American Journal of Health Promotion

Examine the reach, efficacy, adoption, implementation, and maintenance of a physical activity and nutrition curriculum for middle-school students.

Nonexperimental pilot evaluation of a statewide dissemination trial.

California middle schools during the 2006 to 2007 school year.

Sixteen classes (N = 668 students and 16 teachers) sampled from the statewide pool who used the program.

An eight-lesson nutrition and physical activity curriculum, “Exercise Your Options” (EYO), including a teacher guide, video clips, a student activity booklet, and ancillary materials was made available to teachers.

Program records, classroom observations, teacher surveys, and student presurveys and postsurveys (assessing physical activity, sedentary behaviors, and dietary intake).

Descriptive statistics and multilevel random-coefficient modeling.

The EYO program reached 234, 442 middle-school students in California. During the program, total physical activity increased (p ≤ .001), whereas watching TV/DVDs and playing electronic games/computer use decreased (p ≤ .05). Intake of dairy products increased (p < .05), whereas consumption of sugars/sweets decreased (p < .001). Forty-two percent of eligible middle-school classrooms ordered the program materials. Eighty-six percent of sampled teachers implemented all of the lessons. Over the past 5 years, 51% of all middle-school students in California were exposed to the program.

The EYO program showed its potential for moderate to high public health impact among California middle-school students.

Explore the impact of general parenting style and specific food-related parenting practices on children's dietary habits.

Cross-sectional study of sixth graders and their parents.

Data were gathered (in 2003) in 69 of 100 randomly selected elementary schools in Belgium.

All sixth graders (N = 1957) were invited to participate; 82.4% of their parents gave consent and completed questionnaires, resulting in 1614 parent-child pairs.

Children's consumption of breakfast, fruit, vegetables, soft drinks, and sweets was assessed by self-administered food frequency questionnaires. Parents completed questionnaires on sociodemographic characteristics, general parenting styles (authoritarian, authoritative, indulgent, or neglecting) and specific food-related parenting practices (pressure, reward, encouragement through negotiation, catering on children's demands, permissiveness, avoiding negative modeling, and praise).

Logistic regression analyses were performed, with general parenting style and specific food-related parenting practices as predictors and dietary habits as dependent variables, controlling for sociodemographic characteristics and children's weight status.

General parenting style did not show any significant impact on dietary habits. In contrast, the food-related parenting practice “encouragement through negotiation” showed a significant positive impact, whereas “pressure,” “catering on demand,” and “permissiveness” were practices with an unhealthy impact.

Nutrition education programs that guide parents in firm but not coercive food parenting skills are likely to have a positive impact upon children's dietary habits.

Despite the implementation of a host of tobacco control initiatives, tobacco use among active duty members of the U.S. Military remains high. It has been suggested that a positive culture of tobacco, which drives consumption, exists in the military. However, little is know about factors that impact tobacco use among military personnel.

This study provides the first formative data on the culture of tobacco in the U.S. Military.

A total of 15 focus groups on six military installations were conducted (n = 189). These military installations were located throughout the continental United States and were of average size for each service.

Participants suggested that the primary method the military uses to discourage use is tobacco bans. Unfortunately, they also believed that the military accommodates tobacco use so that smoking remains convenient despite the bans on tobacco use. Smoking was believed to be encouraged through liberal smoking breaks, social interaction within designated smoking areas, and cheap and convenient tobacco products sold on military installations. Additionally, smoking was seen as an effective method to combat the stress and boredom of military life and to avoid weight gain.

Suggestions for addressing the culture of tobacco are suggested.

Examine the contextual effects of neighborhood built and social environments on exercise.

Cross-sectional, multilevel study.

City of Chicago.

A probability sample of Chicago adult residents (response rate = 55%).

The exercise measures were based on two questions: “How often a week on average do you work out or exercise?” (N = 3530) and, “Did you exercise regularly in the last year?” (N = 907). Neighborhood social environment was measured by socioeconomic and social capital indicators. Neighborhood built environment was captured by pedestrian injury rate, residential density, distance to subway or parks, land use mix, and access to neighborhood amenities.

Random effects logit and multinomial models.

For weekly workout/exercise, individuals with access to restaurants and bars were more likely to report one to three times of weekly exercise (OR = 1.08; 95% CI: 0.99, 1.19) and four times or more weekly exercise (OR = 1.14; 95% CI: 1.03, 1.26) compared with those who reported no weekly exercise. For regular exercise in the past year, access to restaurants and bars (OR = 1.24; 95% CI: 1.05, 1.46) and neighborhood social environment (OR = 1.37; 95% CI: 1.11, 1.69) were significant. The social environment effects were stronger for women.

Neighborhood social and built environments are both important for exercise independent of an individual's background.

To examine relationships between the neighborhood food environment and fruit and vegetable intake in a multiethnic urban population.

Analysis of cross-sectional survey and observational data.

One hundred forty-six neighborhoods within three large geographic communities of Detroit, Michigan.

Probability sample of 919 African-American, Latino, and white adults.

The dependent variable was mean daily fruit and vegetable servings, as measured by using a modified Block 98 food frequency questionnaire. Independent variables included the neighborhood food environment: store availability (i.e., large grocery, specialty, convenience, liquor, small grocery), supermarket proximity (i.e., street-network distance to nearest chain grocer), and perceived and observed neighborhood fresh fruit and vegetable supply (i.e., availability, variety, quality, affordability).

Weighted, multilevel regression.

Presence of a large grocery store in the neighborhood was associated with, on average, 0.69 more daily fruit and vegetable servings in the full sample. Relationships between the food environment and fruit and vegetable intake did not differ between whites and African-Americans. However, Latinos, compared with African-Americans, who had a large grocery store in the neighborhood consumed 2.20 more daily servings of fruits and vegetables. Presence of a convenience store in the neighborhood was associated with 1.84 fewer daily fruit and vegetable servings among Latinos than among African-Americans.

The neighborhood food environment influences fruit and vegetable intake, and the size of this relationship may vary for different racial/ethnic subpopulations.

Describe the relationship among modifiable health behaviors and short-term medical costs.

Prospective study linking cross-sectional survey data that assessed modifiable risk behaviors with insurance claims.

A large health plan in Minnesota.

A stratified, random sample of 10,000 yielded an analytic data set for 7983 members.

The dependent variable was per-member-per-month insurance payment plus subscriber liability. Eighteen months of medical costs were analyzed. Control variables included subscriber age, sex, type of insurance plan, days of enrollment, chronic disease status, education, and marital status. Independent variables included self-reported health behaviors of smoking, heavy drinking, nutrition, and physical activity.

Linear regression was performed on the natural log of the cost variable, followed by a retransformation to dollars.

Physical inactivity and smoking were significant predictors of higher medical costs. Each day a member did not exercise there was a 2.9% difference in cost. Compared with never smokers, current smokers had 16% higher costs. Former smokers who had quit more than 1 year before taking the survey had 15% higher costs than never smokers. Recent former smokers cost 32% more than never smokers and more frequently experienced smoking-related medical conditions before they quit. Alcohol consumption was nonsignificant. Nutrition also was not significant but was narrowly measured by only fruit and vegetable consumption.

Physical inactivity and smoking were associated with higher short-term medical costs among health plan members.

Examine behavioral, demographic, psychosocial, and sociocultural concomitants of the stages of change for physical activity behavior among college students in South Korea (n = 221) and the United States (n = 166).

Measures obtained in this cross-sectional study included age; body mass index; nationality; gender; exercise behavior; processes of change; decisional balance; self-efficacy; stage of change; and predisposing, reinforcing and enabling factors.

The amount of variance explained for stage of change by the transtheoretical model constructs (i.e., decisional balance, processes of change, self-efficacy) ranged from 11% to 29% (all p < .001), whereas the predisposing (2%; p = .052), reinforcing (3%; p = .06), and enabling (5%; p < .001) factors were not as important. In multivariate ordinal logistic regression analysis, gender (odds ratio [OR] = 3.3; p < .001), gender by nationality interaction (OR = .27; p < .01), weekly exercise behavior (OR = 1.04; p < .001), and behavioral processes of change (OR = 1.12; p < .001) were each significant concomitants of the stages of change.

In terms of physical activity behavior, South Korean women were more likely than South Korean men to be in the early stages, whereas American men were slightly more likely to be in the early stages than American women when all the concomitants were accounted for. Among the psychosocial stage of change concomitants, only the behavioral processes of change were found to be important.

The purpose of this study was to determine the ability of a commonly used fingerstick technology to identify individuals with abnormal blood levels of total cholesterol (TC), calculated low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglycerides (TG), and high-sensitivity C-reactive protein (hsCRP) compared with a standardized laboratory.

Participants (n = 250; mean age, 48.0 + 13.5 years; 66% female; 36% nonwhite) were eligible for primary prevention of cardiovascular disease (CVD). Blood lipids and hsCKP were measured simultaneously by (1) fingerstick analyzed by Cholestech LDX analyzers and (2) fresh venous blood that was analyzed by Columbia University General Clinical Research Center (GCRC) Core Laboratory. Pearson correlation coefficients, kappa, sensitivity, and specificity were calculated for fingerstick versus GCRC laboratory values for lipids and hsCRP.

The correlations between fingerstick and core laboratory for TC, LDL-C, HDL-C, TG, and hsCRP were .91, .88, .77, .93, and .81, respectively (all p < .01). Sensitivity and specificity of the fingerstick to identify those with abnormal lipids and hsCRP ≥ 1 mg/L were all ≥ 75%.

Fingerstick screening is accurate and has good clinical utility to identify persons with abnormal blood lipids and hsCRP at the point of care in a diverse population that is eligible for primary prevention of CVD. These results may not be generalizable to patients at high risk for CVD or who have known hyperlipidemia.

Categorize and describe the content and status of state legislation of worksite wellness.

State worksite wellness legislation was compiled from the Centers for Disease Control's Division of Nutrition, Physical Activity and Obesity State Legislative Database (http://apps.nccd.cdc.gov/DNPALeg/index.asp) and from LexisNexis (http://www.lexisnexis.com). Key word searches were used to gather worksite wellness legislation (2001–2006), with the exception of resolutions and those bills not pertaining to general employee wellness. Legislation was individually examined, categorized, and analyzed for content and status.

The four categories of state legislation that appeared to be most common were tax credits (n = 34; 0 passed), wellness policies and programs (n = 21; 4 passed), alternative transportation (n = 18; 4 passed), and health insurance (n = 14; 3 passed).

During 2001 to 2006, seven of 27 states enacted worksite wellness bills. In the three categories in which bills passed, 19% to 22% were enacted. This proportion, similar to other health promotions bills, indicates that worksite health promotion legislation passed as favorably as other health promotion topics. Further, the language in the bills did not recommend a specific standard for employee health, such as that in the national Healthy People 2010 objectives.