In Briefs

Abstract

Paul E. Terry	475	Editorial Being Safe Versus Being Safer: Mask Guidance and Hard-Earned Lessons From the AIDS Pandemic New Centers for Disease Control and Prevention guidelines recommend wearing cloth masks, but we should expect public adherence to vary as much as expert opinions do. We need to be concerned about the latter because it keenly influences the former. Even toward the tail end of this scourge, it will be as easy as it is discomforting to find credible authorities weighing in on whether or not use of masks by the public will be effective in source control of the novel coronavirus. Those in favor of do-it-yourself (DIY) masks have been consistent and clear that health-care workers must have first priority for professional grade personal protective equipment and that social distancing is of prime importance. They also hang their masks on the commonsensical premise that some protection is better than none, a view that will be espoused ever more urgently when stay-at-home mandates are partially lifted. Those arguing against masks say evidence of mask filtering effectiveness to deter COVID-19 is inconclusive or, for cloth masks, may even make us more susceptible. Do masks bring a new hazard to our face? Do they create a false sense of security? Will people assume masks allow them to ease up on their handwashing or distancing practices?
the science of lifestyle change
Elisheva Leiter Adi Finkelstein Milka Donchin Keren L. Greenberg Osnat Keidar Sima Wetzler Sara Siemiatycki Ronit Calderon-Margalit Donna R. Zwas	479	Qualitative Research Integration of Mixed Methods in Community-Based Participatory Research: Development of a Disease Prevention Intervention for Ultra-Orthodox Jewish Women The current paper details the development of the first disease prevention intervention with UOJ women using mixed methods and community-based participatory research. This collaborative, seven-staged development process included 5 key informant interviewees, 7 participants in 5 focus groups each, a cluster randomized sample of 239 questionnaire respondents (an 87% response rate), and 11 steering committee participants. Barriers to health behavior engagement and intervention preferences were identified. The final intervention included walking programs, health newsletters, community leader trainings, teacher and student trainings, and health integration into schools. Utilizing mixed methods in CBPR improved cultural tailoring, potentially serving as a model for intervention design in other difficult to access, low socio-economic, and culturally insular populations.
Ron Z. Goetzel Rachel Mosher Henke Michael A. Head Richele Benevent Kyu Rhee	490	Quantitative Research Ten Modifiable Health Risk Factors and Employees’ Medical Costs – An Update Half of small firms and 84% of large employers offered health promotion programs in 2019. Despite these programs’ popularity, debate persists about whether they save money. In this study, we used data from 11 large employers included in a multiemployer database to measure the short-term relationship between workers’ health risks and their health-care costs for 10 common modifiable risk factors. Although randomized trials may be the gold standard for testing specific medical treatments, they may not be appropriate for large, multicomponent employer interventions in which a variety of interventions are offered and a change in organizational culture may be needed to achieve population-wide health improvements. We utilize an observational study, including 135 219 employees, comprised of person-level health-care claims and health risk assessment data that used regression models to estimate the relationship between 10 modifiable risk factors and subsequent year 1 health-care costs. We found that health-care costs were significant higher for employees at higher risk for blood glucose (P < .0001), obesity (P < .0001), stress (P < .001), depression (P < .0001), and physical inactivity (P < .0001).
Lorraine B. Robbins Jiying Ling Fujun Wen	500	Quantitative Research Attending After-School Physical Activity Club 2 Days A Week Attenuated an Increase in Percent Body Fat and a Decrease in Fitness Among Adolescent Girls at Risk for Obesity Adolescents having a body mass index (BMI) z score ≥0 are at risk for adverse health outcomes. A secondary analysis of data from a group randomized controlled trial involving 24 US schools was conducted to evaluate the effect of a 17-week intervention, including an after-school physical activity (PA) club 3 d/wk, on moderate-to-vigorous physical activity (MVPA), BMI z score, percentage body fat (%BF), and cardiorespiratory fitness (CRF) among fifth to eighth grade girls having a BMI z score ≥0 (n = 1194 girls) and explore whether intervention outcomes varied by club attendance (1 vs 2 vs 3 d/wk). Intervention girls gained less %BF and their CRF decreased less than control girls, but no differences occurred in BMI z score or MVPA. Girls attending an after-school club (offered 3 d/wk) an average of 1 d/wk had greater increases in %BF and MVPA and a greater decrease in CRF than girls attending 3 d/wk, but no differences in any outcomes occurred between girls who attended 2 versus 3 d/wk. An intervention focusing on PA alone may not be sufficient for reducing at-risk adolescent girls’ BMI. Strategies to help girls achieve adequate MVPA after an intervention ends are needed. To be feasible for girls to attend, offering an after-school PA club 2 d/wk may be adequate for achieving some anticipated, important outcomes and may warrant consideration.
Sean healy John Foley Justin A. Haegele	505	Quantitative Research Physical Activity, Screen Time, and Sleep Duration Among Youth With Chronic Health Conditions in the United States Participation in health behaviors across the 24-hour period, namely, physical activity, screen time, and sleep, is a more potent determinant of health status than participation in any one of the behaviors alone. Recognizing this, this study sought to compare the degree to which youth with and without chronic conditions in the United States met physical activity, screen time, and sleep duration guidelines. Overall, 18.7% of children with chronic conditions did not meet any health behavior guidelines compared to 15.64% of children without chronic conditions. Children with hearing impairments, diabetes, and depression were most likely to not meet any health behavior guidelines (27.79%, 25.42%, and 21.74%, respectively). Of the 3 guidelines, children with chronic conditions were least likely to meet the PA guideline (18.56%). Overall findings suggest a need for a more integrated, holistic view of health promotion for children with chronic conditions.
Zenobia Talati Carly Grapes Emily Davey Trevor Shilton Simone Pettigrew	512	Quantitative Research Implementation Outcomes Following Participation in a Large-Scale Healthy Workplace Program Conducted Across Multiple Worksites Given the number of hours people spend at work, the workplace is an important environment for implementing health and well-being initiatives. Workplace health promotion programs can improve the health and well-being of employees. However, not all workplaces have the necessary in-house expertise or can afford external consultants to deliver such programs. This study evaluated implementation outcomes of a freely available workplace health promotion program that offers services (such as training sessions, tailored advice, grant schemes, online resources) across a range of health areas (including nutrition, physical activity, smoking, alcohol consumption, and mental health) to assist employees gain the knowledge, skills, and confidence to create or improve organizational policies, run educational workshops, implement participation initiatives, and/or change their workplace’s physical environment. The study found that employees who accessed more program services made more changes, as did those who perceived greater responsibility/authority to make changes and felt supported by their coworkers.
Fatih GÜR Ganime CAN GÜR	520	Literature Review Is Exercise a Useful Intervention in the Treatment of Alcohol Use Disorder? Systematic Review and Meta-Analysis This systematic review and meta-analysis examined the effects of exercise on individuals with alcohol use disorders (AUDs) across multiple health outcomes. The PubMed, Medline, Web of Science, Scopus, Akademic Search complete, SportDiscuss, and ERIC were searched for controlled trials studies in regard to effects of exercise on AUD between the years 2000 and 2018. The main outcome measures including physical fitness, depression, anxiety, self-efficacy, quality of life, and alcohol outcomes of consumption. Across the 10 studies, 579 adults with AUDs were included. The findings indicated that exercise significantly improved physical fitness as assessed by VO₂max (standardized mean difference [SMD[: 0.487, P < .05) and HRmax (SMD: 0.717, P < .05). Similarly, exercise significantly improved mental health as assessed by quality of life (SMD: 0.425, P < .05), but levels of depression, anxiety, self-efficacy, and alcohol consumption did not change significantly. Exercise can be an effective and persistent adjunctive treatment for individuals with AUDs.
Sara E. Vargas Colby Norris Ryan R. Landoll Baylee Crone Madison F. Clark Jeffrey D. Quinlan Kate M. Guthrie	538	Literature Review Interventions to Improve Sexual and Reproductive Health in US Active Duty Military Servicemembers: A Systematic Review Active duty military servicemembers and their families are located in all 50 US states and across the globe. Promoting sexual and reproductive in this population is critical to (1) supporting the health and well-being of military servicemembers and their families, (2) maintaining combat readiness of the armed services, and (3) promoting public health on military installations and in surrounding communities. This review synthesizes 15 published research articles that evaluated behavioral interventions to reduce health-risking sexual behaviors or change attitudes to prevent sexual assault among US active duty servicemembers. Studies that assessed clinical outcomes found that interventions were associated with lower rates of sexually transmitted infections and/or unintended pregnancy. Significant effects were found on knowledge-related outcomes, while mixed effects were found on attitudes, intentions, and behaviors. Published research in this area is limited. Research is needed to describe, evaluate, and disseminate the current state of sexual and reproductive health promotion in the US military.
Sohyun Park Stephen Onufrak Angie Cradock Anisha Patel Christina Hecht Caitlin Merlo Heidi M. Blanck	549	Applied Research Brief Correlates of Infrequent Plain Water Intake Among US High School Students: National Youth Risk Behavior Survey, 2017 We examined factors associated with frequency of plain water intake among US high school students using the 2017 national Youth Risk Behavior Survey data (N = 10 698). The outcome was plain water intake. Exposure variables were demographics, academic grades, and behavioral characteristics. We used logistic regression to estimate adjusted odds ratios (aOR) for factors associated with infrequent plain water intake (<3 vs ≥3 times/day). Overall, 48.7% of high school students reported drinking plain water <3 times/day. Factors associated with infrequent plain water intake were younger age (≤15 years; aOR = 1.20); earning mostly D/F grades (aOR = 1.37); consuming regular soda 1 to 6 times/week (aOR = 1.92) or ≥1 time/day (aOR = 3.23), sports drinks 1 to 6 times/week (aOR = 1.30), milk <2 glasses/day (aOR = 1.51), fruits <2 times/day (aOR = 1.92), and vegetables <3 times/day (aOR = 2.42); and being physically active ≥60 minutes/day on <5 days/week (aOR = 1.83). Students with obesity were less likely to have infrequent water intake (aOR = 0.63). Infrequent plain water intake was associated with younger age, poor academic grades, poor dietary behaviors, and physical inactivity. These findings can inform intervention efforts to increase water intake to promote healthy lifestyles among adolescents.
Julia I. Caldwell Brenda Robles Rachel Tyree Renee White Fraser Kelly A. Dumke Tony Kuo	555	Applied Research Brief Does Exposure to the Choose Water Campaign Increase Parental Intentions to Promote More Water and Less Sugar-Sweetened Beverage Consumption? The goal of this study was to examine the extent to which exposure to a public health media campaign, one inititated by a large county public health department and focused on promoting water consumption among low-income families, resulted in intended behavior change among target audiences. Respondents who reported discussing a campaign visual(s) with someone had a higher probability of intending to give their child(ren) more water and fewer sugar-sweetened beverages compared to those who were not exposed and did not speak about the campaign. And while the campaign reached a high proportion of those with less education, this group experienced more barriers to discussing the campaign with someone. Varying levels of campaign exposure, particularly seeing a visual and discussing its content with someone, may be an important dimension to consider for future public health media campaigns.
Kristi Rahrig Jenkins Bruce W Sherman	559	Applied Research Brief Wellness Program Non-Participation and Its Association With Employee Turnover This study examines the association between nonparticipation in wellness activities and employee turnover risk among a large university in the Midwestern United States. The implications of these findings have at least 3 important implications for stakeholders. First, wellness program nonparticipation is a construct that encompasses aspects of both poorer health and lower morale. Since it is also an easy measure to ascertain, it may be a particularly useful tool in assessing disengagement, particularly among higher risk subgroups. Second, a renewed focus on wellness program nonparticipants may help program evaluators enhance enrollee engagement efforts. Lastly, researchers may benefit from the use of these preliminary findings to explore more fully the relationship between wellness program participation and health, productivity, engagement, and retention outcomes.

Sara S. Johnson	TAHP-563	Editor’s Desk: Burnout Burnout—an occupational phenomenon characterized by exhaustion, cynicism, and reduced professional efficacy—is prevalent, costly, and a significant predictor of numerous adverse physical and psychological outcomes. Organizational interventions that target workplace factors, managers, and the physical environment will be critical to preventing it.
Jennifer Moss	TAHP-565	Rethinking Burnout: When Self Care Is Not the Cure Jennifer underscores how critical it is that we shift attention from coping strategies to increased prevention strategies for burnout to reinforce the employer’s accountability and address the fallacy that employees should battle it alone. She highlights that key contributors to burnout are organizational factors and workplace issues such as unfair treatment; unmanageable workloads; time pressures; and lack of role clarity, communication, and support. By measuring and creating innovative solutions to address the conditions that are leading employees to experience burnout, employers can begin to make a meaningful impact on this all too prevalent syndrome.
Amaryllis Sánchez Wohlever	TAHP-568	“Burnout” in the Workplace: Strategies, Omissions, and Lessons From Wounded Healers Using health care as an illustrative example, Amaryllis emphasizes that many misconstrue burnout as an individual experience, neglecting to address pervasive system failures that can exhaust and frustrate even the most engaged employees. She goes on to enumerate 3 common omissions in the discussions about interventions to prevent and reduce burnout (ie, unexpressed grief, time pressures, and the need for every employee to be known and valued). She then provides a call to action to humanize the workplace by acknowledging emotional, spiritual, and mental health needs.
Alexandria Blacker	TAHP-571	Activating Teams to Fight Burnout and Create Joy in Work Alexandria’s article focuses our attention on 5 evidence-based intervention strategies that can be adapted to different workplace cultures at the team level. Each has been demonstrated effective at addressing stress, supporting self-care, and creating a psychologically safe work environment and thus may help address burnout. Her suggestions for using principles of translational science that acknowledge organizational, team, and individual factors will inspire other employers to support their colleagues with consistent compassion and positivity to build joy into their work.
Shimi Kang	TAHP-573	The Power of Play Play has the potential to enhance mental health, creativity, collaboration, and self-motivation. Shimi outlines the benefits of and types of play, providing practical examples of how to incorporate them in diverse workplace settings. She also speaks to the importance of involving diverse play personalities in efforts to develop innovative and intelligent solutions for complex problems and makes a compelling case for play being a secret sauce of resilience.