American Journal of Health Promotion

To evaluate the results of a workplace wellness program that incorporates gamification principles.

In this prospective cohort study, the participation rate and observed health outcomes were evaluated after approximately 2 years.

All permanent employees (n = 775) of a national company located in Canada were eligible to participate.

The wellness program included web-based challenges (team or individual) incorporating gamification strategies to improve exercise, nutrition, weight reduction, and mental health management behaviors.

The primary outcomes were employee participation rates. The secondary pre-specified outcomes were the sustained benefits of the program on physical and mental health measures.

Participation rates in the health screenings were 78% (baseline), 54% (year 1), and 56% (year 2). Participation in the 4 team web-based challenges ranged from 33% to 68% with 76% to 86% of participants tracking their activity on at least half of the days. After 2 years, there were significant clinical improvements in systolic blood pressure (−1.3mm Hg), total cholesterol/high-density lipoprotein (HDL) ratio (−0.14), glycated haemoglobin (HbA_1c; −0.1%), weekly physical activity (+264 Metabolic Equivalents [METs]), perceived stress score (−17%), insomnia severity index (−16%), general fatigue (−10%), and reductions in the cardiovascular age gap (−0.3 years). Greater benefits occurred among employees at higher risk.

Workplace wellness programs that evolve over time and focus primarily on fun and competitive challenges may support long-term participation, behavior change, and sustained improvements in clinical outcomes.

To examine the association between positive and negative experiences on social media (SM) and perceived social isolation (PSI).

Cross-sectional survey.

One large mid-Atlantic University.

A total of 1178 students aged 18 to 30 were recruited in August 2016.

Participants completed an online survey assessing SM use and PSI. We assessed positive and negative experiences on SM by directly asking participants to estimate what percentage of their SM experiences involved positive and negative experiences, respectively. Social isolation was measured using the established Patient-Reported Outcomes Measures Information System scale.

We used multivariable logistic regression to assess associations between both positive and negative experiences on SM and PSI. Primary models controlled for sex, age, race/ethnicity, educational status, relationship status, and living situation.

Participants had an average age of 20.9 (standard deviation = 2.9) and were 62% female. Just over one-quarter (28%) were nonwhite. After controlling for all sociodemographic covariates, each 10% increase in positive experiences was not significantly associated with social isolation (adjusted odds ratio [AOR] = 0.97; 95% confidence interval [CI]: 0.93-1.005). However, each 10% increase in negative experiences was associated with a 13% increase in odds of PSI (AOR = 1.13; 95% CI: 1.05-1.21).

Having positive experiences on SM is not associated with lower social isolation, whereas having negative experiences on SM is associated with higher social isolation. These findings are consistent with the concept of negativity bias, which suggests that humans tend to give greater weight to negative entities compared with positive ones.

To characterize plant-based dietary practices and examine their relationship with body mass index (BMI) in Hispanic/Latino Seventh-day Adventists (SDA).

Cross-sectional analyses of data among Hispanics/Latinos in the Adventist Health Study-2 (AHS-2).

The AHS-2 is a cohort of SDA adults (n = 96 592) in North America.

A total of 3475 Hispanics/Latinos who provided demographic, dietary, anthropometric, and lifestyle data at enrollment.

Plant-based dietary practices were determined from food frequency questionnaire; BMI, demographic, and lifestyle data were assessed by questionnaire.

In linear regression analysis, plant-based diets were modeled as dummy variables with nonvegetarian as the referent group and log(BMI) as the outcome adjusted for age, sex, education, exercise, nativity, alcohol use, smoking, and energy intake.

We identified 202 vegans, 664 vegetarians, 409 pesco-vegetarians, 227 semi-vegetarians, and 1973 nonvegetarians. Compared to the nonvegetarian referent (BMI = 27.50), estimated BMI were lower among vegans (23.58, P < .0001), vegetarians (25.24, P < .0001), pesco-vegetarians (26.36, P = .0002), and semi-vegetarians (26.69, P = .130). Other factors associated with lower BMI were being female (P = .001), nativity (Mexico, P = .002; South America, P < .0001; Caribbean, P = .004), having a college degree or higher (P = .01), exercise (P < .0001), and never smoked (P = .0006).

Hispanic/Latino SDAs who consumed plant-based diets had lower BMI than nonvegetarians. The application of a plant-based diet as practiced by the Hispanic/Latino Adventists in this population may have public health impact on US Hispanic/Latinos.

To compare the relationship between anti-tobacco industry attitudes and intention and attempts to quit smoking across 6 young adult peer crowds.

A cross-sectional bar survey in 2015.

Seven US cities (Albuquerque, Los Angeles, Nashville, Oklahoma City, San Diego, San Francisco, and Tucson).

Two thousand eight hundred seventeen young adult bar patrons who were currently smoking.

Intention to quit in the next 6 months and having made a quit attempt in the last 12 months were binary outcomes. Anti-industry attitudes were measured by 3 items indicating support for action against the tobacco industry. Peer crowd affiliation was measured using the I-Base Survey.

Adjusted multivariable logistic regression models examined the association between anti-industry attitudes and the outcomes for the total sample and for each peer crowd.

Overall, anti-industry attitudes were positively associated with both intention to quit (odds ratio [OR] = 1.37, 95% confidence interval [CI] = 1.24-1.52) and attempt to quit (OR = 1.14, 95% CI = 1.03-1.27). Intriguingly, the relationship between anti-industry attitudes and intention to quit differed by peer crowd affiliation, with significant associations for Homebody, Partier, Hipster, and Hip Hop, but not for Young Professional and Country.

Developing health communication messages that resonate with unique peer crowd values can enhance the relevance of public health campaigns. Tobacco control practitioners should tailor anti-industry messages to promote intention to quit smoking among the highest risk young adults.

To examine differences in physical activity (PA) uptake between black and white employees during a financial incentive-based workplace intervention.

Prospective cohort study from July 2014 to June 2015 (NCT02850094).

Tertiary academic medical center.

Forty-three black and 182 white nonclinical employees.

Participants self-selected or were assigned to teams. Participants completed a 24-week intervention receiving rewards for meeting weekly PA goals (increasing moderate-to-vigorous PA [MVPA] by 10% from previous week or meeting Guidelines threshold of 150 minutes of MVPA).

Outcomes included weekly MVPA in minutes, average daily step counts, number of weeks meeting personal goals and the Guidelines, and Fitbit adherence in days and weeks.

We performed an analysis of covariance for each outcome, with race as the primary independent variable of interest, adjusting for demographic and health-related covariates.

During the intervention, blacks walked 9128 steps per day while whites walked 7826 steps per day, a difference of approximately 1300 steps (P < .05). Blacks also demonstrated a greater uptake in both steps and MVPA from baseline than did whites, resulting in similar MVPA throughout the intervention.

Findings suggest that workplace PA interventions using financial incentives may result in similar engagement in MVPA among white and black employees, while black employees walk more steps during the intervention. Limitations include a primarily white female sample which may not generalize.

Local communities are often active public health policy makers, so state preemption—when the state withdraws authority from local governments—can hinder public health progress. Kansas enacted the most sweeping law in the nation preempting food, nutrition, and agricultural policy.

Qualitative thematic content analysis was used on public comments to identify and evaluate common and key arguments. A codebook was developed using an iterative process. Open coding was applied to all comments.

All testimony and comments submitted by individuals and organizations to the Kansas State Legislature on the preemptive bill.

Eight types of commentators submitted 34 written and 12 oral comments.

The data were evaluated on a latent level to examine underlying drivers of preemption.

Comments addressed 18 themes, referenced 366 times; 68% in opposition. Common themes included local control, food labeling, public health, need for statewide standards, and debate over food regulation. Key themes included the need for state and federal uniformity to support businesses and consumers, debate over topics not in the bill, the value of local control, confusion over bill coverage, and outside influences.

Confusion about bill language and coverage, the combination of food and agricultural issues, and backing by multinational corporations helped propel preemption forward in Kansas. Food policy stakeholders nationally can anticipate similar arguments and strategies in their state.

Less than half of US adults meet the recommended guidelines of 150 minutes of exercise each week. Health promotion messages are frequently used to promote physical activity (PA); however, this messaging may be ineffective if it does not resonate with the target audience. The purpose of this exploratory study is to understand how women respond to examples of PA promotion messages.

A qualitative study.

Washington DC Metro Area.

Forty women, stratified by race/ethnicity (white, black, Latina) and level of self-reported PA (active, inactive).

Eight focus groups were conducted in which participants were shown 3 PA promotion messages representative of typical messaging strategies. Three researchers conducted a thematic analysis to code the data for emergent themes.

Current PA promotion messaging strategies do not resonate with women. Women want to see individuals with “realistic” bodies who look similar to them (eg, body shape, age, race/ethnicity), and for PA messaging to include daily activities as a way to be active.

Public health practitioners who promote PA to women should consider developing messages that better resonate with women’s dynamic roles and lifestyles. Successful strategies may include depicting busy lifestyles that PA may be physically and logistically difficult to fit into and using models with diverse body shapes.

Describe health plan member-level participation, completion, and 6-month outcomes for 5 lifestyle health coaching programs offered by an integrated delivery and financing system (IDFS) over 6 years.

Case series study of 5 lifestyle programs with 180-day follow-up.

Large Western PA integrated delivery and financing system (IDFS) deployed multiple coaching modalities for diverse insurance-member enrolled population.

A total of 14 591 health plan members choosing a lifestyle health coaching program.

Evidence- and curriculum-based lifestyle health coaching programs delivered by 1 of 4 interactive modalities.

A single metric was used as an overall indicator of clinical success for each program. Success measures include a ≥5% reduction of self-reported baseline weight, meeting physical activity guidelines, and 7-day point prevalence abstinence from tobacco. For stress and nutrition, where no single target measure exists, a metric was created that represented a net improvement across all key outcomes measured.

The proportion of members meeting target outcomes were calculated and described across all time points and modalities.

At 180 days, 77% of enrolled members reported reduced stress, 7% quit tobacco, 50.5% met physical activity guidelines, 65.2% improved nutrition, and 44.2% lost 5% or more of baseline weight.

This evaluation describes the real-world effectiveness of evidence- and curriculum-based lifestyle improvement programs delivered by trained health coaches to a diverse health plan member population.

To assess the effectiveness of an intervention to promote influenza vaccination among members of an Affordable Care Act (ACA) insurance plan.

Randomized controlled trial.

Messages were delivered by a community-based, nonprofit health insurance provider to its members in Central Texas.

Adult subscribers for whom either a phone number or an e-mail address was available (n = 25 649).

Participants were randomly assigned to be sent (1) no messages, (2) messages encouraging influenza vaccination via e-mails and texts, and (3) messages encouraging influenza vaccination through e-mails, texts, and postal mail. Messages were sent between September 12, 2017 and November 17, 2017.

Influenza vaccination was determined using medical and pharmacy claims.

Rate differences and 95% confidence intervals between each exposure condition were calculated for the overall population and by subgroups.

The vaccination rate by December 31, 2017 was 16.9%. Those sent both electronic messages and postal mail were significantly more likely to be vaccinated than those who were not sent messages (rate difference: 2.5%; 95% confidence interval [CI]: 1.4-3.6) and those who were sent electronic messages only (rate difference: 1.6%; 95% CI: 0.5-2.8).

A combination of messages delivered via text, e-mail, and postal mail generated a modest but significant positive effect on influenza vaccine rates in an ACA plan population. The postal mail component was essential for achieving this effect.

Social support has been identified as a determinant of physical activity (PA), but research has been primarily cross-sectional, with mixed findings for different Hispanic subgroups and limited longitudinal research with Hispanics. The purpose of this study is to assess the longitudinal associations of social support with PA in Hispanics on the Texas-Mexico Border.

We used 2 time points of data collected from Hispanic adults in the Cameron County Hispanic Cohort (N = 588).

We collected social support for PA and self-reported leisure-time PA.

We used cross-lagged panel models to assess the association between friend support, family support, family punishment (criticizing or complaining) and PA over time.

Although social support overall was low for PA, fully adjusted cross-lagged panel models indicated that time 1 friend support was associated with time 2 PA (adjusted rate ratio = 1.02, 95% confidence interval = 1.00 -1.04), though family support was not associated with time 2 PA. In males, time 1 friend support was inversely associated with time 2 family punishment.

As expected, the directionality of the relation appears to be from social support to PA. Friend support appears to be predictive of PA in Hispanics, whereas family support is not. This should be considered in intervention development, particularly because familismo (commitment and mutual obligation to family) is considered to be a strong value in these communities.

We hypothesized that living with a smoker would be positively associated with general and central adiposity among middle-aged and older women.

Prospective across up to 8 years.

Women’s Health Initiative Observational Study.

A total of 83 492 women (age 50-79 at baseline).

The predictor was living with a smoker at baseline. Outcomes were clinic-assessed obesity and high waist circumference, examined cross-sectionally at baseline and prospectively at year 3 and (for self-reported obesity) year 8.

All analyses used logistic regression and controlled for sociodemographic factors and participants’ current smoking; prospective analyses also adjusted for baseline obesity or high waist circumference.

Living with a smoker was associated (1) cross-sectionally with obesity (n = 82 692, odds ratio [OR] = 1.38, P < .001) and a high waist circumference (n = 83 241, OR = 1.41, P < .001) and (2) prospectively with obesity (n = 68 753, OR = 1.22, P < .001) and a high waist circumference (n = 68 947, OR = 1.22, P < .001) 3 years later and obesity (n = 38 212, OR = 1.21, P < .001) 8 years later.

These results document an essentially unrecognized health risk associated with living with a smoker. For practitioners, these findings underscore the need for innovative household-level interventions for families living with a smoker integrating established smoking and obesity prevention efforts.

To determine whether a 100% healthy vending model would affect revenue, employee satisfaction, and nutrition in the workplace.

This study compared revenue and nutrition data pre- and post-adoption of nutrition standards from the American Heart Association’s (AHA) Healthy Workplace Food and Beverage Toolkit. Employee satisfaction was measured using a survey.

The AHA National Center which, over time, included 5 vending machines and a micromarket.

Comparisons of monthly snack and beverage revenues; survey results assessing employee satisfaction; reduction in mean saturated fat (g) and sodium (mg) per snack sold; reduction in mean sugar (g) per beverage sold; monthly mean number of fruits, vegetable, and dairy sold.

Paired t tests were used to compare monthly revenue while t tests were used to compare nutrition information pre- and post-adoption of nutrition standards. Survey results and food group purchases were analyzed using descriptive statistics.

Mean monthly snack revenue increased (P = .002). Mean monthly beverage revenue did not decrease. Most survey respondents were satisfied with the healthy vending. Mean saturated fat and sodium content per snack sold decreased (P < .001). Mean sugar content per beverage sold decreased. The micromarket sold an average of 210 units of dairy, 85 units of fruit, and 87 units of vegetables per month.

This study was conducted at one workplace.

Healthy vending did not decrease revenue but did decrease saturated fat and sodium per snack, decrease sugar per beverage, and provide fruits, vegetables, and fat-free/low-fat dairy. Employees were generally satisfied with healthy vending.

The purpose of this review is to uncover some best practices for increasing access to physical activity opportunities by examining efforts used within low income and diverse communities. The theoretical lens used is from the Active Living by Design (ALbD) Community Action Model, with a focus on the 6 essential practices (health equity focus, community engagement, facilitative leadership, sustainable thinking, culture of learning, and strategic communication) describing how partnerships can guide and sustain meaningful change in a community.

A 2-step process guided the literature search. In step 1, 4 databases (PubMed, Psych INFO, Social Science Citation Index, and Cochrane Library) were searched using Boolean connections and variations in the key terms. Step 2 assessed articles by title, abstract, and full text to determine whether the studies met the inclusion and exclusion criteria guided by Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. Additionally, included articles were compared against the 6 essential practices outlined by the ecological framework, ALbD.

Of 1775 total articles, 14 studies met inclusion criteria. Most of the studies were case studies located in the United States using several different approaches including, changes in the built environment, implementation of a community-based physical activity program, creating partnerships to leverage resources, and policy change. This review compared the 14 studies against the 6 essential practices of the ALbD model and found 2 studies that met all 6 criteria, and only a few studies meeting more than 2 criteria.

Overall, the conclusions are 2-fold, (1) only 14 cases demonstrate success in increasing access to physical activity opportunities, suggesting that more can be done to address inequalities. (2) Of the existing efforts, few utilize crucial components to create a sustainable change in the community. Future research should take into consideration the ALbD ecological framework, the best existing theory for this type of work, to guide the creation and implementation of a sustainable community access effort.

Preconception health is an important determinant of maternal, paternal, and infant outcomes. Knowledge is commonly used to evaluate the effectiveness of interventions to promote preconception health. Our objective was to examine how preconception health knowledge has been measured in the existing literature and to identify measurement gaps, biases, and logistical challenges.

MEDLINE, EMBASE, PsycINFO, CINAHL, the Cochrane Database of Systematic Reviews, and gray literature were searched from database inception to January 2018.

Studies were included if they measured preconception or interconception health knowledge and included reproductive-aged women and/or men.

Two independent reviewers completed data extraction and quality appraisal using standardized instruments.

Due to measurement heterogeneity, a narrative synthesis was performed.

The review included 34 studies from 14 countries with data collected in 2000 to 2017. Most studies used cross-sectional (n = 24) or prepost designs (n = 7). Studies primarily sampled women (n = 25), and methodological quality was rated largely as weak (n = 18) or moderate (n = 14). Preconception health knowledge tools focused on fertility, folic acid, and alcohol, with few questions pertaining to men’s health, mental health, or the interconception period. Only 19 (56%) studies reported psychometric properties of their knowledge tools.

This systematic review revealed the need for a valid and reliable knowledge tool that reflects a holistic conceptualization of preconception health.