American Journal of Health Promotion

The purpose of the present study was to compare prediction of physical activity (PA) by experiential or behavioral processes of change (POCs) or an interaction between both types of processes.

A cross-sectional study.

This study was conducted using an online questionnaire.

A total of 394 participants (244 women, 150 men), with a mean age of 35.12 ± 12.04 years and a mean body mass index of 22.97 ± 4.25 kg/m² were included.

Participants completed the Processes of Change, Stages of Change questionnaires, and the International Physical Activity Questionnaire to evaluate self-reported PA level (total, vigorous, and moderate PA).

Hierarchical multiple regression models were used to test the prediction of PA level.

For both total PA (β = .261; P < .001) and vigorous PA (β = .297; P < .001), only behavioral POCs were a significant predictor. Regarding moderate PA, only the interaction between experiential and behavioral POCs was a significant predictor (β = .123; P = .017).

Our results provide confirmation that behavioral processes are most prominent in PA behavior. Nevertheless, it is of interest to note that the interaction between experiential and behavioral POCs was the only element predicting moderate PA level. Experiential processes were not associated with PA level.

No epidemiological study has examined the association of objectively measured physical activity with all-cause mortality among adults who have had a stroke, which was the purpose of this study.

Prospective.

National Health and Nutrition Examination Survey 2003 to 2006.

One hundred eighty-four patients with stroke.

Physical activity assessed via accelerometry (ActiGraph 7164), with stroke assessed via self-report of physician diagnosis. Mortality was assessed via linkage with the National Death Index, with follow-up through 2011.

Cox proportional hazard model.

The median follow-up period was 71.96 months, with 13 241 person-months; 53 deaths occurred during this follow-up period. After adjustments, for every 60 min/d increase in total physical activity, adults who have had a stroke had a 28% (hazard ratio = 0.72; 95% confidence interval: 0.59-0.88) reduced risk of all-cause mortality.

Physical activity among stroke survivors is inversely associated with all-cause mortality.

To examine the association of source of social support and size of social support network on sedentary behavior among older adults.

Cross-sectional.

National Health and Nutrition Examination Survey 2003 to 2006.

2519 older adults (60+ years).

Sedentary behavior was assessed via accelerometry over a 7-day period. Social support was assessed via self-report. Sources evaluated include spouse, son, daughter, sibling, neighbor, church member, and friend. Regarding size of social network, participants were asked, “In general, how many close friends do you have?”

Multivariable linear regression.

After adjustment, there was no evidence of an association between the size of social support network and sedentary behavior. With regard to specific sources of social support, spousal social support was associated with less sedentary behavior (β = −11.6; 95% confidence interval: −20.7 to −2.5), with evidence to suggest that this was only true for men. Further, an inverse association was observed between household size and sedentary behavior, with those having a greater number of individuals in the house having lower levels of sedentary behavior. These associations occurred independent of moderate-to-vigorous physical activity, age, gender, race–ethnicity, measured body mass index, total cholesterol, self-reported smoking status, and physician diagnosis of congestive heart failure, coronary artery disease, stroke, cancer, hypertension, or diabetes.

Spouse-specific emotion-related social support (particularly for men) and household size were associated with less sedentary behavior.

The purpose of this investigation was to systematically review work site–based, environmental interventions to reduce sedentary behavior following preferred reporting items for systematic reviews and meta-analyses guidelines.

Data were extracted from Medical Literature Analysis and Retrieval System Online, Cochrane Central Register of Controlled Trials, and Web of Science between January 2005 and December 2015.

Inclusion criteria were work site interventions, published in peer-reviewed journals, employing environmental modalities, targeting sedentary behavior, and using any quantitative design. Exclusion criteria were noninterventions and non-English publications.

Data extracted included study design, population, intervention dosage, intervention activities, evaluation measures, and intervention effects.

Data were tabulated quantitatively and synthesized qualitatively.

A total of 15 articles were identified for review and 14 reported statistically significant decreases in sedentary behavior. The majority of studies employed a randomized controlled trial design (n = 7), used inclinometers to measure sedentary behavior (n = 9), recruited predominantly female samples (n = 15), and utilized sit-to-stand desks as the primary intervention modality (n = 10). The mean methodological quality score was 6.2 out of 10.

Environmental work site interventions to reduce sedentary behavior show promise because work sites often have more control over environmental factors. Limitations of this intervention stream include inconsistent measurement of sedentary behavior, absence of theoretical frameworks to guide program development, and absence of long-term evaluation. Future studies should include clear reporting of intervention strategies and explicit operationalization of theoretical constructs.

To collect information that will inform the development of an intervention to support the maintenance of HIV-related health-promoting behaviors.

Focused, in-depth individual and group interviews.

The New York City (NYC) Department of Health and Mental Hygiene (DOHMH) and DOHMH-funded community-based organizations that primarily serve low-income people living with HIV within the five boroughs of NYC.

A total of 42 individuals who had participated in The Positive Life Workshop—an HIV self-management intervention adapted and implemented by the NYC DOHMH.

Purposive sampling was used to recruit study participants. Five 60- to 90-minute focus groups (n = 38) and 4 individual interviews were conducted to assess motivations for and barriers to maintaining HIV-related health-promoting behaviors and to elicit feedback on the content and format for the proposed maintenance intervention. Thematic analysis was used to summarize the data.

Participants reported that relationships with family, a responsibility to protect others from HIV, and faith/spirituality supported the maintenance of health-promoting behaviors. Barriers to behavior maintenance included substance use and mental health issues. Meeting in small groups was also highlighted as a motivator to sustaining health behaviors, particularly in decreasing isolation and receiving affirmation from others.

Participants identified several factors that could be incorporated into an intervention to support HIV-related health-promoting behavior maintenance that could supplement existing HIV self-management interventions.

Associations between forgiveness and health promotion in the workplace were examined as mediating effects of workplace interpersonal stress.

Cross-sectional.

Multiple Washington, DC, office-based and Midwestern manufacturing workplaces.

Study 1: 108 employees (40 males and 68 females); mean age was 32.4 years. Study 2: 154 employees (14 males and 140 females); mean age was 43.9 years.

Questionnaires measured forgiveness, unproductivity, absenteeism, stress, and health problems.

Bivariate and multiple correlation/regression and structural equation models were used. Indirect effects were estimated with bootstrapping methods.

In study 1, forgiveness of a specific workplace offense was inversely associated with unproductivity (r = −.35, P < .001) and mental (r = −.32, P = .001) and physical (r = −.19, P = .044) health problems. In study 2, trait forgiveness was inversely associated with unproductivity (β = −.20, P = .016) and mental (β = −.31, P < .001) and physical health problems (β = −.28, P = .001), and workplace interpersonal stress partially mediated these associations (indirect effects = −.03, −.04, −.05, respectively).

The association of forgiveness and occupational outcomes is robust. Forgiveness may be associated with outcomes by (at least partially) reducing stress related to workplace offenses. Forgiveness may be an effective means of coping following being emotionally hurt on the job that may promote good health, well-being, and productivity.

To examine whether meeting sleep guidelines (7-9 hours/night) is associated with better health-related quality of life (HRQOL) and reduced all-cause mortality risk.

Prospective cohort study.

2005 to 2010 National Health and Nutrition Examination Survey.

A total of 13 423 adults.

Sleep duration and HRQOL were assessed from self-report; covariates assessed via survey, examination, and laboratory data; and mortality assessed through 2011 via matching from the National Death Index.

Cox proportional hazard regression and ordinal logistic regression.

After adjusting for age, gender, race–ethnicity, body mass index, education, smoking, white blood cell level, iron level, red blood cell distribution width, mean platelet volume, blood pressure, diabetes, coronary artery disease, physical activity, and depression, those meeting sleep guidelines had an 19% reduced risk of premature all-cause mortality (hazard ratio = 0.81; 95% confidence interval [CI]: 0.67-0.99; P = .04). After adjustments, those meeting sleep guidelines had better HRQOL (β = −0.30; 95% CI: −0.38 to −0.21; P < .001). Results for the ordinal regression and Cox proportional analyses were similar in unadjusted and minimally adjusted models.

Obtaining optimal levels of sleep is associated with better HRQOL and reduced premature mortality risk, independent of demographic, behavioral, and biological conditions. These findings underscore the importance of achieving optimal levels of sleep.

We assessed public support for required water access in schools and parks and perceived safety and taste of water in these settings to inform efforts to increase access to and consumption of tap water.

Cross-sectional survey of the US public collected from August to November 2011.

Random digit-dialed telephone survey.

Participants (n = 1218) aged 17 and older from 1055 US counties in 46 states.

Perceived safety and taste of water in schools and parks as well as support for required access to water in these settings.

Survey-adjusted perceived safety and taste as well as support for required access were estimated.

There was broad support for required access to water throughout the day in schools (96%) and parks (89%). Few participants believed water was unsafe in schools (10%) or parks (18%).

This study provides evidence of public support for efforts to increase access to drinking water in schools and parks and documents overall high levels of perceived taste and safety of water provided in these settings.

We investigated the associations between frequency of eating at fast-food, fast-casual, all-you-can-eat, and sit-down restaurants and the body mass index (BMI) in non-large metro Wisconsin communities. To inform prevention efforts, we also analyzed the socioeconomic/environmental and nutrition attitudes/behavior variables that may drive the frequent eating away from home.

Cross-sectional analysis of an ancillary data set from the Survey of Health of Wisconsin collected between October 2012 and February 2013.

Six Wisconsin counties: 1 classified as rural, 1 as large fringe metro, and 4 as small metro.

Adults ≥18 years (N = 1418).

Field staff measured height and weight and administered a survey on the frequency of eating away from home, and socioeconomic and nutritional behavior variables.

Multivariable regression.

The BMI of respondents averaged 29.4 kg/m² (39% obese). Every 1-meal/week increase in fast-food and sit-down restaurant consumption was associated with an increase in BMI by 0.8 and 0.6 kg/m², respectively. Unavailability of healthy foods at shopping and eating venues and lack of cooking skills were both positively associated with consumption of fast-food and sit-down meals. Individuals who described their diet as healthy, who avoided high-fat foods, and who believed their diet was keeping their weight controlled did not visit these restaurants frequently.

Obesity prevention efforts in non-large metro Wisconsin communities should consider socioeconomic/environmental and nutritional attitudes/behavior of residents when designing restaurant-based or community education interventions.

To examine differences in students’ access to school salad bars across sociodemographic groups and changes in availability over time.

Nonexperimental.

Nationally representative 2011 and 2014 YouthStyles surveys.

A total of 833 (2011) and 994 (2014) US youth aged 12 to 17 years.

Youth-reported availability of school salad bars.

Multivariable logistic regression models were used to assess differences in school salad bar availability by sociodemographics and changes in availability from 2011 to 2014.

Youth-reported salad bar availability differed by age in 2011 and race/ethnicity in 2014, but not by sex, income, metropolitan residence, or region in either year. Salad bars were reported by 62% of youth in 2011 and 67% in 2014; the increase was not statistically significant (P = .07). Significant increases from 2011 to 2014 were noted among youth aged 12 to 14 years (56%-69%; P < .01), youth of non-Hispanic other races (60%-85%; P < .01), and youth in the Midwest (58%-72%; P = .01).

These results suggest that youth-reported access to school salad bars does not differ significantly across most sociodemographic groups. Although overall salad bar availability did not increase significantly from 2011 to 2014, some increases were observed among subgroups. Continued efforts to promote school salad bars through initiatives such as Let’s Move Salad Bars to Schools could help increase access for the nearly one-third of US youth reporting no access.

To determine the prevalence and correlates of missing meals among adolescents.

The 2010 National Youth Physical Activity and Nutrition Study, a cross-sectional study.

School based.

A nationally representative sample of 11 429 high school students.

Breakfast, lunch, and dinner consumption; demographics; measured and perceived weight status; physical activity and sedentary behaviors; and fruit, vegetable, milk, sugar-sweetened beverage, and fast-food intake.

Prevalence estimates for missing breakfast, lunch, or dinner on ≥1 day during the past 7 days were calculated. Associations between demographics and missing meals were tested. Associations of lifestyle and dietary behaviors with missing meals were examined using logistic regression controlling for sex, race/ethnicity, and grade.

In 2010, 63.1% of students missed breakfast, 38.2% missed lunch, and 23.3% missed dinner; the prevalence was highest among female and non-Hispanic black students. Being overweight/obese, perceiving oneself to be overweight, and video game/computer use were associated with increased risk of missing meals. Physical activity behaviors were associated with reduced risk of missing meals. Students who missed breakfast were less likely to eat fruits and vegetables and more likely to consume sugar-sweetened beverages and fast food.

Breakfast was the most frequently missed meal, and missing breakfast was associated with the greatest number of less healthy dietary practices. Intervention and education efforts might prioritize breakfast consumption.

To examine the workplace food and physical activity (PA) environments and wellness culture reported by employed United States adults, overall and by employer size.

Cross-sectional study using web-based survey on wellness policies and environmental supports for healthy eating and PA.

Worksites in the United States.

A total of 2101 adults employed outside the home.

Survey items were based on the Centers for Disease Control and Prevention Worksite Health ScoreCard and Checklist of Health Promotion Environments and included the availability and promotion of healthy food items, nutrition education, promotion of breast-feeding, availability of PA amenities and programs, facility discounts, time for PA, stairwell signage, health promotion programs, and health risk assessments.

Descriptive statistics were used to examine the prevalence of worksite environmental and facility supports by employer size (<100 or ≥100 employees). Chi-square tests were used to examine the differences by employer size.

Among employed respondents with workplace food or drink vending machines, approximately 35% indicated the availability of healthy items. Regarding PA, 30.9% of respondents reported that their employer provided opportunities to be physically active and 17.6% reported worksite exercise facilities. Wellness programs were reported by 53.2% working for large employers, compared to 18.1% for smaller employers.

Employee reports suggested that workplace supports for healthy eating, PA, and wellness were limited and were less common among smaller employers.

To assess (1) the cumulative effect of socioecological factors (social risk) on objectively measured physical activity, (2) the cumulative socioecological risk on all-cause mortality, (3) the potential interaction effects of social risk factors on physical activity and mortality, and (4) whether physical activity mediates the relationship between social risk and mortality.

Cross-sectional and prospective.

Laboratory- and survey-based testing of the general US population.

Five thousand five hundred seventy-four adult participants of the National Health and Nutrition Examination Survey 2003 to 2006.

Social risk was assessed from 4 variables, namely poverty level, education, minority status, and social living status. Moderate-to-vigorous physical activity (MVPA) was assessed via accelerometry. Mortality was assessed via linkage with the National Death Index, with follow-up through 2011.

Negative binomial regression and Cox proportional hazard model.

Compared to those with 0 social risk factors, those with 1 and 2+ social risk factors engaged in 11% and 10% less MVPA, respectively. Those with 1 (vs 0) social risk factor had a 2.0-fold increase in mortality risk, and those with 2+ (vs 0) social risk factors had a 2.3-fold increase in mortality risk. Interaction effects for various socioecological factors on both MVPA and mortality were observable.

Cumulative social risk is associated with less MVPA and increased all-cause mortality risk. Given the interaction effects of socioecological factors, targeted interventions in identified populations may be needed.

To assess the feasibility of measuring changes in gene expression associated with post-traumatic stress disorder (PTSD) treatment using emotional freedom techniques (EFT).

Participants were randomized into an EFT group receiving EFT and treatment as usual (TAU) throughout a 10-week intervention period and a group receiving only TAU during the intervention period and then receiving EFT.

A community clinic and a research institute in California.

Sixteen veterans with clinical levels of PTSD symptoms.

Ten hour-long sessions of EFT.

Messenger RNA levels for a focused panel of 93 genes related to PTSD. The Symptom Assessment 45 questionnaire, Hospital Anxiety and Depression Scale, Insomnia Severity Scale, SF-12v2 for physical impairments, and Rivermead Postconcussion Symptoms Questionnaire.

Pre-, posttreatment, and follow-up mean scores on questionnaires were assessed using repeated measures 1-way analysis of variance. A Student t test and post hoc analyses were performed on gene expression data.

Post-traumatic stress disorder symptoms declined significantly in the EFT group (−53%, P < .0001). Participants maintained their gains on follow-up. Significant differential expression of 6 genes was found (P < .05) when comparing the expression levels before and after the intervention period in participants receiving EFT.

Study results identify candidate gene expression correlates of successful PTSD treatment, providing guidelines for the design of further studies aimed at exploring the epigenetic effects of EFT.

The purpose of this study was to assess patterns of health-care utilization among children who potentially had tobacco smoke exposure (TSE) compared to those who were not exposed.

A secondary data analysis of the 2011 to 2012 National Survey on Children’s Health was performed.

Households nationwide were selected.

A total of 95 677 children aged 0 to 17 years.

Sociodemographic characteristics, TSE status, and health-care visits were measured.

Multivariable logistic regression models were performed.

A total of 24.1% of children lived with smokers. Approximately 5% had home TSE. Participants who lived with a smoker were significantly more likely to have had a medical care visit (odds ratio [OR] = 1.22, confidence interval [CI] = 1.21-1.22) and were more likely to seek sick care or health advice at an emergency department (OR = 1.23, CI = 1.23-1.24) but were less likely to have had a dental care visit (OR = 0.82, CI = 0.82-0.83) than those who did not live with a smoker. Similar findings were found among participants who had home TSE.

TSE is a risk factor for increased use of pediatric medical care. Based on the high number of children who potentially had TSE and received sick care or health advice at an emergency emergency department, this setting may be a venue to deliver health messages to caregivers.

To examine locations of secondhand smoke (SHS) exposure among nonsmokers, 7 years after a statewide smoke-free policy.

Data collected via statewide, random digit dial telephone survey. Response rates were 64.7% for landline and 73.5% for cell phone.

Minnesota, 2014.

Representative sample of 7887 nonsmoking adults.

Self-reported locations of SHS exposure and opinions on smoke-free restrictions.

Descriptive statistics and logistic regression.

A total of 35.5% of nonsmokers reported SHS exposure in the past 7 days. The greatest proportion of exposure occurred in community settings (31.7%) followed by cars (6.9%) and in the home (3.2%). Young adults were more likely to be exposed in a home or car than older adults. Nonsmokers living with a smoker were 39.6 (20.6-75.8) times more likely to be exposed to SHS in their home and 5.3 (4.1-6.8) times more likely to be exposed in a car, compared to those who did not live with a smoker.

SHS exposure continues after comprehensive smoke-free policies restricted it from public places. Disparities in exposure rates exist for those who live with a smoker, are young, and have low incomes. Findings suggest the need for additional policies that will have the greatest public health benefit.

The purpose of this study was to explore gender-related factors that motivate and support men’s smoking reduction and cessation to inform effective men-centered interventions.

Focus group design using a semi-structured interview guide.

Three communities in British Columbia, Canada.

A total of 56 men who currently smoked and were interested in reducing or quitting or had quit.

N/A.

Data collected in 6 focus group discussions were transcribed and analyzed in accord with principles of thematic qualitative methods.

We report the results across 4 interconnected themes: (1) the fight to quit takes several rounds, (2) the motivation of supportive competition, (3) challenges and benefits of connecting with smoke-free peers, and (4) playing up the physical and financial gains.

Masculine-based perspectives positioned quitting alongside fighting for self-control, competing, connecting, physical prowess, and having extra cash as motivating components of programs to engage men in efforts to be smoke-free. It may be worthwhile to consider the inclusion of gain-framed and benefit-focused messaging in programs that support men’s tobacco cessation.

This study details the persuasive message development for a theory-based campaign designed to increase compliance with a university’s tobacco-free policy.

The theory of planned behavior (TPB) guided message design and evaluation for focus group–tested messages that were adapted to the context of complying with a tobacco-free policy.

The study was conducted at a university located in the tobacco belt.

Undergraduate focus group participants (n = 65) were mostly male (69%), white (82%), and freshman (62%) who smoked at least 1 cigarette in the last 30 days; on-campus smoking percentages were never/rare (60%), occasionally (23%), and often/frequently (16%).

Data analysis used a theoretical thematic approach to identify how the TPB constructs related to perceptions of message effectiveness.

Participants responded favorably to attitudinal strategies about health, respect, and university figures; they rejected approaches they considered juvenile and offensive. They also discussed the impact of noncompliance and avoiding overgeneralized statements for addressing subjective norms, suggesting shortening text, adjusting picture location, and emphasizing the importance of compliance to increase perceptions of behavioral control.

Applying theory to preexisting messages is challenging. The design approach in this study is an evidence-based strategy that can be used as a universal process for message adaptation. Results offer health promotion suggestions for designing messages aimed at improving undergraduate smokers’ willingness to comply with tobacco-free campus policies.

To examine the sources of tobacco coupons and their influence on susceptibility to snus use.

Cohort study.

Minnesota Adolescent Community Cohort Study.

A population-based sample of US Midwest young adults in 2011 to 2012 and 2012 to 2013 (aged 22-28; n = 2384).

Exposure to coupons for various tobacco products through various sources in the past 6 months, susceptibility to snus use.

Multiple logistic regressions.

During the 6 months prior to 2012 to 2013 survey, 11% of the sample received coupons for cigarettes, 5% received coupons for snus, 3% received coupons for other smokeless tobacco products, and <1% received coupons for little cigars. Direct mail was the most commonly cited source of cigarette and snus coupons. Tobacco product packaging provided the highest number of tobacco coupons for current and former smokers. Participants without a 4-year college education (compared to those who had a 4-year college education) were more likely to have received coupons for cigarettes and snus and received more coupons for both products (P < .05). Racial/ethnic minority young adults (vs non-Hispanic white) received more cigarette and snus coupons (P < .05). Receiving snus coupons was positively associated with susceptibility to snus use (P < .05).

Tobacco companies are successful in reaching young adults using coupons for various tobacco products. Snus coupons may influence snus use, similar to how cigarette coupons influence smoking.

To examine the association between smoking and participation in Supplemental Nutrition Assistance Program (SNAP) among low-income families.

A quasi-experimental design using pooled cross-sectional data from the Bureau of Labor Statistics’ Consumer Expenditure Diary Survey.

A national, representative sample of US households from 2005 through 2012.

A total of 19 395 low-income households.

US poverty thresholds were used, in conjunction with household income, to create a sample of families at 130% of the federal poverty level and below. Expenditures on cigarettes and self-reported enrollment in SNAP were used to measure smoking behavior and program participation, respectively.

Estimation of a maximum likelihood model was used to predict the probability of smoking given participation in SNAP.

The SNAP participation among low-income households was associated with a 30% (P < .01) increase in the likelihood of a household containing at least 1 smoker, relative to low-income non-SNAP households. Among smokers, SNAP households do not spend more money on tobacco products than non-SNAP households.

Given the strong association found between SNAP participation and smoking, connecting program participants who smoke to effective smoking cessation programs could be an effective tool in reducing the prevalence of smoking among the low-income population. States have a unique opportunity to use SNAP-Education programs to integrate tobacco prevention and cessation into curriculum for direct client impact.

To test the effects of employer subsidies on employee enrollment, attendance, and weight loss in a nationally available weight management program.

A randomized trial tested the impact of employer subsidy: 100%; 80%, 50%, and a hybrid 50% subsidy that could become a 100% subsidy by attaining attendance targets. Trial registration: NCT01756066.

Twenty three thousand twenty-three employees of 2 US companies.

The primary outcome was the percentage of employees who enrolled in the weight management program. We also tested whether the subsidies were associated with differential attendance and weight loss over 12 months, as might be predicted by the expectation that they attract employees with differing degrees of motivation.

Enrollment differed significantly by subsidy level (P < .0001). The 100% subsidy produced the highest enrollment (7.7%), significantly higher than each of the lower subsidies (vs 80% subsidy: 6.2%, P = .002; vs 50% subsidy: 3.9%, P < .0001; vs hybrid: 3.7%, P < .0001). Enrollment in the 80% subsidy group was significantly higher than both lower subsidy groups (vs 50% subsidy: 3.9%, P < .0001; vs hybrid: 3.7%, P < .0001). Among enrollees, there were no differences among the 4 groups in attendance or weight loss.

This pragmatic trial, conducted in a real-world workplace setting, suggests that higher rates of employer subsidization help individuals to enroll in weight loss programs, without a decrement in program effectiveness. Future research could explore the cost-effectiveness of such subsidies or alternative designs.

We examine the concurrent relationship between obesity incidence and normal weight status incidence and prevalence in children between 9 months and kindergarten.

Multistage, probability sample from the Early Childhood Longitudinal Study–Birth cohort.

United States.

Representative sample of US preschool children (n = 9950) followed from birth through kindergarten.

From direct, anthropometric measures, we reported prevalence and incidence rates across 4 follow-up periods.

In addition to prevalence and incidence rates, we reported risk ratios based on multiple definitions and estimated predicted probabilities of obesity and normal weight status using clinically meaningful body mass index (BMI)-for-age percentiles.

Obesity prevalence (13%-20%) was much smaller than normal weight status prevalence (66%-70%). Lower socioeconomic status, Hispanic, and non-Hispanic black children had greater risk of obesity. During 9 months to kindergarten, obesity incidence decreased two-thirds (15.6%), while normal weight status incidence decreased almost one-half (44.6%). Coincidently, normal weight status incidence (ranged from 23% to 45%) was consistently and substantially higher than obesity incidence (ranged from 5% to 15%). During 4 years to kindergarten, the obesity risk for overweight children was 13 times higher than that for normal weight status children.

Overall rates of obese and normal weight incidence were substantial at 9 months, trended lower, but remained high through kindergarten. At 4 years to kindergarten, children with relatively high initial BMI were very likely to become obese but far less likely to achieve normal weight status.

To develop a model, based on market segmentation, to improve the quality and efficiency of health promotion materials and programs.

Market segmentation to create segments (groups) based on a cross-sectional questionnaire measuring individual characteristics and preferences for health information. Educational and delivery recommendations developed for each group.

General population of adults in Virginia.

Random sample of 1201 Virginia residents. Respondents are representative of the general population with the exception of older age.

Multiple factors known to impact health promotion including health status, health system utilization, health literacy, Internet use, learning styles, and preferences.

Cluster analysis and discriminate analysis to create and validate segments. Common sized means to compare factors across segments.

Developed educational and delivery recommendations matched to the 8 distinct segments. For example, the “health challenged and hard to reach” are older, lower literacy, and not likely to seek out health information. Their educational and delivery recommendations include a sixth-grade reading level, delivery through a provider, and using a “push” strategy.

This model addresses a need to improve the efficiency and quality of health promotion efforts in an era of personalized medicine. It demonstrates that there are distinct groups with clearly defined educational and delivery recommendations. Health promotion professionals can consider Tailored Educational Approaches for Consumer Health to develop and deliver tailored materials to encourage behavior change.

To examine the characteristics of voluntary online commitment contracts that may be associated with greater weight loss.

Retrospective analysis of weight loss commitment contracts derived from a company that provides web-based support for personal commitment contracts. Using regression, we analyzed whether percentage weight loss differed between participants who incentivized their contract using monetary deposits and those who did not.

Online.

Users (N = 3857) who voluntarily signed up online in 2013 for a weight loss contract.

Participants specified their own weight loss goal, time period, and self-reported weekly weight. Deposits were available in the following 3 categories: charity, anticharity (a nonprofit one does not like), or donations made to a friend.

Percentage weight loss per week.

Multivariable linear regressions.

Controlling for several participant and contract characteristics, contracts with anticharity, charity, and friend deposits had greater reported weight loss than nonincentivized contracts. Weight change per week relative to those without deposits was −0.33%, −0.28%, and −0.25% for anti-charity, charity, and friend, respectively (P < 0.001). Contracts without a weight verification method claimed more weight loss than those with verification.

Voluntary use of commitment contracts may be an effective tool to assist weight loss. Those who choose to use monetary incentives report more weight loss. It is not clear whether this is due to the incentives or higher motivation.

This study assessed whether college student (1) protective behavioral strategy (PBS) use differed between those who reached legal intoxication during their most recent drinking episode compared to those who did not reach the legal blood alcohol concentration (BAC) threshold, and (2) frequency of PBS use could explain the variance associated with BAC during the most recent drinking episode, above and beyond one’s sex, age, and involvement in the Greek system.

Secondary data analysis of the American College of Health Association’s National College Health Assessment.

Forty-four distinct campuses were included.

A total of 21479 college students were included.

BAC and PBS were measured.

The data were analyzed by conducting both independent samples t-tests and a multiple regression model. Effect sizes are reported.

Participants who reached legal intoxication used PBS less frequently (P < .001; d = 0.80). Frequency of PBS use had the strongest unique contribution to the regression model (β = −.315, P < .001), such that participants with higher BAC reported less frequent use of PBS.

Interventions should seek to develop strategies that encourage college student use of PBS prior to, and during, drinking episodes. More frequent use of PBS can reduce intoxication as well as occurrence of alcohol-associated consequences.

To test the feasibility and reliability of a direct observation method for measuring moderate to vigorous physical activity (MVPA) in children visiting an interactive children’s museum exhibition.

Direct observation was used to assess MVPA in children visiting an interactive children’s museum exhibition on 2 weekend days in winter 2013.

The Children’s Museum of Manhattan’s EatSleepPlay™: Building Health Every Day exhibition.

Children (group level) visiting the museum exhibition.

System for Observing Play and Leisure Activity in Youth (SOPLAY).

Interobserver reliability was analyzed for MVPA and activity type. Two-group analyses were conducted using a series of Wilcoxon rank sum tests.

A total of 545 children were observed over 288 observations. No significant differences were found between observers for MVPA (r = .91, P = .6804) or activity type (κ = .90, P = .6334). Children participated in MVPA during 35.2% of all observations. No significant differences were found for participation in MVPA between boys (37.6%) and girls (32.8%, P = .1589).

The SOPLAY may be a useful tool for measuring MVPA in interactive children’s museum exhibitions. Research with multiple museum settings and diverse groups of children over longer periods of time is warranted to further establish the feasibility and reliability of the SOPLAY for measuring MVPA in this novel setting.

Anxiety is the most common and costly mental illness in the United States. Reducing avoidance is a core element of evidence-based treatments. Past research shows readiness to address avoidance affects outcomes. Investigating avoidance from a transtheoretical model (TTM) perspective could facilitate tailored approaches for individuals with low readiness. This study developed and examined psychometric properties of TTM measures for addressing anxiety-based avoidance.

Cross-sectional survey.

Community centers, online survey.

Five hundred ninety-four individuals aged 18 to 70 with clinically significant anxiety.

Overall Anxiety Severity Questionnaire, stages of change, decisional balance, and self-efficacy.

The sample was randomly split into halves for principal component analyses (PCAs) and confirmatory factor analyses (CFAs) to test measurement models. Further analyses examined relationships between constructs.

For decisional balance, PCA indicated two 5-item factors (pros and cons). Confirmatory factor analysis supported a 2-factor correlated model, Satorra-Bentler scaled chi-square ( χ SB 2 [ 35 ] = 80.82 ) , comparative fit index (CFI = 0.94), root mean square error of approximation (RMSEA = 0.07), pros: α = 0.87, ρ = 0.87, cons: α = 0.75, and ρ = 0.75. For self-efficacy, PCA indicated one 6-item factor supported by CFA, χ SB 2 ( 9 ) = 30.39 , P < .01, CFI = 0.98, RMSEA = 0.09, α = 0.90, ρ = 0.87. As hypothesized, significant cross-stage differences were observed for pros and self-efficacy, and significant relationships between anxiety severity and pros, cons, and self-efficacy were found.

Findings show strong psychometric properties and support the application of a readiness-based model to anxiety. In contrast to findings of other behaviors, cons remain high in action and maintenance. These measures provide a solid empirical foundation to develop TTM-tailored interventions to enhance engagement in treatment.

To develop a valid and feasible short-form corner store audit tool (SCAT) that could be used in-store or over the phone to capture the healthfulness of corner stores.

Nonexperimental.

Four New Jersey cities.

Random selection of 229 and 96 corner stores in rounds 1 and 2, respectively.

An adapted version of the Nutrition Environment Measures Survey for Corner Stores (NEMS-CS) was used to conduct in-store audits. The 7-item SCAT was developed and used for round 2 phone audits.

Exploratory factor analysis and item response theory were used to develop the SCAT.

The SCAT was highly correlated with the adapted NEMS-CS (r = .79). Short-form corner store audit tool scores placed stores in the same healthfulness categories as did the adapted NEMS-CS in 88% of the cases. Phone response matches indicated that store owners did not distinguish between 2% and low-fat milk and tended to round up the fruit and vegetable count to 5 if they had fewer varieties.

The SCAT discriminates between higher versus lower healthfulness scores of corner stores and is feasible for use as a phone audit tool.