized estimating equations.

RESULTS

In the intervention group, odds for healthy entrée units and odds for healthy side and beverage units sold significantly increased in phases 2 and 3; odds for healthy entrée revenue significantly increased in phase 1 (odds ratio [OR] 1.16, 95% confidence interval [CI] 1.08-1.26), phase 2 (OR 1.32, 95% CI 1.25-1.41), and phase 3 (OR 1.39, 95% CI 1.14-1.70); and odds for healthy side and beverage revenues increased significantly in phase 2 (OR 1.62, 95% CI 1.33-1.97) and phase 3 (OR 2.73, 95% CI 2.15-3.47) compared to baseline. Total revenue in the intervention group was significantly higher in all phases than in the comparison group (p < .05).

CONCLUSION

Environmental intervention changes such as menu revision, menu labeling, improved healthy food selection, and competitive pricing can increase availability and sales of healthy items in carryouts.

Perceptions of Prostate Cancer Screening Controversy and Informed Decision Making: Implications for Development of a Targeted Decision Aid for Unaffected Male First-Degree Relatives

PURPOSE

First-degree relatives (FDRs) of prostate cancer (PC) patients should consider multiple concurrent personal risk factors when engaging in informed decision making (IDM) about PC screening. This study assessed perceptions of IDM recommendations and risk-appropriate strategies for IDM among FDRs of varied race/ethnicity.

DESIGN

A cross-sectional, qualitative study design was used.

SETTING

Study setting was a cancer center in southwest Florida.

PARTICIPANTS

The study comprised 44 participants (24 PC patients and 20 unaffected FDRs).

METHOD

Focus groups and individual interviews were conducted and analyzed using content analysis and constant comparison methods.

RESULTS

Patients and FDRs found the PC screening debate and IDM recommendations to be complex and counterintuitive. They overwhelmingly believed screening saves lives and does not have associated harms. There was a strongly expressed need to improve communication between patients and FDRs. A single decision aid that addresses the needs of all FDRs, rather than one separating by race/ethnicity, was recommended as sufficient by study participants. These perspectives guided the development of an innovative decision aid that deconstructs the screening controversy and IDM processes into simpler concepts and provides step-by-step strategies for FDRs to engage in IDM.

CONCLUSION

Implementing IDM among FDRs is challenging because the IDM paradigm departs from historical messages promoting routine screening. These contradictions should be recognized and addressed for men to participate effectively in IDM. A randomized pilot study evaluating outcomes of the resulting decision aid is underway.

Validation of Performance Indicators for Evaluation of Workplace Health Promotion

PURPOSE

To validate performance indicators for evaluating workplace health promotion (WHP) programs based on a logic model and to analyze the structural relationships between constructs.

DESIGN

The study design is cross-sectional.

SETTING

Design setting was small manufacturing companies implementing WHP programs provided by the Korea Industrial Health Association.

SUBJECTS

Seventeen occupational health experts completed a questionnaire to determine the content validity of indicators. In addition, 58 health care managers completed a questionnaire to determine reliability and construct validation. The response rate was 84.1%.

MEASURES

Based on a logic model, 13 constructs of WHP programs were identified: WHP program input, four activities for workplace environment management, two activities for employee health care management, two outputs, and two short-term outcomes.

ANALYSIS

Interrater agreement index was used for testing the content validity of indicators. Confirmatory factor analysis was used to test for the reliabilities, and the convergent and discriminant validities. Structuring equation modeling was also used to analyze the relationships among constructs.

RESULTS

A total of 35 performance indicators from 11 constructs showed good reliability and validity. All relationships among WHP input, activities, outputs, and short-term outcomes were significant, except for the relationship between environment outputs and short-term outcome.

CONCLUSION

These findings illustrate that the logic model and structuring equation modeling can be used to develop and validate performance indicators for planning and evaluation of the WHP program.

Factors Facilitating the Implementation of Church-Based Heart Health Promotion Programs for Older Adults: A Qualitative Study Guided by the Precede-Proceed Model

PURPOSE

To describe the factors facilitating the implementation of heart health promotion programs for older adults in Anglican, United, and Catholic churches.

DESIGN

The study used qualitative methods comprising semistructured interviews and focus groups.

SETTING

The interviews and focus groups were conducted in Anglican, Catholic, and United churches located in the Canadian cities of Toronto and Hamilton, Ontario.

PARTICIPANTS

Twelve ordained pastors and 21 older parishioners who attended church regularly and who had no health conditions were recruited to best explain how churches could be suitable locations for health promotion activities targeting older adults.

METHODS

Twelve semistructured interviews with the pastors and three focus groups with the 21 parishioners were undertaken. A component of the Precede-Proceed model (a model for planning health education and health promotion programs and policies) was applied to the findings after direct content analysis of the data.

RESULTS

Participants identified pastor leadership, funding for a parish nurse, community-focused interventions, secured infrastructure, and social support from congregation members as pertinent factors required for implementing health promotion programs in Anglican, United, and Catholic churches.

CONCLUSION

The findings have particular relevance for health promotion and public health because they suggest factors that would be necessary to design church-based heart health promotion programs for older adults at risk of chronic diseases.

Development and Reliability Testing of a Fast-Food Restaurant Observation Form

PURPOSE

To develop a reliable observational data collection instrument to measure characteristics of the fast-food restaurant environment likely to influence consumer behaviors, including product availability, pricing, and promotion.

DESIGN

The study used observational data collection.

SETTING

Restaurants were in the Chicago Metropolitan Statistical Area.

SUBJECTS

A total of 131 chain fast-food restaurant outlets were included.

MEASURES

Interrater reliability was measured for product availability, pricing, and promotion measures on a fast-food restaurant observational data collection instrument.

ANALYSIS

Analysis was done with Cohen's κ coefficient and proportion of overall agreement for categorical variables and intraclass correlation coefficient (ICC) for continuous variables.

RESULTS

Interrater reliability, as measured by average κ coefficient, was .79 for menu characteristics, .84 for kids' menu characteristics, .92 for food availability and sizes, .85 for beverage availability and sizes, .78 for measures on the availability of nutrition information,.75 for characteristics of exterior advertisements, and .62 and .90 for exterior and interior characteristics measures, respectively. For continuous measures, average ICC was .88 for food pricing measures, .83 for beverage prices, and .65 for counts of exterior advertisements.

CONCLUSION

Over 85% of measures demonstrated substantial or almost perfect agreement. Although some measures required revision or protocol clarification, results from this study suggest that the instrument may be used to reliably measure the fast-food restaurant environment.

Reliability and validity of the Turkish version of the situational self-efficacy scale for fruit and vegetable consumption in adolescents

PURPOSE

The purpose of this research was to examine the psychometric properties of the Turkish version of the situational self-efficacy scale for vegetable and fruit consumption in adolescents.

DESIGN

This was a methodological study.

SETTING

The study was conducted in four public secondary schools in Istanbul, Turkey.

SUBJECTS

Subjects were 1586 adolescents.

MEASURES

Content and construct validity were assessed to test the validity of the scale. The reliability was assessed in terms of internal consistency and test-retest reliability.

ANALYSIS

For confirmatory factor analysis, χ(2) statistics plus other fit indices were used, including the goodness-of-fit index, the adjusted goodness-of-fit index, the nonnormed fit index, the comparative fit index, the standardized root mean residual, and the root mean square error of approximation. Pearson's correlation was used for test-retest reliability and item total correlation. The internal consistency was assessed by using Cronbach α.

RESULTS

Confirmatory factor analysis strongly supported the three-component structure representing positive social situations (α = .81), negative effect situations (α = .93), and difficult situations (α = .78). Psychometric analyses of the Turkish version of the situational self-efficacy scale indicate high reliability and good content and construct validity.

CONCLUSION

Researchers and health professionals will find it useful to employ the Turkish situational self-efficacy scale in evaluating situational self-efficacy for fruit and vegetable consumption in Turkish adolescents.

The influence of gender stereotypes on eating habits among Costa Rican adolescents

PURPOSE

To identify the influence of gender stereotypes on eating habits among Costa Rican adolescents.

DESIGN

Qualitative, descriptive research was used in this study.

SETTING

Adolescents and parents were recruited from socioeconomically diverse populations in rural and urban areas of San José, Costa Rica.

SUBJECTS

Subjects were 92 adolescents (14 to 17 years old) and 48 parents.

METHODS

Focus group data were transcribed and entered into the qualitative data analysis software Atlas.ti version 5.0. Analyses were grounded on the social cognitive theory.

RESULTS

Five themes emerged from the focus group discussions: (1) Costa Rican adolescents associate the consumption of moderate quantities of healthy foods with femininity and male homosexuality. (2) The consumption of hearty portions of nonhealthy foods was associated with masculinity and male heterosexuality. (3) There is an emerging view that it is acceptable for heterosexual male adolescents to take care of their bodies through healthy eating. (4) Body care among female adolescents is an element of femininity and body image. (5) Parents reinforce their daughters' persistent concern with weight control because they perceive it as feminine behavior.

CONCLUSION

Health promoters should be aware of the existing and changing food stereotypes around gender as an avenue for the promotion of healthy eating.

Establishing the psychometric properties of constructs in a community-based participatory research conceptual model

PURPOSE

The purpose of this study is to establish the psychometric properties of 22 measures from a community-based participatory research (CBPR) conceptual model.

DESIGN

The design of this study was an online, cross-sectional survey of academic and community partners involved in a CPBR project.

SETTING

CPBR projects (294) in the United States with federal funding in 2009.

SUBJECTS

Of the 404 academic and community partners invited, 312 (77.2%) participated. Of the 200 principal investigators/project directors invited, 138 (69.0%) participated.

MEASURES

Twenty-two measures of CBPR context, group dynamics, methods, and health-related outcomes were examined.

ANALYSIS

Confirmatory factor analysis to establish factorial validity and Pearson correlations to establish convergent and divergent validity were used.

RESULTS

Confirmatory factor analysis demonstrated strong factorial validity for the 22 constructs. Pearson correlations (p < .001) supported the convergent and divergent validity of the measures. Internal consistency was strong, with 18 of 22 measures achieving at least a .78 Cronbach α.

CONCLUSION

CBPR is a key approach for health promotion in underserved communities and/or communities of color, yet the basic psychometric properties of CBPR constructs have not been well established. This study provides evidence of the factorial, convergent, and discriminant validity and the internal consistency of 22 measures related to the CBPR conceptual model. Thus, these measures can be used with confidence by both CBPR practitioners and researchers to evaluate their own CBPR partnerships and to advance the science of CBPR.

A 4-year prospective study of soft drink consumption and weight gain: the role of calorie intake and physical activity

PURPOSE

Examine the association between soft drink consumption and risk of weight gain over 4 years. Also, determine if the relationship between soft drink intake and weight gain is a result of differences in calorie intake or physical activity (PA), or other potential mediating factors.

DESIGN

Four-year prospective cohort.

SETTING

Approximately 20 cities in Utah and Wyoming.

SUBJECTS

One hundred seventy nonsmoking, apparently healthy women.

MEASURES

At baseline, soft drink consumption and menopause status were measured using a questionnaire; calorie intake was estimated using 7-day, weighed food records; and PA was assessed using 7-day accelerometer data. Weight was assessed using an electronic scale at baseline and follow-up.

ANALYSIS

Multiple regression and partial correlation.

RESULTS

Four-year weight gain in participants who, at baseline, consumed sugar-sweetened soft drinks (2.7 ± 5.1 kg) was greater than in participants who consumed artificially sweetened soft drinks (-.1 ± 4.4 kg) or no soft drinks (.5 ± 5.1 kg) (F = 5.4, p = .022). Adjusting for objectively measured PA had no effect on risk of weight gain. However, controlling statistically for differences in calorie intake significantly weakened the relationship between soft drink consumption and weight gain by 28%.

CONCLUSION

Consuming artificially sweetened soft drinks or no soft drinks instead of sugar-sweetened soft drinks may help to reduce risk of weight gain in women. The relationship appears to be partly a function of differences in calorie intake, but not differences in PA.

A qualitative study of recruitment barriers, motivators, and community-based strategies for increasing clinical trials participation among rural and urban populations

PURPOSE

Participation in clinical trials (CTs) is low among rural communities. Investigators report difficulty recruiting rural individuals for CTs. The study purpose was to identify recruitment barriers, motivators, and strategies to help increase access to and participation in CTs in rural and urban communities.

APPROACH

Qualitative focus groups/interviews.

SETTING

Rural and urban counties in one southeastern state.

PARTICIPANTS

Two hundred twelve African-American and white men and women ages 21+.

METHOD

Nineteen focus groups and nine interviews were conducted. Audio files were transcribed and organized into NVivo10. Recurring themes were examined by geographic location.

RESULTS

Although similar barriers, motivators, and strategies were reported by urban and rural groups, perceptions regarding their importance varied. Recruitment barriers mentioned in both rural and urban groups included fear, side effects, limited understanding, limited time, and mistrust. Rural groups were more mindful of time commitment involved. Both rural and urban participants reported financial incentives as the top motivator to CT participation, followed by personal illness (urban groups) and benefits to family (rural groups). Recruitment strategies suggested by rural participants involved working with schools/churches and using word of mouth, whereas partnering with schools, word of mouth, and media were recommended most by urban groups.

CONCLUSION

Perceived recruitment barriers, motivators, and strategies did not differ considerably between rural and urban groups. Major barriers identified by participants should be addressed in future CT recruitment and education efforts. Findings can inform recruitment and communication strategies for reaching both urban and rural communities.

Exploratory and confirmatory factor analyses and demographic correlate models of the strategies for weight management measure for overweight or obese adults

PURPOSE

There is a need for a self-report measure that assesses use of recommended strategies related to weight management.

DESIGN

Cross-sectional analysis.

SETTING

Universities, community.

SUBJECTS

Exploratory factor analysis (EFA) involved data from 404 overweight/obese young adults (mean age = 22 years, 48% non-Hispanic white, 68% ethnic minority). Confirmatory factor analysis (CFA) involved data from 236 overweight/obese adults (mean age = 42 years, 63% non-Hispanic white, 84% ethnic minority).

MEASURES

The Strategies for Weight Management (SWM) measure is a 35-item questionnaire that assesses use of recommended behavioral strategies for reducing energy intake and increasing energy expenditure in overweight/obese adults.

ANALYSIS

EFA and CFA were conducted on the SWM. Correlate models assessed the associations between SWM factor/total scores and demographics by using linear regressions.

RESULTS

EFA suggested a four-factor model: strategies categorized as targeting (1) energy intake, (2) energy expenditure, (3) self-monitoring, and (4) self-regulation. CFA indicated good model fit (χ(2)/df = 2.0, comparative fit index = .90, standardized root mean square residual = .06, and root mean square error of approximation = .07, confidence interval = .06-.08, R(2) = .11-.74). The fourth factor had the lowest loadings, possibly because the items cover a wide domain. The final model included 20 items. Correlate models revealed weak associations between the SWM scores and age, gender, Hispanic ethnicity, and relationship status in both samples, with the models explaining only 1% to 8% of the variance (betas = -.04 to .29, p < .05).

CONCLUSION

The SWM has promising psychometric qualities in two diverse samples.