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Paul E. Terry	337	Editorial Untangling truth, facts and opinions: Why simple tenets of science have become uneasy TIME magazine selected “The Guardians and the War on Truth” as their 2018 “Person of the Year.” Journalists everywhere urge us to remember writer Jamal Khashoggi’s murder as a harsh testament to the risks of speaking truth to power. But Khashoggi was a perceived threat to a totalitarian government, surely truth is more respected in America, right? Suggest that to the Columbia University School of Law who built a “silencing science tracker” to document “government attempts to restrict or prohibit scientific research, education or discussion.” In this editorial, I argue that researchers who publish their scientific findings in peer-reviewed journals must also embrace the role of “guardians” against the growing assaults on science. In an era where the majority of Americans get their health information via social media, our challenge as scientists is to transcend our basic calling as truth seekers and truth tellers. Closely aligned with this truth guardian’s work in health promotion is the True Health Initiative, a cohort of renowned scientists dedicated to offering “clarity over confusion”; they “work to spread the fundamental evidence and consensus-based truths about lifestyle as medicine.” When purveyors of falsehoods have such unfettered channels as they do today, my hope for scientists and for this journal is that we grow our ambitions relating to curating facts, authoritative dissemination, and persuasive communications alongside our usual work of learning and teaching.
the Science of lifestyle change
Désirée Schliemann Michelle McKinley Jayne V. Woodside	342	Quantitative Research The impact of a policy-based, multicomponent nutrition intervention on young adult employee’s diet and health outcomes This study evaluated the effect of a policy-based, multicomponent workplace diet intervention on young adult employees’ diet and health. A multicomponent diet intervention was tested that included a ban of unhealthy foods, free fruit, education, individual advice, and further support. Diet-, health- and work-related measures were assessed quantitatively, and the campaign was evaluated quantitatively (via questionnaire) and qualitatively (via semi-structured interviews). Study findings indicate that males reduced their sugar intake on working days (−8.7% of total energy standard deviation [SD]: 20.1; P value <.01). Systolic blood pressure reduced in males and females (−3.3 SD: 9.9; P value <.05 and −8.0 SD: 7.7; P value <.001, respectively). In total, 85.2% of staff strongly agreed/agreed they appreciated the healthy eating ethos. This was supported by the qualitative analysis which furthermore suggested that the education, team support, individual advice, and free fruit were beneficial. Study findings support the conclusion that influencing workplace policies and offering additional dietary support can lead to meaningful changes in employees’ diet and health and may change workplace culture.
Jerome F. Walker Paul D. Loprinzi	358	Quantitative Research Association of BMI changes between adolescence and young adulthood with smoking cessation This study used a longitudinal, observational design to examine whether increasing body mass index during the early years of smoking influences quitting by young adulthood. The authors analyzed data from National Longitudinal Study of Adolescent and Adult Health (Add Health) 1994-2008 which included 949 adolescent smokers (12-19 years) followed into young adulthood (20-32 years) through 4 waves of in-home interviews using binary logistic regression. The results indicated that longitudinal changes in BMI trajectory and gender interact to influence young adult smoking status. Women having normal/overweight and normal/obese BMI trajectories were less likely to quit smoking than men. Odds that young adults having some college or post-high school education quit smoking were greater than those with high school education or less. Based on these results, the authors suggested that providing direct information regarding anticipated weight changes after quitting should be indicated in smoking cessation intervention, in addition to strategies to mitigate postcessation weight gain. Faced with weight gain, younger smokers, particularly women, may be more resistant to quitting smoking.
Zinat Jourabchi Sazlina Sharif Munn Sann Lye Asefzadeh Saeed Geok Lin Khor Syed Tajuddin Syed Hassan	363	Quantitative Research Association between preconception care and birth outcomes Prenatal care (care after conception till delivery) has been the cornerstone for improving birth outcomes to reduce maternal and neonatal morbidity and mortality, but despite efforts to improve prenatal care, the proportion of preterm births continues to rise and significant disparities between developed and developing countries in birth outcomes, maternal morbidity, and mortality persist. Starting prenatal care late in the first trimester may contribute to adverse birth outcomes as the opportunity to screen for possible risk factors would have been delayed. This delay could lead to less opportunity to prevent serious maternal and neonatal health problems. The importance of maternal health before pregnancy (preconception care) has been increasingly recognized and optimizing a woman’s health and knowledge before pregnancy may eliminate or reduce the risk of adverse birth outcomes. This study compared an integrated maternal health care (MHC) program (with preconception care) with a standard MHC program (without preconception care) to evaluate the association between preconception care and risk of adverse birth outcomes in MHC clinics in Alvand and Qazvin cities in Qazvin Province, Iran. The birth outcomes measured included low birth weight, preterm birth, maternal and neonatal complications, and mode of delivery (normal vaginal delivery and cesarean delivery). The findings of the present study revealed that preconception care was associated with reduced risk of preterm birth, low birth weight, and maternal and neonatal complications.
Eric M. VanEpps Andrea B. Troxel Elizabeth Villamil Kathryn A. Saulsgiver Jingsan Zhu Jo-Yu Chin Jacqueline Matson Joseph Anarella Patrick Roohan Foster Gesten Kevin G. Volpp	372	Quantitative Research Effect of Process- and Outcome-Based Financial Incentives on Weight Loss among Prediabetic New York Medicaid Patients: A Randomized Clinical Trial The goal of this work was to examine the influence of different financial incentives in promoting weight loss among prediabetic Medicaid recipients. The sample included approximately 700 individuals, aged 18 to 64, separated into a 4-group, multicenter, randomized clinical trial. All participants were Medicaid managed care enrollees who had been diagnosed as prediabetic or high risk for diabetes (N = 703). The intervention extended across 16 weeks and included the following groups: (1) control (no incentives), (2) process incentives for attending weekly Diabetes Prevention Program sessions, (3) outcome incentives for achieving weekly weight loss goals, and (4) combined process and outcome incentives. The primary outcome measures focused on weight loss and achievement of weight loss goals. Secondarily, the study considered the proportion of participants that completed the program. No significant differences were found between the groups, but some differences in the group rates of completion were found. The authors note that the failure to find incentive effects, which have been found in prior studies of health behavior, may have resulted, at least in part because there were delays in providing payments in the current study. Incentive magnitude was also viewed as potentially an important limitation as the incentives that were offered were relatively modest.
Katherine A. Treiman Stephanie Teixeria Poit Lei Li Miriam Tardif Douglin Jean Gaines Thomas Hoerger	381	Quantitative Research Participant Satisfaction and Perceptions about Program Impact in the Medicaid Incentives for Prevention of Chronic Disease Pilot Program Effective chronic disease prevention programs are needed for the Medicaid population, which has high rates of chronic disease and is more likely to smoke, be physically inactive, and be overweight or obese. Incentive-based programs have the potential to encourage healthy lifestyle behaviors. The Centers for Medicaid and Medicare Services Medicaid Incentives for Prevention of Chronic Disease (MIPCD) Pilot Program, implemented in 10 states, used incentives to promote health behaviors, including smoking cessation, weight management, and physical activity. We conducted a participant survey to assess satisfaction with and impact of the program. Two-thirds of participants were very satisfied with the program and 76% strongly agreed that the program encouraged healthy lifestyle changes. Drivers of both program satisfaction and impact included program accessibility, communication with and helpfulness of program staff, and incentives in the form preferred by participants. Money-valued incentives (e.g., gift cards) performed better than points redeemable for rewards.
Adilson Marques Miguel Peralta João Martins Vânia Loureiro Paola Cortés Almanzar Margarida Gaspar de Matos	391	Quantitative Research Few European adults are living a healthy lifestyle Only 5.8% of the adults reported a healthy lifestyle. The prevalence of having a healthy lifestyle varied among European countries. The lowest rates were in Hungary (1.3%) and Czech Republic (1.9%). The highest rates were in United Kingdom (8.6%) and Finland (9.2%). Those who presented a higher likelihood of having a healthy lifestyle were: Middle age (OR = 1.20), older people (OR = 1.34), having higher household income (OR = 1.33), being a student (OR = 1.38) and retired (OR = 1.31). Those less likely to have a healthy lifestyle were: lived without a partner (OR = 0.82), unemployed (OR = 0.73), and lived in rural areas (OR = 0.86). Few European adults were practicing five healthy behaviors. This should be a message for governments and be considered in the establishment of preventive public policies in the areas of health and health education.
Meghan Finch Kirsty Seward Taya Wedesweiler Fiona Stacey Alice Grady Jannah Jones Luke Wolfenden Sze Lin Yoong	399	Quantitative Research Challenges of increasing childcare center compliance with nutrition guidelines: A randomized controlled trial of an intervention providing training, written menu feedback, and printed resources Although childcare centers provide an opportune setting to improve children’s nutrition, most are not compliant with nutritional guideline recommendations. Effective interventions that are suitable for delivery to large numbers of centers and target reported practice barriers to implementation are required. Strategies, such as training and provision of printed resources, frequently used to support nutrition guideline implementation, had not been rigorously evaluated in this setting. This study examined the effect of a theoretically informed and potentially scalable intervention on menu nutrition guideline compliance in childcare centers, specifically designed to address barriers and enablers. The implementation strategies were not effective in improving menu compliance. Although the application of the theoretical framework produced a broader understanding of the determinants of menu compliance, due to the complexity of guidelines, limited follow-up support, lower training uptake, and low intervention dose, the intervention was not effective in supporting the practice change required to improve menus.
Danhong Chen Edward C. Jaenicke Richard J. Volpe	412	Quantitative Research The Healthfulness of Food-at-Home Expenditures, the Local Food Environment, and Childhood Obesity Food-at-home (FAH) expenditures may have important impacts on children’s diets and, consequently, their weight statuses. Two thousand six hundred forty-five children aged 2 to 17 from 1731 households across the United States were surveyed repeatedly over 3 years (MedProfiler surveys 2010-2012). The survey data were linked to the households’ food purchase data from the 2010 to 2012 IRI Consumer Panel. We calculated households’ expenditure shares for different food stores and their expenditure shares for 24 food categories. The latter was evaluated by an index reflecting its adherence to the values recommended by the USDA Thrifty Food Plans. The expenditure shares for different food stores were not significantly associated with childhood overweight or obesity. Higher compliance with the USDA Thrifty Food Plans was associated with lower risk of childhood overweight or obesity. To prevent childhood obesity, the USDA Thrifty Food Plans can provide potential guidelines for households to decide the composition of their FAH expenditures.
Jessica K. Pepper Ellen M. Coats James M. Nonnemaker Brett R. Loomis	420	Quantitative Research How Do Adolescents Get Their E-Cigarettes and Other Electronic Vaping Devices? This study analyzed data from 1729 adolescents who “vaped” (used e-cigarettes) in the past 30 days to understand how underage users get vaping devices and use them in social situations. The most common sources were purchasing from a store or online (31%), buying from another person (16%), or giving someone money to purchase for them (15%). Even though 78% of adolescent vapers owned their own vaping device, most (73%) had used someone else’s device in the past 30 days. This finding suggests that borrowing is part of users’ social experience, not just a means of acquisition. Better enforcement of age restrictions could lessen purchasing but will not be sufficient for preventing youth access because of this widespread pattern of borrowing and sharing. Future research is needed to understand how adolescents’ sources of acquisition change over time and why they borrow. That information could be harnessed for developing borrowing-related antivaping campaigns.
Valentine Y. Njike Victoria C. Costales Paul Petraro Rachel Annam Niloufarsadat Yarandi David L. Katz	430	Quantitative Research The Resulting Variation in Nutrient Intake with the Inclusion of Walnuts in the Diets of Adults at Risk for Type 2 Diabetes: A Randomized, Controlled, Cross-over Trial Purpose: Examines nutrients displaced with inclusion of walnuts in diets of individuals at risk for Type 2 diabetes (T2DM). Design: Randomized, controlled, modified Latin square parallel design trial with 2 treatment arms. Participants were randomized to include walnuts in their diets with, or without, dietary advice to regulate caloric intake. Within each treatment arm, participants were further randomized to one of two sequence permutations (walnut-included/excluded or walnut-excluded/included diet), with a 3-month washout between treatment phases. Setting: Community hospital in Connecticut. Subjects: 112 participants (31 men, 81 women) at risk for T2DM. Intervention: With or without dietary advice to regulate calorie, participants included 56 grams of walnuts in their daily diets for 6 months. Measures: Nutrient intake. Analysis: Generalized linear models. Results: Inclusion of walnut increased intake of calcium, magnesium, thiamin, protein, monounsaturated and polyunsaturated fats. Conclusion: Inclusion of walnuts in diets increased intake of nutrients likely to prevent T2DM.
Ron Z. Goetzel Raymond Fabius Enid Chung Roemer Karen B. Kent Jeffrey Berko Michael A. Head Rachel Mosher Henke	439	Quantitative Research The Stock Performance of American Companies Investing in a Culture of Health Purpose: We investigated the relationship between companies’ efforts to build internal (COH-INT) and external cultures of health (COH-EXT) and their stock performance. Design: We administered 2 surveys, which measure companies’ programs, policies, and supports for improving the health of their employees and communities. We then compared the companies’ stock performance to the Standard and Poor’s (S&P) 500 Index from January 2013 through August 2017. Setting: United States. Participants: Representatives from 17 publicly traded companies who completed the COH-INT survey, of whom 14 also completed the COH-EXT. Measures: Culture of health scores were dichotomized into high versus low for both surveys. Stock price data for all companies were gathered from public sources. Analysis: We constructed 5 stock portfolios: all 17 companies, high COH-INT, low COH-INT, high COH-EXT, and low COHEXT companies. We examined total returns for each portfolio compared to the S&P 500. Results: High COH-INT companies’ stock price appreciated by 115% compared to the S&P benchmark (þ69%), while low COHINT companies appreciated only 43%. In contrast, high COH-EXT companies underperformed (þ44%) when compared to the S&P 500 (þ69%) and low COH-EXT companies (þ89%). Conclusion: This study supports the view that employers’ efforts to build an internal culture of health is a sound business strategy. More research is needed, however, to establish whether a link exists between supporting healthy community initiatives and company stock performance.
Victor Cotton Mitesh S. Patel	448	Applied Research Brief Gamification Use and Design in Popular Health and Fitness Mobile Applications The authors evaluate the most popular health and fitness mobile applications and find that nearly two-thirds of them use gamification to motivate behavior. The most common game design elements were goal-setting, social influences, and challenges while points and levels were used less commonly. None of the applications were found to design rewards or points using principles from behavioral economics, which suggests that there may be an opportunity to improve the design of these applications to increase their use.
Jenifer J. Thomas Lesley Lutes Ekaterina Smirnova Bhibha M. Das Snehalata Huzurbazar Lisa Aldrich Mariah Lee	452	Applied Research Brief Self-Concept in the Context of Diabetes Prevention: Development of the Lifestyle Health-Related Self-Concept (Lifestyle-HRSC) Questionnaire Psychological and behavioral factors are associated with type 2 diabetes prevention program goals such as weight loss and increased physical activity. The stable self-appraisal of health, or self-concept, may be relevant to understanding participation in prevention behaviors associated with type 2 diabetes. Increased self-awareness may lead to more effective self-regulation and positive behaviors associated with health-related self-concept (HRSC) may advance lifestyle change. The purpose of this study was to create a questionnaire specific to dimensions of HRSC and lifestyle change activities by modifying a current measure of HRSC. A new questionnaire, the Lifestyle-HRSC, was completed by 101 college students. The Lifestyle-HRSC questionnaire presents a means for understanding health behavior, as well as the role of self-concept, in the context of diabetes prevention. The relatively brief 31-item questionnaire can be utilized in health research and clinical settings to understand the long-term effectiveness of prevention interventions and patient/client lifestyle change efforts.
Jack Andrzejewski Nicole Liddon Sandra Leonard	457	Literature Review Condom Availability Programs in Schools: a Review of the Literature This review synthesizes findings from the peer-reviewed evaluation literature on condom availability programs (CAPs) in secondary schools in the United States. Evaluations indicate CAPs yield condom acquisition rates between 23% and 48%, have mixed results related to condom use, and are not associated with increases in sexual and other risk behaviors. Condom availability programs are accepted by students and can be an appropriate and relevant school-based intervention for teens. Programmatic elements such as privacy, confidentiality, parental consent, the development of an oversight committee, and the implementation of advertising strategies may effect program use by students.Additionally, use of the program differed by biological sex and sexual risk behavior. Condom availability programs should be implemented in a way that carefully considers the elements of confidentiality, privacy, and parental consent that best fit the needs of the students and their parents. Evaluators should consider stratifying analyses by biological sex and by level of risk behavior to understand differential program effects on these subgroups.
Jessica Grossmeier	TAHP-468	Editor’s Desk: The Storytelling Issue: Storytelling is a powerful skill that can help health promotion professionals be more successful at engaging stakeholders at every level in an organization. It is also a skill that can be learned and strengthened.
Carmine Gallo	TAHP-469	Storytelling to Inspire, Educate, and Engage: This article summarizes the neuroscience supporting how and why storytelling can help inspire, educate, and engage the listener. He also provides three suggestions for sourcing the best stories.
Laura Putnam	TAHP-472	How to Be a Storyteller (Even If You Think You’re Not): Storytelling begins by identifying stories to tell. This article offers suggestions for sourcing one’s stories, incorporating them into a learning framework, and delivering them effectively.
Brian Passon	TAHP-475	The Power of Storytelling for Behavior Change and Business: An interview with Brian Passon reflects on how storytelling has helped him to be a more impactful consultant and educator and shares the resources he has used to hone his storytelling skills.
Shawn McCann Jody Barto Nancy Goldman	TAHP-477	Learning Through Story Listening: Storytelling only has the power to change lives when coupled with engaged listeners. This article discusses how being heard can contribute to the health and well-being of the storyteller with implications for health promotion professionals to elicit and listen to stories told by those they aim to serve.
Elena Valentine	TAHP-481	The Power of Video to Promote Corporate Wellness: Video is an effective medium for capturing and sharing stories that effectively engage and connect people to one another and to an organization. This article profiles a case study of how one organization used video stories to address mental health stigma and offers four ways that video can be used to support health and well-being initiatives.
Sara S. Johnson	TAHP-482	The Unlimited Potential of Storytelling as a Tool for Health Promotion: This issue clearly illustrates that we can rely on storytelling to make a compelling case for the need for health promotion, design effective and engaging interventions, and infuse “soul” into our data. The Closing Commentary highlights additional opportunities for our field to use storytelling to influence behavior change by promoting shifts in personal narratives and to create more robust social connections.