Development and Pilot Test of the Workplace Readiness Questionnaire, a Theory-Based Instrument to Measure Small Workplaces' Readiness to Implement Wellness Programs

PURPOSE

To develop a theory-based questionnaire to assess readiness for change in small workplaces adopting wellness programs.

DESIGN

In developing our scale, we first tested items via "think-aloud" interviews. We tested the revised items in a cross-sectional quantitative telephone survey.

SETTING

The study setting comprised small workplaces (20-250 employees) in low-wage industries.

SUBJECTS

Decision-makers representing small workplaces in King County, Washington (think-aloud interviews, n = 9), and the United States (telephone survey, n = 201) served as study subjects.

MEASURES

We generated items for each construct in Weiner's theory of organizational readiness for change. We also measured workplace characteristics and current implementation of workplace wellness programs.

ANALYSIS

We assessed reliability by coefficient alpha for each of the readiness questionnaire subscales. We tested the association of all subscales with employers' current implementation of wellness policies, programs, and communications, and conducted a path analysis to test the associations in the theory of organizational readiness to change.

RESULTS

Each of the readiness subscales exhibited acceptable internal reliability (coefficient alpha range, .75-.88) and was positively associated with wellness program implementation ( p < .05). The path analysis was consistent with the theory of organizational readiness to change, except change efficacy did not predict change-related effort.

CONCLUSION

We developed a new questionnaire to assess small workplaces' readiness to adopt and implement evidence-based wellness programs. Our findings also provide empirical validation of Weiner's theory of readiness for change.

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.

Toward Effective Water Pipe Tobacco Control Policy in the United States: Synthesis of Federal, State, and Local Policy Texts

PURPOSE

Water pipe tobacco smoking (WTS) is growing in popularity among U.S. young adults and is associated with health risks similar to those of cigarette smoking. The purpose of this study is to examine existing tobacco control policies (TCPs) in order to investigate how they engage WTS.

APPROACH

A systematic synthesis of content and legal interactions among federal, state, and local TCP documents.

SETTING

Pennsylvania, which represents a politically and demographically diverse microcosm of the United States.

PARTICIPANTS

No human subjects.

METHOD

Federal and state TCPs were retrieved via public legal repositories. Local policy searches were conducted via county/municipal Web sites, inclusive of 13 localities that had autonomous health departments or existing TCPs based on a National Cancer Institute report. Full-text TCPs were double coded within a grounded theory framework for health policy analysis. Emergent codes were used to compare and contrast policy texts and to examine legal interactions among TCPs.

RESULTS

Examination of policy categories including youth access, use restrictions, and taxation revealed WTS as largely omitted from current TCPs. WTS was sometimes addressed as an "other" tobacco product under older TCPs, though ambiguities in language led to questionable enforceability. State preemptions have rolled back or prevented well-tailored reforms at the local level. Federal preemptions have likewise constrained state TCPs.

CONCLUSION

Outdated, preempted, and unclear policies limit the extent to which TCPs engage WTS. Health advocates might target these aspects of TCP reform.

A Qualitative Examination of Smoke-Free Policies and Electronic Cigarettes Among Sheltered Homeless Adults

PURPOSE

To examine attitudes toward smoke-free policies and perceptions of e-cigarette use among homeless adults.

APPROACH

A cross-sectional qualitative study was conducted.

SETTING

Study setting comprised seven transitional homeless shelters with indoor smoke-free policies in San Diego County; facilities differed in outdoor restrictions on smoking.

PARTICIPANTS

Sixty-six current or former smokers were the study participants.

METHOD

Participants completed a questionnaire on smoking behaviors, perceived antitobacco norms, and attitudes toward smoke-free policies, and attended a focus group interview that explored these topics. We used a directed content analysis approach to analyze the focus group transcripts.

RESULTS

Clients in facilities with outdoor restrictions on smoking had stronger perceived antitobacco norms than those in facilities without such restrictions. We identified the following major themes: attitudes toward smoke-free policies, the use of e-cigarettes, the addictive potential of cigarettes, vulnerability to tobacco industry marketing, and interest in smoking cessation. The consensus was that smoke-free policies were important because they limited secondhand smoke exposure to nonsmokers and children. All were curious about e-cigarettes, particularly if they could be smoked in areas where smoking was prohibited and/or used as a cessation aid.

CONCLUSION

In this study of homeless adults, there was strong support for indoor and outdoor smoke-free policies. However, misperceptions that e-cigarettes could be used indoors could threaten antitobacco norms, highlighting opportunities to educate about the potential risks of e-cigarette use among homeless individuals.

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.

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.

Living With a Smoker and Physical Inactivity: An Unexplored Health Behavior Pathway

PURPOSE

The present study investigated an unexplored health behavior pathway: the association between living with a smoker and physical inactivity.

DESIGN

The study performed an analysis of cross-sectional data from the second wave of the Survey of Midlife Development in the United States (2004-2006).

SUBJECTS

The sample included 1050 women and 945 men, ages 30 to 84 years (mean, 56.5 years).

MEASURES

In addition to control variables, survey items indexed presence of a smoker in the respondent's home, and physical inactivity and low health commitment on the part of the respondent.

ANALYSIS

Analysis employed multiple logistic regression analyses, controlling for sociodemographic factors as well as health restrictions on physical activity and respondents' current smoking status.

RESULTS

Living with a smoker was linked to 56% higher odds of physical inactivity. Low health commitment mediated this association. Living with a smoker was linked to lower health commitment (B = .31), and low health commitment was linked in turn to increased odds of physical inactivity (odds ratio, 1.36).

CONCLUSIONS

The increased health risk among individuals living with a smoker is assumed to be a function of exposure to secondhand smoke. We demonstrate an unexplored behavioral pathway involving a link between living with a smoker and physical inactivity. These findings suggest that household smoking bans may have broad health behavior effects beyond reducing smoking.

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.