American Journal of Health Promotion

To systematically review the effectiveness of intervention studies promoting diet and physical activity (PA) in nurses.

English language manuscripts published between 1970 and 2014 in PubMed, Scopus, CINAHL, and EMBASE, as well as those accessed with the PICO tool, were reviewed.

Inclusion criteria comprised (1) nurses/student nurses working in a health care setting and (2) interventions where PA and/or diet behaviors were the primary outcome. Exclusion criteria were (1) non–peer-reviewed articles or conference abstracts and (2) interventions focused on treatment of chronic conditions or lifestyle factors other than PA or diet in nurses.

Seventy-one full texts were retrieved and assessed for inclusion by two reviewers. Data were extracted by one reviewer and checked for accuracy by a second reviewer.

Extracted data were synthesized in a tabular format and narrative summary.

Nine (n = 737 nurses) studies met the inclusion criteria. Quality of the studies was low to moderate. Four studies reported an increase in self-reported PA through structured exercise and goal setting. Dietary outcomes were generally positive, but were only measured in three studies with some limitations in the assessment methods. Two studies reported improved body composition without significant changes in diet or PA.

Outcomes of interventions to change nurses’ PA and diet behavior are promising, but inconsistent. Additional and higher quality interventions that include objective and validated outcome measures and appropriate process evaluation are required.

Employers are increasingly exploring health benefits that incentivize lifestyle change for employees. We used early data from an ongoing study of one such model—the Health Engagement Model (HEM), which Oregon implemented for all public employees in 2012—to analyze variation in employee participation and engagement.

A survey was designed to assess program engagement, opinions of the program, and self-reported lifestyle changes.

Data were collected in 2012, about 9 months after HEM launched.

A representative random sample of 4500 state employees served as the study subjects.

Primary measures included whether employees signed up for the program, completed its required activities, and reported making lifestyle changes.

Logistic regression was used to analyze survey results.

Most employees (86%) chose to participate, but there were important socioeconomic differences: some key target populations, including smokers and obese employees, were the least likely to sign up; less educated employees were also less likely to complete program activities. Despite mostly negative opinions of the program, almost half of participants reported making lifestyle changes.

Oregon’s HEM launch was largely unpopular with employees, but many reported making the desired lifestyle changes. However, some of those the program is most interested in enrolling were the least likely to engage. People involved with implementing similar programs will need to think carefully about how to cultivate broad interest among employees.

To assess use, screening, and disclosure of perinatal marijuana and other illicit drugs during first obstetric visits.

Observational study that qualitatively assesses provider screening and patient disclosure of substance use.

Study sites were five urban outpatient prenatal clinics and practices located in Pittsburgh, Pennsylvania.

Pregnant patients and obstetric providers were recruited as participants.

We audio recorded patient-provider conversations during first obstetric visits and obtained patient urine samples for drug analyses. Audio recordings were reviewed for provider screening and patient disclosure of illicit drug use. Urine analyses were compared with audio recordings to determine disclosure.

Four hundred and twenty-two pregnant patients provided complete audio recordings and urine samples for analyses. Providers asked about illicit drug use in 81% of the visits. One hundred twenty-three patients (29%) disclosed any current or past illicit drug use; 48 patients (11%) disclosed current use of marijuana while pregnant. One hundred and forty-five samples (34%) tested positive for one or more substances; marijuana was most commonly detected (N = 114, 27%). Of patients who tested positive for any substance, 66 (46%) did not disclose any use; only 36% of patients who tested positive for marijuana disclosed current use.

Although marijuana is illegal in Pennsylvania, a high proportion of pregnant patients used marijuana, with many not disclosing use to their obstetric care providers.

To examine the effects of a smoking cessation campaign.

Data from the 2010–2011 Taiwan Adult Tobacco Surveys were analyzed.

The study was set among a nationally representative sample of adults in Taiwan.

The surveys included 16,282 and 16,886 adults in 2010 and 2011, respectively, while our analyses focused on current smokers, 2518 and 2507 adults in 2010 and 2011, respectively.

In 2010 the Taiwanese government launched a national smoking cessation campaign through mass media in conjunction with community-based smoking cessation programs throughout the nation.

Outcome variables include awareness of cessation services, quit attempts, intention to quit, and use of quitting method.

Multivariate logistic regressions were used to analyze data.

The implementation of the national smoking cessation campaign was associated with an increase in awareness of cessation services (odds ratio [OR] = 1.36; 95% confidence interval [CI] = 1.20–1.53), in quit attempts (OR = 1.12; 95% CI = 1.01–1.25), in use of unassisted quitting methods (OR = 1.39; 95% CI = 1.13–1.72), and in intention to quit smoking (OR = 1.15; 95% CI = 1.02–1.30).

The implementation of the national smoking cessation campaign through media and community programs was effective in increasing smokers’ awareness of cessation services, quit attempts, and intention to quit.

To examine frequency, prominence, and content of local print media after a 4-year policy advocacy intervention.

This was a controlled community-based trial.

The study took place in 39 rural counties (22 intervention, 17 comparison).

Subjects consisted of 2525 newspaper articles monitored over 18 quarters (July 2007 to December 2011).

One key element of the tailored policy advocacy intervention delivered by community advisors was building demand for smoke-free policy via media advocacy strategies.

Media clips were coded to assess number of articles; percent of tobacco-related articles on the front page or bold heading section; percent of pro-health articles; and percent of articles with secondhand smoke (SHS)–relevant topics or themes.

Coded data were entered into Atlas.ti software. Article frequencies and attributes were compared between groups and over time using negative binomial regression for longitudinal data, with county-level demographics as covariates.

In the last 3 years, there were approximately twice as many articles in intervention than in comparison counties. Media clips from newspapers in intervention counties were between 1.4 and 2 times more likely to have front page placement and percent of relevant topic or theme than were those in comparison counties. There was no difference in rate of pro-health articles by group.

The policy advocacy intervention to promote smoke-free policy increased media attention to SHS and may have increased public awareness of issues related to smoke-free policy.

Interest and funding continue to grow for bringing supermarkets to underserved areas, yet little is known about their impact.

A quasi-experimental study was used to determine the impact of a new supermarket opening as a result of tax and zoning incentives.

The study took place in the South Bronx, New York City, New York.

Studied were residents of two South Bronx neighborhoods deemed high need.

Food purchasing and consumption were examined via surveys and 24-hour dietary recalls before and at two points after the supermarket opened (1–5, 13–17 months).

Data were analyzed using difference-in-difference models controlling for gender, race and ethnicity, age, education, marital status, and self-reported income. Ordinary least squares and logistic regression models were estimated for continuous and binary outcomes, respectively.

At baseline, 94% to 97% of consumers shopped at a supermarket. There was a 2% increase in this behavior in the intervention community (p < .05) not seen in the comparison community. One year later there was a 7% net increase in eating at home (p < .1) and a 20% decrease in drinking sugary beverages (p < .05), but no appreciable change in fruit/vegetable consumption or overall dietary quality.

The new supermarket did not result in substantial or broad changes in purchasing patterns or nutritional quality of food consumed, though smaller, positive changes were observed over a 1-year period. Future work should examine different contexts and a broader set of outcomes, including economic development.

To develop a theory-based questionnaire to assess readiness for change in small workplaces adopting wellness programs.

In developing our scale, we first tested items via “think-aloud” interviews. We tested the revised items in a cross-sectional quantitative telephone survey.

The study setting comprised small workplaces (20–250 employees) in low-wage industries.

Decision-makers representing small workplaces in King County, Washington (think-aloud interviews, n = 9), and the United States (telephone survey, n = 201) served as study subjects.

We generated items for each construct in Weiner’s theory of organizational readiness for change. We also measured workplace characteristics and current implementation of workplace wellness programs.

We assessed reliability by coefficient alpha for each of the readiness questionnaire subscales. We tested the association of all subscales with employers’ current implementation of wellness policies, programs, and communications, and conducted a path analysis to test the associations in the theory of organizational readiness to change.

Each of the readiness subscales exhibited acceptable internal reliability (coefficient alpha range, .75–.88) and was positively associated with wellness program implementation (p < .05). The path analysis was consistent with the theory of organizational readiness to change, except change efficacy did not predict change-related effort.

We developed a new questionnaire to assess small workplaces’ readiness to adopt and implement evidence-based wellness programs. Our findings also provide empirical validation of Weiner’s theory of readiness for change.

To describe the prevalence and determinants of sodium-related knowledge, attitudes, and behaviors among U.S. adults

A cross-sectional survey was used.

The study was set in the United States in 2012.

Participants were 6122 U.S. adults.

Sodium-related knowledge, attitudes, and behaviors were measured.

Chi-squared tests were used to determine differences in sodium-related knowledge, attitude, and behaviors by respondent characteristics; multiple logistic regression was used to examine associations between selected respondent characteristics and health professional advice, reported action, or knowledge, attitudes, and behaviors (adjusted for all other respondent characteristics).

About three-fourths of respondents answered eating too much sodium is “somewhat” or “very” harmful to their health. Twenty-six percent reported receiving health professional advice, and 45% reported taking action to reduce their sodium intake. The prevalence of reported action was highest among adults receiving advice, those with hypertension, blacks, and those aged ≥65 years. Sixty-two percent who reported action agreed that most of their sodium comes from processed or restaurant foods. Of those reporting action, the most common tactics to reduce sodium intake were checking nutrition labels, using other spices than salt, and choosing low-sodium foods; requesting lower-sodium options when eating out was the least common tactic.

Results suggest almost half of adults overall and the vast majority of those receiving health professional advice are taking some action to watch or reduce sodium intake. Although a substantial proportion report using recommended tactics to lower intake, many are not using the most effective tactics. In order to reach the general population, health communication messages could be simpler and focus on the most effective tactics to reduce sodium intake. Furthermore, health professionals can help reduce sodium intake by discussing the benefits of sodium reduction and tactics to do so, regardless of a hypertension diagnosis.