American Journal of Health Promotion


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Delivering the Science and the Art of Health Promotion

Robert F. Allen Symbol of HOPE Award

Volume 22, Issue 6
Michael P. O'Donnell	iv v-vi	Editor’s Notes: Has Health Promotion Reached the Tipping Point? Recognition of Reviewers
THE SCIENCE OF HEALTH PROMOTION
Critical Issues and Trends
Helena Leurent K. Srinath Reddy Janet Voûte Derek Yach	379	Wellness in the Workplace: A Multi-Stakeholder Health Promoting Initiative of the World Economic Forum The World Economic Forum and the World Health Organization, arguably the most powerful business and health organizations in the world, are collaborating on an effort to make workplace wellness a global priority. The authors discuss progress on this effort.
Interventions
		Medical Self-Care
Judith K. Barr Tierney E. Giannotti Thomas J. Van Hoof Jennifer Mongoven Maureen Curry	381	Understanding Barriers to Participation in Mammography by Women With Disabilities The study purpose was to identify barriers to mammography screening among women with different disabilities and suggest interventions to address barriers. Forty-two women self-reporting disabilities participated in one of six disability-specific focus groups. Qualitative analysis applied an iterative coding process to generate themes and categories. Four themes were identified (i.e., access, beliefs, social support and comfort/ accommodations) and nine sub-themes characterizing barriers. In all focus groups, women mentioned physical access and physical comfort/accommodations barriers. Other major sub-themes were communication and professional support. Women also described mammography facilitators. Despite frequent use of health care and personal strategies to facilitate mammography screening, women with disabilities reported barriers to getting mammograms.
		Nutrition
Brian S. Armour M. Melinda Pitts Chung-Won Lee	386	Cigarette Smoking and Food Insecurity Among Low-Income Families in the United States, 2001 This study examined the association between food insecurity and smoking among low-income families 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. Family income was linked with U.S. poverty thresholds to identify 2099 families living near or below 200% of the federal poverty level. Smoking prevalence is higher among low-income families who are food insecure compared to low-income families who are food secure (43.6% vs. 31.9%; p<0.01). Multivariate analysis revealed that smoking was associated with an increase in food insecurity of approximately six percentage points (p<0.01). 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.
		Smoking Control
Diane B. Mitschke Doris Segal Matsunaga Karen Loebl Elitei Tatafu, Jr. Hali Robinett	393	Multi-Ethnic Adolescents’ Attitudes Toward Smoking: A Focus Group Analysis Using focus groups, this study explored young multi-ethnic adolescents’ (n=54) attitudes and influences related to cigarette smoking for the purpose of developing and producing a youth-led tobacco prevention drama. Content analysis consisted of coding focus group notes for recurrent themes, using the audio recording as confirmation. Just over one quarter (n=15) of the youth had tried smoking, and 2/3 (n=35) currently lived with someone who smoked. Participants expressed feeling surrounded by smoking influences at home, in their communities, and at school. Youth were negatively affected by family members’ tobacco use, and they desired skills that could enable them to help family members stop using tobacco.
		Stress Management
Melissa C. Nelson Katherine Lust Mary Story Ed Ehlinger	400	Credit Card Debt, Stress and Key Health Risk Behaviors Among College Students This study examines cross-sectional associations between credit card debt, stress and health risk behaviors among 3,206 college students, focusing particularly on weight-related behaviors. Over 23% of students reported credit card debt ≥$1000. Using Poisson regression to predict relative risks (RR) of health behaviors, debt ≥$1000 was associated with nearly every risk indicator tested, including overweight/obesity, insufficient physical activity, excess television viewing, infrequent breakfast consumption, fast food consumption, unhealthy weight control, body dissatisfaction, insufficient vigorous activity, as well as binge drinking, substance use and violence. Poor stress management was also a robust indicator of health risk.
		Weight Control
Michael A. Benedict David Arterburn	408	Worksite-Based Weight Loss Programs: A Systematic Review of Recent Literature The purpose of this study was to update a review on the effectiveness of worksite-based weight-loss programs. Electronic databases were searched and 11 randomized controlled trials published after 1994 met the inclusion criteria. In general, the methodological quality of the studies was poor and the mix of study designs precluded a quantitative analysis. The results suggest that worksite-based weight loss programs can result in modest short-term improvements in body weight; however, long-term data on health and economic outcomes are lacking.
Strategies
		Behavior Change
H. de Vries S. P. J. Kremers T. Smeets J. Brug K. Eijmael	417	The Effectiveness of Tailored Feedback and Action Plans in an Intervention Addressing Multiple Health Behaviors This study examined the effects of three iterative tailored feedback letters addressing smoking, physical activity, and fruit, vegetables and fat intake, and the effects of providing feedback on intervention action plans. A total of 2827 participants were randomly assigned to treatment and control groups with the experimental group receiving three printed tailored letters. Tailored information resulted in improvement over time for the intake of fruit, vegetables and fat and for physical activity. Action planning feedback did not increase the effects.
Applications
		Health Promoting Community Design
Eric Hemphill Kim Raine John C. Spence Karen E. Smoyer-Tomic	426	Exploring Obesogenic Food Environments in Edmonton, Canada: The Association Between Socioeconomic Factors and Fast-Food Outlet Access This descriptive analysis of fast-food outlets in Edmonton, Alberta, Canada, classified 204 neighborhoods as being high, medium or low access, based on the number of fast-food outlets per neighborhood. Associations between the number of fast-food outlets and five neighborhood-level socioeconomic variables (income, education, employment, immigration status and housing tenure) were explored. Urban neighborhoods with high fast-food outlet access had significantly higher rates of low income and unemployed individuals and renters than more affluent neighborhoods with low access to fast-food outlets. The findings add to the debate about what constitutes an obesogenic environment.
Noreen C. McDonald	433	The Effect of Objectively Measured Crime on Walking in Minority Adults The study evaluates the relationship between neighborhood crime and the amount of daily walking done by 359 minority adults in Oakland, California. Data on leisure and utilitarian walking was collected through the 2000 Bay Area Travel Survey and combined with crime data from the Oakland Police Department. A negative binomial model was used to test whether violent, property, or quality of life crimes had significant associations with daily minutes walked. The model showed a significant negative association between violent crime and minutes walked per day. Neither property nor quality of life crimes were correlated with the amount of walking. Reductions in violent crime may increase opportunities for minority residents in urban areas to participate in physical activity, such as walking, thereby providing another reason to pursue anti-crime measures.
Research Methods
		Qualitative Research
Gerjo Kok Nell H. Gottlieb Matthew Commers Chris Smerecnik	437	The Ecological Approach in Health Promotion Programs: A Decade Later The study presents a ten-year-later update of the ecological model of health promotion adapted and simplified by the authors. A convenience sample of 43 program coordinators (responsible for 47 programs) were interviewed in the USA and the Netherlands using a systematic interview protocol designed to elicit a general program description and relevant aspects of the ecological approach. The programs had 244 strategies and 276 targets with twenty-seven distinct intervention strategies. These data fit the ecological model and our adaptations and indicate that, over the past decade, health promotion practice may have changed to include more multi-level programs.
DataBase: Research and Evaluation Results	443	Four new studies are critiqued and added to the DataBase chart.
Abstracts	448	5 abstracts are featured from a variety of publications.
	450	Call for Conference Proposals
*The Art* of Health Promotion**
Mari Ryan Larry S. Chapman Mary Jane Rink	1	Planning Worksite Health Promotion Programs: Models, Methods and Design Implications As the field of Worksite Health Promotion and Wellness matures, greater pressure is being place on programs that produce mitigation of health risks, improved employee productivity and increased levels of economic return. To achieve these expected results and to successfully contend with the challenges of today’s workplace and work force it will likely become even more critical to carefully plan both new and existing programs each year. A model for the planning and development of worksite programs is presented and discussed along with a variety of design implications for different population segments.
		Selected Abstracts No selected abstracts are provided in this edition.
Larry S. Chapman	12	Closing Thoughts Editorial comments on the need for improved planning and the unique challenges facing program planners are identified.

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