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Paul E. Terry	854	Editorial Breaking the Silence and other Prevention Lessons from the Opioid Epidemic The goal of this editorial is to equip readers with opioid education resources that enable you to role model what it looks like to speak out about addiction. How are we doing as a profession speaking up about addiction? Stigma is commanded by a deep irony: where peer pressure is what likely keeps us quiet, peer support is what enables us to speak up. The “#MeToo” movement is an extraordinary example of the inertia needed to break open a taboo topic. From Hollywood celebrities to USA women’s gymnastics stars, it was clear that as more women spoke up about sexual harassment, well, the more women spoke out. As unnatural as it felt to talk about being harassed or abused, many simply acknowledged that it was the courage of their peers that helped them find their courage. Workplace supervisors have a front row seat for watching the epidemic and our role relates to what I consider the most straightforward definition of addiction: It is when “it” (i.e., alcohol, opioids, gambling) begins to cause problems.
the Science of lifestyle change
Interventions
James Woodall	858	Social Policy Why has the health promoting prison concept failed to translate to the US? Two decades since the World Health Organization Regional Office for Europe published a report on health promotion in prison that stimulated further debate on the concept of the “health-promoting prison,” this article discusses the extent to which the concept has translated to the United States. One predicted indicator of success for the health-promoting prison movement was the expansion of activity beyond European borders; yet 2 decades since the European model was put forward, there has been very limited activity in the United States. This “Critical Issues and Trends” article suggests reasons why this translation has failed to occur.
Strategies
Anna McCullough Leah M. Ranney Daniel J. Simons Adam O. Goldstein	861	“The Job has Become Advocating for the Job:” Threats to Funding Dramatically Influence Program Outcomes The authors provide insight on the effects on threatened funding cuts in morale and productivity of grantees and program staff in statewide tobacco prevention programs, and emphasize the need to create infrastructures to ensure sustainability
Specific Populations
Lois J. Loescher Stephen A. Rains Sandra S. Kramer Chelsie Akers Renee Moussa	865	A Systematic Review of Interventions to Enhance Healthy Lifestyle Behaviors in Adolescents Delivered via Mobile Phone Text Messaging The objective of the research is to systematically review healthy lifestyle interventions targeted to adolescents and delivered using text messaging (TM). Across studies, 16 (59.3%) of 27 included non-Caucasians. The gender was split for 22 (81.5%) of 27 studies. Thirteen studies were randomized controlled trials. There was heterogeneity among targeted conditions, rigor of methods, and intervention effects. Interventions for monitoring/adherence (n = 8) reported more positive results than those for health behavior change (n = 19). Studies that only included message delivered via TM (n = 14) reported more positive effects than studies integrating multiple intervention components. Interventions delivered using TM presented minimal challenges, but selection and performance bias were observed across studies. The conclusion of the research is that Interventions delivered using TM have the potential, under certain conditions, to improve healthy lifestyle behaviors in adolescents. However, the rigor of studies varies, and established theory and validated measures have been inconsistently incorporated.
Research Methods
Patricia A. Cavazos-Rehg Kidist Zewdie Melissa J. Krauss Shaina J. Sowles	880	Qualitative Research“No High Like a Brownie High”: A Content Analysis of Edible Marijuana TweetsThis paper investigates tweets about marijuana edibles for surveillance into the content of edibles-related tweets among individuals socially networking about this topic on Twitter. It uses a cross-sectional analysis of tweets containing edible marijuana-related keywords during one month, January 1-31, 2015. A random sample of 5,000 tweets containing edibles-related keywords was coded for sentiment (positive, negative, neutral) by crowdsourced workers. Tweets normalizing or promoting edibles use were further analyzed, and demographic characteristics of the Twitter handles sending these tweets were inferred. Of the 5,000 tweets, 4,166 (83%) were about marijuana edibles, and of those 75% (3134/4166) normalized or encouraged edibles use. Nearly half of the tweets normalizing edibles (48%, 1,509/3,134) mentioned wanting or planning to consume, currently consuming, or recently consuming edibles, and 12% (378/3,134) described the intense or long-lasting effects following use. Individuals whose tweets promoted/encouraged edibles use were more likely to be young (between 17-24 years old) and of a racial/ethnic minority (52% Black; 12% Hispanic), when compared to the Twitter average. Tweets that normalize edibles use have the potential to increase their popularity.
Jeff Niederdeppe Rosemary J. Avery Emily Elizabeth Namaste Miller	887	Qualitative ResearchTheoretical Foundations of Appeals Used in Alcohol-Abuse and Drunk-Driving Public Service Announcements in the United States, 1995-2010This study employed content analyses of 18,530,141 alcohol-abuse (AA) and drunk-driving (DD) public service announcements (PSAs) to identify the extent to which theoretical constructs drawn from well-established message effect communication theories were reflected in the content of alcohol-related PSAs airing in the United States over a 16-year period (January 1995 through December 2010). The authors showed patterns using basic descriptive statistics. The results indicated that although both classes of alcohol-related PSAs used strategies that were consistent with major message effect theories, their specific theoretical orientations differed dramatically. AA PSAs were generally consistent with constructs emphasized by the Extended Parallel Process Model, whereas DD PSAs were more likely to use normative strategies emphasized by the Focus Theory of Narrative Conduct or source credibility appeals central to the Elaboration Likelihood Model. Based on these findings, the authors concluded that after identifying message content, future research should use deductive approaches to determine if volume and message content of alcohol-control PSAs have an impact on measures of alcohol consumption and/or measures of drunk driving, such as fatalities or DWI/DUI arrests.
Priya Batra Carol M. Mangione Eric Cheng W. Neil Steers Tina A. Nguyen Douglas Bell Alice A. Kuo Kimberly D. Gregory	897	Quantitative ResearchA Cluster Randomized Controlled Trial of the MyFamilyPlan Online Preconception Health Education ToolThis paper evaluates whether exposure to MyFamilyPlan – a web-based preconception health education module – changes the proportion of women discussing reproductive health with providers at well-woman visits. A cluster randomized controlled trial was conducted with 130 participants at an urban academic medical center in California. The 130 per arm were distributed among 34 clusters (physicians) required to detect a 20% change in the primary outcome. The women included were 18-45 years old, English-speaking, non-pregnant, able to access the Internet, and had an upcoming well-woman visit. Email and phone recruitment was between September 2015 and May 2016. The intervention participants completed the MyFamilyPlan module online 7-10 days before a scheduled well-woman visit; control participants reviewed standard online preconception health education materials. The primary outcome was self-reported discussion of reproductive health with the physician at the well-woman visit. Secondary outcomes were folic acid use, contraceptive method initiation/change, and self-efficacy score. Multilevel multivariate logistic regression was used. After adjusting for covariates and cluster, exposure to MyFamilyPlan was the only variable significantly associated with an increase in the proportion of women discussing reproductive health with providers (odds ratio 1.97, 95% confidence interval 1.22-3.19). Pre-specified secondary outcomes were unaffected.
Ashlee N. Sawyer Melissa A. Kwitowski Eric G. Benotsch	906	Quantitative ResearchAre You Covered? Associations Between Patient Protection and Affordable Care Act Knowledge and Preventive Reproductive Service UseSexual and reproductive health conditions (eg, infections, cancers) represent public health concerns for American women. The present study examined how knowledge of the Patient Protection and Affordable Care Act (PPACA) relates to receipt of preventive reproductive health services among women. Online questionnaires were completed via Amazon Mechanical Turk (MTurk), a crowdsourcing website where individuals complete web-based tasks for compensation. Cisgendered women aged 18 to 44 years (N = 1083) from across the United States completed the questionnaire, which assessed demographics, insurance status, preventive service use, and knowledge of PPACA provisions. Chi-squares showed that receipt of well-woman, pelvic, and breast examinations, as well as pap smears, was related to insurance coverage, with those not having coverage at all during the previous year having significantly lower rates of use. Hierarchical logistic regressions determined the independent relationship between PPACA knowledge and use of health services after controlling for demographic factors and insurance status. Knowledge of PPACA provisions was associated with receiving well-woman, pelvic, and breast examinations, HPV vaccination, and STI testings. Expanding knowledge about health-care legislation may be beneficial in increasing preventive reproductive health service use among women.
Ilya Rahkovsky Tobenna Anekwe Christian Gregory	916	Quantitative ResearchChronic Disease, Prescription Medications, and Food PurchasesThis study used Information Resources, Inc (IRI)’s national consumer panel data to identify the effect of prescription medication use on the healthfulness of purchases. To do so, the authors measured the effect of a diagnosis of chronic disease and subsequent pharmacological treatment on the dietary quality of food purchases by estimating the effect of prescription drug utilization on food purchases for the following chronic diseases: type 2 diabetes, high cholesterol, heart disease, and obesity. Dietary quality was measured as purchases of (1) food groups (ie, fruit, vegetables, and sweets) and (2) nutrients (ie, saturated fat, fiber, sodium, sugar, and total calories). Because there could be geographic effects in people’s buying habits and responses to illness, the authors employed mixed effects and separated out models by race, gender, and educational status. The results indicated that there were no strong effects of either diagnosis or pharmacological treatment of diet-related disease on food purchases.
Bobbi Jo H. Yarborough Ginger C. Hanson Nancy A. Perrin Scott P. Stumbo Carla A. Green	925	Quantitative ResearchColorectal Cancer Screening Completion Among Individuals With and Without Mental Illnesses: A Comparison of 2 Screening MethodsA secondary analysis of data from a general population cohort study (N=92,445) that assessed effects of two types of colorectal (CRC) screening test kits on CRC screening completion among members of an integrated health system who were overdue for CRC screening. Subjects were categorized by mental illness diagnosis, age, at average risk for CRC, and at least 366 days past their last guiac fecal occult blood testing ( gFOBT) test with no evidence of other CRC screening. Cox proportional hazard model was used to analyze data. Results showed that fecal immunochemical testing (FIT) reduced CRC screening barriers for all groups. Also, compared to people without mental illness diagnoses those with psychotic disorders were equally likely to screen using FIT (HR=.95, p=.679) and those with depression were more likely (HR=1.17, p=.006). The authors concluded that FIT can improve CRC screening rates among people with mental illnesses. The observational nature of this study makes it difficult to rule out effects of secular changes.
Jessica Fishman Patricia Greenberg Margy Barbieri Bagga David Casarett Kathleen Propert	932	Quantitative ResearchComparing Strategies for Health Information Dissemination: Messengers that Can Help or HinderThe current manuscript tested the effects of different messengers on the dissemination of health information. Patients with breast cancer being seen at 1 clinic were offered copies of up to 12 different news articles and were told they could select any news to take home and read. Of 122 patients approached, 89 agreed to participate. A research assistant described each article as pertaining to 1 of 3 different health topics and as written by religious figures, doctors, celebrity patients, or ordinary patients. The 12 articles focused on 1 of 3 different health topics: (1) surviving cancer, (2) coping with a terminal illness, or (3) health-care reform controversies. There was little variation in the degree to which topic areas resulted in selection, with at least 79% of patients selecting at least 1 news article on each health topic and, more generally, selecting at least 5 of 12 available news articles. The likelihood that a news article was selected did depend on the messenger. News articles using celebrity and religious messengers were likely to be rejected. In contrast, news articles that used ordinary patients or doctors as the messenger were likely to be selected—nearly all participants selected at least 1 of these news stories. The authors’ conclude that participants had high levels of need for information but that they most frequently sought such information from individuals who might be most knowledgeable about their circumstances.
Moon J. Lee Hannah Kang	939	Quantitative ResearchDesigning Skin Cancer Prevention Messages: Should We Emphasize Gains or Losses? Message Framing, Risk Type, and Prior ExperienceThis study used 2 experiments with a 2 (message framing: gain vs loss) × 2 (risk type: health vs appearance risk) factorial design to test whether message framing (ie gain vs loss) and risk type (ie, health vs appearance risk) in skin cancer prevention messages interact with one’s prior experience. This study included 397 participants (236 for experiment 1 and 161 for experiment 2). The authors found 3-way interactions among message framing, risk type, and prior experience. When the intent of the message was to encourage sunscreen use, the effects of message framing and risk type were shown to be the exact opposite directions from when the intent was to discourage indoor/outdoor tanning. Based on these results, the authors concluded that in order to discourage tanning among those with prior experience, messages emphasizing losses in terms of one’s health will work better. Additionally, for those with no prior experience, messages emphasizing potential appearance losses will work better for discouraging tanning while messages emphasizing gains like improving appearance will do a better job in encouraging sunscreen use.
Meghan K. Edwards Simon Rosenbaum Paul D. Loprinzi	949	Quantitative ResearchDifferential Experimental Effects of a Short-Bout of Walking, Meditation, or Combination of Walking and Meditation on State Anxiety Among Young AdultsThis article examines single bouts of aerobic exercise and meditation as related to anxiety states. The article examined the effects of a single, short bout of aerobic exercise or meditation, as well as exercise and meditation combined on state anxiety among young adults. It used a randomized controlled trial. Set in a university with 110 participants with a mean age = 21.4 year. These people were randomly assigned to walk, meditate, walk then meditate, meditate then walk, or to sit (inactive control). All walking and meditation bouts were 10 minutes in duration. Participants’ state anxiety was monitored before and after the intervention using the State Trait Anxiety Inventory questionnaire. Significant group × time interaction effects were observed (P = .01). Post hoc paired t tests revealed that state anxiety significantly decreased from baseline to postintervention in the meditation (P = .002), meditation then walk (P = .002), and walk then meditation (P = .03) groups but not the walk (P = .75) or control (P = .45) groups. Meditation (vs a brisk walk) may be a preferred method of attenuating anxiety symptomology.
Marilyn B. Wolff Jennifer L. Gay Mark G. Wilson David M. DeJoy Robert J. Vandenberg	959	Quantitative ResearchDoes Organizational and Co-Worker Support Moderate Diabetes Risk and Job Stress Among Employees?This study examined the moderating role of perceived organizational and coworker support on the relationship between job stress and type 2 diabetes risk among employees using a cross-sectional survey data on 1,595 employees in 21 stores from four operational districts within the southern United States region. A multilevel multiple regression was conducted to test the interaction effect of support on the association between job stress and diabetes risk. The results indicated that while organizational support was positively associated with coworker support, both were negatively associated with job stress. Thus, organizational support, but not coworker support, moderated the relationship of job stress with diabetes risk. Participants with greater perceived organizational support had lower diabetes risk scores compared to those with lower perceived organizational support. Based on these findings, the authors concluded that organizational support may be a key factor for workplaces to reduce stress and diabetes risk. Further testing of organizations’ supportive role on employee health may be helpful in developing future workplace programs.
Jeremy W. Bray Jesse Michael Hinde David J. Kaiser Michael J. Mills Georgia T. Karuntzos Katie R. Genadek Erin L. Kelly Ellen E. Kossek David A. Hurtado	963	Quantitative ResearchEffects of a Flexibility/Support Intervention on Work Performance: Evidence from the Work, Family, & Health NetworkThis study used a group-randomized multisite controlled experimental design with follow-up to estimate the effects of a workplace initiative to reduce work–family conflict on employee performance in an information technology firm. The intervention, Start Transform Achieve Results was designed to enhance employees’ control over their work time, to increase supervisors’ support for this change, and to increase employees’ and supervisors’ focus on results. The participants included employees randomized to the intervention (n = 348) and control condition (n = 345). The authors estimated the effect of the intervention on 9 self-reported employee performance measures using a difference-in-differences approach with generalized linear mixed models. The authors found little evidence that an intervention targeting work–family conflict affected employee performance. The only significant effect of the intervention was an approximately 1-hour reduction in expected work hours. The intervention effect was marginally insignificant at 6 months and marginally significant at 12 and 18 months. The authors concluded that when coupled with the other positive wellness and firm outcomes, this intervention may be useful for improving employee perceptions of increased access to personal time or personal wellness without sacrificing performance.
Alain K. Koyama Vishal Bali Irina Yermilov Antonio P. Legorreta	971	Quantitative ResearchIdentification of Undiagnosed Hyperlipidemia: Do Worksite Screening Programs Work?The manuscript uses a nonexperimental longitudinal approach in an effort to evaluate the utility of a workplace-screening program to determine its utility for assessing the rate of hyperlipidemia in previously undiagnosed individuals. It further sought to understand the association between workplace hyperlipidemia screening and use of medical care during follow-up as well as changes in lipid profile among individuals with hyperlipidemia at screening. Participants included 18 993 individuals from 39 self-insured employers in the United States. A total of 1872 (9.9%) participants had hyperlipidemia at screening. Among all individuals, a significantly greater rate of new hyperlipidemia diagnoses was observed during the first month after screening versus the 3 months before screening. Of the 987 individuals followed up 1 year later, significant improvements in total cholesterol and low-density lipoprotein (LDL) levels were observed. The significance of the manuscript lies in demonstrating the relatively high levels of undiagnosed hyperlipidemia and the utility of workplace health screenings in an insured population for yielding increases in physician visits and 1 year improvements in total cholesterol and LDL levels among individuals who screened positive for hyperlipidemia.
Michelle I. Jongenelis Simone Pettigrew Melanie Wakefield Terry Slevin Iain S. Pratt Tanya Chikritzhs Wenbin Liang	979	Quantitative ResearchInvestigating single- versus multiple-source approaches to communicating health messages via an online simulationData from the third stage of a multi-stage study was analyzed with the purpose of comparing outcomes from exposure to warning messages relating to the alcohol-cancer link delivered by a single source versus multiple sources. Two thousand and eighty-seven (n=2087) Australian drinkers were randomly assigned to either single-source or multiple-source conditions where they were exposed to warning statements. Measures included assessment of believability, convincingness, and personal relevance, and behavioral intentions. Hierarchical linear regression was conducted to analyze data. Results showed source condition was significantly associated with all three attitudinal variables (p<.001) and those in the multiple-source condition reported reduced intentions to consume five or more standard drinks in a single setting. The authors concluded that multiple-source messages about cancer risks associated with alcohol are significantly more believable and convincing. A key limitation is that the online simulation used in the multiple-source conditions only partially reflects real life making generalizability difficult.
Sandra McGinnis Eunju Lee Kristen Kirkland Claudia Miranda-Julian Rose Greene	989	Quantitative ResearchLet's Talk About Breastfeeding: The Importance of Delivering a Message in a Home Visiting ProgramThis study sought to examine the potential impact of paraprofessional home visitors in promoting breastfeeding initiation and continuation among a high risk population. Participants included 3,521 high risk pregnat mothers from a statewide home visting program that includes a focus on educating high risk mothers regarding the benefits of breastfeeding, and supporting their efforts during prenatal and postnatal periods. Data was drawn from home-visitor reports regarding aspects of breastfeeding. Breastfeeding initiation was increased by 1.5% for each one-point increase in the percentage of prenatal home visits that included breastfeeding discussions. Breastfeeding continuation during the first six months also increased with the percentage of earlier home visits that included breastfeeding discussions. Additionally the likelihood of breastfeeding at 6 months increases by 11% with an additional visit in the third month. The authors conclude that delivering a breastfeeding message during regular home visits is important for increasing breastfeeding rates.
Spencer Greenberg Danielle Brand Aislinn Pluta Douglas Moore Kirsten DeConti	997	Quantitative ResearchNudging Resisters Towards Change: Self-Persuasion Interventions for Reducing Attitude CertaintySix hundred seventeen (n = 617) adults were recruited to participate in a randomized controlled experiment designed to identify self-persuasion protocols that could be effective in breaking patient resistance. The 2 experimental interventions prompted participants for self-referenced pro- and counterattitudinal thoughts to elicit attitude-related thought (ART) and subsequent doubt about the attitude. Changes in attitude certainty were measured by subjects pre- and post-ratio scale ratings, and ART was measured by the number of words participants used to respond to the interventions. Results showed that ART was significantly correlated with attitude certainty change in intervention 1, r(158) = .17, t = 4.28, P = .02, but not intervention 2, r(161) = .002, t = −.03, P = .98. The authors concluded that it may be worthwhile to let patients elaborate on their personal reasons for initially forming an unhealthy attitude to increase doubt about the strongly held attitude. Since correlations between ART and attitude certainty decreases were small, continued investigations of self-persuasion prompts is needed.
GracieLee M. Weaver Brandon N. Mendenhall David Hunnicutt Ryan Picarella Brittanie Leffelman Michael Perko Daniel L. Bibeau	1010	Quantitative ResearchPerformance Against WELCOA’s Worksite Health Promotion Benchmarks Across Years Among Selected US OrganizationsThis study analyzed data from a convenience sample of 4,643 U.S. organizations who completed the checklist from 2008–2015 to describe the performance of organizations’ worksite health promotion (WHP) activities against the benchmarking criteria included in the Well Workplace Checklist (WWC). The results indicated that the majority of the organizations represented each year were multi-site, multi-shift, and medium to large-sized companies mostly in the services industry. Despite yearly changes in participating organizations, results across the WELCOA 7 Benchmark scores were consistent year to year. Across all years, benchmarks that organizations performed lowest on were senior-level support, data collection, and programming (mean score, 40–47); wellness teams and supportive environments were the highest scoring benchmarks (mean score, 52–58). Based on these results, the authors concluded that in an era marked with economic swings and health care reform, it appears that organizations are staying consistent in their performance across these benchmarks. The WWC could be useful for organizations, practitioners, and researchers in assessing quality of WHP programs.
Bernadette Mazurek Melnyk Laura A. Szalacha Megan Amaya	1021	Quantitative ResearchPsychometric Properties of the Perceived Wellness Culture and Environment Support ScaleThis study reports on the psychometric properties of the 110- item Perceived Wellness Culture and Environment Support Scale (PWCESS) and its relationship to employee healthy lifestyle beliefs and behaviors. Faculty and staff (N=3,959) at a large public university in the U.S. mid-west completed the PWCESS along with healthy lifestyle beliefs and behaviors scales. Data were randomly split into two halves to explore the PWCESS’ validity and reliability and the second half to confirm findings. Results show that principal components analysis indicated a unidimensional construct. The PWCESS was positively related to healthy lifestyle beliefs and behaviors supporting the scale’s validity. Confirmatory factor analysis supported confirmed the unidimensional construct (Cronbach’s α = .92). This research shows strong evidence in support of the validity and reliability of the PWCESS. Future use of this scale could guide workplace intervention strategies to improve organizational wellness culture and employee health outcomes.
Swati Mukerjee Arun Venugopal	1028	Quantitative ResearchReligiosity and Health Through the Decades: Is There a Gender Difference?This paper presents an empirical examination of the long term association, disaggregated by gender, between religiosity and self-rated health with reference to demographic shifts in labor force participation, education, and income. It uses General Social Survey data from the United States from 1974 to 2012 with 23,353 respondents. Measures used include self-assessed health; two key religiosity variables (attendance and intensity of belief), income, labor market variables, education, standard demographic variables, household size, region and time dummies. Probit estimation is conducted for the aggregate sample and by gender as well as by decades to examine possible gender differentials changes over time. Attendance has declined overall with a much greater decline for women. The overall positive association between religiosity and health masks considerable heterogeneity across gender and time. Results are higher and more stable for males. Increased education, income and labor force participation can explain only part of this association. Education is the strongest mediator.
David B. Buller Barbara J. Walkosz Mary Klein Buller Allan Wallis Peter A. Andersen Michael D. Scott Rachel Eye Xia Liu Gary Cutter	1042	Quantitative ResearchResults of a Randomized Trial on an Intervention Promoting Adoption of Occupational Sun Protection PoliciesThis study used a randomized pretest–posttest controlled design with 2-year follow-up to evaluate an intervention promoting adoption of occupational sun protection policy by employers in local government organizations in Colorado who had outdoor workers in public works, public safety, and/or parks and recreation. Participants included 98 local government organizations (n = 51 municipalities, 10 counties, and 37 special districts). The organizations were randomly assigned to receive a policy and education intervention comprised of personal contacts and theory-based training and materials or to an attention control group. Policy scores were analyzed with logistic and Poisson regression models using imputation. The results indicated that at posttest, more organizations in the intervention group had a sun protection policy than in the control group (odds ratio [OR] = 4.91, P < .05; intent to treat: OR = 5.95, P < .05) and policies were more extensive (χ2 = 31.29, P < .01; intent to treat: χ2 = 73.79, P < .01) and stronger (χ2 = 24.50, P < .01; intent to treat: χ2 = 51.95, P < .01). Policy adoption was higher when number of contacts and trainings increased (P < .05). Based on these results, the authors concluded that the intervention had a large effect on adoption of formal sun protection policies, perhaps because of its fit with legal requirements to maintain safe workplaces.
Jennifer Hoert Ann M. Herd Marion Hambrick	1054	Quantitative ResearchThe Role of Leadership Support for Health Promotion In Employee Wellness Program Participation, Perceived Job Stress, and Health BehaviorsSix hundred eighteen employees from 4 organizations offering wellness programs participated in this study exploring the relationship between leadership support for health promotion and employee wellness participation, perceived job stress, and health behaviors. Measures included demographic questions, the Leading by Example survey, self-reported participation in wellness activities, job stress, and health behaviors. Descriptive statistics, correlation, and regression analyses were used to analyze data. Results showed the correlation between employees perception of leadership support for health promotion and (1) wellness program participation was statistically significant (r = .36, P = .001), (2) reported job stress was significantly negative (r = −.33, P = .001), and (3) reported health behaviors were significantly positive (r = .34, P = .001). The authors concluded that higher levels of leadership support for health promotion can result in higher levels of participation in wellness programs, lower levels of job stress, and higher levels of positive health behaviors. Generalizability is limited because of a lack of objective measures.
Laurie A. Cluff Jason E. Lang Jennifer R. Rineer Nkenge H. Jones-Jack Karen M. Strazza	1062	Quantitative ResearchTraining Employers to Implement Health Promotion Programs: Results from the CDC Work@Health® ProgramCDC initiated the Work@Health® Program to teach employers how to improve worker health using evidence-based strategies. Program goals included: 1) determining the best way(s) to deliver employer training; 2) increasing employers’ knowledge of workplace health promotion (WHP); and 3) increasing the number of evidence-based WHP interventions at employers’ worksites. This study examines the effectiveness of a program designed to train employers how to implement WHP programs. Training was via one of three formats Hands-on, Online, or Blended. 206 individual participants from 173 employers of all sizes were included. An eight-module training curriculum to guide participants through building an evidence-based WHP program, followed by 6-10 months of technical assistance, was studied using the CDC Worksite Health ScoreCard, and knowledge, attitudes and behavior survey. Descriptive statistics, paired t-tests, and mixed linear models were used. Participants’ post-training mean knowledge scores were significantly greater than the pre-training scores (61.1 vs. 53.2, p < .001). A year after training, employers had significantly increased the number of evidence-based interventions in place (47.7 vs. 35.5, p < .001). Employers’ improvements did not significantly differ among the three training delivery formats.
Serena Tonstad Patti Herring Jerry Lee Jennifer Duxbury Johnson	1070	Quantitative ResearchTwo Physical Activity Measures: Paffenbarger Physical Activity Questionnaire Versus Aerobics Center Longitudinal Study as Predictors of Adult-Onset Type 2 Diabetes in a Follow-Up StudyThis article compares 2 self-report methods of measuring weekly minutes of physical activity based on the Aerobics Center Longitudinal Study questionnaire (ACLS) and question 6 of the Paffenbarger Physical Activity Questionnaire (PPAQ) to determine the better predictor of adult-onset type II diabetes mellitus (T2DM). It is an observational, prospective study using survey data from the Adventist Health Study-2 (AHS-2) and the Psychosocial Manifestations of Religion Sub-Study (PsyMRS). There were 9873 male and female participants aged 23 to 106 years (mean, 63 years). Three hundred eighty participants reported adult-onset T2DM at follow-up. Incident diabetes was defined as participants who reported receiving treatment for adult-onset T2DM in the last 12 months in the PsyMRS and not at baseline. Multivariate logistic regression analyses controlled for age, gender, ethnicity, education, BMI, diet, and sedentary activity. Each exposure variable was compared to nonexercisers. The PPAQ (odds ratio [OR]: 0.998, 95% CI: 0.997-1.000) and the ACLS (OR: 0.999, 95% CI 0.998-1.001) exhibited similar likelihood of predicting incident adult-onset T2DM in a healthy, mixed gender population when controlling for several confounders.
Literature Review
Pauline Lubens Tim A. Bruckner	1078	A Review of Military Health Research Using a Social-Ecological Framework Web of Science, PubMed, and SCOPUS were used to search for articles focused on somatic and psychological sequelae of combat employed US military personnel. Excluded from the review were literature that did not focus exclusively on US military personnel, book, chapters, other systematic reviews, and theoretical papers. The full text of an article meeting inclusion criteria was read, identifying whether the study focused on somatic, behavioral, psychological outcomes, or comorbidities. Articles within each of the socioecological tiers were then classified according to health outcomes and predictors. Results showed that of the 352 peer-reviewed papers, 84% focused on war’s sequelae on the index military personnel and 75% focused on mental or behavioral outcomes. The authors concluded that relatively little is known about how family and community health respond to the return of personnel for combat deployment. A key limitation is that the taxonomy used was limited to direct effects of war on health, not indirect pathways.
Applied Research Brief
Stefan B. Gingerich Erin L. D. Seaverson David R. Anderson	1091	Association Between Sleep and Productivity Loss Among 598 676 Employees From Multiple Industries This study used a cross-sectional health risk assessment data on 598 676 employed adults from employer-sponsored health and well-being programs from multiple industries to examine the relationship between sleep habits and employee productivity. Bivariate analyses were used to assess the relationships between self-reported hours of sleep and self-reported fatigue and mean and median absence and presenteeism. The results indicated that the relationship between sleep hours and both measures of productivity was U-shaped, with the least productivity loss among employees who reported 8 hours of sleep. More daytime fatigue correlated with more absence and presenteeism. Median absence and presenteeism was consistently lower than mean absence and presenteeism, respectively, for the various hours of sleep and levels of fatigue. Based on these results, the authors concluded that organizations looking to expand the value of their investment in employee health and well-being should consider addressing the employee sleep habits that may be negatively impacting productivity.
Cherisse L. Seaton Nikolai Holm Joan L. Bottorff Margaret Jones-Bricker Sally Errey Cristina M. Caperchione Sonia Lamont Steven T. Johnson Theresa Healy	1095	Factors That Impact the Success of Interorganizational Health Promotion Collaborations: A Scoping Review A systematic search of the literature following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) was conducted to explore recurring themes and develop an overview of the type, extent, and quality of research on factors impacting the success of interorganizational health promotion collaborations. MEDLINE, CINAHL, ScienceDirect, PsychINFO, and Academic Search Complete were searched. Inclusion criteria were articles published in English, involved health promotion, involved at least 2 organizations in a partnership, examined the collaboration process and presented evidence that collaborations were underway, resolved, or complete. Twenty-five articles were identified for analysis, and NVIVO10 was used for coding. Results showed the key factors contributing to collaboration effectiveness were shared vision, leadership, organizational commitment, member characteristics, available resources, clear roles/responsibilities, trust/clear communication, and engagement of the target populations. The authors concluded that the findings were consistent with previous reviews. Given the qualitative nature of the studies reviewed, it is unclear the extent to which factors identified contribute to collaborative success.
Substance Abuse/Youth Systematic Review
Kelly Dickson G. J. Melendez-Torres Adam Fletcher Kate Hinds James Thomas Claire Stansfield Simon Murphy Rona Campbell Chris Bonell	1110	How Do Contextual Factors Influence Implementation and Receipt of Positive Youth Development Programs Addressing Substance Use and Violence? A Qualitative Meta-Synthesis of Process Evaluations The objective of the research is positive youth development (PYD) often aims to prevent tobacco, alcohol, and drugs use and violence. Wesystematically reviewed PYD interventions, synthesizing process, and outcomes evidence. Synthesis of outcomes, published elsewhere, found no overall evidence of reducing substance use or violence but notable variability of fidelity. Our synthesis of process evaluations examined how implementation varied and was influenced by context. We identified 12 reports. Community engagement enhanced program appeal. Collaboration with other agencies could broaden the activities offered. Calm but authoritative staff increased acceptability. Staff continuity underpinned diverse activities and durable relationships. Empowering participants were sometimes in tension with requiring them to engage in diverse activities. Conclusion: Our systematic review identified factors that might help improve the fidelity and acceptability of PYD interventions. Addressing these might enable PYD to fulfill its potential as a means of promoting health.
Cother Hajat Adriana Selwyn Mark Harris Derek Yach	1122	Preventive Interventions for the Second Half of Life: A Systematic Review In this systematic review, the authors searched PubMed, Cochrane database, and Google Scholar and explicit outreach to experts in the field to inform the development of age-specific prevention guidelines for adults aged 50 and older. They included meta-analyses, intervention-based, and prospective cohort studies that reported all-cause mortality, disease-specific mortality, or morbidity in adults. Data extraction was undertaken in 2015 using search terms of a combination of <risk factor> and “intervention,” “mortality,” “reduction,” “improvement,” “death,” and “morbidity.” Interventions were categorized according to the Center for Evidence Based Medicine Level of Evidence framework. Based on the results, the authors concluded that clear recommendations have been made according to the existing evidence base, but further research investment is needed to fill many existing gaps. Further, personalized approaches to healthy aging complemented by population-wide approaches and broader cross-sector partnerships will help to ensure greater longevity is an opportunity, rather than a burden, for society.
Sara Champlin Gwendolyn Nisbett	1140	Promoting Mental Health Resource Use on Campus by “Trying Something New” This study examined a persuasive health promotion campaign that aligns with the qualities of trying something new for the first time. Participants viewed an online informational message, information message plus first-time experience banner, or 1 of 4 full campaigns, each depicting a student story and photo about a first-time experience. In comparison to information-only messages, framing mental health help seeking as a first-time experience was linked with increased appeal, support, and engagement. The full campaign garnered the highest affect and engagement scores. A behavior that is linked to a familiar form of interpersonal help seeking, like personal training, can create receptivity to the stigmatized issue of mental health help seeking.
Jessica Grossmeier	TAHP-1145	Editor’s Desk: The Sustainability Issue: This issue discusses opportunities to better align workplace health and well-being with corporate sustainability efforts.
Eileen McNeely	TAHP-1146	Following Footprints: What Corporate Health Can Learn from Environmental Sustainability: Dr. Eileen McNeely describes the drivers of the corporate sustainability movement and contrasts its function, operation and effectiveness within organizations with that of corporate health promotion initiatives, closing with practical lessons for the health promotion field.
Melinda Vertin Jennifer Bruno	TAHP-1150	Employee Health and Well-being as a Key Sustainability Strategy – A Johnson & Johnson Case Study: Melinda Vertin, global head of Health Services Planning, Governance and Strategy, and Jennifer Bruno, vice president of Global Health Services, describe the evolution of Johnson & Johnson’s more than 100-year old legacy of investing in employee health and well-being as a corporate business strategy. They share the emergence of corporate sustainability efforts at the company and describe how these two areas have become inextricably integrated from positioning, to programs, to metrics for success.
Giselle Sebag	TAHP-1153	Measurement Tools Identify Practices to Support Employee Health and Corporate Sustainability Goals: Giselle Sebag discusses several tools available to assess the influence of the environment on population health. She also explains how the tools work in complementary ways to identify actionable strategies that employers, real estate developers, urban planners, and health promotion professionals can implement to improve workforce and community well-being.
Jessica Grossmeier	TAHP-1155	Closing Commentary: How Can Workplace Health Promotion Practitioners Work More Closely with Corporate Sustainability Professionals? I close this issue by offering some specific steps that health promotion professionals can take to better understand how their efforts align with corporate sustainability efforts.