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.

"Get drunk. Smoke weed. Have fun.": A Content Analysis of Tweets About Marijuana and Alcohol

PURPOSE

To explore the sentiment and themes of Twitter chatter that mentions both alcohol and marijuana.

DESIGN

Cross-sectional analysis of tweets mentioning both alcohol and marijuana during 1 month was performed.

SETTING

The study setting was Twitter.

PARTICIPANTS

Tweets sent from February 4 to March 5, 2014, were studied.

METHOD

A random sample (n = 5000) of tweets that mentioned alcohol and marijuana were qualitatively coded as normalizing both substances, preferring one substance over the other, or discouraging both substances. Other common themes were identified.

RESULTS

More than half (54%) of the tweets normalized marijuana and alcohol (without preferring one substance over the other), and 24% preferred marijuana over alcohol. Only 2% expressed a preference for alcohol over marijuana, 7% discouraged the use of both substances, and the sentiment was unknown for 13% of the tweets. Common themes among tweets that normalized both substances included using the substances with friends (17%) and mentioning substance use in the context of sex or romance (14%). Common themes among tweets that preferred marijuana over alcohol were the beliefs that marijuana is safer than alcohol (46%) and preferences for effects of marijuana over alcohol (40%).

CONCLUSION

Tweets normalizing polysubstance use or encouraging marijuana use over alcohol use are common. Both online and offline prevention efforts are needed to increase awareness of the risks associated with polysubstance use and marijuana use.

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.

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.

Community Lenses Revealing the Role of Sociocultural Environment on Physical Activity

PURPOSE

To identify perceptions of how sociocultural environment enabled and hindered physical activity (PA) participation.

DESIGN

Community-based participatory research.

SETTING

Two semirural and two urban communities located in Alberta, Canada.

PARTICIPANTS

Thirty-five people (74.3% females, 71.4% aged 25-64 years) across the four communities.

METHOD

PhotoVoice activities occurred over 3 months during the spring of 2009. Participants were asked to document perceived environmental attributes that might foster or inhibit PA in their community. Photographs and narratives were shared in one-on-one interviews. Line-by-line coding of the transcripts was independently conducted by two researchers using an inductive approach. Codes were arranged into themes and subthemes, which were then organized into the Analysis Grid for Environments Linked to Obesity (ANGELO) framework.

RESULTS

Six main themes (accompanied by subthemes) emerged: sociocultural aesthetics, safety, social involvement, PA motivation, cultural ideas of recreation, and car culture. Representative quotes and photographs illustrate enablers and obstacles identified by participants.

CONCLUSION

This PhotoVoice study revealed how aspects of participants' sociocultural environments shaped their decisions to be physically active. Providing more PA resources is only one step in the promotion of supportive environments. Strategies should also account for the beautification and maintenance of communities, increasing feelings of safety, enhancement of social support among community members, popularization of PA, and mitigating car culture, among others.

Which Type of Antismoking Advertisement Is Perceived as More Effective? An Experimental Study With a Sample of Australian Socially Disadvantaged Welfare Recipients

PURPOSE

Evaluate the perceived effectiveness of key antismoking messages among highly disadvantaged smokers and assess the impact of nicotine dependence and cessation cognitions on message processing.

DESIGN

The experimental crossover trial, undertaken between March and December 2012, randomly exposed participants to two of three antismoking advertisements delivered via touchscreen computer.

SETTING

Welfare recipients were recruited from a community service organization in New South Wales, Australia.

SUBJECTS

Subjects were 354 smokers (79% response rate). Participants resided in government rental housing (52%), earned less than AUD$400/wk (72%), and received their primary income from government welfare (95%).

INTERVENTION

Three 30-second antismoking television advertisements representing common campaign themes: why to quit (graphic imagery), why to quit (personal testimonial), or how to quit.

MEASURES

An 11-item scale assessed perceived effectiveness and message acceptance. An eight-item cessation cognitions index assessed motivations and readiness to quit, and the heaviness of smoking index was used to classify nicotine dependence.

ANALYSIS

Descriptive statistics, generalized linear mixed models, and multiple linear regression analyses are reported.

RESULTS

Why-to-quit advertisements were perceived as significantly more effective than the how-to-quit advertisement (all p < .0001). Smokers with positive cessation cognitions were more likely to accept antismoking messages (p = .0003) and perceive them as effective (p < .0001). Nicotine dependence level did not influence message acceptance (p = .7322) or effectiveness (p = .8872).

CONCLUSION

Highly emotive advertisements providing good reasons to quit may be the most effective in promoting the antismoking message among groups with high smoking rates.

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.

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.

Factors influencing physical activity behaviors in colorectal cancer survivors

PURPOSE

To elucidate factors that impact intention (INT) to be active as well as actual physical activity (PA) behavior in colorectal cancer survivors (CRC-S) using the theory of planned behavior (TpB). Planning for PA was explored as a mediator of the INT-behavior relationship. Chemotherapy-induced neuropathy and fatigue were also explored.

DESIGN

A cross-sectional quantitative mailed survey was used.

SETTING

The study was conducted among community-dwelling adults living in Pennsylvania when diagnosed with colorectal cancer (CRC).

SUBJECTS

Subjects comprised 843 CRC-S diagnosed with CRC in Pennsylvania in 2009.

MEASURES

The survey included questions about planning for PA, TpB constructs, medical and social variables, and PA as measured by a modified Godin Leisure Time Questionnaire.

ANALYSIS

Descriptive statistics were used to characterize the sample. A mediation analysis was used to determine if planning mediated the relationship between INT and actual PA behavior. A stepwise regression was used to determine predictors of INT and PA.

RESULTS

Ninety-six CRC-S responded, with 25% meeting PA recommendations for health promotion, suggesting that CRC-S are insufficiently active. Perceived behavioral control (PBC) and social norm (SN) accounted for 43% of the variance in INT, whereas 30% of the variance in PA was explained by PBC and age. Neuropathy negatively impacted PA behavior (p = .008). Both action and coping planning partially mediated the INT-behavior relationship (β = 20.08, p = .007; β = 22.85, p = .001, respectively).

CONCLUSION

Survivors at risk for inactivity are those with low PBC, low SN, and neuropathy, and those who are older.

Effectiveness of interventions targeting health behaviors in university and college staff: a systematic review

OBJECTIVE

Evaluate the literature on interventions targeting tertiary education staff within colleges and universities for improvements in health behaviors such as physical activity, dietary intake, and weight loss.

DATA SOURCE

One online database, Medline, was searched for literature published between January 1970 and February 2013.

STUDY INCLUSION AND EXCLUSION CRITERIA

All quantitative study designs, including but not limited to randomized controlled trials, quasi-experimental studies, nonrandomized experimental trials, cohort studies, and case-control studies, were eligible.

DATA EXTRACTION

Data extraction was performed by one reviewer using a standardized form developed by the researchers. Extraction was checked for accuracy and consistency by a second reviewer.

DATA SYNTHESIS

Data in relation to the above objective were extracted and described in a narrative synthesis.

RESULTS

Seventeen studies were identified that focused on staff within the tertiary education setting. The review yielded overall positive results with 13 reporting significant health-related improvements. Weight loss, physical activity and fitness, and/or nutrition were the focus in more than half (n = 9) of the studies.

CONCLUSION

This appears to be the first review to examine health interventions for tertiary education staff. There is scope to enhance cross-disciplinary collaboration in the development and implementation of a "Healthy University" settings-based approach to health promotion in tertiary education workplaces. Universities or colleges could serve as a research platform to evaluate such intervention strategies.

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 mixed-methods study of young adults' receptivity to using Facebook for smoking cessation: if you build it, will they come?

PURPOSE

To determine whether young adults are interested in a Facebook intervention for smoking cessation and to inform the design of such an intervention.

DESIGN

Mixed-methods.

SETTING

Participants throughout the United States were recruited through Facebook.

PARTICIPANTS

Young adults aged 18 to 25 years who had smoked at least once in the past month.

METHOD

Participants (N = 570) completed an online survey of tobacco and social media use. A subset of 30 survey completers, stratified by motivation to quit smoking, agreed to participate in a structured interview over online chat. Themes were identified by using grounded theory.

RESULTS

Approximately a third of the full sample (31%) reported they would want to get help to quit smoking by using Facebook. Interest in using Facebook to quit was greater among those who were more motivated to quit (χ(2) = 75.2, p < .001), had made a quit attempt in the past year (χ(2) = 16.0, p < .001), and had previously used the Internet for assistance with a quit attempt (χ(2) = 6.2, p = .013). In qualitative interviews, social support and convenience were identified as strengths of a Facebook intervention, while privacy was the main issue of concern.

CONCLUSION

Nearly one in three young adult smokers on Facebook expressed interest in using Facebook for quitting smoking. Social media approaches that respect privacy and tailor to readiness to quit are likely to maximize participation.

The association between sport participation and dietary behaviors among fourth graders in the school physical activity and nutrition survey, 2009-2010

PURPOSE

To determine the association between youth sport team participation and dietary behaviors among elementary school-aged children.

DESIGN

Cross-sectional survey.

SETTING

Public schools in Texas during 2009-2010.

SUBJECTS

A total of 5035 ethnically diverse fourth graders.

MEASURES

Participation in organized sports teams, consumption of select food items (fruits, vegetables, beverages, sweets/snacks).

ANALYSIS

Multiple logistic regression was used to assess the association between each food item (eaten at least once on the previous day) and number of sports teams as the independent class variable (0, 1 ,2, ≥3), adjusting for body mass index physical activity, socioeconomic status, and ethnicity.

RESULTS

Significant dose-response associations were observed between number of sports teams and consumption of fruits and vegetables. For boys, the likelihood of eating fruit and fruit-flavored drinks was significantly higher and the odds of drinking soda were lower with the number of teams. For girls, the likelihood of consuming green vegetables increased as sports teams participation increased, and participation was positively associated with diet soda consumption. A positive association was observed between the number of sports teams and scores on the Healthy Food Index for boys and girls.

CONCLUSION

The findings that sports participation is associated with consumption of fruits and vegetables and lower consumption of soda suggest that efforts should be focused on supporting youth team sports to promote healthier food choices. Since sports are available to all ages, sports may be an important venue for promoting healthier dietary behaviors.

A closer examination of the interaction among risk factors for low back pain

PURPOSE

To evaluate the interactions of risk factors and identify their most powerful discrimination pathway for the occurrence of low back pain (LBP).

DESIGN

A cross-sectional study.

SETTING

Taiwan.

SUBJECTS

Taiwanese population of 30 to 64 years old.

MEASURES

A self-reported question, "Have you experienced LBP within the last 3 months?" was used to evaluate LBP. The study variables included demographics (age, gender, occupation, education level, marital status, and household income), biometric health measures (bone mineral density and body mass index), dietary habits (weekly milk, coffee, tea, and soybean consumption), and other lifestyle factors (smoking habits, alcohol consumption, betel nut chewing, body weight control, exercise regularity, and stress management).

ANALYSIS

Logistic regression and classification tree analyses.

RESULTS

A total of 969 Taiwanese participants were analyzed. Primary logistic regression analysis identified three critical risk factors (gender, bone mineral density, and exercise regularity) for the occurrence of LBP. By classification tree analysis, demographic factors, dietary habits, and lifestyle factors had modifying effects on LBP.

CONCLUSIONS

Various factors contribute to the risk of LBP. Interactions between risk factors should be considered when developing future strategies for the prevention and management of LBP.