Showing papers in "American Journal of Health Promotion in 1999"

A Review and Analysis of the Clinical- and Cost-effectiveness Studies of Comprehensive Health Promotion and Disease Management Programs at the Worksite: 1998–2000 Update

Abstract: Purpose. 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. Data Sources. A comprehensive search was conducted using a multist...

A return on investment evaluation of the Citibank, N.A., health management program.

Abstract: Objectives. Citibank, N.A., initiated a comprehensive health, demand, and disease management program in 1994, using program services offered by Healthtrac, Inc., of Menlo Park, California. Program components included an initial screening of employees, computerized triage of subjects into higher and lower risk intervention programs, extensive follow-up with the higher risk subjects, and general health education and awareness building. The objective of this study was to estimate the financial impact of this program on medical expenditures. Methods. A quasiexperimental design was applied comparing medical expenditures before vs. after the intervention for program participants and nonparticipants. The 22,838 subjects (11,194 program participants and 11,644 nonparticipants) were followed for an average of 38 months before and after administration of a Healthtrac health risk appraisal (HRA) instrument that triggered the start of the program. To adjust for selection bias to the extent possible with thes...

Improving exercise behavior: an application of the stages of change model in a worksite setting.

Abstract: Randomized trial of 527 corporate employees was conducted to evaluate an exercise intervention based on the transtheoretical model and tailored to individual stages of change. No significant difference in physical activity by stage was evident at baseline among three treatment groups. At follow-up, the group receiving a staged-based message increased activity by 13% and a significant difference was evident in the magnitude and direction of movement across stages, suggesting that tailored messages to stages of change may be an effective strategy for physical activity interventions.

Incentives and barriers to physical activity for working women.

Abstract: A questionnaire was completed by 393 working women to examine incentives and barriers to physical activity based on the stages of change from the transtheoretical model. Using Chi Square tests, differences were found across the five stages suggesting that work site programs be designed and tailored for women at different stages of readiness.

The effectiveness of a point-of-decision prompt in deterring sedentary behavior.

Abstract: Individuals using a university library were observed using stairs or elevators to travel up one to three floors. After a baseline assessment, a sign was posted by the elevator to discourage elevator use over a five-week period. A hierarchical log linear analysis indicated that stair use increased significantly after the intervention moderated by day of the week, sex, and age. The study suggests that point-of-decision prompts to deter sedentary activity may be effective.

Rating Our Progress in Population Health Promotion: Report Card on Six Behaviors

Abstract: Using McKinlay's population model of prevention, this series assesses the current state of the art for six lifestyle behaviors: tobacco use, alcohol abuse, drug abuse, unhealthy diet, sedentary lifestyle, and risky sexual practices related to human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS). More progress has been made in "downstream" individually oriented treatments than in broader, more environmentally focused interventions. Promising trends include: a shift toward lower cost minimal-contact and self-help "downstream" programs; the development of tailored messages and stage-based "midstream" initiatives that can reach everyone in a defined population or setting; and the emergence of "upstream" policy advocacy strategies. Improving the power and reach of health behavior change will require advances in biobehavioral research to develop more powerful behavior change strategies along with efforts to more widely disseminate the effective interventions that already exist. Growing evidence supports McKinlay's premise that full-spectrum (downstream to upstream) interventions are needed for greatest population impact. Progress also will depend on finding new ways to address the needs of special populations--including underserved low-income groups, racial and ethnic minorities, individuals with multiple risk behaviors, and youth and their families.

How are we doing with physical activity

Abstract: An estimated 60% of U.S. adults are inactive or underactive, and nearly half of America's youth (aged 12 to 21 years) are not vigorously active on a regular basis. Downstream interventions provide individual strategies that effectively increase short-term participation in physical activity by 10% to 25%. Downstream and midstream approaches tailored to individual preferences have greater success. Packaging and disseminating physical activity programs for community, worksite, and health care settings are not as far along as for other areas, although inactivity prevalence is about twice that of smoking, and both risk factors have substantial morbidity and mortality. Less is known about effectiveness of upstream approaches, which have potential for the greatest public health impact. Suggestions include continued promotion of moderate-intensity physical activity, greater dissemination of successful programs, and investigation of physical environment influences.

Current trends in the integration and reimbursement of complementary and alternative medicine by managed care organizations (MCOs) and insurance providers: 1998 update and cohort analysis.

Abstract: Objectives. 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. Methods. 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. Results. 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, p...

The correlation between spiritual well-being and health behaviors

Abstract: Contemporary worksite wellness programs may be limited in their ability to produce significant long-term behavior change, in part, because they fail to adequately address important psychosocial issues related to health behaviors. Research has been done recently, for example, that demonstrates moderate relationships between psychosocial constructs, such as self-esteem and locus of control, and health behaviors. Another psychosocial construct receiving greater attention lately is spiritual health.~-5 Some believe that this construct is really a broader measure of self-esteem, locus of control, connectedness, and possibly other psychosocial variables. 6 Hawks 6 states that spiritual health might be defined as a "high level of faith, hope, and commitment in relation to a well-defined worldview or belief system that provides a sense of meaning and purpose to existence in general, and that offers an ethical path to personal fulfillment which includes connectedness to self, others and a higher power or larger reality." Attitudes of faith, hope, and commitment imply an internal locus of control, and following an ethical path that involves fulfillment, purpose, and meaning may lead to enhanced self-esteem and a sense of connectedness with self and others. In at least one study, correlations between connectedness, meaning and purpose, sense of coherence (well-defined worldview), and spiritual well-being were strong enough to support the premise that spiritual health may be a broader concept that encompasses some of these psychosocial variables (M. Hull, unpublished data, 1990). Little research has been done to determine if a relationship exists between spiritual health (sometimes called

An analysis of breast cancer coverage in selected women's magazines, 1987-1995.

Abstract: Purpose. 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. Search Methods. 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 cancel-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% pres...

Do blue-collar workers perceive the worksite health climate differently than white-collar workers?

Abstract: A mail survey was distributed to a random sample of 497 both blue- and white-collar workers employed at a large manufacturing company to measure dimensions of worksite health climate: organizational and interpersonal support, and health norms. Statistically significant differences were observed for nearly all aspects of the dimensions with white-collar workers having more positive perceptions than blue-collar workers. The study suggests that future research explore how these perceptions may be enhanced and what role they may play in promoting worker health.

Health promotion programs in small worksites: results of a national survey.

Abstract: Purpose. This study documents the prevalence of workplace health promotion activities at small worksites with 15 to 99 employees. Design. A random sample of U.S. worksites stratified by size and industry (n = 3628) was drawn using American Business Lists. Measures. Each worksite was surveyed using a computer-assisted telephone interview system to document activities related to health promotion and related programs, worksite policies regarding health and safety, health insurance, and philanthropic activities. Subjects. Participation varied by industry and size, with an overall response rate for eligible worksites of 78% for a total sample of 2680 worksites. Data analysis. Data were analyzed using SUDAAN statistical software. Results. Approximately 25 % of worksites with 15 to 99 employees offered health promotion programs to their employees, compared with 44% of worksites with 100+ employees. As with the larger worksites, the most common programs for worksites with 15 to 99 employees were those related to ...

Inactive Australian college students' preferred activities, sources of assistance, and motivators.

Abstract: a cross-sectional survey was sent to students at four college campuses to assess self-reported physical activity, sources of assistance to exercise, and motivators for regular activity . The study focused on 864 (40%) of 2148 students surveyed who were classified as inactive. Attributes of inactive male and female college students differed by gender. such differences may be used in tailoring health promotion interventions to increase physical activity.

Progress in dietary behavior change.

Abstract: SYNOPSIS Nutrition has important influences on health and mortality. Public response to current dietary guidance is indicated by positive movement on some indicators, notably reductions in calories from fat and in blood cholesterol levels. Downstream case finding and intensive educational and behavioral interventions are often effective for high risk and motivated subjects and for persons with diet-related disease. Midstream environmental changes (e.g., in grocery stores, schools) proffer improved nutritional choices and supports. Individualized dietary counseling has yet to become the norm. Despite recent upstream success in developing broad dietary guidance and improving nutrition labeling policies, numerous avenues remain open for aggressive national policy developments. Emerging studies and continuing improvement in intervention methods, measurement, and research design will help realize the preventive effects of healthful diets.

Applying the health promotion model to development of a worksite intervention.

Abstract: Introduction. Consistent use of hearing protection devices (HPDs) decreases noise-in- duced hearing loss, however, many workers do not use them consistently. Past research has supported the need to use a conceptual framework to understand behaviors and guide in- tervention programs; however, few reports have specified a process to translate a conceptual model into an intervention. Purpose. The strongest predictors from the Health Promotion Model were used to design a training program to increase HPD use among construction workers. Subjects/Setting. Carpenters (n = 118), operating engineers (n = 109), and plumber/ pipefitters (n = 129) in the Midwest were recruited to participate in the study. Design. Written questionnaires including scales measuring the components of the Health Promotion Model were completed in classroom settings at worker trade group meetings. Measures. All items from scales predicting HPD use were reviewed to determine the basis for the content of a program to promote the use of HPDs. Three selection criteria were de- veloped: (1) correlation with use of hearing protection (at least .20), (2) amenability to change, and (3) room for improvement (mean score not at ceiling). Results. Linear regression and Pearson 's correlation were used to assess the components of the model as predictors of HPD use. Five predictors had statistically significant regres- sion coefficients: perceived noise exposure, self-efficacy, value of use, barriers to use, and modeling of use of hearing protection. Using items meeting the selection criteria, a 20-min- ute videotape with written handouts was developed as the core of an intervention. A clear- ly defined practice session was also incorporated in the training intervention. Conclusion. Determining salient factors for worker populations and specific protective equipment prior to designing an intervention is essential. These predictors provided the ba- sis for a training program that addressed the specific needs of construction workers. Results of tests of the effectiveness of the program will be available in the near future. (Am J Health Promot 1999;13(4):219-227.)

Psychosocial and demographic correlates of television viewing.

Abstract: Purpose. The present study was grounded in the notion that previously identified physical activity determinants were associated in reverse with television viewing. Identifying demographic and psychosocial correlates and other potential determinants of television viewing may allow for the development and conceptualization of models and interventions to reduce sedentary behavior. Design. Cross-sectional data from self-report measures were analyzed using multiple hierarchical regression. Setting. Data were collected from 1995 to 1996 on seniors attending a large public university in southern California. Sample. Subjects were 321 female and 255 male university seniors attending a public university in southern California. The sample's ethnic distribution was 53.8% European-American, 16.3% Latino, 16.6% Asian/Pacific Islander, 16.1% African-American, and 4.3% other. Measures. Typical television viewing practices on weekdays and weekends were assessed using self-report items. Physical activity determinants were ...

Factors associated with attendance in a voluntary nutrition education program.

Abstract: Purpose.This paper examines factors associated with attendance in a National Cancer Institute-funded randomized trial of nutrition education to increase fruit and vegetable consumption among women ...

Self-Efficacy and Consumption of Fruit and Vegetables: Validation of a Summated Scale:

Abstract: Purpose. To develop and validate a scale to assess self-efficacy for increasing fruit and vegetable consumption, and to assess the ability of the scale to discriminate individuals at different stages of readiness to change. Methods. Data were collected using a combination of self-administered mail questionnaires and phone interviews from a sample of 1200 Chinese Singaporeans randomly selected from residential phone listings. Principal-components analysis was conducted with half the sample, and model fit was measured using structural modeling procedures on the other half. Analyses of variance were used to determine whether self-efficacy differed across the stages of change. Setting. Data were collected as part of a larger study investigating factors influencing consumption of fruit, vegetables, and cereal foods. Measures. Fruit and vegetable intake was measured using a validated seven-item food frequency questionnaire. Subjects were assigned to stages using a phone-administered staging algorithm. Self-effi...

Perceptions of Secondary School Staff Toward the Implementation of School-Based Activities to Prevent Weight-Related Disorders: A Needs Assessment

Abstract: School-based programs have the potential to prevent unhealthy weight-related concerns and behaviors among youth. However, the successful implementation of school programs is dependent upon the support of school staff. The purpose of this study was to assess attitudes among secondary school staff regarding the implementation of a school-based program aimed at the prevention of weightrelated disorders and to assess current involvement of staff in related activities. The Centers for Disease Control guidelines for school programs to promote healthy eating stress the importance of a comprehensive approach, including developing a coordinated school nutrition policy, implementing educational activities for students, training staff, integrating food service and nutrition education, and involving family and community.1 Based on similar principles, Neumark-Sztainer 2 has proposed a more specific framework for a comprehensive school-based program aimed at the prevention of weight-related disorders. The suggested components of this framework include: staff training; a module focusing on prevention for all students; integration of prevention material into the existing curricula; more intensive activities targeted at the secondary prevention of eating disorders and obesity; a referral system between school and community health care services; opportunities for healthy eating at school; modifications in physical education and sport activities; and

The relationship between the stages of exercise adoption and other health behaviors.

Abstract: Purpose. To examine the relationship between stage of exercise adoption and the practice of other health behaviors. Design. Demographic, socioeconomic, and health behavior data were collected, using a cross-sectional mail survey. Data were collected as part of a larger employee benefits research study. Setting. Montana State University-Bozeman, Bozeman, Montana. Subjects. University employees (n = 1269) comprised of 46% men with a mean age of 44 years. Measures. Demographic and socioeconomic data included age, sex, marital status, level of income and education, dependent status, and job classification. Stage of exercise adoption classifications were based on self-reported responses to four exercise statements. The health behaviors included in this study were cigarette and smokeless tobacco use, seat belt use, alcohol use, and use of stress management practices. Logistic regression analysis was used to determine if stage of exercise predicted the presence of each of the health behaviors while cont...

Intraclass correlation for measures from a worksite health promotion study: estimates, correlates, and applications.

Abstract: Intervention trials that employ a group-randomized trial design require an adaptation of the usual analytic methods to account for the randomization of intact economic/social groups to study conditions and the positive ICC that is implied by such a design. In the absence of valid estimates of the ICCs for the outcomes of interest, investigators designing trials could only guess at how large a problem they faced and how much they would need to increase sample size to compensate. Aside from this paper, we are aware of only one other publication that provides such estimates, and that study provides estimates for only a handful of outcomes. Our purpose here has been to provide a replication and extension of those findings to a broader array of outcomes. The results presented here suggest that worksite-level ICCs for a variety of smoking and health-related outcomes are generally small and that these ICCs can generally be reduced by adjustment for individual-level characteristics. We have demonstrated how information about these ICCs can be incorporated in sample size calculations to avoid designing "underpowered" studies. Our results should assist investigators in planning studies to evaluate the effectiveness of worksite-based health promotion efforts.

Acceptability of computer assessments among ethnically diverse, low-income smokers.

Abstract: Purpose. To examine the acceptability of computer-based assessments among an ethnically diverse, low-income population of primary care patients. Although computers have been used to provide assessments and interventions in health care settings, members of ethnic minority and low-income households have less access to computers than other groups, and therefore the acceptability of computers as a health care assessment and delivery tool needs to be examined. Design. We examined the acceptability of computers for providing assessments of smoking history, nicotine dependence, and other related variables among an ethnically diverse, low-income primary care population. No intervention was used in this study. Setting. Three inner-city primary care clinics located in hospitals were used as sites for this study. These hospitals were located in areas of the city where low-income and ethnic minority households are overrepresented relative to the total population. Subjects. Adult male and female smokers (n = 522) were...

Carrots and sticks: impact of an incentive/disincentive employee flexible credit benefit plan on health status and medical costs.

Abstract: Purpose. Employee wellness programs aim to assist in controlling employer costs by improving the health status and fitness of employees, potentially increasing productivity, decreasing absenteeism, and reducing medical claims. Most such programs offer no disincentive for nonparticipation. We evaluated an incentive/disincentive program initiated by a large teaching hospital in western Michigan. Methods. The HealthPlus Health Quotient program is an incentive/disincentive approach to health promotion. The employer's contribution to the cafeteria plan benefit package is adjusted based on results of an annual appraisal of serum cholesterol, blood pressure, tobacco use, body fat, physical fitness, motor vehicle safety, nutrition, and alcohol consumption. The adjustment (health quotient [HQ]) can range from −$25 to +$25 per pay period. We examined whether appraised health improved between 1993 and 1996 and whether the HQ predicted medical claims. Results. Mean HQ increased slightly (+$0.47 per pay period in 1993...

Diet and physical activity patterns of urban American Indian women.

Abstract: A cross sectional survey was conducted of American Indian women ages 18 years and older and residing in Minneapolis to assess dietary and physical activity practices. Results indicate a high amount of fat foods and low amount of fruits or vegetables consumed, and little regular physical activity. For adequate dietary intake, barriers included expense, and for physical activity barriers included lack of child care, health problems and safety concerns.

Managing alcohol problems and risky drinking.

Abstract: SYNOPSIS While overall alcohol consumption and alcohol-related automobile deaths have declined, rates of alcohol dependence, liver cirrhosis, and alcohol-related problems remain high among adults, and binge drinking continues as a major health risk for high school and college students. Some individual-level downstream interventions have been evaluated with sufficient rigor to recommend widespread dissemination, and widened availability of new pharmacotherapies could further increase effectiveness. Midstream population-based programs, such as screening and brief interventions in hospitals and managed care organizations, may have greater public health impact than tertiary treatment because of early identification and low cost. Upstream programs and policies that place limits on alcohol availability (e.g., higher legal purchasing age) have the greatest potential to reduce morbidity and mortality at the least cost to society.

Population-based tobacco control: progress and prospects.

Abstract: One in four U.S. adults smokes. Downstream cognitive-behavioral interventions coupled with effective pharmacotherapy can produce 40% quit rates, particularly for those least addicted, most highly motivated, and without psychiatric comorbidity. Effective midstream school-based prevention activities delay youth use. Worksite programs and physician "quit smoking" advice can be cost-effective, although these are not sufficiently widespread. Community strategies show promise of preventing youth use and helping addicted users quit. Despite failed federal tobacco control legislation, great strides have been made upstream, including proposed regulation of nicotine as a drug, the state master settlement agreement with the tobacco industry, and excise tax increases funding statewide tobacco control programs. Wider dissemination of effective programs and better coordination with upstream policies hold great potential to significantly reduce future use rates and related disease.

The Impact of California's Smoking Ordinances on Worksite Smoking Policy and Exposure to Environmental Tobacco Smoke

Abstract: A subsample of 5776 respondents to the California Tobacco Survey who do not smoke and work indoors outside of their home was analyzed regarding worksite smoking policy and worksite exposure to environmental tobacco smoke. To obtain study results, survey responses were linked to tobacco ordinance data. Nonsmokers who worked in localities with moderate or strong laws were more likely to report worksite smoking policies than nonsmokers in localities without laws. Even in localities with strong laws, 23.5% of respondents reported no worksite policy, and 26.4% reported recent exposure to environmental tobacco smoke at the worksite. Comprehensive laws with minimal exemptions may be necessary to ensure adequate compliance and protection from environmental tobacco smoke.

Evaluation of a skin cancer prevention module for nurses: change in knowledge, self-efficacy, and attitudes.

Abstract: Purpose. The purpose of this study was to evaluate the effectiveness of a 1-week didactic and clinical skin cancer prevention training module. The evaluation assessed both the immediate and the 3-month effects of the module on nurse participants. In addition, this study assessed whether the module had any secondary effects on skin cancer practices, including perceived support from colleagues, resources, time, and perceived responsibility to conduct skin cancer screening activities and education. Methods. A quasi-experimental design with 32 intervention and 87 comparison subjects was employed. Instruments developed and validated specifically for this study were used to assess knowledge, self-efficacy, priority of skin cancer, and organizational level constructs. Results. The findings indicate that the module significantly increased general and prevention knowledge as well as screening ability; the increase was stable over time. The module was also found to improve self-efficacy to screen and to educate. Th...

Six-month outcomes of an alcohol prevention program for inner-city youth.

Abstract: Six-hundred and fifty 6th grade students were randomly assigned with the intervention group receiving the STARS for Families Program, an alcohol reduction program consisting of standardized health consultations provided by nurses and mailed follow-up information. The control group received minimum information. Students in the study attended either a neighborhood or a bused inner-city middle school. Students receiving the intervention had significantly less intentions to use alcohol in the future and less alcohol quantity. The study suggests that brief, provider-involved interventions may be a viable school based approach to prevention.

Assessment of Stages of Change for Exercise Within a Worksite Lifestyle Screening Program

Abstract: Worksite health promotion programs have been shown to have a positive impact on absenteeism, productivity, and morale. 1-4 Although the programs vary in complexity, historically most worksite screening programs have offered clients a series of medical tests, a physician consultation, and a report of the results, combined with general lifestyle advice. Clinical health problems are identified in fewer than 5% of cases. 5 About two-thirds of the screenings, however, reveal identifiable lifestyle concerns, such as obesity, poor diet, inactivity, or stress, that represent multiple risk factors for coronary heart disease, yet screening has traditionally ignored this important group and the psychological factors inherent in trying to modify lifestyle behaviors. The purpose of this study was to explore the relationship between an individual’s motivational readiness to adopt exercise, expressed through the stages-of-change model, and coronary heart disease risk factors. The stagesof-change model describes the series of stages individuals move through in adopting new behaviors, from precontemplation (not intending to change) to contemplation (considering change), preparation (considering imminent change), action (actively engaging in the new behavior), and, finally, maintenance (maintaining the new behavior longer than 6 months). The model suggests that individuals at different stages use different processes to consider and adopt new behaviors. Research has demonstrated the model’s applicability to exercise and other health-promoting behaviors. 6