American journal of health promotion: AJHP

Published by American Journal of Health Promotion
Online ISSN: 2168-6602
Publications
Article
Abstract In view of the spread of the AIDS epidemic in France, knowledge of the disease and sexual behavior, particularly use of condoms, was examined in 1,586 high school pupils in the Toulouse area. Modes of HIV transmission were found to be well known. However, some misconceptions existed, including the possibility of contagion from drinking utensils or from being around someone with AIDS. One third of the pupils had had sexual intercourse with more than one partner, and of these, 42 percent had never used condoms. A total of 65 percent of those questioned were in favor of condom use, but nearly 25 percent of students who had already used condoms found them difficult to use. Use of condoms appeared more likely if students felt personally at risk.
 
Article
This study was designed (1) to examine the effects of a 10,000 steps d(-1) exercise prescription on sedentary, overweight/obese adults, and (2) to examine the effects of adherence on body composition and cardiovascular risk factors. Fifty-six overweight/obese adults participated in the study. Body composition and cardiovascular risk factors were determined at baseline, 20 weeks, and 36 weeks. Adherence was defined as averaging > or = 9500 steps d(-1) from week 4 to week 36. 38 participants (68%) wore pedometers daily for 36 weeks and were available for posttesting. Significant improvements were noted in mean values for walking volume (3994 steps x d(-1)), body weight (-2.4 kg), body mass index (-0.8 kg x m(-2)), percentage body fat (-1.9%), fat mass (-2.7 kg), waist circumference (-1.8 cm), hip circumference (-1.9 cm) and high-density lipoprotein (3 mg/dl). The adherers had large improvements in body composition measures, whereas the nonadherers showed little or no change in these variables. A 10,000 steps (d(-1) exercise prescription resulted in weight loss over 36 weeks in previously sedentary, overweight/obese adults. Adherence to the step goal had a marked effect on the outcome.
 
Article
This study was conducted to determine the extent of the relationship between obesity and absenteeism due to illness. A secondary objective was to ascertain the extent to which age, gender, family income, length of workweek, and cigarette smoking influenced the obesity-absenteeism association. A cross-sectional design was used. Data regarding obesity, absenteeism, and the potential confounding factors were collected during the same time period. Data were collected within workplaces throughout the U.S., and at the headquarters of Health Advancement Services, Inc. (HAS). Subjects were 10,825 employed men and women who participated in an ongoing wellness screening program administered by HAS. The three-site skinfold technique was used to estimate body fat percentage. Absenteeism due to illness and the potential confounding variables were assessed using a structured paper-pencil questionnaire. Without controlling for any potential confounders, obese employees were more than twice as likely to experience high-level absenteeism (seven or more absences due to illness during the past 6 months), and 1.49 times more likely to suffer from moderate absenteeism (three to six absences due to illness during the last 6 months) than were lean employees. With all of the potential confounders controlled simultaneously, obese employees were 1.74 and 1.61 times more likely to experience high and moderate levels of absenteeism, respectively, than were lean individuals. Obese employees tend to be absent from work due to illness substantially more than their counterparts.
 
Article
Purpose: This study investigates cardiovascular disease risk factor response in adolescents following introduction of brisk walking into curriculum lessons. Design: Quasi-experimental. Setting: School-based. Subjects: An intervention group consisted of 115 (aged 12.4 ± 0.5 y) year eight participants, and 77 (aged 12.1 ± 1.1 y) year seven and year nine participants formed a control. Intervention: An 18-week cross-curricular physical activity intervention was implemented in one secondary school. Measures: Adiposity variables, blood pressure, lipids, lipoproteins, glucose, insulin, high-sensitivity C-reactive protein, high-molecular-weight adiponectin, aerobic fitness, physical activity behavior, and diet were assessed preintervention and postintervention. Analysis: Dependent and independent t-tests. Results: Prevalence of elevated waist circumference (9.8% vs. 6.9%), systolic blood pressure (3.3% vs. 0%), triglycerides (2.5% vs. 1.2%), and reduced high density lipoprotein cholesterol (3.7% vs. 2.7%) decreased in the intervention group. Significant improvements in high density lipoprotein cholesterol to total cholesterol ratio (mean ± SD: 2% ± 4% [confidence interval (CI)(0.05) = 1% to 2%], t(80) = -3.5, p = .001) and glucose (-.1 ± .4 mmol/L [CI(0.05) = -.2% to 0%], t(79) = 3.2, p = .002) were evident for the intervention group. Conclusion: The Activity Knowledge Circuit may prove to be a sustainable, effective, and cost-effective strategy to engage schoolchildren in physical activity on a daily basis. A longer-duration intervention is required to fully understand risk factor response in adolescents.
 
Article
The purpose of this study was to determine the prevalence of hypercholesterolemia among high-, moderate-, and low-duration television viewers. The confounding effects of age, gender, income, body fat percentage, weekly exercise duration, and smoking were also examined. A cross-sectional or correlational design was employed. Cochran-Mantel-Haenszel odds ratios were used to estimate risk of the television viewers regarding hypercholesterolemia. Participants were employees of over 55 corporations that had their employees screened as part of the ongoing risk-management program of Health Advancement Services (HAS), Inc. Subjects were 11,947 employed adults. About 85% of the subjects eligible for participation completed the screenings and were used in the study. Serum cholesterol was assessed in a certified lab, and lifestyle information, including television viewing habits, was collected via a written questionnaire. Body fat was measured using skinfolds from three body sites. High-duration television viewers were almost two times more likely to suffer from hypercholesterolemia as infrequent viewers, with and without control of multiple confounding factors. Moderate-duration viewers were at 1.5 times the risk of hypercholesterolemia compared to infrequent viewers. Neither television group was at greater risk of moderately elevated cholesterol levels (200-239) compared to the infrequent viewers with all of the potential confounders controlled. Cause-and-effect conclusions are not warranted; however, this study coupled with other investigations shows that excessive television viewing may be an important lifestyle factor linked to decreased health and functioning.
 
Article
Determine the effects of telephone-based coaching and a weight-loss supplement on the weight and body fat (BF) of overweight adults. Randomized, placebo-controlled experiment with assessments at baseline, 2 months, and 4 months. Community. Sixty overweight or obese men and 60 overweight or obese women, 25 to 60 years Eleven 30-minute telephone coaching sessions were spaced throughout the study; the initial conversation lasted 60 to 90 minutes. Supplement or placebo capsules were taken daily over the 17 weeks. Weight was measured using an electronic scale, and BF was assessed using dual energy x-ray absorptiometry. Subjects taking the placebo lost 1.8 +/- 3.3 kg of weight and 0.7 +/- 2.2 kg of BF, whereas supplement users lost more: 3.1 +/- 3.7 kg of weight (F = 4.1, P = .045) and 1.7 +/- 2.6 kg of BF (F = 4.4, p = .039). Participants receiving no coaching lost 1.8 +/- 3.3 kg of weight and 0.7 +/- 2.2 kg of BF, whereas adults receiving coaching lost more: 3.2 +/- 3.6 kg of weight (F = 4.8, p = .032) and 1.6 +/- 2.5 kg of BF (F = 4.2, p = .044). Adults receiving both the supplement and coaching had the greatest losses of weight and BF, suggesting an additive effect (F = 3.2, p = .026; F = 2.9, p = .039, respectively). Both treatments, coaching and the supplement, viewed separately and in combination, worked to help subjects lose weight and BF. Adults can be educated and motivated via telephone to change behaviors leading to weight loss, and a weight-loss supplement can be included to increase success.
 
Article
Women's magazines are a significant source of health information for many women, but there is some concern that the media may misrepresent a woman's risk of breast cancer. This review analyzes breast cancer articles in selected women's magazines to determine if the information presented is accurate and balanced. For the years 1987 to 1995, the quantity and content of breast cancer articles were examined in four popular women's magazines and three magazines with a large African-American audience. Fifty-nine lead factual breast cancer articles were analyzed for the information presented on prevention measures, risk factors, incidence/mortality statistics, and lifetime risk. The age at diagnosis for women featured in these articles was also determined. SUMMARY OF IMPORTANT FINDINGS: Breast cancer was the topic of 34.9% of the 585 cancer articles published in these seven magazines. Mammography screening guidelines were recommended in 68% of articles that discussed prevention; 66% presented the American Cancer Society guidelines. Risk factors for breast cancer were reported as age greater than 50 in 41% and family history in 78% of the articles that discussed risk factors. Twenty articles used the lifetime risk statistic of developing breast cancer; six explained what this statistic means. The average age of diagnosis for women featured in the articles was 40.5. The proportion of breast cancer articles to all cancer articles in these magazines (34.9%) was similar to breast cancer incidence (32.2%) but was higher than its contribution to either female cancer mortality (17.2%) or overall female mortality (4.0%). Magazines that targeted the African-American audience had fewer breast cancer articles than the other four magazines. Risk factors for breast cancer were not discussed in proportion to their impact on risk. The popular lifetime risk statistic was not explained in the majority of cases where it was presented. The average age of diagnosis for the women featured in these articles was far below the median age of diagnosis of 65. Thus, magazine reports may be contributing to women's misunderstanding of their true breast cancer risk.
 
Article
PurposE: Report effects on knowledge of sexual health and gender from an intervention using peer methodology in Nicaragua. A prepost nonequivalent control group design. Ciudad Sandino, Managua, Nicaragua. A total of 599 girls were surveyed, 60% nonintervened and 40% intervened. Peer methodology consisted of (1) meetings in which girls talked and worked with other girls, (2) mothers taking an active role in the peer groups, and/or (3) girls watching the soap opera "Sexto Sentido." Indices measuring changes in sexual knowledge and gender vision. Girls participating in the peer groups were twice as likely to have satisfactory sexual health-related self-esteem as those who did not participate. Eleven percent of the girls achieved satisfactory self-esteem as a result of the (peer groups x mothers) interaction and 15% due to the (peer groups x mothers x "Sexto Sentido") interaction. Girls participating in the peer groups were three times as likely to have satisfactory gender visions; if exposed to all three components, they were almost four times as likely to develop satisfactory gender visions. Peer methodology, participation of a female family member, and an educational soap opera seem beneficial in promoting sexual health-related knowledge and gender vision in young girls.
 
Article
The purpose of this study was to investigate the proportion of short trips made by walking among Michigan adults and barriers to walking for transportation. Four questions on walking for transportation were asked of 3808 respondents to the Michigan Behavioral Risk Factor Surveillance System (BRFSS) between January and December 2001. Three quarters (74.3%) of Michigan adults were estimated to have made at least one short trip (.25-1 mile) in the previous week; however, only 36.2% of them walked even one of these trips. The mean proportion of short trips walked was 21.4%; less than 10% of all respondents walked five or more trips per week. Our results provide a Michigan-specific baseline for Healthy People 2010 Objective 22-14 (i.e., increase the proportion of trips made by walking) and suggest the potential for these questions to be used to monitor active transportation via the BRFSS.
 
Article
Assess whether family environmental factors affected changes in fruit and snack consumption among 12- to 14-year-old adolescents participating in a Dutch healthy diet promotion program. Data were derived from pretest and posttest questionnaires completed by adolescents in 10 schools in the intervention arm of the program trial and questionnaires completed by their parents during program implementation. Lower vocational schools in the southern and central parts of The Netherlands. Questionnaire answers of 502 parents were matched with those of their children. Eight school lessons using various theory-based materials and strategies. Dietary intake, ethnicity, education level, employment status, parenting style, food purchase considerations, family food rules, and food availability and accessibility at home. Regression analyses. No significant family environmental predictors of program-induced changes in either fruit or snack intake were found. A limitation of the study was that all data were self-reported. No evidence was found that there were subgroups of adolescents who profited less from the program because of family environmental factors.
 
Description of the Nutrition Education Materials* 
Quantitative Evaluation of Materials* 
Qualitative Evaluation of Nutrition Education Materials 
Article
Food insecurity in the United States is a major public health issue. The main objective of this study was to evaluate the availability and quality of printed materials addressing food security targeted to special populations by the United States Department of Agriculture (USDA). Nutrition education resources addressing food security available from USDA websites were selected for analysis. Not applicable. The review team consisted of project staff (n = 6), two of who were fluent in Spanish. Selection criteria were established to identify the food-security materials, and a group of reviewers assessed the quality of each publication both quantitatively and qualitatively. A consensus meeting among the reviewers was held to make final determinations of the quality of the materials. The quantitative data analysis consisted of basic descriptive statistics. Among the 27 materials initially identified, 20 were either irrelevant or of low relevance to food security. Moreover, very few of them were intended for minority populations. The quality of most of the materials ranged from "average" to "good." Some of the major weaknesses include readability level, lack of cultural relevance, and inadequate coverage of food insecurity. Very few materials on food insecurity are of high quality. In the development of such materials, emphasis should be given to the readability level, content, and cultural relevance.
 
Article
To examine the appropriateness of the five-stage schema developed for addictive behaviors when applied to nonaddictive behaviors such as fruit and vegetable consumption. A cross-sectional mail survey was conducted. Self-administered questionnaires were mailed to the home addresses of respondents recruited in 10 states and returned upon completion. In all, 116 male and 185 female young adults (response rate = 70%) completed the questionnaires. Most respondents were Caucasian (74.4%) and college students (62.2%). Statistical analyses included analysis of variance with Scheffe's test, Pearson correlation and Cronbach's alpha coefficients, factor analysis, and cluster analysis. Staging algorithms for fruits and vegetables were developed according to the five-stage schema, and their construct validity was verified by the incremental trend of food intakes. The algorithms identified more than 80% of the subjects as precontemplators, preparers, or maintainers for both food groups. This distribution pattern agreed well with the three-factor solution generated from the stages of change questionnaire, for which internal reliability and validity were confirmed. Seven cluster profiles of the respondents were derived based on the three generated factors and appeared to represent stage subgroupings of those factors. The two food groups shared marked similarities regarding the profiling of the clusters, which was validated by comparing food intake. The results, however, cannot be generalized because of limitations involved in the current sample. The original five stages of change and traditional staging measures may need to be adapted and/or extended for dietary change.
 
Article
One aim of this study was to make a contribution toward understanding how health issues are viewed from the legislator's perspective. This information may assist health educators develop social action strategies and tactics necessary to ensure that health promotion obtains high priority on the legislative agenda. Health educators may need awareness of how the political process operates and may need to develop skills necessary to be successsful in the political environment, which has become a major arena for dealing with health issues.
 
Article
To estimate the independent effect of cigarette smoking on respiratory tract symptoms and health status indicators among high school seniors. Consolidated data sets from one-time cross-sectional survey designs. High schools in the United States, 1982-1989. A total of 26,504 high school seniors, with an 83% response rate. Odds ratios for respiratory tract symptoms and health status indicators for cigarette smokers compared with nonsmokers, while controlling for sex, socioeconomic status, and use of other drugs. High school seniors who were regular cigarette smokers and who began smoking by grade nine were significantly more likely than never smokers to report shortness of breath when not exercising (adjusted odds ratio [OR] = 2.7), coughing spells (OR = 2.1), productive cough (OR = 2.4), and wheezing or gasping (OR = 2.6). These smokers were also more likely to have seen a doctor or other health professional for an emotional or psychologic complaint (OR = 3.0) and to rate their overall health as poorer than average (OR = 2.4). We found strong dose-response relationships for most outcome measures. Cigarette smoking among high school seniors is associated with respiratory tract symptoms and poorer overall physical health and may be a marker for underlying mental health problems. Smoking prevention activities directed at adolescents should include information on the early adverse health consequences of cigarette smoking.
 
Article
To examine compliance with the guideline for dietary fat (i.e., 30% of total daily colonies) and covariates of fat intake in a cohort of adults using both 24-hour recall and food frequency questionnaire (FFQ). Prospective, observational cohort study over 5 years. Community-based sample in Reno, Nevada. Equal numbers of male and female, lean and overweight adults (n = 508), recruited from 1985 to 1986, of whom 348 completed all relevant surveys. Subjects underwent repeated anthropometric measures and completed extensive surveys on diet, weight cycling, lifestyle, and physical activity. Mean fat intake by 24-hour recall declined from 36.9% to 33.6% of calories between years 1 and 5 (p < .001), while calorie intake increased (p = .2). As measured by FFQ at year 2, mean fat intake was 39.1% of calories, and only 11.8% of subjects were in compliance with the guideline for dietary fat intake. Fat intake by FFQ at year 2 was statistically higher than by 24-hour recall in year 1 for lean women (p = .02) and lean men (p = .02), but not for the overweight of either gender, and was significantly higher than the year 5 24-hour recall for all categories of gender and weight (p < .001). Calorie intake, gender, and body mass index were significant in regression models that explained less than 10% of total variability in fat intake (r2 = .08; p < .01). Compliance with the nationally recommended level of dietary fat intake was poor in this cohort, especially as measured by FFQ. Variability in fat intake was largely unexplained by host characteristics, including education. Further study is required to corroborate secular trends in population fat intake, elucidate the determinants of such intake, and identify cost-effective strategies for reducing the consumption of dietary fat.
 
Article
Assess changes in chronic disease-related health behaviors and risk factors from 1990 to 2000, by race/ethnicity, age, and gender. Stratified cross-sectional design. United States. 16,948 black, 11,956 Hispanic, and 158,707 white women and men, ages 18 to 74. Cigarette smoking, obesity, sedentary behavior, low vegetable or fruit intake. From the Behavioral Risk Factor Surveillance System. Young women and men, ages 18 to 24, had poor health profiles and experienced adverse changes from 1990 to 2000. After the variables were adjusted for education and income, these young people had the highest prevalence of smoking (34%-36% current smokers among white women and men), the largest increases in smoking (10%-12% increase among white women and men; 9% increase among Hispanic women), and large increases in obesity (4%-9% increase, all gender and racial/ethnic groups). Young women and men from each racial/ethnic group also had high levels of sedentary behavior (approximately 20%-30%) and low vegetable or fruit intake (approximately 35%-50%). In contrast, older Hispanic women and men and older black men, ages 65 to 74, showed some of the most positive changes. They had the largest decreases in smoking (Hispanic women), largest decreases in sedentary behavior (Hispanic women and black men), and largest increases in vegetable or fruit intake (Hispanic women and men, and black men). The poor and worsening health profile of young women and men is a particular concern, as they will soon enter the ages of high chronic disease burden.
 
Article
To determine the prevalence of tobacco use among Centers for Disease Control and Prevention (CDC)/Agency for Toxic Substances and Disease Registry (ATSDR) employees and the effect of the smoke-free policy on smoking behavior and air quality at work. A stratified telephone survey of 1181 CDC/ATSDR employees randomly selected from employee rosters. CDC/ATSDR work sites in Atlanta, Georgia, and other major CDC locations throughout the United States and Puerto Rico. Randomly selected employees of CDC/ATSDR1, or about 22% of the total CDC/ATSDR population; 98% of eligible persons selected agreed to participate. Demographic and smoking history variables, attitudes toward and impact of the smoke-free policy on smoking behavior, and self-report changes in air quality were the measures used. Overall cigarette smoking prevalence was only 11.1%. One percent reported using chewing tobacco, 1.1% reported smoking a pipe, and 1.4% reported smoking cigars. Average self-reported, daily cigarette consumption significantly decreased after the smoking ban took effect. Overall, 90% of the employees supported the smoke-free policy, and 80% of the employees believed that smokers were complying with the smoke-free policy. Most employees believed that the air quality of work areas and nonwork areas (65% and 69%, respectively) had improved since the smoke-free policy was implemented. These findings are consistent with previous evaluations of smoke-free policies and suggest that most employees are generally supportive of workplace smoking restrictions. Such policies can also have a positive impact on smoking behavior and perceived air quality.
 
Article
Seven major consumer trends including time control, component lifestyles, voluntary activities and environmental concerns, children as consumers, aging baby boomers, globalization, and a changing workplace are projected to have a significant impact on our success in achieving the Year 2000 Health Objectives for the Nation.
 
Article
Editor Note: This is the third in a series of articles written by Dr. Kenneth R. Pelletier summarizing the results of studies examining the impact of comprehensive health promotion programs on health and cost. We received more than i0,000 reprint requests for these articles, which is far more than we have received for any other article we have published. Dr. Pelletier updated the summary because of the tremendous response it received and because additional studies have been published since the first two summaries were printed. Our intention is to continue publishing updated summaries of the impact of comprehensive health promotion programs on health and financial outcome measures periodically and to include all studies published in rigorous peer-reviewed journals. If we have missed a study, please send us a copy to include in the next update. At the request of Dr. Pelletier, this article is dedicated to Dr. Andrea Foote for her innovative and enduring impact on worksite health promotion that recognized the value of the individual worker and the power of the worksite as an ad hoc community to improve individual and organizational health.
 
Article
The purpose of this study was to compare the results from a survey of Omaha worksite health promotion activities with the results of a 1992 national survey. Comparisons were made on: (1) the kinds of health promotion activities offered, (2) progress toward the Healthy People 2000 worksite objectives, (3) types of program intervention offered, and (4) administrative factors. A one-time, written, mail-out/mail-back survey design was used. The study took place in Omaha, Nebraska. All area public and private worksites with 250 or more employees were sent surveys. Individuals who were preselected and identified as the best qualified within the company completed the survey instrument. Of the 176 worksites surveyed, 86 completed the survey (49%). Descriptive statistics (percentages) were used to compare the two surveys on kinds of programs offered, progress toward Healthy People 2000 related to worksite health promotion, the types of program intervention offered, and administrative factors. Generally, a greater percentage of respondent worksites from the national survey are offering more health promotion activities and have made more progress toward the Healthy People 2000 worksite objectives than the Omaha worksites. Results from both surveys showed that low levels of intervention are more prevalent than high levels of intervention, and that health promotion activities in most worksites are coordinated by human resources departments and not by someone professionally prepared in health education. Traditionally, major goals of worksite health promotion programs have focused on important organizational outcomes such as improved productivity/morale, reduction in absenteeism, and health care cost-containment. It is important to recognize, however, that low levels of intervention have less impact than more intensive programs on these desired outcomes. Future goals for local and national worksite health promotion programs may need to encourage implementation of more intensive intervention programs.
 
Article
The fourth in a series of critical reviews, this study examines the clinical and cost outcome evaluations of 10 worksite health promotion programs that were comprehensive, multifactorial, and directed at risk management. The studies, conducted between 1994 and 1998, indicate favorable clinical and cost outcomes and suggest characteristics of worksite interventions that may be critical for effectiveness.
 
Article
To operationalize, estimate the prevalence, and ascertain the epidemiology of complete health. Cross-sectional analyses of self-reported survey data collected via a telephone interview and a self-administered questionnaire. Households in the 48 contiguous states in the United States in 1995. Random-digit dialing sample of 3032 adults between the ages of 25 and 74, with a response rate of 61%. Physical illness and health were measured with a total of 37 items--a checklist of 29 chronic health conditions, a six-item scale of limitations of daily living, and a single item for perceived current health and for perceived 5-year change in energy. Mental illness and health were measured with the Composite International Diagnostic Interview Short Form diagnostic scale of major depression, panic, and generalized anxiety disorders and three established multi-item scales of subjective well-being (emotional, psychological, and social well-being). Completely healthy adults have high levels of physical and mental health and low levels of physical and mental illnesses; completely unhealthy adults have high levels of physical and mental illnesses and low levels of physical and mental health. Incompletely healthy adults consisted of two groups: one group is physically healthy (high physical health and low physical illness) and mentally unhealthy, and the second group is mentally healthy (high mental health and low mental illness) and physically unhealthy. Nineteen percent of adults were completely healthy, 18.8% were completely unhealthy, and 62.2% had a version of incomplete health. Compared with completely unhealthy adults, completely healthy adults are likely to be young (25-34 years of age) or old (55-64 and 65-74 years), are married, are male, are college educated, and have higher household incomes. Operationalizing complete health highlights objectives for increasing the prevalence of complete health, and reducing the prevalence of complete ill-health and incomplete health.
 
Article
To assess the status of managed care and insurance coverage of complementary and alternative medicine (CAM) and the integration of such services into conventional medicine. A literature review and information search was conducted to determine which insurers had special policies for CAM. Telephone interviews were conducted with a definitive sample of 9 out of 10 new MCOs or insurers identified in 1998 and a cohort of eight MCOs and insurers who responded both to the original survey in 1997 and again in 1998 to determine trends. This study constitutes the results of the second year of a 3-year ongoing survey. For 1998, 10 MCOs and insurance carriers initiated CAM coverage. Survey results are analyzed for these 10 new providers as well as the results of a cohort of eight insurers surveyed in both 1997 and 1998 to determine current trends. A majority of the insurers interviewed offer some coverage for the following: nutrition counseling, biofeedback, psychotherapy, acupuncture, preventive medicine, chiropractic, osteopathy, and physical therapy. All new MCOs and insurers said that market demand was their primary motivation for covering CAM. Factors determining whether insurers would offer coverage for additional therapies included potential cost-effectiveness, consumer interest, demonstrable clinical efficacy, and state mandates. Among the most common obstacles listed to incorporating CAM into mainstream health care were lack of research on efficacy, economics, ignorance about CAM, provider competition and division, and lack of standards of practice. Consumer demand for CAM is motivating more MCOs and insurance companies to assess the benefits of incorporating CAM. Outcomes studies for both conventional and CAM therapies are needed to help create a health care system based upon treatments that work, whether they are conventional, complementary, or alternative.
 
Article
This article is the fifth in a series of critical reviews of the clinical effectiveness and cost-effectiveness studies of comprehensive, multifactorial health promotion and disease management programs conducted in worksites. As with the previous reviews, the purpose of this article is to review and assess the randomized control trials that have focused on both clinical and cost outcomes of worksite health promotion and disease management programs. For this current review, a new category of quasi-experimental studies has been added because this represents a major new trend in such interventions over the last 2 years. Comprehensive worksite programs are those that provide an ongoing, integrated program of health promotion and disease prevention that integrates specific components into a coherent, ongoing program that is consistent with corporate objectives and includes program evaluations of both clinical and cost outcomes. A comprehensive search was conducted using a multistage process that included MEDLINE, ERIC, ADI, EDGAR, CARL, Inform, and Lexis-Nexis databases and direct inquiries to worksite researchers. The search identified 27 new studies to which the following inclusion criteria were applied: research conducted in the United States; results published in English; methodological quality of nonexperimental (pre- and postmeasures but no comparison group); quasi-experimental to randomized control trials; and both clinical and cost outcomes. Exclusion criteria were studies outside of the United States; non-English publications; and clinical or cost outcomes only. Fifteen studies remained for this review. FINDINGS EXTRACTION METHODS: Findings extraction and analysis of the 15 studies was done by extracting the relevant population, intervention design, clinical results, and cost outcomes from the published article. As in previous reviews, findings are summarized in a table format that extracts and describes each study by the following: (1) study author(s); (2) corporate site; (3) purpose of the evaluation; (4) employee population; (5) percentage of program participants; (6) number of employees included in the evaluation; (7) brief description of the intervention; (8) evaluation design; (9) evaluation period; (10) outcomes; (11) research rating; and (12) findings. FINDINGS SYNTHESIS: Based on these 15 studies, a methodological critique was conducted with brief reference to appropriate prior studies. Conclusions regarding study quality and new trends over the time period of 1998 to 2000 are discussed. Results from randomized clinical trials and quasi-experimental designs suggest that providing individualized risk reduction for high risk employees within the context of comprehensive programming is the critical element of worksite interventions. Despite the many limitations of the current methodologies of the 15 new studies, the vast majority of the research to date indicates positive clinical and cost outcomes.
 
Article
This study was conducted to develop a regression equation that accurately estimates body fat percentage using relatively easy and inexpensive methods that do not require women to remove clothing. A cross-sectional design was employed. All data were collected at the University. Subjects were 200 white women ages 20 to 65 years. The sample was equally distributed across four age groups, 20-29, 30-39, 40-49, and 50-65, and within each age group, one-third of the women were lean, one-third were of average weight, and one-third were obese. Subjects were hydrostatically weighed and participated in a variety of anthropometric and lifestyle assessments, including skinfolds, circumferences, and questionnaire responses. The full regression model included six measures: hip circumference, triceps skinfold (observed and quadratic), age (quadratic), self-reported physical activity, and calf skinfold (quadratic). This equation accounted for 81% of the variance in body weight measured by hydrostatic weighing (SEE = 3.5%). A simpler, five-variable equation was also formed that did not include the calf skinfold assessment (R2 = .800, SEE = 3.6%). The prediction equations in this study afford accurate and relatively easy and inexpensive means of estimating body fat percentage in a wide range of white women without having them remove their clothing.
 
Article
PURPOSE: To characterize factors associated with smoking-cessation counseling in clinical encounters. DESIGN: Cross-sectional analysis of Behavioral Risk Factor Surveillance System (BRFSS) 2000 data. SETTING: U.S. households. SUBJECTS: 10,582 smokers (aged > or = 18 years) reporting one or more clinical encounters during the prior year. MEASURES: Multivariate-adjusted odds ratios (OR) and 95% confidence intervals (CI) for quit advice associated with respondent and encounter variables. RESULTS: Almost 55% of respondents were advised to quit smoking. Young men were advised to quit least often. Increasing age (18-24, 25-39, 40-64, > or = 65 years) was associated with increasing odds of receiving quit advice (OR = 1.33, CI 1.10-1.61) for men. Other positive associations with quit advice included patient education, BMI, diagnosis of asthma, and private health insurance. Patients seeing physicians had greater odds of being advised to quit smoking (OR = 3.29, CI 2.13-5.06) than those seeing dentists. There was a 4% to 23% chance of receiving quit advice at any given nondental clinical encounter; the odds of such counseling did not rise significantly with the number of visits. CONCLUSION: Smoking cessation counseling may be provided preferentially on the basis of patient demographics, and often is not provided at all. In a given year, just over half of smoking patients are advised to quit, and such counseling is provided at less than a quarter of clinical encounters.
 
Article
Questionnaries with 22 multiple-choice questions were mailed to a random sample of 450 Missouri employers with 250 or more employees to determine the prevalence and types of workplace health promotion programs; 262 (58%) responded. Only 34% of the responding companies offered any kind of program and 65% of these offered only awareness programs, but most offered programs on all 18 topics listed in the questionnaire; 48% had a full-time program manager, 79% had some form of evaluation, and 36% had some form of financial incentives.
 
Article
Document changes from 2000 to 2004 in youth reports of exposure to pro-tobacco messages in the mass media, including images of smoking and tobacco advertising. Comparison of cross-sectional data from three waves of the school-based National Youth Tobacco Surveys conducted in 2000 (N= 33,772), 2002 (N= 23,439), and 2004 (N= 23,540). Public and private middle schools and high schools across the United States. Students in grades 6 through 12. Smoking status; exposure to images of smoking on television and in movies; exposure to advertisements for tobacco products in stores, on the Internet, and in newspapers and magazines; demographic data. Youth exposure to pro-tobacco messages declined within all media channels studied from 2000 to 2004, except the Internet. Despite these declines, most youth in the United States remain exposed to pro-tobacco messages: 81% saw images of smoking on television or in movies (down from 90%), 85% saw tobacco ads in stores (down from 88%), 50% saw tobacco ads in newspapers and magazines (down from 66%), and 33 % saw tobacco ads on the Internet (up from 22%). Despite recent progress in this area, most youth in the United States are still at increased risk of smoking as a result of exposure to pro-tobacco messages in the mass media.
 
Article
To examine the relationship between smoking status and health-related quality of life (HRQOL). Our study used a cross-sectional analysis with self-reported data from the 2001 Behavioral Risk Factor Surveillance System (BRFSS). United States. Subjects were a representative sample of noninstitutionalized adults aged 18 years and older. After excluding respondents who reported being pregnant and for whom smoking status could not be determined, we included 209,031 respondents. Multiple logistic regressions were performed to examine the associations of smoking status with the four HRQOL items, controlling for demographic and health-related characteristics. Current smokers had a higher likelihood of reporting poor general health status compared with nonsmokers and ex-smokers. Compared with nonsmokers, current smokers had a higher likelihood of reporting > or = 14 days of poor physical health (odds ratio [OR] = 1.64, 95% confidence interval [CI] = 1.51-1.77), poor mental health (OR = 1.99, 95% Cl = 1.84-2.16), and activity limitations (OR = 1.80, 95% Cl = 1.63-2.00). Similarly, compared with ex-smokers, current smokers had a higher likelihood of reporting > or = 14 days of poor physical health (OR = 1.30, 95% CI = 1.19-1.42), poor mental health (OR = 1.65, 95% CI = 1.50-1.81), and activity limitations (OR = 1.48, 95% CI = 1.32-1.65). Age, income, and presence of comorbidities also significantly explained variation in HRQOL. Our study reaffirms the significant association between smoking and HRQOL in a large nationally representative sample. Poor health associated with smoking persists as a major public health problem, and effective preventive and smoking cessation efforts should be undertaken.
 
Article
To quantify the association between food insecurity and smoking among low-income families. A retrospective study using data from the 2001 Panel Study of Income Dynamics (PSID), a longitudinal study of a representative sample of U.S. men, women, and children and the family units in which they reside. Low-income families. Family income was linked with U.S. poverty thresholds to identify 2099 families living near or below 200% of the federal poverty level. Food insecurity (i.e., having insufficient funds to purchase enough food to maintain an active and healthy lifestyle) was calculated from the 18-core-item food security module of the U.S. Department of Agriculture. Current smoking status was determined. Smoking prevalence was higher among low-income families who were food insecure compared with low-income families who were food secure (43.6% vs. 31.9%; p < .01). Multivariate analysis revealed that smoking was associated with an increase in food insecurity of approximately six percentage points (p < .01). Given our finding that families near the federal poverty level spend a large share of their income on cigarettes, perhaps it would be prudent for food-assistance and tobacco-control programs to work together to help low-income people quit smoking.
 
Characteristics of the 2007 Total Survey Population and Recent pbCAM Users Who Are Nonsmokers and Smokers † 
Changes in Percentage of pbCAM Users Between 2002 and 2007 Among the Total Sample and Current Smokers 
Percentage and Population Estimates of 2007 CAM Users Who Are Smokers* 
Article
Purpose: To provide a snapshot of provider-based complementary and alternative medicine (pbCAM) use among adult smokers and assess the opportunity for these providers to deliver tobacco cessation interventions. Design: Cross-sectional analysis of data from the 2002 and 2007 National Health Interview Surveys. Setting: Nationally representative sample. Subjects: A total of 54,437 (31,044 from 2002; 23,393 from 2007) adults 18 years and older. Measures: The analysis focuses on 10 types of pbCAM, including acupuncture, Ayurveda, biofeedback, chelation therapy, chiropractic care, energy therapy, folk medicine, hypnosis, massage, and naturopathy. Analysis: The proportions of current smokers using any pbCAM as well as specific types of pbCAM in 2002 and 2007 are compared using SAS SURVEYLOGISTIC. Results: Between 2002 and 2007, the percentage of recent users of any pbCAM therapy increased from 12.5% to 15.4% (p = .001). The largest increases occurred in massage, chiropractic, and acupuncture. Despite a decrease in the national average of current smokers (22.0% to 19.4%; p = .001), proportions of smokers within specific pbCAM disciplines remained consistent. Conclusion: Complementary and alternative medicine (CAM) practitioners, particularly those in chiropractic, acupuncture, and massage, represent new cohorts in the health care community to promote tobacco cessation. There is an opportunity to provide brief tobacco intervention training to CAM practitioners and engage them in public health efforts to reduce the burden of tobacco use in the United States.
 
Article
We investigated the prevalence of hypertension-lowering lifestyle-modification advice given to adults living in Iowa. We sought to determine if persons with high blood pressure and those who are overweight receive more advice than do persons with normal blood pressure and a desirable body weight. By using the 2002 Behavioral Risk Factor Surveillance System, we asked Iowa adults with (N=1050) and without (N=2514) high blood pressure five questions relating to the most recent Joint National Committee guidelines on lowering blood pressure. Respondents with high blood pressure were placed into normal weight and overweight categories. Chi-square analysis revealed group differences in amount of advice received. To reflect the true Iowa population, data were weighted by SPSS software. Compared with persons without high blood pressure, those with high blood pressure received more lifestyle-modification advice (p < .001) for eating less high-fat or high-cholesterol foods (28.3% vs. 12.5%), eating more fruits and vegetables (35.7% vs. 20.0%), exercising more (37.6% vs. 20.8%), losing weight (19.3% vs. 9.3%), and quitting smoking (80.5% vs. 64.6%). Although persons with multiple chronic-disease risk factors are given more advice, the prevalence of advice given to individuals when lifestyle changes may reduce risk factors is still very low. Methods of translating research on lifestyle modifications into practice are discussed.
 
Article
To examine the prevalence of health behaviors, including clinical preventive services and lifestyle risk behaviors, among insured workers and to determine whether disparities in health behaviors based on demographic factors exist among this group. Cross-sectional analysis of 2004-2005 Behavioral Risk Factor Surveillance System data. United States. . A representative sample of noninstitutionalized employed and insured adults aged 18 to 64 years (139,738 in 2004 and 159,755 in 2005). Self-reported clinical preventive services utilization and lifestyle-related behaviors, as well as multiple logistic regression analyses assessing the independent effects of demographic and access variables on health behaviors. Among insured workers, rates of not using recommended clinical preventive services ranged from 8.5% (cervical cancer screening) to 73.9% (influenza vaccination). Rates for engaging in lifestyle-related risks ranged from 5.5% (heavy drinking) to 77.1% (inadequate fruit-vegetable consumption). In multivariate analyses, lower income, lower education, cost as a barrier to health care, and no health care provider were associated with significantly decreased clinical preventive services utilization (p < .01). Lower education and no health care provider were associated with lifestyle-related risks (p < .01). Working insured adults are not meeting recommendations for health behaviors. Significant disparities in health behaviors related to socioeconomic status exist among this group. Employers and insurers should consider these poor health behaviors and disparities when designing insurance benefits addressing clinical preventive services utilization and workplace health promotion programs addressing lifestyle-related behaviors.
 
Article
Worksite Health Promotion (WHP) offers employers a potential solution for the problem of rising employee health care costs. However, the spread of Health Promotion to more employer worksites still requires credible evidence concerning its likely economic return. In this issue of The Art of Health Promotion a 2005 update of an earlier meta-evaluation of economic return studies of WHP programs is presented. The meta-evaluation methodology was adapted from the smoking cessation and weight management literature. Fifty-six peer reviewed studies that met the selection criteria are evaluated and summarized in this issue. Economic return is examined in regard to: health plan, sick leave absenteeism, workers' compensation, disability management and presenteeism costs. Twenty-one of the fifty-six studies also addressed the issue of cost/benefit analysis.
 
Article
To determine self-identified barriers to cancer screening participation in Montana among respondents to the Behavioral Risk Factor Surveillance System (BRFSS). The 2007 BRFSS survey. State of Montana. A total of 3433 respondents (2020 women) 50 years and older. Respondents who had never had an endoscopy and women who had not had a recent mammogram were asked why they had not been screened. Associations between health care access variables and screening participation were assessed using chi2 tests. Joint effects of multiple independent predictors of screening participation were assessed using odds ratios (ORs) and 95% confidence intervals (CIs) from multiple logistic regression analysis. The strongest predictor of having an endoscopy (OR, 23.62; 95% CI, 18.42-30.28) or recent mammogram (OR, 10.87; 95%, CI, 6.42-18.40) was provider recommendation. The most common reasons for not being screened were respondent's belief that it was not necessary (44% for endoscopy and 39% for mammography), no provider recommendation (22% for endoscopy), and cost (12% for endoscopy and 19% for mammography). Among unscreened respondents whose providers recommended endoscopy and mammography, 30% and 36%, respectively, believed that it was not necessary. Many Montanans remain unaware of the importance of cancer screening Health care providers and public health officials must increase patient education, and providers must continue to refer patients for screening.
 
Demographic Characteristics of the Sample* 
Odds Ratios for Food/Beverage Consumed the Previous Day by Sports Team Participation Among Fourth-Grade Boysf 
Odds Ratios for Food/Beverage Consumed the Previous Day by Sports Team Participation Among Fourth-Grade Girlsf 
Odds Ratios for Food/Beverage Consumed the Previous Day by Sports Team Participation for Significant Ethnic Subgroups! 
Article
Purpose To determine the association between youth sport team participation and dietary behaviors among elementary school–aged children. Design Cross-sectional survey. Setting Public schools in Texas during 2009–2010. Subjects A total of 5035 ethnically diverse fourth graders. Measures Participation in organized sports teams, consumption of select food items (fruits, vegetables, beverages, sweets/snacks). Analysis Multiple logistic regression was used to assess the association between each food item (eaten at least once on the previous day) and number of sports teams as the independent class variable (0, 1, 2, ≥3), adjusting for body mass index physical activity, socioeconomic status, and ethnicity. Results Significant dose-response associations were observed between number of sports teams and consumption of fruits and vegetables. For boys, the likelihood of eating fruit and fruit-flavored drinks was significantly higher and the odds of drinking soda were lower with the number of teams. For girls, the likelihood of consuming green vegetables increased as sports teams participation increased, and participation was positively associated with diet soda consumption. A positive association was observed between the number of sports teams and scores on the Healthy Food Index for boys and girls. Conclusion The findings that sports participation is associated with consumption of fruits and vegetables and lower consumption of soda suggest that efforts should be focused on supporting youth team sports to promote healthier food choices. Since sports are available to all ages, sports may be an important venue for promoting healthier dietary behaviors.
 
Top-cited authors
Amelia M Arria
  • University of Maryland, College Park
Kathryn B Vincent
  • University of Maryland, College Park
Kimberly M Caldeira
  • University of Maryland, College Park
Devon C Payne-Sturges
  • University of Maryland, College Park
David L Katz
  • True Health Initiative