January / February 2020



AJHE: American Journal of Health Education

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  January/February 2020 (Volume 51, Issue 1)

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Table of Contents

Free Access Article
/When Workplace Wellness Programs Work: Lessons Learned from a Large Employer in Texas
 – Ohbet Cheon, George Naufal & Bita A. Kash

Background: Workplace wellness programs have been widely implemented to promote employee health outcomes and reduce health costs. However, little is known about how designs of wellness programs matter for best promoting positive employee health outcomes.
Purpose: This research aims to identify the most effective designs of workplace wellness programs resulting in positive employee health outcomes.
Methods: We conducted endogenous treatment analyses to compare the effectiveness of three wellness programs (diabetes prevention, hypertension prevention, and nutrition classes) on employees’ health outcomes. Data were analyzed from 24,117 full-time employees who received the pre- and post-intervention biometric screening in 2012–2016 at a large employer in Texas, U.S.
Results: Unlike the mixed effects in diabetes and hypertension prevention programs, the nutrition program, which exhibited a high level of topic relevance, impact, and intensity, significantly decreases all four biometric indicators: decreasing systolic blood pressure (4%), diastolic blood pressure (10%), glucose (2%), and cholesterol (26%), which improves health outcomes.
Discussion: This study prompts health educators to consider comparative effectiveness of workplace wellness programs for maximized impact on employees’ health outcomes.
Translation to Health Education Practice: Designing wellness programs with high topic relevance, impact, and intensity should be emphasized in implementing workplace wellness programs.

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Research Articles

Predicting Intention to be Physically Active Among Volunteer Firefighters
– Kayla L. Amodeo & Jen Nickelson
Background: Over half of all firefighter deaths are due to heart attacks. Physical activity (PA) is a protective factor against cardiovascular disease, but most firefighters do not meet recommended PA levels. Volunteer firefighters (VFFs), particularly in rural areas, may have unique reasons for not meeting recommendations.
Purpose: To examine VFFs’ PA intention and factors that might influence it, using the Theory of Planned Behavior.
Methods: Using a cross-sectional study design, we surveyed 123 North Carolina VFFs.
Results: Most VFFs were overweight (35.9%) or obese (44.4%), and many did not participate in any moderate-intensity cardiovascular (14.4%), vigorous-intensity cardiovascular (40.8%), or strength training (45.2%) exercise in the prior 7 days. On average, participants did not perceive themselves at high risk for heart disease. Regression analyses found that attitudes, perceived behavioral control, and past PA behavior accounted for 57.9% of the variance in PA intention (p = .031).
Discussion: Many firefighters in this study were not meeting recommended PA guidelines and did not perceive themselves at high risk for heart disease. Relationships among variables should be explored more fully by quantitative and qualitative methods.
Translation to Health Education Practice: Findings from this study have implications for future PA intervention development aimed at VFF populations.

Worry about lung cancer is related to numeracy and risk perception of diseases associated with smoking
– Destiny Diaz, Brian Fix, Rosalie Caruso, Maansi Bansal Travers & Richard J. O’Connor
Background:Numeracy is one’s ability to use numbers in context and influence’s decision making and perceptions of health risk. Worry about lung cancer is an indicator of perceived risk (PR) and is related to interest in cessation and cancer screening.
Purpose:The analysis sought to explore underlying relationships among worry about lung cancer, smoking-related disease risk perceptions, and numeracy in a web-based panel.
Methods:A Web-based survey, including a numeracy measure, was completed by 1,682 participants aged 18–65 recruited in 2014. Former and current smokers were asked about LC worry and current smokers were asked their PR of diseases associated with smoking.
Results: Females (m = 25.64, 95% CI (24.67, 26.61)), respondents aged 45–65 (m = 26.15, 95% CI (24.89, 27.41)), those who worry “all the time” about LC (m = 27.62, 95% CI (25.66, 29.58)), and respondents perceiving a higher risk of LC compared to other smokers (m = 28.84, 95% CI (27.66, 30.01)) expressed significantly higher PR means. Higher household income (OR = 1.20, 95% CI (1.08, 1.34)), age (OR = 0.86, 95% CI (0.77, 0.98)), and comparative LC risk (OR = 2.52, 95% CI (2.01, 3.17)) were significantly associated with greater worry about LC. As PR increases by one unit, the probability of worrying increases by 4.6%. For numeracy scores, odds ratio showed that as scores increased by one unit, the probability of worrying decreased by 11.9%.
Discussion:In this study, we have shown that PR has a positive association with LC worry and that numeracy has a negative association with LC worry.
Translation to Health Education Practice: This information can be used to target subpopulations with low PR and numeracy about their risks for lung cancer and to develop tailored messages to educate these people.

A Qualitative Exploration of Womens’ Experiences Who Belong to a “Fitness Community”
– Andrew Carter & Adam C. Alexander
Background: A promising method for improving physical inactivity among women is to increase their engagement in group-based exercise programs. Fitness communities are exercise groups that practice the principles of group dynamics and promote a lifestyle of physical activity by engaging members through social media and hosting social event/hangouts outside of the gym or “fitness” setting.
Purpose: The purpose of this study was to examine the role of “fitness communities” as a mechanism for increasing engagement in physical activity.
Methods:In-depth, semi-structured interviews (N = 15) from women who were members of an established fitness community (i.e. Titan Fitness; the original name has been changed for purposes of anonymity) in Southern California.
Results: Results suggested that the women’s experiences in Titan Fitness were encompassed by six sub-themes which were the following: Structured Exercise Classes with Group Dynamics: (1) personal and group accountability and (2) minimizing intimidation; Social Media Engagement: (3) empowerment and (4) accountability via online engagement; and Engagement Outside of the Physical Gym Setting: (5) in-group engagement and (6) out-group (extended) engagement.
Discussion: Our findings illustrated that community members that were engaged in all three components of a fitness community described improved physical activity adherence.
Translation to Health Education Practice: These findings may benefit fitness professionals, researchers, and Health Education practitioners who desire to develop innovative theoretically-based interventions for women having difficulty with physical activity adherence.

Social Capital and Physical Activity Level in an Urban Adult Population
– Zeinab Aliyas
Background: Despite several studies on the concept of social capital in relation to health during the last two decades, the majority of these works have been conducted in developed countries.
Purpose: This study examines the correlation between domains of social capital (reciprocity, trust, and social network) and physical activity level in an Iranian adult population. In addition, the study explores to find whether this relation is affected by socioeconomic status.
Methods:A total of 2000 questionnaires were distributed among adults living in 12 neighborhoods of Bandar Abbas city, Iran. Of this population, 1828 qualified questionnaires were utilized for further analysis.
Results:High level of physical inactivity (62.3%) was reported by the participants.
Discussion: Norms of reciprocity and neighborhood trust associated with the higher physical activity level among men and women. However, social network contributed to a higher level of physical activity among women group. The study indicated the correlation of socioeconomic variables with social capital indicators and physical activity level.
Translation to Health Education Practice: Findings suggest that programming efforts and research should focus on increasing organized activities that support neighborhood participation and social activity to promote social interaction and trust among residents.

A Qualitative Investigation of College Student Perceptions of Their Nutrition Environment: Recommendations for Improvement
– Marney A. White
Background: College is the first environment in which students are responsible for making all decisions relating to their eating and exercise behaviors. Of all contributing factors to overweight and obesity, one main influence seems to be the environment.
Purpose:This study explored college students’ perceptions of their nutrition environment on campus.
Methods:: A convenience sample of 33 undergraduate college students (15 males, 18 females) participated in focus groups and key informant interviews on topics related to the college nutrition environment.
Results: : Major themes included accessibility, money, food, education, and student opinions. Students indicated that unhealthy, processed foods are more available than healthy foods on campus. They also brought up many barriers for eating healthy on campus.
Discussion:The accessibility of healthy foods was a major barrier brought up by participants. This barrier included issues with ongoing construction limiting access to food locations, lack of locations for healthy foods, lack of a market-type store, time, and a plethora of vending machines. Elimination of these barriers would help to improve the campus’ overall nutrition environment.
Translation to Health Education Practice: Health Educators should work with college personnel to develop policies and practices that promote healthy eating and prevent college weight gain.

Perceived versus Actual Risk of Cardiovascular Disease in College Students
– E. W. Holt, A. L. Cass, H. Park, S. Criss, M. Burges, E. Isley & S. Murr
Background: College wellness interventions have potential to reduce the growing burden of cardiovascular disease (CVD) by guiding students to establish behaviors for lifetime CVD risk reduction. Yet, some students may not see CVD prevention as a relevant issue during young adulthood. Purpose: We examined perceived risk of CVD amongst 148 college students and compared perceived risk to demographic characteristics and traditional risk markers.
Methods:Survey data on perceived CVD risk and student characteristics were linked to biochemical lab values from a cholesterol screening program.
Results:Only 39.2% of students had been previously screened for dyslipidemia. Mean perceived CVD risk was highest amongst students with age ≥21 years, BMI ≥30, a family history of CVD, and a fair or poor rating of overall health. Perceived risk was not higher amongst students with total cholesterol values outside of the normal range.
Discussion:While some students were aware they may possess an elevated CVD risk, we identified others who were unaware of a potential risk.
Translation to Health Education Practice: These variations in perceived risk indicate that individualized intervention approaches may be necessary to engage college students in behaviors for lifelong CVD prevention.