American Journal of Health Promotion

To examine associations of adolescent sugar-sweetened beverage (SSB) intake with parent SSB intake and parent and adolescent knowledge of SSB-related health risks.

Quantitative, cross-sectional.

2014 SummerStyles survey.

Nine hundred and ninety parent and adolescent (12-17 years) pairs.

The outcome was self-reported adolescent intake (0, >0 to <1, or ≥1 time/day) of SSBs (soda, fruit drinks, sports/energy drinks, other SSBs). The exposures were self-reported parent SSB intake (0, >0 to <1, ≥1 to <2, or ≥2 times/day) and parent and adolescent knowledge of SSB-related health risks (weight gain, diabetes, and dental caries).

Separate multinomial logistic regression models were used to estimate adjusted odds ratios (aORs) for adolescent SSB intake ≥1 time/day (ref: 0 times/day), according to (1) parent SSB intake and (2) parent and (3) adolescent knowledge.

About 31% of adolescents consumed SSBs ≥1 time/day, and 43.2% of parents consumed SSBs ≥2 times/day. Adolescent and parent knowledge that SSB intake is related to health conditions ranged from 60.7% to 80.4%: weight gain (75.0% and 80.4%, respectively), diabetes (60.7% and 71.4%, respectively), and dental caries (77.5% and 72.9%, respectively). In adjusted models, adolescent SSB intake ≥1 time/day was associated with parent intake ≥2 times/day (aOR = 3.30; 95% confidence interval = 1.62-6.74) but not with parent or adolescent knowledge of health risks.

Parental SSB intake may be an important factor in understanding adolescent behavior; knowledge of SSB-related health conditions alone may not influence adolescent SSB behavior.

Clinicians and fitness professionals are increasingly recommending the use of activity trackers. This study compares commercially available activity tracking devices for step and distance accuracy in common exercise settings.

Cross sectional.

Rochester, Minnesota.

Thirty-two men (n = 10) and women (n = 22) participated in the study.

Researchers manually counted steps and measured distance for all trials, while participants wore 6 activity tracking devices that measured steps and distance.

We computed the difference between the number of steps measured by the device and the actual number of steps recorded by the observers, as well as the distance displayed by the device and the actual distance measured.

The analyses showed that both the device and walking trials affected the accuracy of the results (steps or distance, P < .001). Hip-based devices were more accurate and consistent for measuring step count. No significant differences were found among devices or locations for the distance measured.

Hip-based activity tracking devices varied in accuracy but performed better than their wrist-based counterparts for step accuracy. Distance measurements for both types of devices were more consistent but lacked accuracy.

To describe the presence of licensed tobacco retailers (LTRs), cigarette advertisements, price-reducing promotions, and compliance with tobacco control policies in New York State from 2004 to 2015 and to discuss implications and lessons learned from 11 years of experience conducting LTR surveys.

Annual surveys of tobacco advertising from cross-sectional, stratified random samples of LTRs in New York State from 2004 to 2015 were conducted by professional data collectors. Data for 2013 were unavailable as the survey was not fielded in that year.

New York State.

Licensed tobacco retailers, which are stores licensed to sell tobacco in the state of New York. Between 3.6% (n = 800) and 19.7% (n = 3945) of all LTRs were sampled annually.

The presence and number of cigarette advertisements and the presence of price-reducing promotions, required age-of-sale signage, and self-service tobacco displays were documented.

We tested for significant differences between 2014 and 2015 and significant trends overall and by outlet type. We used logistic regression for binary outcomes and Poisson regression for count variables.

The number of LTRs in New York State decreased 22.9% from 2004 (n = 25 740) to 2015 (n = 19 855). The prevalence and number of cigarette advertisements and the prevalence of cigarette price-reducing promotions decreased significantly over time. Compliance with posting required age-of-sale signs increased significantly from 2004 to 2015 and from 2014 to 2015. Compliance with the ban on self-service tobacco displays was consistently near 100%.

The tobacco retail environment in New York State improved substantially from 2004 to 2015. The implications of these findings for youth and adult smoking and the associated social costs are unknown; however, decreases in pro-tobacco marketing, decreases in the number of LTRs, and improvements in compliance are likely to have positive impacts on youth and adult smoking outcomes, such as reduced initiation and increased cessation, given previous research findings.

The purpose of this study was to explore the relationship between ecological factors and occupational sedentary behavior (SB).

Cross-sectional online survey.

Participants were employees recruited from a large, public university in the Southeastern United States from August to November 2016.

The final sample included 527 (56% response rate) employees.

Data were collected through an 87-item survey using previously validated scales that assessed occupational SB, perceived behavioral control, barrier self-efficacy, self-regulation strategies, organizational social norms, office environment, and worksite climate.

One-way analysis of variance analyses were used to determine differences in occupational SB by demographic factors. A multivariate regression model was used to determine significant ecological determinants of occupational SB.

Mean SB was 342.45 (standard deviation = 133.25) minutes. Significant differences in SB were found by gender, education, and employment classification. Barrier self-efficacy and workplace connectivity, which evaluates the spatial layout of the office setting that may impact mobility within the workplace, were significant predictors of SB in the multivariate model.

Results from this study provide new information regarding the potential impact of workplace barriers and connectivity on occupational SB. The findings from this study support the inclusion of intervention modalities to minimize workplace barriers and increase workplace connectivity to increase workplace mobility and decrease SB.

The purpose of this study is to evaluate managers’ barriers and facilitators to supporting employee participation in the Washington State Wellness program.

Exploratory sequential mixed methods.

Four Washington State agencies located in Olympia and Tumwater, Washington.

State employees in management positions (executive, middle, and line), whose job includes supervision of subordinates and responsibility for the performance and conduct of a subunit or group.

We interviewed 23 managers and then used the results to create a survey that was fielded to all managers at the 4 agencies. The survey response rate was 65% (n = 607/935).

We used qualitative coding techniques to analyze interview transcripts and descriptive statistics to summarize survey data. We used the Total Worker Health framework to organize our findings and conclusions.

Managers support the wellness program, but they also face challenges with accommodating employees’ participation due to workload, scheduling inflexibility, and self-efficacy to discuss wellness with direct reports. About half the managers receive support from the manager above them, and most have not received training on the wellness program.

Our findings point to several strategies that can strengthen managers’ role in supporting the wellness program: the provision of training, targeted messages, formal expectations, and encouragement (from the manager above) to support employees’ participation.

To test the effectiveness of an intervention to increase motivation for physical activity in racially diverse third- through fifth-grade students.

Natural experiment.

Elementary schools in Minneapolis, Minnesota.

Two hundred ninety-one students in 18 Minne-Loppet Ski Program classes and 210 students in 12 control classrooms from the same schools.

The Minne-Loppet Ski Program, an 8-week curriculum in elementary schools that teaches healthy physical activity behaviors through cross-country skiing.

Pretest and posttest surveys measured self-determination theory outcomes: intrinsic exercise motivation, intrinsic ski motivation, autonomy, competence, and relatedness.

Hierarchical linear regression models tested treatment effects controlled for grade, race, sex, and baseline measures of the outcomes.

Minne-Loppet program students showed significantly greater motivation to ski (β = 0.95, 95% confidence interval [CI]: 0.15-1.75) and significantly greater perceived competence (β = 0.78, 95% CI: 0.06-1.50) than students in control classrooms. Treatment effects for general exercise motivation and perceived competence differed by race. African American students in Minne-Loppet classes showed significantly greater general exercise motivation (β = 1.08, 95% CI: 0.03-2.14) and perceived competence (β = 1.95, 95% CI: 0.91-2.99) than African American students in control classes.

The Minne-Loppet program promoted perceived competence and motivation to ski. Future improvements to the Minne-Loppet and similar interventions should aim to build general motivation and provide support needed to better engage all participants.

This study investigated the resilience of single-family housing values in walkable versus unwalkable neighborhoods during the economic downturn from 2008 to 2012 in Dallas, Texas.

Using propensity score matching and difference in differences methods, this study established a natural experimental design to compare before-and-after value changes of single-family (SF) homes in walkable neighborhoods with unwalkable neighborhoods during the Great Recession. Two thousand seven hundred ninety-nine SF homes within 18 Tax Increment Financing (TIF) districts were categorized into walkable (Walk Score ≥50) and unwalkable (<50) groups. Six hundred twenty-four dwellings in walkable neighborhoods were matched with the most identical ones in the unwalkable neighborhoods by controlling for the selected structural and residential location variables. Relative average treatment effects were examined for SF values in walkable and unwalkable neighborhoods.

On average, the SF homes in walkable neighborhoods held $4566 (2.08%) more value than their how walkable counterparts.

This study aims to help planners and decision-makers by documenting the unmet demand for walkable communities and their sustained economic benefit. Increased awareness of the sustained value of walkable communities can be used by lenders who finance and by policy makers who regulate placemaking. Results from this study can be integrated with research that demonstrates health-care cost savings of walkable environments to create an even more comprehensive set of evidence-based interventions to increase their supply.

To investigate relations of perceived worksite neighborhood environments to total physical activity and active transportation, over and above home neighborhood built environments.

Observational epidemiologic study.

Baltimore, Maryland-Washington, DC, and Seattle-King County, Washington metropolitan areas.

One thousand eighty-five adults (mean age = 45.0 [10.2]; 46% women) recruited from 32 neighborhoods stratified by high/low neighborhood income and walkability.

The Neighborhood Environment Walkability Survey assessed perceptions of worksite and home neighborhood environments. Accelerometers assessed total moderate-to-vigorous physical activity (MVPA). The International Physical Activity Questionnaire assessed total active transportation and active transportation to and around work.

Mixed-effects regression tested relations of home and worksite neighborhood environments to each physical activity outcome, adjusted for demographics.

Home and worksite mixed land use and street connectivity had the most consistent positive associations with physical activity outcomes. Worksite traffic and pedestrian safety were also associated with multiple physical activity outcomes. The worksite neighborhood explained additional variance in physical activity outcomes than explained by the home neighborhood. Worksite and home neighborhood environments interacted in explaining active transportation to work, with the greatest impacts occurring when both neighborhoods were activity supportive.

Both worksite and home neighborhood environments were independently related to total MVPA and active transportation. Community design policies should target improving the physical activity supportiveness of worksite neighborhood environments and integrating commercial and residential development.

Individuals with mental illnesses have higher morbidity rates and reduced life expectancy compared to the general population. Understanding how patients and providers perceive the need for prevention, as well as the barriers and beliefs that may contribute to insufficient care, are important for improving service delivery tailored to this population.

Cross-sectional; mixed methods.

An integrated health system and a network of federally qualified health centers and safety net clinics.

Interviews (n = 30) and surveys (n = 249) with primary care providers. Interviews (n = 158) and surveys (n = 160) with patients diagnosed with schizophrenia, bipolar, anxiety, or major depressive disorders.

Semi-structured interviews and surveys.

Thematic analysis for qualitative data; frequencies for quantitative data.

More than half (n = 131, 53%) of clinicians believed patients with mental illnesses care less about preventive care than the general population, yet 88% (n = 139) of patients reported interest in improving health. Most providers (n = 216, 88%) lacked confidence that patients with mental illnesses would follow preventive recommendations; 82% (n = 129) of patients reported they would try to change lifestyles if their doctor recommended. Clinicians explained that their perception of patients’ chaotic lives and lack of interest in preventive care contributed to their fatalistic attitudes on care delivery to this population. Clinicians and patients agreed on substantial need for additional support for behavior changes. Clinicians reported providing informational support by keeping messages simple; patients reported a desire for more detailed information on reasons to complete preventive care. Patients also detailed the need for assistive and tangible support to manage behavioral health changes.

Our results suggest a few clinical changes could help patients complete preventive care recommendations and improve health behaviors: improving clinician–patient collaboration on realistic goal setting, increasing visit time or utilizing behavioral health consultants that bridge primary and specialty mental health care, and increasing educational and tangible patient support services.

To explore why some hotels have implemented 100% smoke-free policies voluntarily, the perceived consequences of doing so, and media responses.

Qualitative study of hotel management and quantitative content analysis of media coverage of smoke-free hotels.

Hotels and media based in the United States.

Eleven representatives of 5 independent and 4 chain hotels. Other data included 265 news items about smoke-free hotels.

We conducted 30-minute semi-structured interviews with hotel representatives and analyzed the data using qualitative content analysis. We also searched 3 online news databases for news items about hotels in our study, and collaboratively coded retrieved items; we analyzed the content and slant of news items.

Business considerations, including guest requests, competitor action, and cost savings, were the primary motivations for implementing 100% smoke-free guest-room policies. Health concerns played a minimal role. Hotels received positive feedback from customers and employees. Media coverage was favorable, emphasizing positive aspects of going smoke-free; the overall slant of news items was positive or neutral. However, few hotels marketed the change.

Since hotel customers and employees are likely to experience long periods of smoke exposure and smoke-free hotels appear to be so well received, it may be timely to pursue policies making all hotels smoke-free.

The “fat-but-fit” paradigm has been evaluated. However, the duration of overweight/obesity within the “fat-but-fit” paradigm (ie, assessing body mass at more than 1 time point) has not been extensively evaluated, which was this study’s purpose.

Cross-sectional.

National Health and Nutrition Examination Survey 2003 to 2006.

Ages 36 to 85; N = 3621.

Physical activity assessed via accelerometry. Medical multimorbidity was assessed via physician diagnosis of 13 chronic diseases. Height and body mass were directly measured for current body mass index (BMI), and 10-year prior BMI was calculated using current height and self-reported weight 10 years prior. Six mutually exclusive groups were created: (1) active, normal weight now and 10 years ago; (2) inactive, normal weight now and 10 years ago; (3) active, overweight/obese now but not 10 years ago; (4) active, overweight/obese now and 10 years ago; (5) inactive, overweight/obese now but not 10 years ago; and (6) inactive, overweight/obese now and 10 years ago.

Logistic regression.

Compared to group 1, adjusted odds ratios (ORs) were as follows: group 2: OR = 2.0 (P = .004), group 3: OR = 1.7 (P = .004), group 4: OR = 2.5 (P < .001), group 5: OR = 2.9 (P < .001), and group 6: OR = 4.8 (P < .001).

All patterns of weight change/duration and activity level altered the odds of medical multimorbidity, suggesting that the duration of overweight/obesity should also be taken into consideration when assessing the “fat-but-fit” paradigm.

Substantial research has demonstrated that assets (eg, family communication, school connectedness) protect youth from participation in numerous risk behaviors. However, very few studies have explored the relationship between assets and positive health behaviors. This study investigated prospective associations among assets and physical activity (PA) and body mass index (BMI).

Longitudinal design with 5 waves of data collected annually over a 4-year period.

Community-based setting with participants recruited via door-to-door canvasing of homes located in stratified (by race and income) randomly selected census tracts and blocks.

Participants were 1111 youth (baseline mean age = 14.3 years [SD = 1.6]; 53% female; 40.6% white, 28.6% Hispanic, 24.4% black, 6.4% other) and their parents.

Weekly participation in PA, BMI, and 14 youth assets representing multiple levels of influence (individual, family, and community).

Generalized linear mixed models assessed associations among the assets and PA and BMI over the 5 waves of data.

There was a significant and graded relationship between assets and weekly participation in PA. For example, at the community-asset level, PA minutes were higher among youth with 2 assets (P = .006), 3 assets (P = .0006), and 4 to 5 assets (P < .0001) compared to youth with 0 to 1 assets. No effects were found for BMI.

Asset-based health promotion programs for youth may promote positive health behaviors and prevent participation in risk behaviors.

To identify and evaluate the evidence base for culture of health elements.

Multiple databases were systematically searched to identify research studies published between 1990 and 2015 on culture of health elements.

Researchers included studies based on the following criteria: (1) conducted in a worksite setting; (2) applied and evaluated 1 or more culture of health elements; and (3) reported 1 or more health or safety factors.

Eleven researchers screened the identified studies with abstraction conducted by a primary and secondary reviewer. Of the 1023 articles identified, 10 research reviews and 95 standard studies were eligible and abstracted.

Data synthesis focused on research approach and design as well as culture of health elements evaluated.

The majority of published studies reviewed were identified as quantitative studies (62), whereas fewer were qualitative (27), research reviews (10), or other study approaches. Three of the most frequently studied culture of health elements were built environment (25), policies and procedures (28), and communications (27). Although all studies included a health or safety factor, not all reported a statistically significant outcome.

A considerable number of cross-sectional studies demonstrated significant and salient correlations between culture of health elements and the health and safety of employees, but more research is needed to examine causality.

The aim of this integrative literature review is to synthesize the existing evidence regarding managers’ support for employee wellness programs.

The search utilized multiple electronic databases and libraries.

Inclusion criteria comprised peer-reviewed research published in English, between 1990 and 2016, and examining managers’ support in the context of a worksite intervention. The final sample included 21 articles for analysis.

Two researchers extracted and described results from each of the included articles using a content analysis.

Two researchers independently rated the quality of the included articles. Researchers synthesized data into a summary table by study design, sample, data collected, key findings, and quality rating.

Factors that may influence managers’ support include their organization’s management structure, senior leadership support, their expected roles, training on health topics, and their beliefs and attitudes toward wellness programs and employee health. Managers’ support may influence the organizational culture, employees’ perception of support, and employees’ behaviors.

When designing interventions, health promotion practitioners and researchers should consider strategies that target senior, middle, and line managers’ support. Interventions need to include explicit measures of managers’ support as part of the evaluation plan.

To propose collective well-being as a holistic measure of the overall “health” of a community. To define collective well-being as a group-level construct measured across 5 domains (vitality, opportunity, connectedness, contribution, and inspiration) and introduce an actionable model that demonstrates how community characteristics affect collective well-being. To review the literature describing each domain’s association with health outcomes and community characteristics’ associations with collective well-being.

We came to consensus on topics describing each component of our conceptual model. Because “well-being” is not indexed in MEDLINE, we performed topic-specific database searches and examined bibliographies of papers retrieved. We excluded articles that were limited to narrow subtopics or studies within small subpopulations. Preference was given to quasi-experimental or randomized studies, systematic reviews, or meta-analyses. Consensus was reached on inclusion or exclusion of all articles.

Reviewed literature supported each of the proposed domains as important aspects of collective well-being and as determinants of individual or community health. Evidence suggests a broad range of community characteristics support collective well-being.

The health and quality of life of a community may be improved by focusing efforts on community characteristics that support key aspects of well-being. Future work should develop a unified measure of collective well-being to evaluate the relative impact of specific efforts on the collective well-being of communities.