In Briefs

Abstract

Paul E. Terry	493	Editorial Fearless Health Promotion and an Interview with Dr. Amy Edmondson Psychological safety at work means that you can be yourself at work and speak up with a dissenting opinion without fear of reprisals. I’m lucky to have worked more often than not in cultures predominantly defined by respect and with colleagues who not only make me feel safe but who also routinely inspire me to bring my best self to the office. Can the same be said for most workplaces in America? If you study this question, you will find that all roads lead to the extraordinary scholarship of Harvard Business School’s Amy Edmondson. This editorial reviews the advantages of building a fearless health promotion profession and argues that we need to substitute some natural, understandable tendencies with some unnatural but powerful traits.
the Science of lifestyle change
Hermine Poghosyan Erika L. Moen Daniel Kim Justin Manjourides Mary E. Cooley	498	Quantitative Research Social and structural determinants of smoking status and quit attempts among adults living in 12 US States, 2015 This study examined the relationships among intermediary determinants, structural determinants, and adult smoking status and quit attempts. Cross-sectional data come from the 2015 Behavioral Risk Factor Surveillance System, Social Context module (n = 64 053) that was administered in 12 US states. The sample of 64 053 participants corresponds to a population estimate of 26.5 million in the included 12 states. Current smoking was greater among men, respondents aged between 35-64 and 55-64, adults who reported food insecurity, housing insecurity, frequent mental distress, binge drinking, and who were unemployed. Current smokers had higher odds of making quit attempts in the past 12 months if they were non-Hispanic black, graduated college, and reported food and housing insecurity. Multifaceted smoking cessation interventions that address food and housing needs also incorporate screening for potential comorbidities such as mental distress and/or hazardous alcohol use may be needed to enhance smoking cessation rates among racially diverse adults.
Yueyao Li Kellee White Katherine R. O’Shields Alexander C. McLain Anwar T. Merchant	507	Quantitative Research Light-intensity physical activity and cardiometabolic risk factor outcomes among middle-aged and older-adults with multiple chronic conditions Engaging in moderate to vigorous physical activity is an important primary prevention strategy to prevent adverse cardiovascular health outcomes and secondary prevention strategy to minimize the severity of cardiovascular disease. However, middle-aged and older adults with multiple chronic conditions are least likely to meet the recommended physical activity guidelines. It is possible that engaging in light-intensity physical activity can help high-risk groups better manage their cardiometabolic risk factors. This study uses data from the Health and Retirement Study to assess the relationship between light-intensity physical activity and cardiometabolic risk factors (ie, HbA_1c, systolic blood pressure, diastolic blood pressure, high-density lipoprotein cholesterol [HDL-C], total cholesterol, and non-HDL-C). Our findings suggest that light-intensity physical activity was independently associated with favorable HDL-C and total cholesterol. If the results of our study are confirmed in longitudinal studies, the findings will underscore the need to reevaluate current physical activity guidelines to include light-intensity physical activity.
Krysten W. Bold Lisa Kimmel Tess H. Hanrahan Denise Romano Alana M. Rojewski Suchitra Krishnan-Sarin Lisa M. Fucito Stephanie S. O’Malley	516	Quantitative Research A pilot clinical trial of smoking cessation services implemented in the workplace for service industry employees While smoking rates have declined in recent years in the general population, it remain elevated among certain populations such as racial/ethnic minorities and those with lower education and socioeconomic status. Service industry settings may provide a novel opportunity to deliver evidence-based smoking cessation treatment to a vulnerable population of smokers to help promote smoking cessation and reduce tobacco-related health disparities. This study examines a comprehensive smoking cessation intervention delivered to service industry employees at their workplace. Employees were recruited from university food service settings to participate in a randomized trial using 6 paired worksites (3 test and 3 delayed intervention control sites). Primary measures included a smoking status survey administered at the test and control sites. Findings suggest workplace treatment is feasible and effective at promoting change in smoking behavior. Providing smoking cessation interventions at the workplace may help reduce barriers to treatment to help reduce tobacco-related health disparities.
Chelsea R. Singleton Yu Li, MBA Angela Odoms-Young Shannon N. Zenk Lisa M. Powell	525	Quantitative Research Change in Food and Beverage Availability and Marketing following the Introduction of a Healthy Food Financing Initiative Supported Supermarket The Health Food Financing Initiative (HFFI) is a federal initiative that aims to expand the availability of healthy foods and beverages in low-resourced communities across the United States. The objective of this research was to examine changes in food availability and marketing in a predominately low-income and African American community in Rockford, Illinois, after the opening of a HFFI-supported chain supermarket. A full audit of the small grocery and limited service stores located within a 1-mile radius of the HFFI-supported supermarket (N = 22), and a 1-square mile area in a demographically matched community (N = 18), was conducted 1 month before the supermarket’s opening and 1 year afterward. Difference-in-difference (DID) regression models assessed pre–post intervention changes in availability and marketing. Results from DID regression models indicated no difference between intervention and comparison communities with respect to changes in availability and marketing of food and beverages.
Rosenda Murillo Bozena J. Katic Tailisha Gonzalez Elizabeth Vasquez Sandra Echeverria	534	Quantitative Research The Association of Prediabetes and Diabetes Risk Perception with Leisure-time Physical Activity and Weight Loss This study used cross-sectional data from the 2011-2014 National Health and Nutrition Examination Survey to examine the association of perceived risk of prediabetes and diabetes with leisure-time physical activity (LTPA) and weight loss, and whether associations varies by race/ethnicity. Participants included Non-Latino white, non-Latino black, and Latino adults ≥18 years of age (n = 9,550). Log-binomial regression models were fit to assess the associations overall and by race/ethnicity. Individuals reporting that they perceived they could be at risk were less likely to meet the LTPA recommendation (Adjusted Prevalence Ratio (aPR): 0.87; 95% Confidence Interval (CI): 0.79-0.95), but significantly more likely to report attempting weight loss in the past year (aPR: 1.14; 95%CI: 1.04 -1.25). Latino and non-Latino Blacks who perceived they were could be at risk were 25% and 35% more likely to report attempting weight loss (aPR: 1.25; 95% CI: 1.08,1.44 and aPR: 1.35; 95% CI: 1.19,1.54 respectively) whereas non-Latino Whites were 20% less likely to report meeting the LTPA recommendation (aPR: 0.80; 95% CI: 0.72,0.89). Awareness of prediabetes and diabetes risk could contribute to improving LTPA and weight loss across all segments of the population.
Caroline Fitzpatrick Stephanie Alexander Melanie Henderson Tracie A. Barnett	541	Quantitative Research Prospective Associations between Play Environments and Pediatric Obesity The play environments of youth may influence opportunities for physical activity and subsequent adiposity. In the present study, we examine the associations between school play environments and child adiposity. We studied 512 children attending 296 schools followed longitudinally in the context of the Quebec Adipose and Lifestyle Investigation in Youth study. The presence of play equipment indoors and outdoors was recorded when students were between 8 and 10 years old. A trained nurse directly assessed child anthropometric measurements 2 years later. We used K-clusters analyses to identify 4 distinct school typologies. Multiple regression indicated that relative to children in schools with the least varied indoor play environments, children with the most varied indoor play environment had lower overall body fat and smaller waist circumferences. Our results suggest that developing policies that regulate the availability of play materials in elementary schools may benefit more comprehensive school-based child obesity prevention strategies.
Karen H. Kim Yeary Page C. Moore C. Heath Gauss Carol Cornell T. Elaine Prewitt Samjhana Shakya Jerome Turner Catherine Scarbrough Gwenndolyn Porter Paul A. Estabrooks	549	Quantitative Research Reach and Adoption of a randomized weight loss maintenance trial in rural African Americans of faith: The WORD (Wholeness, Oneness, Righteousness, Deliverance) There is minimal information regarding the external validity of evidence-based weight loss interventions in real-world settings. WORD (Wholeness, Oneness, Righteousness, Deliverance) was lay-led, 18-month, cluster randomized trial designed to reduce and maintain weight loss in 426 African American adults across 30 churches in the Lower Mississippi Delta. The current article focuses on assessing reach and adoption at baseline and 6 months using the RE-AIM framework. Participants’ participation rate was 0.84; they were predominantly female, employed, and had a mean age of 49.8. Dropouts by 6 months were younger, had differential marital status, and religious attendance compared with retained participants. Church participation rate was 0.63 and the majority reported ≤100 active members. Lay leader participation rate was 0.61; they were primarily female and age 53.9 (mean). Recruitment, engagement, and delivery strategies employed by WORD show promise of sustained engagement and adoption in other faith-based behavioral weight management programs for African Americans.
Laurel Curry Carol L. Schmitt Amy Henes Christina Ortega-Peluso Haven Battles	558	Quantitative Research How Low-income Smokers in New York Access Cheaper Cigarettes Despite increases in the prevalence of quit attempts by low-income smokers and declines in smoking among all income groups over time, smoking prevalence in New York has consistently been highest among its low-income populations. We sought to understand the tobacco acquisition practices of low-income smokers in New York in light of high cigarette prices due to high cigarette taxes in the state. Using focus groups, we learned that high cigarette prices appear to result in different behavioral reactions depending on geography. While some smokers in Western New York have switched to untaxed cigarettes from Native American reservations, low-income smokers in New York City described convenient sources of bootlegged cigarettes (packs or loosies) in their local neighborhood stores, through acquaintances, or on the street. Familiarity with the retailer was key to accessing bootlegged cigarettes from retailers. Such access to cheaper cigarettes discourages quit attempts. Their apparent availability attenuates public health efforts aimed at reducing smoking prevalence through price and tax increases and underscores the need to promote and support cessation in low-income populations.
Nilda Peragallo Montano Rosina Cianelli Natalia Villegas Rosa Gonzalez-Guarda Weston O. Williams Lila de Tantillo	566	Quantitative Research Evaluating a Culturally Tailored HIV Risk Reduction Intervention among Hispanic Women Delivered in a Real World Setting by Community Agency Personnel Evaluating a Culturally Tailored HIV Risk Reduction Intervention among Hispanic Women Delivered in a Real World Setting by Community Agency Personnel. This study used a randomized controlled trial to evaluate the effectiveness of SEPA intervention to increase HIV/STI prevention behaviors for Hispanic women delivered in a real world setting. A sample of 320 Hispanic women participated in the study. Significant outcomes improvements were observed in the SEPA group at 6 and 12 months follow-up. The adjusted prevalence of any condom use was 30% and 37% higher at each follow-up. The adjusted prevalence of answering 10/12 HIV knowledge questions correctly rose by 57% and 63% at each follow-up. Intimate Partner Violence was significantly lower at each time subsequent point (62% and 41% of baseline). Moderate depressive symptoms were reduced to 50% and 42%, getting drunk was reduced to 20% and 30%, and condom use self-efficacy was significantly higher (84% and 96%). The authors concluded that successfully translating research into population-based interventions is vital to improve minority health and to eliminate health disparities
Billy A. Caceres Nour Makarem Kathleen T. Hickey Tonda L. Hughes	576	Quantitative Research Cardiovascular disease disparities in sexual minority adults: An examination of the Behavioral Risk Factor Surveillance System (2014-2016) To investigate sexual orientation differences in cardiovascular disease risk and cardiovascular disease among adults, the authors conducted a cross-sectional analysis of data from the 2014-2016 Behavioral Risk Factor Surveillance System. The analytic sample consisted of 395 154 participants. Sex-stratified logistic regression models were used to examine sexual orientation differences in cardiovascular disease risk and cardiovascular disease, adjusted for relevant covariates (heterosexuals = reference group). Several sexual orientation differences in cardiovascular risk factors were observed. Sexual minority men reported higher rates of mental distress and lifetime depression. Gay men reported higher rates of current smoking but lower rates of obesity compared to heterosexual men. Sexual minority women displayed higher rates of several cardiovascular risk factors including mental distress, lifetime depression, current smoking, heavy drinking, and obesity, but were more likely to report exercising in the past month than heterosexual women. Lesbian women reported lower rates of heart attack, but bisexual women had higher rates of stroke than heterosexual women. No sexual orientation differences in cardiovascular disease diagnoses were noted among men. These findings have significant practice and research implications. In particular, there is a need to develop initiatives to promote cardiovascular risk reduction in this population, specifically among sexual minority women.
Kathryn P. Derose Malcolm V. Williams Karen R. Flo´rez Beth Ann Griffin Denise D. Paya´n Rachana Seelam Cheryl A. Branch Jennifer Hawes-Dawson Michael A. Mata Margaret D. Whitley Eunice C. Wong	586	Quantitative Research Eat, Pray, Move: A Pilot Cluster Randomized Controlled Trial of a Multi-level Church-based Intervention to Address Obesity among African Americans and Latinos This study implemented and evaluated a multilevel church-based intervention with African American and Latinos using community-based participatory research. Churches were matched in race–ethnicity, size, and denomination and randomly assigned to intervention or control. Intervention components were implemented over 5 months and included 2 sermons by pastor, educational handouts, planting and maintenance of church vegetable and fruit gardens, series of 5 cooking and nutrition classes using garden produce, daily mobile messaging, mapping of community food and physical activity environments, and identification of congregational policy changes to increase healthy meals. Analyses conducted using 4 churches in 2 matched pairs (2 midsized African American Baptist and 2 very large Latino Catholic) with 183 total study participants found that the intervention resulted in statistically significant lower weight gain and greater weight loss, lower body mass index, and healthier diet. A longer time line is needed to fully implement and assess effects of community and congregation environmental strategies.
Karen M. Butler Luz Huntington-Moskos Mary Kay Rayens Amanda T. Wiggins Ellen J. Hahn	597	Applied Research Brief Perceived Synergistic Risk for Lung Cancer after Environmental Report-Back Study on Home Exposure to Tobacco Smoke and Radon The purpose of this study was to examine the short-term impact of a personalized environmental report-back intervention to reduce home exposure to tobacco smoke and radon on perception of synergistic risk for lung cancer. In a randomized controlled trial, adult homeowners and renters were recruited from primary care clinics and a pharmacy waiting area at a University Medical Center in the Southeastern U.S., as well as community events. All participants completed a brief survey at baseline (N = 560) and 3 months post intervention (n = 310). Synergistic risk was measured using a single item synergistic risk perception measure using 5-point Likert scale. Change in synergistic risk from baseline to 3 months was evaluated using a Generalized Estimating Equation (GEE) model containing main effects of treatment group and time. Covariates in the model included age, gender, education, and home smoking status. For Treatment and Control groups combined, there was a significant increase in perception of synergistic risk from baseline to 3 months, but the study groups did not differ. There was no association between perceived synergistic risk and whether or not there were smokers in the home. Learning about combined risks for lung cancer, with or without dual home screening for SHS and radon and environmental report-back, may enhance perceived risk for combined environmental exposures. Evaluation of perceived synergistic risk with a single item is a study limitation.
Maria L. Alva Melissa Romaire Joseph Acquah	601	Applied Research Brief Impact of financial incentives on diabetes prevention class attendance and program completion: Evidence from Minnesota, Montana, and New York Minnesota, Montana, and New York randomized participants at risk for diabetes into receiving financial incentives or receiving no financial incentives to participate in a diabetes prevention program. States tested three different approaches to providing incentives: incentivizing class attendance and weight loss (MN, MT, and NY), class attendance only (NY) and weight loss only (NY). We used New York to test how different approaches to providing incentives influence DPP completion and attendance. In New York, individuals paid to attend classes attended more classes than individuals paid based on results only. Receipt of incentives was associated with being two to three times more likely to complete the program. In New York, individuals paid to attend classes attended more classes than individuals paid based on results only.
Amanda H. Wilkerson Stuart L. Usdan Adam P. Knowlden James L. Leeper David A. Birch Elizabeth E. Hibberd	606	Applied Research Brief Workplace-related factors associated with employees’ standing time at work: A research brief Sedentary behavior is a significant public health problem, and the workplace is an important domain to address sedentary behavior. Current recommendations to reduce sitting time include suggestions to modify workplace environments and policies to change behavior. One of the primary modalities used in workplace health promotion research and practice is to increase standing time throughout the workday. However, minimal information is available addressing factors that may be related to increased standing time during the workday. The findings from this study provide exploratory information regarding individual and workplace-related factors that may influence workplace standing time among employees in an academic setting. The information from this study suggests that health promotion researchers and practitioners should consider workplace-related factors and differences in standing by employee subgroups when conducting research and developing health promotion programs to reduce sedentary behavior.
Zachary H. Hopkins Aaron M. Secrest	611	Applied Research Brief Public health implications of Google searches for sunscreen, sunburn, skin cancer, and melanoma in the United States Google Trends has been used to demonstrate seasonal variation and decreasing overall interest in searches for tanning beds as well as trends in searches for sunscreen. We used this technology to evaluate interest in the terms sunscreen, sunburn, skin cancer, and melanoma. This research offers guidance for online public outreach campaigns by understanding the public’s interest in these terms. We found that sunscreen and sunburn searches were highly correlated and the popularity of these terms were increasing; however, searches skin cancer and melanoma have been decreasing in popularity. We recommend that online campaigns target the terms sunscreen and sunburn for skin cancer/melanoma prevention. Additionally, we evaluated whether melanoma outcomes altered interests in these terms. We found that melanoma outcomes were associated with varied interests in these terms. We conclude that campaigns should specifically target the local population’s interests using location-specific Google Trends data.
Lindsey Menge Yueqin Hu Sylvia Hurd Crixell Lisa Lloyd Janet Bezner Tricia J Burke	616	Applied Research Brief Influences on Catered Event Ordering in a University Workplace: Development and Validation of the Understanding Food Ordering (UFO) Survey Obesity and chronic diseases are linked to poor diet. People spend the majority of their time at work and may be required to attend catered events. This study aimed to determine factors that affect what food is ordered by those charged with organizing catered events at work. Themes derived from focus groups involving administrative assistants who order food for catered events at a large university were used to develop a survey about factors that influence food ordering. A sample of 138 administrative assistants completed the 114-question survey. Principal component analyses explored constructs. Test–retest analyses (subset n = 31) assessed reliability. The final survey included 19 items within 3 factors; all factor loadings were above 0.3, with no cross-loadings. Three factors, including social influences, ordering restrictions, and personal views about nutrition, explained 55.5% of the variance. Confirmatory factor analysis was constructed using these 3 factors. Fit indices indicated a good fit between the proposed factor model and observed data.

Jessica Grossmeier	TAHP-620	Editor’s Desk: The Global Health Issue: Our increasingly diverse world requires today’s health promotion professional to develop a more global perspective. Addressing health and well-being on a global level requires more than cultural sensitivity and accurate language translation. This issue of The Art of Health Promotion aims to provide guidance to anyone interested in advancing the health and well-being of populations from countries other than their own.
Alberto Jose Niituma Ogata	TAHP-621	A Global View of Health and Well-being: In order for global workplace health promotion initiatives to be most effective, it is important to know the epidemiological, social, and cultural aspects in each place. Dr Ogata identifies standard metrics and health objectives that can inform strategic planning, implementation, and evaluation of health promotion initiatives worldwide.
Mark Attridge	TAHP-622	A Global Perspective on Promoting Workplace Mental Health and the Role of Employee Assistance Programs: This article identifies the prevalence of mental health issues globally followed by an examination of how the workplace can both contribute to and ameliorate the problem. The growth of employee assistance programs (EAP) around the world is recognized and emerging research on EAP effectiveness is provided.
Anne Marie Kirby Rodrigo Rodriguez-Fernandez	TAHP-629	Taking Workplace Health Promotion Global: The Art of Cultural Integration: Working with large multinational organizations with a widely dispersed global population can be incredibly challenging. This article discusses some of the biggest challenges of delivering well-being programs and services to widely dispersed populations and profiles several organizations that are successfully tackling them.
Jay E. Maddock	TAHP-632	Developing a Global Perspective for Health Promotion: Given the large differences in health behaviors and approaches to health promotion in different countries, an improved global understanding can improve our effectiveness in health promotion. This article provides resources and tips on how to develop a more global perspective for health promotion.