American Journal of Health Promotion

This study provides insight into decision making about food choices in the family and its relationship with (un)healthy eating, by including the responses of four members of the family as a sampling unit.

The study was conducted through four medical centers, visited by 69 classes from 19 different schools in Belgium.

Ninety-two family quartets, including both parents and two adolescents between 12 and 18 years old, completed questionnaires independently.

Four previously investigated measures of decision-making power (30 items on a seven-point scale) were administered, along with a short food choice questionnaire and demographic variables.

Results indicate that the influence of fathers but more especially that of children is important in food decisions. Moreover, the relative influence of each family member is dependent on the kind of product or product group considered. Differences in perceptions between the four family members show the importance of considering the responses of all the people involved in family decision making. Finally, it is clear that in families where adolescents have more power, food choices are less healthy.

Our main conclusion is the rejection of the “gatekeeper hypothesis” as an artifact of biased measurement. A multidimensional approach to the issue of influence in food decision making in the family is potentially richer and leads to different conclusions. The necessity of the involvement of the entire family for the introduction and adoption of healthy eating is emphasized.

To summarize and provide a critical review of worksite health promotion program evaluations published between 1968 and 1994 that addressed the health impact of worksite smoking cessation programs and smoking policies.

A comprehensive literature search conducted under the auspices of the Centers for Disease Control and Prevention identified 53 smoking cessation program evaluation reports, of which 41 covered worksite single-topic cessation programs. Nine additional reports were located through manual search of citations from published reports and reviews. These 50 reports covered 52 original data-based studies of cessation programs. The search produced 19 reports for tobacco policy evaluations, of which 12 addressed health impact. An additional 17 reports were located by the authors. These 29 reports covered 29 studies of policy impact.

Smoking cessation group programs were found to be more effective than minimal treatment programs, although less intensive treatment, when combined with high participation rates, can influence the total population. Tobacco policies were found to reduce cigarette consumption at work and worksite environmental tobacco smoke (ETS) exposure.

The literature is rated suggestive for group and incentive interventions; indicative for minimal interventions, competitions, and medical interventions; and acceptable for the testing of incremental effects. Because of the lack of experimental control, the smoking policy literature is rated as weak, although there is strong consistency in results for reduced cigarette consumption and decreased exposure to ETS at work.

To determine the effectiveness of a multicomponent smoking cessation program supplemented by incentives and team competition.

A quasi-experimental design was employed to compare the effectiveness of three different smoking cessation programs, each assigned to separate worksites.

The study was conducted from 1990 to 1991 at three aerospace industry worksites in California.

All employees who were current, regular tobacco users were eligible to participate in the program offered at their site.

The multicomponent program included a self-help package, telephone counseling, and other elements. The incentive-competition program included the multicomponent program plus cash incentives and team competition for the first 5 months of the program. The traditional program offered a standard smoking cessation program.

Self-reported questionnaires and carbon monoxide tests of tobacco use or abstinence were used over a 12-month period.

The incentive-competition program had an abstinence rate of 41% at 6 months (n = 68), which was significantly better than the multicomponent program (23%, n = 81) or the traditional program (8%, n = 36). At 12 months, the quit rates for the incentive and multicomponent programs were statistically indistinguishable (37% vs. 30%), but remained higher than the traditional program (11%). Chi-square tests, t-tests, and logistic regression were used to compare smoking abstinence across the three programs.

Offering a multicomponent program with telephone counseling may be just as effective for long-term smoking cessation as such a program plus incentives and competition, and more effective than a traditional program.

To estimate the economic costs of obesity to U.S. business.

Standard epidemiologic methods for risk attribution and techniques for ascertaining cost of illness were used to estimate obesity-attributable expenditures on selected employee benefits, including health, life, and disability insurance and paid sick leave by private-sector firms in the U.S. in 1994. Data were obtained from a variety of secondary sources, including the National Health Interview Survey, reports from the Bureau of Labor Statistics and other federal agencies, and the published literature. Attention was focused on employees between the ages of 25 and 64 years who were classified according to body mass index (BMI) as “nonobese” (BMI < 25 kg/m²), “mildly obese” (BMI = 25–28.9 kg/m²), or “moderately to severely obese” (BMI ≥ 29 kg/m²).

The cost of obesity to U.S. business in 1994 was estimated to total $12.7 billion, including $2.6 billion as a result of mild obesity and $10.1 billion due to moderate to severe obesity. Health insurance expenditures constituted $7.7 billion of the total amount, representing 43% of all spending by U.S. business on coronary heart disease, hypertension, type 2 diabetes, hypercholesterolemia, stroke, gallbladder disease, osteoarthritis of the knee, and endometrial cancer. Obesity-attributable business expenditures on paid sick leave, life insurance, and disability insurance amounted to $2.4 billion, $1.8 billion, and $800 million, respectively.

The health-related economic cost of obesity to U.S. business is substantial, representing approximately 5% of total medical care costs. Further research is needed to determine the cost-effectiveness of worksite weight management programs and of other efforts to reduce the prevalence of obesity in the U.S. workforce.