American Journal of Health Promotion

To provide a nationally representative snapshot of workplace health promotion (WHP) and protection practices among United States worksites.

Cross-sectional, self-report Workplace Health in America (WHA) Survey between November 2016 and September 2017.

National.

Random sample of US worksites with ≥10 employees, stratified by region, size, and North American Industrial Classification System sector.

Workplace health promotion programs, program administration, evidence-based strategies, health screenings, disease management, incentives, work–life policies, implementation barriers, and occupational safety and health (OSH).

Descriptive statistics, t tests, and logistic regression.

Among eligible worksites, 10.1% (n = 3109) responded, 2843 retained in final sample, and 46.1% offered some type of WHP program. The proportion of comparable worksites with comprehensive programs (as defined in Healthy People 2010) rose from 6.9% in 2004 to 17.1% in 2017 (P < .001). Occupational safety and health programs were more prevalent than WHP programs, and 83.5% of all worksites had an individual responsible for employee safety, while only 72.2% of those with a WHP program had an individual responsible for it. Smaller worksites were less likely than larger to offer most programs.

The prevalence of WHP programs has increased but remains low across most health programs; few worksites have comprehensive programs. Smaller worksites have persistent deficits and require targeted approaches; integrated OSH and WHP efforts may help. Ongoing monitoring using the WHA Survey benchmarks OSH and WHP in US worksites, updates estimates from previous surveys, and identifies gaps in research and practice.

As part of wellness efforts, employers may seek to improve the nutritional quality of foods offered and consumed in cafeterias and vending machines. However, little is known about who consumes food from these venues and the types and dietary quality of the foods consumed.

Cross-sectional.

Nonschool cafeterias and vending machines.

US adults ≥20 years old.

Prevalence of consuming foods, most common foods eaten, leading calorie sources, 2010 Healthy Eating Index

Using 24-hour dietary recall data from NHANES 2005-2014 (N = 25,549 adults), we estimated the prevalence of consuming foods, assessed the most commonly consumed foods, and calculated dietary quality of foods.

On a given day, 3.1% of adults consumed foods from cafeterias and 3.9% from vending machines. Consumers averaged 692 kcal from cafeterias and 264 kcal from vending machines. Cafeteria consumers had higher income and education, while vending consumers were more likely to be male and younger adults. Common cafeteria foods included vegetables and fruits, but cafeteria foods were generally high in sodium and low in whole grains. Sugar-sweetened beverages and candies accounted for approximately half of all vending calories.

Foods chosen from cafeterias and vending machines do not align well with the Dietary Guidelines for Americans. Improving the dietary quality of foods consumed from these venues could impact millions of adults.

To examine and compare the role of self-assessed sport and physical activity involvement on the health-related quality of life among undergraduate student-athletes and general undergraduate college students.

Cross-sectional survey. Data set was examined for differences in physical and mental health by self-assessed sport and physical activity level.

Large Midwestern University in the fall of 2016.

A combined data set representing undergraduate Division I student athletes (n = 842) and general undergraduate students (n = 1322).

Veterans RAND 12 Item Health Survey (VR-12), as measure of health-related quality of life, comprised of physical component score (PCS) and mental component score (MCS). Self-assessed sport and physical activity level categorized as Division I athlete, club athlete, intramural player, student who works out regularly, or student who is physically inactive.

Standard univariable statistics described the study population. Two-sample t tests and χ² tests were conducted, as appropriate, to compare Division I student-athletes to the general undergraduate group. Multivariable linear regression models were then built to assess associations between physical activity level and year in school with VR-12 outcomes, after adjusting for sex. All pairwise interactions were considered for inclusion in the final models. Adjusted least-square means were calculated for all variables in the model; pairwise comparisons were adjusted for multiple comparisons via Tukey-Kramer adjustment criteria. A linear test for trend was also conducted for the association between VR-12 MCS and increasing physical activity.

Significant differences in MCS were noted between levels of sport and physical activity; however, such differences were not detected in PCS. After controlling for sex, a positive relationship between increased sport and physical activity level and greater MCS was found.

This study represents the first prospective assessment of health-related quality of life among undergraduate athletes and general college students. Higher levels of sport and physical activity were associated with more positive mental health in these populations.

Implementation of employer sun safety actions was assessed in a 2-year follow-up to an occupational sun protection policy intervention.

Two-year follow-up assessment in a randomized pretest–posttest controlled design.

Local government organizations with workers in public safety, public works, and parks and recreation.

Sixty-three local government organizations (participation = 64%) and 330 frontline supervisors and 1454 workers.

Sun Safe Workplaces (SSW) intervention promoting occupational sun safety policy and education.

Observations of SSW messages and sun safety items and surveys on organizations’ communication and actions on sun safety.

Comparison between SSW and control groups was conducted using regression models and adjusted for clustering where appropriate, with α criterion set at P = .05 (2-tailed).

At intervention worksites, more SSW messages (P < .001) and sun safety items (P = .025) were observed; more frontline supervisors reported organizations provided free/reduced price sunscreen (P = .005) and communicated about sun safety (P < .001); and more workers recalled receiving sun safety messages (P < .001) and sun safety training (P <.001) compared to control organizations. Implementation was greater at larger than smaller intervention organizations for wide-brimmed hats (P = .009), long work pants (P = .017), and shade structures (P = .036). Older workers received the most written messages (P = .015).

Sun Safe Workplaces appeared to produce actions by organizations to support employee sun safety. Large organizations may have processes, communication channels, and slack resources to achieve more implementation.

To examine whether food insecurity longitudinally affects smoking status.

Population-based prospective study

Data from the 2003 and 2015 Panel Study of Income Dynamics (PSID).

Four thousand five hundred sixty-three adults who were smokers and nonsmokers, participating in the 2003 (current study baseline) and 2015 (current study follow-up) waves of PSID.

Based on self-reported smoking status at baseline and follow-up, respondents were categorized as continued smoking, stopped smoking, started smoking, and continued nonsmoking. Similarly, respondents were categorized as stayed food secure, stayed food insecure, became food insecure, and became food secure based on responses to the Food Security Survey at baseline and follow-up.

Two logistic regression analyses to examine (1) among smokers at baseline the odds of stopping versus continuing smoking by follow-up and (2) among nonsmokers at baseline the odds of starting versus continuing nonsmoking by follow-up. In both models, change in food insecurity status was the primary independent variable, controlling for demographics including poverty.

Among smokers at baseline, becoming food insecure (vs staying food secure) was independently associated with lower likelihood of stopping smoking by follow-up (odds ratio [OR] = 0.66). Among nonsmokers at baseline, becoming food insecure (vs staying food secure) was independently associated with higher likelihood of starting smoking by follow-up (OR = 3.77).

Food insecurity is a risk factor for smoking, which has significant implications for developing interventions to reduce smoking prevalence, especially among low-income groups.

African Americans (AAs) in rural south and southeast regions of the United States have among the highest prevalence of cardiovascular disease (CVD) in the country. The purpose of this qualitative, exploratory study is to understand family influences on CVD-related knowledge and health-related behaviors among rural AA adults.

Qualitative descriptive study design using a community-based participatory research approach.

Two rural North Carolina counties.

Eligible participants were AA adults (at least 21 years of age), who self-reported either CVD diagnosis or selected CVD risk factor(s) for themselves or for an adult family member (N = 37).

Directed content analysis of semistructured interviews by community and academic partners.

Family health history and familial norms and preferences influenced participants’ CVD-related knowledge, beliefs, and health-related behaviors. Participants reported their families were helpful for increasing motivation for and overcoming barriers to healthy behaviors, including hard-to-access community resources and physical challenges. Conversely, and to a lesser extent, participants also reported that family members hindered or had little influence (positive or negative) on their engagement in healthy behaviors.

Family played an important role in helping individuals overcome personal and community-related challenges. Efforts to reduce CVD burden among rural AAs should seek to understand the family-related facilitators, barriers, and processes associated with CVD knowledge and risk-reduction behaviors.

To describe perceptions of physical activity, opinions, on intergenerational approaches to physical activity and a vision for increasing physical activity in an underresourced urban community.

Focus groups embedded in a large Community-Based Participatory Research Project.

West and Southwest Philadelphia.

15 parents, 16 youth, and 14 athletic coaches; youth were 13 to 18 years old and attended West Philadelphia schools; parents’ children attended West Philadelphia schools; and coaches worked in West Philadelphia schools.

Six focus groups (2 youth, 2 parent, and 2 coach) were conducted guided by the Socio-Ecological Model; transcriptions were analyzed using a rigorous process of directed content analysis.

Factors on all levels of the Socio-Ecological Model influence the perception of and engagement in physical activity for youth and their families. Future strategies to increase engagement in physical activity need to be collaborative and multifaceted.

When physical activity is reframed as a broad goal that is normative and gender-neutral, a potential exists to engage youth and their families over their lifetimes; with attention to cross-sector collaboration and resource sharing, engaging and sustainable intergenerational physical activity interventions can be developed to promote health in underresourced urban communities.

To understand parental ethnotheories (ie, belief systems) and practices about preschoolers’ healthy eating guided by the developmental niche framework.

Qualitative hermeneutic phenomenology.

Home.

Participants were 20 parents of preschool-age children ages 3 to 5 years, recruited from a quantitative investigation. A majority of the participants were white, female, married, well educated, and working full time.

Participants who completed the quantitative survey were asked to provide their contact information if they were willing to be interviewed. From the pool of participants who expressed their willingness to participate in the interviews, 20 participants were selected using a random number generator. In-person semistructured interviews were conducted until data saturation (n = 20). Thematic analysis was performed.

Three themes and 6 subthemes emerged: theme 1—parental ethnotheories about healthy eating included subthemes of knowledge about healthy eating, motivations to promote healthy child development through healthy eating, and sources of knowledge about healthy eating (eg, doctors, social media, government guidelines, positive family-of-origin experiences); theme 2—parental ethnotheories that supported organization of children’s physical and social settings included structured mealtime routines and food socialization influences (eg, grandparents, siblings, and childcare programs); and theme 3—parental ethnotheories that supported children’s learning about healthy eating included parent–child engagement, communication, and encouragement in food-related activities (eg, meal preparation, visiting farmer’s market, grocery shopping, gardening, cooking, baking).

Findings advance the literature on parental practices about healthy eating. Parental ethnotheories (eg, beliefs, motivations, knowledge, and skills) matter. Developmental niche of preschoolers (ie, physical and social settings, childrearing practices, and parental ethnotheories) constitutes an interactive system in which ethnotheories serve as guides to parental practices. Fostering nutrition education and parent–child engagement, communication, and encouragement in food-related activities are recommended to promote children’s healthy eating in daily routines.

To better understand the barriers to implementing Supplemental Nutrition Assistance Program Education (SNAP-Ed) direct education programming in rural communities, as well as strategies to overcome these barriers. This includes (1) barriers to implementing direct education in rural communities, and (2) facilitators to overcoming direct-education barriers in rural communities.

This was a qualitative study that included in-depth interviews.

Fifteen states across all 7 SNAP-Ed regions.

Participants were eligible if they (1) were SNAP-Ed staff who were involved with implementing programs; (2) implemented at least 50% of their programming in rural communities, and (3) worked in their role for at least 12 months. Twenty-seven (n = 27) staff participated in interviews.

Online surveys ascertained if participants were interested in participating in a 60-minute interview about implementing SNAP-Ed in rural communities. Interviews were semistructured and focused on the barriers and facilitators to implementing SNAP-Ed direct-education nutrition programming in rural areas.

Qualitative interviews were analyzed using content analysis in Atlas.ti.

Barriers to implementing direct education in rural communities included lack of healthy food and physical activity infrastructure to reinforce messages taught in class, funding restrictions, transportation for SNAP-Ed staff and the perception that this was also a problem for participants, and SNAP-Ed staff being seen as “outsiders” (not from the community). Facilitators included partnering with other organizations to increase recruitment and retention of SNAP-Ed participants, buy-in from local leaders, and SNAP-Ed staff being from the community.

Partnerships between SNAP-Ed programs and non-SNAP-Ed organizations were essential in helping to recruit and retain participants. The SNAP-Ed staff should get buy-in from local leaders before starting direct-education programming. The SNAP-Ed programs should explore innovative delivery modalities including online and text messaging due to transportation issues in widespread rural geographies. Lastly, more work should be done to complement SNAP-Ed direct education with policy, systems, and environmental change initiatives.

Diabetes imposes a significant economic burden on employers, particularly when including productivity costs. Given the great interest on multicomponent lifestyle interventions in these individuals, we assessed the short-term and long-term efficacy of a structured lifestyle modification program, My Unlimited Potential, among employees with diabetes of Baptist Health South Florida (BHSF), a large non-for profit health-care system.

This is a pre- and post-effectiveness of a workplace health promotion program.

Worksite intervention at BHSF.

The study analyzed the data of 93 employees with diabetes involved in a worksite wellness program after completion of a year long program.

The intervention was an intense lifestyle modification program that was targeted to the individual needs of the participants.

Cardimetabolic risk factors such as body mass index (BMI), weight, systolic blood pressure, diastolic blood pressure, glycated hemoglobin, total cholesterol, triglycerides, high-sensitivity C-reactive protein, low-density lipoprotein, high-density lipoprotein, and maximal oxygen consumption.

Paired 2-sample t tests for means and descriptive statistics were used.

A mean decrease of 0.6 percentage points was observed in HbA_1c values from baseline to 12 months. Weight, BMI, blood pressure, and lipid profile improved significantly after 12 months.

This study suggests worksites with existing health promotion programs, and health-care staff can effectively deliver a diabetes prevention program that appears to have a long-term impact on employee health.

To describe teacher’s integration of activity into general education classroom time (ie, movement integration—MI).

Cross-sectional, observational.

Eight elementary schools in a rural, low-income school district.

Elementary classroom teachers (N = 48).

Classroom teachers were observed using the System for Observing Student Movement in Academic Routines and Transitions (SOSMART) on random, unannounced days during the 2015-16 academic year.

Descriptive statistics were calculated for the frequency and types of MI being used.

Of the 9398 SOSMART scans completed, students engaged in movement in 41.3% of the scans. Student movement was observed to be teacher directed in 14.4% and nonteacher directed in 26.9% of scans. Nonteacher-directed movement consisted mostly of transitions (M = 99.5%) in which movement occurred as a result of preestablished classroom rules, protocols, and organization.

This is one of the first studies to provide objective information about MI. These descriptive data lay the groundwork for future correlational and experimental research that can lead to the development of effective intervention design to increase MI use in schools.

The Flint, Michigan, water crisis (2014 to present) increased awareness of the dangers of lead-contaminated water. Consumption of lead-contaminated water is associated with adverse pregnancy outcomes. The purpose of this research was to identify intervention strategies to decrease consumption of lead-contaminated water among women of reproductive age.

Qualitative data were collected via an online survey consisting of open-ended questions among 63 women and 3 focus groups among 27 women.

The University of Michigan–Flint.

Qualitative data were analyzed utilizing a grounded theory approach.

Participants recommended professional educational reading materials regarding lead be placed in public places. Women highlighted the need for interventions where women, partners, and relatives test water in homes, install water filters, cook lead-mitigating meals, and receive education on the pregnancy risks of consuming contaminated water.

The study offers women perspectives on strategies to decrease consumption of lead-contaminated water. Future investigations may examine the influence of such strategies on knowledge and behaviors that promote safe water drinking.

To examine the trends in total and segmented sedentary and physical activity behaviors during a Sports, Play, and Recreation for Kids (SPARK) program in incarcerated adolescent boys.

Longitudinal trend analysis.

Two juvenile justice facilities.

Eighty-six adolescent boys (mean age = 17.1 ± 1.0 years).

Sports, Play, and Recreation for Kids implemented over 36 weeks.

Sedentary times and physical activity were examined at baseline and at 3 follow-up time points at 12, 24, and 36 weeks after SPARK implementation. Physical activity was assessed using the percentage of accelerometer wear time within each segment for sedentary (%SED) and moderate-to-vigorous physical activity (%MVPA).

Trends in %SED and %MVPA were assessed using 2 × 4 doubly multivariate analysis of variance tests.

For the total week, there was a significantly lower %SED (mean difference = −10.6%, P < .001) and significantly higher %MVPA (mean difference = +3.0%, P < .001) at the 24-week follow-up compared to baseline. There were also significantly lower %SED and higher %MVPA before school, after school, and during the weekends at 24-week follow-up compared to baseline (P < .01).

There were significantly lower sedentary times and higher levels of physical activity during the middle portions of the SPARK intervention in incarcerated adolescent boys, highlighting the potential of this intervention to affect sedentary and physical activity behaviors in the population.

The purposes of this study were to examine associations between objectively measured walkable urban design attributes with Japanese older adults’ body mass index (BMI) and to test whether objectively assessed physical activity and sedentary behavior mediated such associations.

Cross-sectional.

Matsudo City, Chiba Prefecture, Japan.

Participants were 297 older residents (aged 65-84 years) randomly selected from the registry of residential addresses.

Walkable urban design attributes, including population density, availability of physical activity facilities, intersection density, and access to public transportation stations, were calculated using geographic information systems. Physical activity, sedentary behavior, and BMI were measured objectively.

The relationships of walkable urban design attributes, Walk Score®, and BMI were examined by multiple linear regression with adjustment for covariates in all models. Mediation effects of the physical activity and sedentary behavior variables in these relationships were tested using a product-of-coefficients test.

Higher population density and Walk Score® were associated with lower BMI. Light and moderate-to-vigorous physical activities partially mediated the relationships between these walkable urban design attributes and BMI.

Developing active-friendly environmental policies to (re)design neighborhoods may not only promote active transport behaviors but also help in improving residents’ health status in non-Western contexts.

The study’s purpose was to improve the psychometric properties of the Youth Asset Survey (YAS).

Longitudinal cohort study with youth and parents recruited via door-to-door canvassing to participate in a 5-wave, 4-year study that assessed prospective associations among youth assets and youth health-related behaviors. Additional test items were added in the last 2 waves of a study to improve the YAS.

Households in randomly selected census tracts located in the Oklahoma City metropolitan area.

Youth and their parents (N = 1111 parent/child dyads). Youth demographic characteristics at wave 4 were mean age = 17.3 (standard deviation = 1.62) years; 53% female, 41% white, 28% Hispanic, 24% African American, and 6% other.

Sixty-eight items assessing 17 youth asset constructs and 8 single items assessing youth risk behaviors.

Confirmatory factor analysis and generalized linear models were conducted to assess construct reliability and predictive validity, respectively.

Cronbach α for the revised asset constructs ranged from .72 to .82, predictive validity was strong, and all revised asset constructs were assessed via 4 items.

Researchers and practitioners have an improved 68-item YAS-Revised, freely available for their use, which measures 17 youth assets with good reliability, validity, and functionality.

To describe changes in health-related quality of life (HRQOL) related to variation in demographic characteristics, program goals, and program participation, among health coaching program participants.

A retrospective observational study of a health coaching program.

A total of 2169 adults enrolled in an individually purchased or employer-sponsored health plan from a large health and well-being company, who participated in a health coaching program between January 2016 and April 2017.

The health coaching program used evidence-based behavior change strategies to encourage skill development, self-monitoring, and goal setting/achievement. Health coaching program modalities included online and telephonic coaching sessions.

Demographic characteristics (gender, age, race, income), goal categories (weight management, fitness, nutrition, stress management, other), program modality (online, telephonic, both), engagement level (low, medium, high), and Healthy Days, a validated HRQOL measure developed by the Centers for Disease Control and Prevention.

t Tests, mixed analysis of variance (ANOVA).

There were significant (P < .05) reductions in average total unhealthy days (UHDs) across all goal categories. Mixed ANOVAs identified a significant main effect for time, for all demographic characteristics (P values < .05), and a significant effect for program modality (P < .0001), time (P < .0001), and interaction effects, between program modality and time, on average UHD (P = .01).

Our findings indicate significant reductions in UHD, following 6 months of health coaching, and support the use of HRQOL measures, which are known to be highly correlated with traditional measures of health, to evaluate health coaching programs.

To evaluate the effectiveness of wearable device interventions (eg, Fitbit) to improve physical activity (PA) outcomes (eg, steps/day, moderate to vigorous physical activity [MVPA]) in populations diagnosed with cardiometabolic chronic disease.

Based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses, an electronic search of 5 databases (Medline, PsychINFO, Scopus, Web of Science, and PubMed) was conducted.

Randomized controlled trials (RCTs) published between January 2000 and May 2018 that used a wearable device for the full intervention in adults (18+) diagnosed with a cardiometabolic chronic disease were included. Excluded trials included studies that used devices at pre–post only, devices that administered medication, and interventions with no prospective control group comparison.

Thirty-five studies examining 4528 participants met the inclusion criteria. Study quality and RCT risk of bias were assessed using the Cochrane Collaboration Tool.

Meta-analyses to compute PA (eg, steps/day) and selected physical dispersion and summary effects were conducted using the raw unstandardized pooled mean difference (MD). Sensitivity analyses were examined.

Statistically significant increases in PA steps/day (MD = 2592 steps/day; 95% confidence interval [CI]: 1689-3496) and MVPA min/wk (MD = 36.31 min/wk; 95% CI: 18.33-54.29) were found for the intervention condition.

Wearable devices positively impact physical health in clinical populations with cardiometabolic diseases. Future research using the most current technologies (eg, Fitbit) will serve to amplify these findings.

This study aims to identify groups of the social and built environment factors that have been studied substantially along with factors that need further attention, to guide the research, designing, and planning of the social and built environment for reducing obesity prevalence.

A systematic search of literature was undertaken from PubMed, Google Scholar, and Web of Knowledge.

Keyword combination of “built environment,” “social environment,” and “obesity” were used to expand the search scope. Exclusion criteria included (1) any article with less than 50 citations from 2005 to 2010, and those with less than 25 citations from 2011 to 2015. In this way we included the most prominent peer-reviewed studies published in recent years while excluding less influential publications; (2) any article published in a language other than English; (3) literature review articles; (4) any article studying health outcomes not obesity related. We included research on eating behaviors since the studies contributed profoundly to food environment research.

A meta-analysis of 153 empirical studies, selected from 2005 to 2015 based on a series of criteria, was conducted using factor analysis. The exploratory factor analysis was undertaken to group the prevalence and use of the social and built environment factors associated with obesity.

The findings suggested that the research community has gained a substantial understanding of the D variables of the built environment, including density, diversity, design, distance to transit, and destination access. Factors concerning different age groups, minority populations, groups with low socioeconomic status, food environment, and street-level urban design features have been less examined.

The findings are important to guide future research directions, giving more attention to the factors in need of more in-depth research.

To synthesize evidence from qualitative studies relating to adolescent girls’ perceptions of physical activity participation. The protocol for this review is registered with PROSPERO (ID no. CRD42017054944).

PubMed, Sports Discus, Academic Search Complete, and Education Resources Information Centre.

Studies reporting qualitative data that explored the views/opinions/perceptions of adolescent girls (>12 and <18 years old) published between 2001 and 2016 were included. Studies not in English, those focusing on school physical education or specific sports, and those including special populations were excluded.

Study characteristics and results were extracted to a form developed by the authors and managed using NVivo 10 (QSR International’s NVivo 10 software). Data were extracted by 1 reviewer, and a sample (25%) was checked by a second reviewer.

Data were synthesized using a thematic network and managed using NVivo 10. The validity of the included studies was assessed using the “Critical Appraisal Skills Programme (2018)” checklist. The ENTREQ and PRISMA statement was followed when reporting this qualitative synthesis.

Of the 1818 studies identified in the search strategy, 24 met the inclusion criteria and were included in the analysis. Global themes were identified using a thematic network. These themes were “Gender Bias in Sport,” “Motivation and Perceived Competence,” “Competing Priorities during Adolescence,” and “Meeting Societal Expectations.”

The results of this review provide insights into adolescent girls’ views on physical activity. Future research is needed to investigate the potential impact of alternative activity programs on adolescent girls with appropriate follow-up. Researchers and individuals working with young girls must consider the role of perceived motor competence in participation and how this can impact their perceptions.