Publications by authors named "Laura Linnan"

101 Publications

Implementation of a workplace physical activity intervention in child care: process evaluation results from the Care2BWell trial.

Transl Behav Med 2021 Apr 17. Epub 2021 Apr 17.

Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.

Care2BWell was designed to evaluate the efficacy of Healthy Lifestyles (HL), a worksite health promotion intervention to increase child care workers' physical activity. The purpose of this study was to use process evaluation to describe the implementation of HL and determine if different levels of implementation are associated with changes in workers' physical activity. Data were collected from 250 workers randomized to HL, a 6 month, multilevel intervention that included an educational workshop followed by three 8 week campaigns that included self-monitoring and feedback, raffle incentive, social support, and center director coaching. Process evaluation data collection included direct observation, self-reported evaluation surveys, website analytics and user test account data, tracking databases and semi-structured interviews. Implementation scores were calculated for each intervention component and compared at the center and individual levels. Nearly a third of workers never self-monitored and few (16%) met self-monitoring goals. Only 39% of centers engaged with the social support component as intended. Raffle and social support components were perceived as the least useful. Implementation varied widely by center (25%-76%) and individual workers (0%-94%). No within- or between-group differences for high compared to low implementation groups for change in physical activity were evident. Interview themes included limited sustainability, competing priorities, importance of social support, and desire for a more intensive, personalized intervention. Wide variation in implementation may explain limited effects on intervention outcomes. Future worksite interventions designed for child care workers can use these findings to optimize health promotion in this setting.
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http://dx.doi.org/10.1093/tbm/ibab034DOI Listing
April 2021

Association Between Previous Concussion Education and Concussion Care-Seeking Outcomes Among National Collegiate Athletic Association Division I Student-Athletes.

J Athl Train 2021 Feb 22. Epub 2021 Feb 22.

Keller Army Community Hospital, West Point, NY.

Context: Limited data exist concerning differences in concussion-education exposure and how education exposures relate to care seeking and symptom disclosure, specifically by National Collegiate Athletic Association Division I student-athletes.

Objective: To investigate demographic characteristics associated with concussion-education exposure and examine whether overall education exposure (yes versus no) and education-source exposure number (multiple sources versus a single source) affect concussion care-seeking and disclosure factors in Division I student-athletes.

Design: Cross-sectional study.

Setting: Classroom or online survey.

Patients Or Other Participants: Division I student-athletes (n = 341).

Main Outcome Measure(s): Frequencies and proportions were computed for sex, race, school year, sport, and concussion history across concussion-education groups. Prevalence ratios (PRs) and 95% CIs were calculated to quantify the associations between student-athlete characteristics and (1) overall concussion-education exposure and (2) source-exposure number. Separate multivariable linear regression models estimated adjusted mean differences (MDs) and 95% CIs, which allowed us to assess differences in concussion knowledge, attitudes, and perceived social norms relative to concussion-education exposure and exposure to multiple sources. Separate multivariable binomial regression models were performed to estimate adjusted PRs and 95% CIs in order to evaluate associations of intention, perceived control, and care-seeking or disclosure behaviors and overall concussion-education exposure and exposure to multiple sources. All models controlled for sex, sport, and concussion history.

Results: Overall, 276 (80.9%) participants reported previous concussion education, with 179 (64.9%) being exposed to multiple sources. Student-athletes who participated in a contact sport (adjusted PR = 1.24; 95% CI = 1.06, 1.44) and those who had a concussion history (adjusted PR = 1.19; 95% CI = 1.09, 1.31) had higher prevalences of concussion-education exposure. Females had a lower prevalence of reporting multiple sources (adjusted PR = 0.82; 95% CI = 0.68, 0.99). Overall concussion-education exposure was significantly associated with more favorable perceived social norms surrounding concussion care seeking (adjusted MD = 1.37; 95% CI = 0.13, 2.61).

Conclusions: These findings highlighted the potential differences in overall concussion-education exposure and provide clinicians with information on groups who may benefit from additional targeted education.
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http://dx.doi.org/10.4085/1062-6050-0211.20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8010936PMC
February 2021

Association Between Previous Concussion Education and Concussion Care-Seeking Outcomes among NCAA Division I Student-Athletes.

J Athl Train 2020 Nov 5. Epub 2020 Nov 5.

1. Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, Department of Exercise and Sport Science, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.

Context: There are limited data concerning differences in concussion education exposure and how education exposures relates to care-seeking and symptom disclosure, specifically in Division I student-athletes.

Objective: Investigate demographic characteristics associated with concussion education exposure and examine whether overall education exposure (yes vs. no) and education source exposure number (multiple sources vs. single source) affects concussion care-seeking and disclosure factors in Division I student-athletes.

Design: Cross-sectional survey.

Setting: Classroom or online.

Participants: NCAA Division I student-athletes (n=341).

Main Outcome Measure(s): Frequencies and proportions were computed for sex, race, school year, sport, and concussion history across concussion education groups. Prevalence ratios (PR) and 95% confidence intervals (CI) quantified the association between student-athlete characteristics and 1) overall concussion education exposure and 2) source exposure number. Separate multivariable linear regression models estimated adjusted mean differences (MD) and 95%CI to assess differences in concussion knowledge, attitudes, and perceived social norms relative to concussion education exposure and exposure to multiple sources. Separate multivariable binomial regression models estimated adjusted PRs and 95%CI to assess associations of intention, perceived control, and care-seeking/disclosure behaviors and overall concussion education exposure and exposure to multiple sources. All models controlled for sex, sport, and concussion history.

Results: Overall, n=276 (80.9%) reported previous concussion education, with 179 (64.9%) exposed to multiple sources. Student-athletes that participated in a contact sport (adjusted PR=1.24, 95%CI=1.06,1.44) and those who had a concussion history (adjusted PR=1.19, 95%CI=1.09,1.31) had higher prevalence of previous concussion education exposure. Females had a lower prevalence of reporting multiple sources (adjusted PR=0.82, 95%CI=0.68, 0.99). Overall concussion education exposure was significantly associated with more favorable perceived social norms surrounding concussion care-seeking (adjusted MD=1.37, 95%CI=0.13,2.61).

Conclusions: Findings highlight potential differences in overall concussion education exposure and provide clinicians with information on groups who may benefit from targeted additional education.
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http://dx.doi.org/10.4085/211-20DOI Listing
November 2020

Using a Social Capital Framework to Explore a Broker's Role in Small Employer Wellness Program Uptake and Implementation.

Am J Health Promot 2021 02 11;35(2):214-225. Epub 2020 Sep 11.

Department of Health Behavior, Gillings School of Global Public Health, 446733University of North Carolina at Chapel Hill, NC, USA.

Purpose: Small employers, while motivated to implement wellness programs, often lack knowledge and resources to do so. As a result, these firms rely on external decision-making support from insurance brokers. The objective of this study was to analyze brokers' familiarity with wellness programs and to characterize their role and interactions with small employers.

Design: Using a newly developed common interview guide (20 questions), protocol and analysis plan, 20 interviews were conducted with health insurance brokers in Illinois, Minnesota, North Carolina and Washington in 2016 and 2017. In addition to exploring patterns of broker interactions and familiarity by segment, we propose a framework to conceptualize the broker-client relationship using social capital theory and the RE-AIM model.

Methods: Interviews were transcribed, summarized and a common codebook was established using DeDoose. Themes were identified following multi-rater coding and structured within the framework.

Results: Participating brokers reported having a high to moderate familiarity with wellness programs (65%) and a majority (80%) indicated that they have previously advised their small business clients on the availability and features of them. Further, we find that brokers may help eliminate barriers to resources and act as a connector to wellness opportunities within their professional network.

Conclusion: New initiatives to promote small employer wellness programs can benefit from examining the influence of brokers on the decision-making process. When engaged and supported with resources, brokers may be effective champions for employer wellness programs.
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http://dx.doi.org/10.1177/0890117120957159DOI Listing
February 2021

Workplace-based opportunities to support child care workers' health and safety.

Prev Med Rep 2020 Sep 30;19:101154. Epub 2020 Jun 30.

Department of Health Behavior, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, 307 Rosenau Hall, CB 7440, Chapel Hill, NC 27599-7440, USA.

Child care workers earn among the lowest wages in the United States and they struggle with many health issues. The purpose of this study was to describe workplace supports for nutrition, physical activity, other health behaviors (e.g., smoking cessation, stress management), and occupational health and safety available to child care workers, and thereby inform the development of future workplace-based interventions to improve worker well-being. Between 2015 and 2016, 74 North Carolina child care centers (and directors), participating in a larger randomized controlled trial, completed a Workplace Health and Safety Assessment (interview and observation) measuring four domains: Infrastructure, Organizational Policies and Procedures, Programs and Promotions, and Internal Physical Environment. This study used baseline data to report means and standard deviations. Participating child care centers employed, on average, 12.7 ± 8.4 employees. Total scores from the Workplace Health and Safety Assessment averaged 41.3 ± 12.6 out of a possible 154, demonstrating many missed opportunities for supporting health/safety. More specifically, centers scored on average 9.5 ± 3.9 on Infrastructure (35% of potential points), 11.1 ± 3.9 on Organizational Policies and Procedures (32% of potential), 7.6 ± 5.4 on Programs and Promotions (12% of potential), and 13.1 ± 2.2 on Internal Physical Environment (49% of potential). The most frequent supports available were for occupational health and safety issues, while fewer supports were available for physical activity and other health behaviors. Child care workers could benefit greatly from more comprehensive workplace health and safety interventions; however, strategies must overcome centers' limited capacity and resources.
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http://dx.doi.org/10.1016/j.pmedr.2020.101154DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7369321PMC
September 2020

Communication Cues and Engagement Behavior: Identifying Advertisement Strategies to Attract Middle-Aged Adults to a Study of the Chronic Disease Self-Management Program.

Prev Chronic Dis 2020 06 25;17:E48. Epub 2020 Jun 25.

University of North Carolina at Chapel Hill, School of Nursing, Chapel Hill, North Carolina.

Introduction: Low- and middle-income, middle-aged adults have high rates of disease and death from chronic disease, yet their participation in self-management programs is low. This may be because advertisements for such programs often target elderly, predominantly white, affluent adults. Our study used data from a parent randomized controlled trial to identify theoretically driven advertisement cues to engage low- and middle-income, middle-aged adults in the Chronic Disease Self-Management Program (CDSMP).

Methods: A framework that combined the Elaboration Likelihood Model and Protection Motivation Theory was used to guide χ and regression analyses to assess relationships between advertisement cue preferences and 5 stages of cognitive engagement (cue processing, cognitive appraisal of the advertised study, motivation to enroll) and behavioral engagement of study participants (enrollment and program participation).

Results: One advertisement cue (taking control of one's future) and 1 cue combination (financial security and taking control of one's future) were significantly associated with study enrollment, as were motivation to enroll and cue processing.

Conclusion: These results can inform CDSMP recruitment efforts to better engage low- and middle-income, middle-aged adults in an effort to mitigate the disproportionate burden of chronic disease in this population.
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http://dx.doi.org/10.5888/pcd17.190413DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7316415PMC
June 2020

Results of caring and reaching for health (CARE): a cluster-randomized controlled trial assessing a worksite wellness intervention for child care staff.

Int J Behav Nutr Phys Act 2020 05 15;17(1):64. Epub 2020 May 15.

Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.

Background: Child care workers are among the lowest paid US workers and experience a wide array of health concerns. The physical and mental demands of their job and the lack of employer-provided health-insurance increase health risks. The Caring and Reaching for Health (CARE) study evaluated a 6-month Healthy Lifestyles intervention targeting child care workers' physical activity (primary outcome), other health behaviors, and their workplace health environment.

Methods: Eligible child care centers, defined as being in operation for at least 2 years and employing at least four staff, were enrolled into CARE's cluster-randomized trial. Centers and their child care staff were randomly assigned to either the Healthy Lifestyles (HL) intervention arm or the Healthy Finances (HF) attention control arm using a block randomization approach. Intervention components were delivered through in-person workshops, center-level displays, informational magazines, director coaching, electronic messaging, and an interactive website. Outcome measures were collected during center visits at baseline and immediately post-intervention by trained data collectors blinded to center arm assignment. Workers' physical activity was assessed with accelerometers, worn for 7 days. Secondary outcome measures included biometric assessments of health and fitness, web-based surveys about health behaviors, and an environmental audit of workplace supports for health. Multi-level linear mixed models assessed worker- and center-level changes in these outcomes.

Results: Participants included 553 child care workers representing 56 centers (HL = 250 staff/28 centers, HF = 303 staff/28 centers). At 6 months, moderate-to-vigorous physical activity declined slightly in both arms (- 1.3 min/day, 95% CI: - 3.0, 0.3 in HL; - 1.9 min/day, 95% CI: - 3.3, - 0.5 in HF), but there was no significant group by time interaction. Several secondary outcomes for other health behaviors and workplace health environment showed improvements in favor of the intervention arm, yet differences did not remain statistically significant after adjustment for multiple comparisons.

Conclusions: While the Healthy Lifestyles intervention did not improve health behaviors or the workplace health environment, results confirmed the pressing need to focus on the health of child care workers. Future interventions should focus on prevalent health issues (e.g., weight, stress), include both high-tech and high-touch intervention strategies, and address work conditions or other social determinants of health (e.g. wages) as a means of improving the health of these essential workers.

Trial Registration: Care2BWell: Worksite Wellness for Child Care (NCT02381938).
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http://dx.doi.org/10.1186/s12966-020-00968-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7227251PMC
May 2020

Education and Training to Build Capacity in Total Worker Health®: Proposed Competencies for an Emerging Field.

J Occup Environ Med 2020 08;62(8):e384-e391

Center for Health, Work & Environment (Dr Newman); Department of Environmental and Occupational Health (Dr Newman, Dr Scott, Ms Tenney); Department of Epidemiology (Dr Newman), Colorado School of Public Health; Department of Medicine (Dr Newman), Anschutz Medical Campus, University of Colorado, Aurora, Colorado; 2U, Inc, Lanham, Maryland (Dr Scott); Office of the Director, Office for Total Worker Health, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Atlanta, Georgia (Dr Childress, Dr Newhall); University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina (Dr Linnan, Dr Rogers); Center for Community-Based Research, Dana-Farber Cancer Institute, Boston, Massachusetts (Dr McLellan); Center for Work, Health, and Well-Being, Harvard T.H. Chan School of Public Health, Boston, Massachusetts (Dr McLellan); Healthier Workforce Center of the Midwest College of Public Health, University of Iowa, Iowa City, Iowa (Dr Campo, Dr Rohlman); Department of Community and Behavioral Health, College of Public Health, University of Iowa (Dr Campo); Safe and Healthy Workplace Center, SAIF, Salem, Oregon (Ms Freewynn); Oregon Healthy Workplace Center, Oregon Health & Science University (Dr Hammer), Portland, Oregon; Carolina Collaborative for Research on Work and Health, Chapel Hill, North Carolina (Ms Leff); Center for Environmental and Workplace Health, Department of Public Health, College of Health & Human Services, Western Kentucky University, Bowling Green, Kentucky (Dr Macy, Dr Watkins); Office of the Director, Office of Extramural Program, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Atlanta, Georgia (Dr Maples); North Carolina Occupational Safety and Health and Education and Research Center, Chapel Hill, North Carolina (Dr Rogers); Department of Environmental Sciences and Engineering, University of North Carolina, Chapel Hill, North Carolina (Dr Rogers), Chapel Hill, North Carolina; Department of Occupational and Environmental Health (Dr Rohlman), College of Public Health, University of Iowa, Iowa City, Iowa.

Objective: Establishment of core competencies for education and training of professionals entering the emerging field of Total Worker Health®.

Methods: Compilation and distillation of information obtained over a 5-year period from Total Worker Health symposia, workshops, and academic offerings, plus contributions from key stakeholders regarding education and training needs.

Results: A proposed set of Total Worker Health competencies aligns under six broad domains: Subject Matter Expertize; Advocacy and Engagement; Program Planning, Implementation and Evaluation; Communications and Dissemination; Leadership and Management; and Partnership Building and Coordination.

Conclusions: Proposed set of core competencies will help standardize education and training for professionals being trained in Total Worker Health. It serves as an invitation for further input from stakeholders in academia, business, labor, and government.
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http://dx.doi.org/10.1097/JOM.0000000000001906DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7409771PMC
August 2020

Evaluation and Dissemination of a Checklist to Improve Implementation of Work Environment Initiatives in the Eldercare Sector: Protocol for a Prospective Observational Study.

JMIR Res Protoc 2020 May 13;9(5):e16039. Epub 2020 May 13.

Health and Safety, Municipality of Copenhagen, Copenhagen, Denmark.

Background: To measure sustainable improvements in the work environment, a flexible and highly responsive tool is needed that will give important focus to the implementation process. A digital checklist was developed in collaboration with key stakeholders to document the implementation of changes in eldercare sector workplaces.

Objective: This paper describes the study protocol of a dissemination study that aims to examine when, why, and how the digital checklist is spread to the Danish eldercare sector following a national campaign particularly targeting nursing homes and home care.

Methods: This prospective observational study will use quantitative data from Google Analytics describing use of the checklist as documented website engagement, a survey among members in the largest union in the sector, information from a central business register, and monitoring of campaign activities. The evaluation will be guided by the five elements of the RE-AIM framework: reach, effectiveness, adoption, implementation, and maintenance.

Results: The study was approved in June 2016 and began in October 2018. The campaign that is the foundation for the evaluation began in 2017 and ended in 2018. However, the webpage where we collect data is still running. Results are expected in 2020.

Conclusions: This protocol provides a working example of how to evaluate dissemination of a checklist to improve implementation of work environment initiatives in the eldercare sector in Denmark. To our knowledge, implementation in a nationwide Danish work environment has not been previously undertaken. Given that the checklist is sector-specific for work environment initiatives and developed through systematic collaboration between research and practice, it is likely to have high utility and impact; however, the proposed evaluation will determine this. This study will advance dissemination research and, in particular, the evaluation of the impact of these types of studies. Finally, this study advances the field through digital tools that can be used for evaluation of dissemination efforts (eg, Google Analytics associated with website) in the context of a rigorous research design activity.

International Registered Report Identifier (irrid): DERR1-10.2196/16039.
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http://dx.doi.org/10.2196/16039DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7254284PMC
May 2020

Perceived social norms and concussion-disclosure behaviours among first-year NCAA student-athletes: implications for concussion prevention and education.

Res Sports Med 2021 Jan-Feb;29(1):1-11. Epub 2020 Jan 25.

John A. Feagin Jr. Sports Medicine Fellowship, Keller Army Hospital , West Point, NY, USA.

Timely disclosure and identification of concussion symptoms are essential to proper care. Perceived social norms are a potential driving factor in many health-related decisions. The study purpose was to describe concussion disclosure behaviours and identify the association between perceived social norms and these disclosure behaviours. First-year student-athletes (n = 391) at two NCAA institutions completed a cross-sectional survey about concussion disclosure and disclosure determinants. Log-binomial regression models identified factors associated with concussion disclosure behaviour prevalence for: higher intention to disclose symptoms, disclosed all at time of injury, eventually disclosed all, and never participated with concussion symptoms. More favourable perceived social norms were associated with higher prevalence of intention to disclose (PR = 1.34; 95%CI: 1.18, 1.53) and higher prevalence of never participating in sports with concussion symptoms (PR = 1.50; 95%CI: 1.07, 2.10). Clinicians, coaches, sports administrators, and healthcare practitioners should be mindful of the need to create supportive social environments to improve concussion symptom disclosure.
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http://dx.doi.org/10.1080/15438627.2020.1719493DOI Listing
March 2021

Physical activity calorie expenditure (PACE) labels in worksite cafeterias: effects on physical activity.

BMC Public Health 2019 Nov 29;19(1):1596. Epub 2019 Nov 29.

Department of Family Medicine and Community Health, Duke University School of Medicine, 2200 West Main Street, Suite 400, Durham, NC, 27705, USA.

Background: Regular physical activity is an important component of healthy living and wellbeing. Current guidelines recommend that adults participate in at least 150 min of moderate or vigorous-intensity physical activity weekly. In spite of the benefits, just over half of U.S. adults meet these recommendations. Calorie-only food labels at points of food purchase have had limited success in motivating people to change eating behaviors and increase physical activity. One new point of purchase approach to promote healthy behaviors is the addition of food labels that display the physical activity requirement needed to burn the calories in a food item (e.g. walk 15 min).

Methods: The Physical Activity Calorie Expenditure (PACE) Study compared activity-based calorie-expenditure food labels with calorie-only labels at three Blue Cross and Blue Shield of North Carolina worksite cafeterias. After 1 year of baseline data collection, one cafeteria had food items labeled with PACE labels, two others had calorie-only food labels. Cohort participants were asked to wear an accelerometer and complete a self-report activity questionnaire on two occasions during the baseline year and twice during the intervention year.

Results: A total of 366 study participants were included in the analysis. In the PACE-label group, self-reported physical activity increased by 13-26% compared to the calorie-only label group. Moderate-to-vigorous physical activity (MVPA) increased by 24 min per week in the PACE-label group compared to the calorie-label group (p = 0.06). Changes in accelerometer measured steps, sedentary time, and MVPA had modest increases. Change ranged from 1 to 12% with effect size values from 0.08 to 0.15. Baseline physical activity level significantly moderated the intervention effects for all physical activity outcomes. Participants in both label groups starting in the lowest tertile of activity saw the largest increase in their physical activity.

Conclusion: Results suggest small positive effects for the PACE labels on self-reported and objective physical activity measures. Minutes of weekly MVPA, strength training, and exercise activities showed modest increases. These results suggest that calorie-expenditure food labels may result in some limited increases in physical activity.
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http://dx.doi.org/10.1186/s12889-019-7960-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6884791PMC
November 2019

Nursing Assistants' Use of Personal Protective Equipment Regarding Contact With Excreta Contaminated With Antineoplastic Drugs.

Oncol Nurs Forum 2019 11;46(6):689-700

University of North Carolina.

Purpose: To examine the feasibility of observing and interviewing nursing assistants about handling of antineoplastic drugs contaminated with excreta, acceptability of a measure of personal protective equipment (PPE) use with nursing assistants, and predictors of PPE use.

Participants & Setting: 27 nursing assistants in an inpatient hematology-oncology unit at an academic medical center in the southeastern United States.

Methodologic Approach: This was an exploratory, multimethod study using observation, verbally administered questionnaires, and interviews. Research variables included recruitment rates, acceptability of observation, and understandability of a safe-handling instrument.

Findings: Observed use of double gloves, chemotherapy gowns, and face shields was low; use of plastic-backed pads when flushing excreta was high.

Implications For Nursing: Nursing assistants are willing to participate in research. Standardized training and education about PPE use are needed.
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http://dx.doi.org/10.1188/19.ONF.689-700DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7886377PMC
November 2019

Growing Evidence for Barbershop-Based Interventions to Promote Health and Address Chronic Diseases.

Authors:
Laura A Linnan

Am J Public Health 2019 08;109(8):1073-1074

Laura A. Linnan is with the Department of Health Behavior, University of North Carolina Gillings School of Global Public Health, Chapel Hill.

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http://dx.doi.org/10.2105/AJPH.2019.305182DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6611103PMC
August 2019

Participation of lower-to-middle wage workers in a study of Chronic Disease Self-Management Program (CDSMP) effectiveness: Implications for reducing chronic disease burden among racial and ethnic minority populations.

Public Health Nurs 2019 09 5;36(5):591-602. Epub 2019 Jun 5.

Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.

Background: Although the Chronic Disease Self-Management Program (CDSMP) improves chronic disease outcomes, little is known about CDSMP participation in populations less than 65 years of age. We explore study and CDSMP participation rates by demographic characteristics with younger (40-64 years old), lower-to-middle wage workers with chronic disease in a randomized clinical trial (RCT) conducted in North Carolina.

Methods: Descriptive statistics and regression models were used to examine associations between demographic, chronic disease burden, and employment variables, and time-dependent study enrollment and intervention participation outcomes that ranged from initiating consent (n = 1,067) to CDSMP completion (n = 41).

Results: Overall, participation among non-Whites was disproportionately higher (43%-59%) than that of Whites (42%-57%) relative to the age-matched racial composition of North Carolina (31% non-White and 69% White). Among participants randomized to the CDSMP, racial and ethnic minorities had the highest rates of participation. There were no significant demographic, chronic disease burden, or employment predictors among the participation outcomes examined, although this may have been due to the limited number of CDSMP workshop participation observations.

Conclusions: Extending the CDSMP to lower-to-middle wage workers may be particularly effective in reaching racial and ethnic minority populations, who complete the program to a greater extent than their White, non-Hispanic counterparts.
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http://dx.doi.org/10.1111/phn.12623DOI Listing
September 2019

Overweight and Obesity Among School Bus Drivers in Rural Arkansas.

Prev Chronic Dis 2019 05 16;16:E61. Epub 2019 May 16.

University of North Carolina at Chapel Hill, Gillings School of Public Health, Chapel Hill, North Carolina.

Introduction: Obesity is a major public health concern. Compared with other occupational groups, transportation workers, such as school bus drivers, have higher rates of obesity. However, little is known about the body weight and related health behaviors of these drivers, and opportunities for intervention are undetermined.

Methods: We collected multilevel data from school bus drivers working from 4 school bus garages in Little Rock, Arkansas, and their work environment from January through July of 2017. Data on weight, height, sociodemographic characteristics, work factors, weight-related behaviors, and psychosocial variables were collected from 45 drivers. Analyses explored associations between body mass index (BMI; weight in kg/ height in m) and sociodemographic characteristics, work factors, weight-related behaviors, and psychosocial variables. Two focus groups with a total of 20 drivers explored drivers' perspectives about healthy weight. Observational data at the bus and garage levels were collected through 2 "ride-alongs" and an environmental scan.

Results: Drivers in our sample were predominately overweight or obese (91.1%), and most did not meet dietary or physical activity guidelines. Drivers who were currently dieting had higher BMIs (36.4; standard deviation [SD], 8.2) than drivers who were not dieting (28.5; SD, 7.7); drivers who reported eating less to lose weight had higher BMIs (38.1; SD, 8.5) than those who did not report eating less (29.5; SD, 6.0). Drivers who did not meet physical activity recommendations had higher BMIs (36.5; SD, 9.8) than those who met recommendations (30.9; SD, 4.8). Structural barriers and work stress were significant barriers to achieving a healthy weight. Resources for healthful eating and physical activity were limited in the garage.

Conclusion: Our study provides preliminary data on the prevalence, risk factors, and perceptions of overweight and obesity among school bus drivers. Study data on drivers' body weight, health-related behaviors, and psychosocial characteristics could serve as a basis for worksite interventions to improve drivers' health.
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http://dx.doi.org/10.5888/pcd16.180413DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6549416PMC
May 2019

Results of the Workplace Health in America Survey.

Am J Health Promot 2019 06 22;33(5):652-665. Epub 2019 Apr 22.

1 Department of Health Behavior, UNC Gillings School of Global Public Health, Chapel Hill, NC, USA.

Purpose: To provide a nationally representative snapshot of workplace health promotion (WHP) and protection practices among United States worksites.

Design: Cross-sectional, self-report Workplace Health in America (WHA) Survey between November 2016 and September 2017.

Setting: National.

Participants: Random sample of US worksites with ≥10 employees, stratified by region, size, and North American Industrial Classification System sector.

Measures: Workplace health promotion programs, program administration, evidence-based strategies, health screenings, disease management, incentives, work-life policies, implementation barriers, and occupational safety and health (OSH).

Analysis: Descriptive statistics, t tests, and logistic regression.

Results: Among eligible worksites, 10.1% (n = 3109) responded, 2843 retained in final sample, and 46.1% offered some type of WHP program. The proportion of comparable worksites with comprehensive programs (as defined in Healthy People 2010) rose from 6.9% in 2004 to 17.1% in 2017 ( P < .001). Occupational safety and health programs were more prevalent than WHP programs, and 83.5% of all worksites had an individual responsible for employee safety, while only 72.2% of those with a WHP program had an individual responsible for it. Smaller worksites were less likely than larger to offer most programs.

Conclusion: The prevalence of WHP programs has increased but remains low across most health programs; few worksites have comprehensive programs. Smaller worksites have persistent deficits and require targeted approaches; integrated OSH and WHP efforts may help. Ongoing monitoring using the WHA Survey benchmarks OSH and WHP in US worksites, updates estimates from previous surveys, and identifies gaps in research and practice.
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http://dx.doi.org/10.1177/0890117119842047DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6643274PMC
June 2019

Workplace health promotion and safety in state and territorial health departments in the United States: a national mixed-methods study of activity, capacity, and growth opportunities.

BMC Public Health 2019 Mar 12;19(1):291. Epub 2019 Mar 12.

Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, CB #7411, Chapel Hill, NC, 27599, USA.

Background: State and Territorial Health Departments (SHDs) have a unique role in protecting and promoting workers' health. This mixed-methods study presents the first systematic investigation of SHDs' activities and capacity in both Occupational Safety and Health (OSH) and Workplace Health Promotion (WHP) in the United States (US).

Methods: National survey of OSH and WHP practitioners from each of 56 SHDs, followed by in-depth interviews with a subset of survey respondents. We calculated descriptive statistics for survey variables and conducted conventional content analysis of interviews.

Results: Seventy percent (n = 39) of OSH and 71% (n = 40) of WHP contacts responded to the survey. Twenty-seven (n = 14 OSH, n = 13 WHP) participated in follow-up interviews. Despite limited funding, staffing, or organizational support, SHDs reported a wide array of activities. We assessed OSH and WHP surveillance activities, support that SHDs provided to employers to implement OSH and WHP interventions (implementation support), OSH and WHP services provided directly to workers, OSH follow-back investigations, and OSH standard and policy development. Each of the categories we asked about (excluding OSH standard and policy development) were performed by more than half of responding SHDs. Surveillance was the area of greatest OSH activity, while implementation support was the area of greatest WHP activity. Respondents characterized their overall capacity as low. Thirty percent (n = 9) of WHP and 19% (n = 6) of OSH respondents reported no funds at all for OSH/WHP work, and both groups reported a median 1.0 FTEs working on OSH/WHP at the SHD. Organizational support for OSH and WHP was characterized as "low" to "moderate". To increase SHDs' capacity for OSH and WHP, interview respondents recommended that OSH and WHP approaches be better integrated into other public health initiatives (e.g., infectious disease prevention), and that federal funding for OSH and WHP increase. They also discussed specific recommendations for improving the accessibility and utility of existing funding mechanisms, and the educational resources they desired from the CDC.

Conclusions: Results revealed current activities and specific strategies for increasing capacity of SHDs to promote the safety and health of workers and workplaces - an important public health setting for reducing acute injury and chronic disease.
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http://dx.doi.org/10.1186/s12889-019-6575-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6417036PMC
March 2019

Effect of calories-only vs physical activity calorie expenditure labeling on lunch calories purchased in worksite cafeterias.

BMC Public Health 2019 Jan 23;19(1):107. Epub 2019 Jan 23.

Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, USA.

Background: Calorie labeling on restaurant menus is a public health strategy to guide consumer ordering behaviors, but effects on calories purchased have been minimal. Displaying labels communicating the physical activity required to burn calories may be a more effective approach, but real-world comparisons are needed.

Methods: In a quasi-experimental study, we examined the effect of physical activity calorie expenditure (PACE) food labels compared to calorie-only labels on point-of-decision food purchasing in three worksite cafeterias in North Carolina. After a year of quarterly baseline data collection, one cafeteria prominently displayed PACE labels, and two cafeterias prominently displayed calorie-only labels. Calories from foods purchased in the cafeteria during lunch were assessed over 2 weeks every 3 months for 2 years by photographs of meals. We compared differences in purchased calorie estimates before and after the labeling intervention was introduced using longitudinal generalized linear mixed model regressions that included a random intercept for each participant.

Results: In unadjusted models comparing average meal calories after vs before labeling, participants exposed to PACE labels purchased 40.4 fewer calories (P = 0.002), and participants exposed to calorie-only labels purchased 38.2 fewer calories (P = 0.0002). The small difference of 2 fewer calories purchased among participants exposed to PACE labeling vs calorie-only labeling was not significant (P = 0.90). Models adjusting for age, sex, race, occupation, numeracy level, and health literacy level did not change estimates appreciably.

Conclusion: In this workplace cafeteria setting, PACE labeling was no more effective than calorie-only labeling in reducing lunchtime calories purchased.
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http://dx.doi.org/10.1186/s12889-019-6433-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6343240PMC
January 2019

Predictors of Health Self-Management Program Preference Among Lower-to-Middle Wage Employed Adults With Chronic Health Conditions.

Am J Health Promot 2019 02 6;33(2):172-182. Epub 2019 Jan 6.

5 Clarity Consulting and Communications, Atlanta, GA, USA.

Purpose: We examined the extent to which demographic, chronic disease burden, and financial strain characteristics were associated with a preference for engaging in the Chronic Disease Self-Management Program (presented as a "health self-management program" [HSMP]) over a financial self-management program (FSMP) and a no program preference (NPP) group among employed adults.

Design: Cross-sectional, correlation design using baseline data from a randomized controlled trial (RCT).

Subjects: The analytic sample included 324 workers aged 40 to 64 years with 1 or more chronic disease conditions recruited into the RCT from 2015 to 2017.

Measures: Chronic disease burden measures included the number of chronic conditions, body mass index (BMI), and the 8-item and 15-item Patient Health Questionnaire (PHQ-8 and PHQ-15). Financial strain was measured as the inability to purchase essentials and food assistance receipt. Both individual and household measures of income were assessed.

Analyses: Multinomial logistic regression and post-hoc marginal effects models.

Results: Moderate-to-severe depressive symptoms increased the likelihood of having an HSMP preference when compared with those preferring the FSMP (RR = 4.2, P < .05) but not those having NPP; while higher BMI marginally increased HSMP preference over FSMP preference, but not NPP groups (RR = 1.04, P < .05). Financial strain differentially, but significantly, reduces the likelihood of HSMP preference at varying levels of household poverty, depressive symptom severity, and financial strain.

Conclusion: Middle-aged, lower-to-middle income workers with moderate-to-severe depressive symptoms opt for HSMPs over FSMPs, but preference for HSMPs significantly diminished when they are experiencing financial strain.
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http://dx.doi.org/10.1177/0890117118821843DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7161073PMC
February 2019

Determinants of intention to disclose concussion symptoms in a population of U.S. military cadets.

J Sci Med Sport 2019 May 14;22(5):509-515. Epub 2018 Nov 14.

Injury Prevention Research Center, University of North Carolina at Chapel Hill, USA; Department of Epidemiology, Curriculum in Human Movement Science, University of North Carolina at Chapel Hill, USA.

Objectives: Non-disclosure of concussion complicates concussion management, but almost nothing is known about non-disclosure in military settings. This study describes concussion disclosure-related knowledge, attitudes, perceived social norms, perceived control, and intention. Additionally, the study identifies determinants of high intention to disclose concussion symptoms.

Design: Cross sectional survey.

Methods: First-year service academy cadets completed a cross-sectional survey to assess perceptions of concussion disclosure. Independent variables included: gender, race, ethnicity, high school athlete status, NCAA athlete status, previous concussion history, previous concussion education, socioeconomic proxy, concussion-related knowledge, attitudes about concussion, perceived social norms (perceived peer/organizational support and actions), and perceived control over disclosure. Log-binomial regression was used to identify determinants of high intention to disclose concussion symptoms.

Results: A total of 972 first-year military service academy cadets completed the survey [85% response; age=18.4±0.9y]. In the simple models, previous concussion history was associated with lower intention to disclose concussion symptoms. High perceived control over disclosure, higher concussion knowledge, more favorable attitudes and social norms about concussion were associated with high intention to disclose. In the multivariable model, a 10% shift towards more favorable perceived social norms (PR=1.28; p<0.001) and attitudes (PR=1.07; p=0.05) about concussion were associated with high intention to disclose concussion symptoms. High perceived control over disclosure was associated with high intention to disclose concussion symptoms (PR=1.39; p=0.08).

Conclusions: Concussion-related perceived social norms, attitudes, and perceived control are associated with intention to disclose. Organizationally appropriate intervention strategies can be developed from these data.
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http://dx.doi.org/10.1016/j.jsams.2018.11.003DOI Listing
May 2019

Research Methodologies for Total Worker Health®: Proceedings From a Workshop.

J Occup Environ Med 2018 11;60(11):968-978

Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Washington, DC (Dr Tamers, Ms Chang, Dr Childress, Dr Schill); Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Atlanta, GA (Dr Chosewood); Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Cincinnati, OH (Dr Luckhaupt, Ms Hudson, Dr Cunningham, Dr Bushnell, Dr Scholl, Ms Nigam); Johns Hopkins University, Baltimore, Maryland (Dr Goetzel); IBM Watson Health, Bethesda, Maryland (Dr Goetzel, Dr Ozminkowski); University of Iowa, Iowa City, Iowa (Dr Kelly, Dr Rohlman, Dr Campo); HealthPartners Institute, Minneapolis, Minnesota (Dr Pronk); City University of New York, New York City, New York (Dr Baron, Dr Huang); University of Illinois at Chicago, Chicago, Illinois (Dr Brosseau); Center for Construction Research and Training, Silver Spring, Maryland (Dr Goldenhar); University of North Carolina-Chapel Hill, Chapel Hill, North Carolina (Dr Linnan); Center for Health, Work & Environment, Colorado School of Public Health, University of Colorado, Colorado (Dr Newman); Oregon Health and Science University, Portland, Oregon (Dr Olson); University of Massachusetts Lowell, Lowell, Massachusetts (Dr Punnett); Harvard University, Cambridge, Massachusetts (Dr Pronk, Dr Sorensen).

Objective: There is growing interest in the NIOSH Total Worker Health program, specifically in the process of designing and implementing safer, health-promoting work and workplaces. A Total Worker Health (TWH) Research Methodology Workshop was convened to discuss research methods and future needs.

Methods: Twenty-six experts in occupational safety and health and related fields reviewed and discussed current methodological and measurement issues and those showing promise.

Results: TWH intervention studies face the same challenges as other workplace intervention studies and some unique ones. Examples are provided of different approaches and their applications to TWH intervention studies, and desired developments in the TWH literature.

Conclusions: This report discusses and outlines principles important to building the TWH intervention research base. Rigorous, valid methodologic, and measurement approaches are needed for TWH intervention as well as for basic/etiologic, translational, and surveillance research.
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http://dx.doi.org/10.1097/JOM.0000000000001404DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6221402PMC
November 2018

Demographic, Parental, and Personal Factors and Youth Athletes' Concussion-Related Knowledge and Beliefs.

J Athl Train 2018 Aug 10;53(8):768-775. Epub 2018 Sep 10.

Athletic Training Programs, A.T. Still University, Mesa.

Context: : Currently, significant attention is focused on improving care for patients with concussions through legislative mandates that include educational interventions. Few researchers have examined young athletes' concussion knowledge and the factors that may influence their knowledge.

Objective: : To use the socioecological model to examine demographic, parental, and personal factors associated with youth athletes' knowledge of concussion. Our ultimate goal is to inform the planning and implementation of youth sport concussion-related interventions.

Design: : Cross-sectional survey.

Setting: : Gymnasium and classroom.

Patients Or Other Participants: : North Carolina and Arizona youth athletes (n = 225; age = 8 to 15 years) active in football, boys' or girls' soccer, boys' or girls' ice hockey, or boys' or girls' lacrosse in 2012-2013.

Main Outcome Measure(s): : Participants completed a validated, self-administered survey. The intention and belief measures were guided by the theory of planned behavior. Perceptions of concussion and intention to seek care were examined using descriptive statistics. Athletes' concussion knowledge was modeled using linear regressions and generalized estimating equations, with child demographic and personal factors and parental knowledge and attitudes about concussion as predictors.

Results: : Geography, sport, parental attitudes toward concussion, and athlete age were associated with athlete knowledge in the univariable analyses ( P < .10). In the multivariable model, geographic location (North Carolina versus Arizona, mean difference [MD] = 2.2, 95% confidence interval [CI] = 1.1, 3.2), sport (girls' soccer versus girls' lacrosse, MD = 2.2, 95% CI = 0.7, 3.6), more favorable parental attitudes toward concussion (MD = 1.2 for a 2-standard deviation shift; 95% CI = 0.3, 2.1), and older age (>12 years, MD = 1.6; 95% CI = 0.5, 2.6) were associated with better knowledge about concussion.

Conclusions: : Geographic location, sport, parental attitudes about concussion, and athlete's age influenced athletes' concussion-related perceptions, indicating the need to address multiple levels of the socioecological model when targeting youth sport interventions. Parental interventions that translate to an improved culture of youth sport by improving youth athletes' perceptions and experiences are key areas for future work.
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http://dx.doi.org/10.4085/1062-6050-223-17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6188083PMC
August 2018

Development of a Workplace Intervention for Child Care Staff: Caring and Reaching for Health's (CARE) Healthy Lifestyles Intervention.

Health Promot Pract 2020 03 22;21(2):277-287. Epub 2018 Jul 22.

University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.

Child care staff are among the lowest wage workers, a group at increased risk for a wide array of chronic diseases. To date, the health of child care staff has been largely ignored, and there have been very few interventions designed for child care staff. This article describes the development of the Caring and Reaching for Health (CARE) Healthy Lifestyles intervention, a workplace intervention aimed at improving physical activity and health behaviors among child care staff. Theory and evidence-based behavior change techniques informed the development of intervention components with targets at multiple social ecological levels. Final intervention components included an educational workshop held at a kick-off event, followed by three 8-week campaigns. Intervention components within each campaign included (1) an informational magazine, (2) goal setting and weekly behavior self-monitoring, (3) weekly tailored feedback, (4) e-mail/text prompts, (5) center-level displays that encouraged team-based goals and activities, and (6) coaching for center directors. This multilevel, theory-driven intervention is currently being evaluated as part of a larger randomized controlled trial. Process evaluation efforts will assess the extent to which child care staff participated in, engaged with, and were satisfied with the intervention. Lessons learned will guide future intervention research engaging child care workers.
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http://dx.doi.org/10.1177/1524839918786214DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7163301PMC
March 2020

Workplace health and safety intervention for child care staff: Rationale, design, and baseline results from the CARE cluster randomized control trial.

Contemp Clin Trials 2018 05 1;68:116-126. Epub 2018 Mar 1.

Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 302 Rosenau Hall, CB 7440, Chapel Hill, NC 27599-7440, USA. Electronic address:

Background: Low-wage workers suffer disproportionately high rates of chronic disease and are important targets for workplace health and safety interventions. Child care centers offer an ideal opportunity to reach some of the lowest paid workers, but these settings have been ignored in workplace intervention studies.

Methods: Caring and Reaching for Health (CARE) is a cluster-randomized controlled trial evaluating efficacy of a multi-level, workplace-based intervention set in child care centers that promotes physical activity and other health behaviors among staff. Centers are randomized (1:1) into the Healthy Lifestyles (intervention) or the Healthy Finances (attention control) program. Healthy Lifestyles is delivered over six months including a kick-off event and three 8-week health campaigns (magazines, goal setting, behavior monitoring, tailored feedback, prompts, center displays, director coaching). The primary outcome is minutes of moderate and vigorous physical activity (MVPA); secondary outcomes are health behaviors (diet, smoking, sleep, stress), physical assessments (body mass index (BMI), waist circumference, blood pressure, fitness), and workplace supports for health and safety.

Results: In total, 56 centers and 553 participants have been recruited and randomized. Participants are predominately female (96.7%) and either Non-Hispanic African American (51.6%) or Non-Hispanic White (36.7%). Most participants (63.4%) are obese. They accumulate 17.4 (±14.2) minutes/day of MVPA and consume 1.3 (±1.4) and 1.3 (±0.8) servings/day of fruits and vegetables, respectively. Also, 14.2% are smokers; they report 6.4 (±1.4) hours/night of sleep; and 34.9% are high risk for depression.

Conclusions: Baseline data demonstrate several serious health risks, confirming the importance of workplace interventions in child care.
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http://dx.doi.org/10.1016/j.cct.2018.02.018DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5944351PMC
May 2018

Chronic Disease Risk Typologies among Young Adults in Community College.

Am J Health Behav 2018 03;42(2):71-84

UNC Gillings School of Global Public Health, Chapel Hill, NC.

Objectives: To address chronic disease risk holistically from a behavioral perspective, insights are needed to refine understanding of the covariance of key health behaviors. This study aims to identify distinct typologies of young adults based on 4 modifiable risk factors of chronic disease using a latent class analysis approach, and to describe patterns of class membership based on demographic characteristics, living arrangements, and weight.

Methods: Overall, 441 young adults aged 18-35 attending community colleges in the Minnesota Twin Cities area completed a baseline questionnaire for the Choosing Healthy Options in College Environments and Settings study, a RCT. Behavioral items were used to create indicators for latent classes, and individuals were classified using maximum-probability assignment.

Results: Three latent classes were identified: 'active, binge-drinkers with a healthy dietary intake' (13.1%); 'non-active, moderate-smokers and non-drinkers with poor dietary intake' (38.2%); 'moderately active, non-smokers and non-drinkers with moderately healthy dietary intake' (48.7%). Classes exhibited unique demographic and weight-related profiles.

Conclusions: This study may contribute to the literature on health behaviors among young adults and provides evidence that there are weight and age differences among subgroups. Understanding how behaviors cluster is important for identifying groups for targeted interventions in community colleges.
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http://dx.doi.org/10.5993/AJHB.42.2.7DOI Listing
March 2018

The association of depression and diabetes across methods, measures, and study contexts.

Clin Diabetes Endocrinol 2018 4;4. Epub 2018 Jan 4.

Department of Health Behavior, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC USA.

Background: Empirical research has revealed a positive relationship between type 2 diabetes mellitus and depression, but questions remain regarding timing of depression measurement, types of instruments used to measure depression, and whether "depression" is defined as clinical depression or depressive symptoms. The present study sought to establish the robustness of the depression-diabetes relationship across depression definition, severity of depressive symptoms, recent depression, and lifetime depression in a nationally representative dataset and a large rural dataset.

Methods: The present examination, conducted between 2014 and 2015, used two large secondary datasets: the National Health and Nutrition Examination Survey (NHANES) from 2007 to 2008 ( = 3072) and the Arthritis, Coping, and Emotion Study (ACES) from 2002 to 2006 ( = 2300). Depressive symptoms in NHANES were measured using the Patient Health Questionnaire 9-item survey (PHQ-9). ACES used the Center for Epidemiologic Studies-Depression Scale (CES-D) to measure depressive symptoms and the Composite International Diagnostic Interview (CIDI) to measure diagnosable depression. Diabetes was modelled as the dichotomous outcome variable (presence vs. absence of diabetes). Logistic regression was used for all analyses, most of which were cross-sectional. Analyses controlled for age, ethnicity, sex, education, and body mass index, and NHANES analyses used sample weights to account for the complex survey design. Additional analyses using NHANES data focused on the addition of health behavior variables and inflammation to the model.

Results: Every one-point increase in depressive symptoms was associated with a 5% increase in odds of having diabetes [OR: 1.05 (CI: 1.03, 1.07)]. These findings persisted after controlling for health behaviors and inflammation. . For every one-point increase in depressive symptom score, odds of having diabetes increased by 2% [OR: 1.02 (CI: 1.01, 1.03)]. Recent (past 12 months) depression [OR: 1.49, (CI: 1.03, 2.13)] and lifetime depression [OR: 1.40 (CI: 1.09, 1.81)] were also significantly associated with having diabetes.

Conclusions: This study provides evidence for the robustness of the relationship between depression or depressive symptoms and diabetes and demonstrates that depression occurring over the lifetime can be associated with diabetes just as robustly as that which occurs more proximal to the time of study measurement.
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http://dx.doi.org/10.1186/s40842-017-0052-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5755050PMC
January 2018

Organizational-Level Recruitment of Barbershops as Health Promotion Intervention Study Sites: Addressing Health Disparities Among Black Men.

Health Promot Pract 2018 05 23;19(3):377-389. Epub 2017 Mar 23.

5 Univeristy of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA.

This article describes the process and results associated with the organizational-level recruitment of Black barbershops into Fitness in the Shop (FITShop), a 6-month barbershop-based intervention study designed to promote physical activity among Black men. Organizational-level recruitment activities included (1) a telephone call to prospective barbershop owners to assess their interest and eligibility for participation, (2) an organizational eligibility letter sent to all interested and eligible barbershops, (3) a visit to interested and eligible barbershops, where a culturally sensitive informational video was shown to barbershop owners to describe the study activities and share testimonies from trusted community stakeholders, and (4) a signed agreement with barbershop owners and barbers, which formalized the organizational partnership. Structured interviews were conducted with owners of a total of 14 enrolled barbershops, representing 30% of those determined to be eligible and interested. Most enrolled shops were located in urban settings and strip malls. Barbershop owners were motivated to enroll in the study based on commitment to their community, perceived client benefits, personal interest in physical activity, and a perception that the study had potential to make a positive impact on the barbershop and on reducing health disparities. Results offer important insights about recruiting barbershops into intervention trials.
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http://dx.doi.org/10.1177/1524839917696715DOI Listing
May 2018

Assessing Opportunities to Enhance Comprehensive Health Promotion and Wellness Programming in a State Community College System.

N C Med J 2017 Sep-Oct;78(5):296-303

research associate, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.

North Carolina has the third largest community college system in the nation and reaches residents in all 100 counties. Few studies have focused on the health of employees who work at these institutions. We assessed the current status of and interest in supporting health promotion efforts among North Carolina Community College System members. North Carolina Community College System presidents completed a brief 15-item survey assessing support for and interest in offering health promotion programs. Wellness coordinators completed a 60-item questionnaire assessing current health promotion programming and organizational, environmental, and policy supports for health promotion efforts. Onsite interviews with a sub-sample of Wellness coordinators offered insights into important implementation considerations. We examined differences by campus size with Fisher's exact test. All 58 presidents (100%) and 51 wellness coordinators (88%) completed surveys. Ten percent of colleges offered comprehensive employee health promotion programming. Most offered physical activity (70.6%), tobacco cessation (51.0%), weight loss/management (49.0%), and/or nutrition counseling (47.1%). Larger colleges were more likely to offer programming and environmental support. Nearly all presidents (89.7%) believed it is "very" or "extremely" important to offer health promotion programs to employees, and most (84%) were interested in promoting health through a university partnership. Despite very high survey response rates from presidents and wellness coordinators at each community college, onsite interviews were only done at select campuses, limiting the generalizability and scope of conclusions derived from interview data. Community colleges in North Carolina are promising settings for promoting employee health. Findings identify resources, barriers, and technical assistance that could facilitate greater adoption and implementation of programs.
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http://dx.doi.org/10.18043/ncm.78.5.296DOI Listing
July 2018

Feasibility of Assessing Falls Risk and Promoting Falls Prevention in Beauty Salons.

J Prim Prev 2017 Dec;38(6):567-581

Department of Health Behavior, University of North Carolina at Chapel Hill Gillings School of Global Public Health, 307 Rosenau Hall, CB# 7440, Chapel Hill, NC, 27599-7440, USA.

Falls are a major public health risk and a leading cause of emergency room visits for people of all ages. Finding ways to increase access to information and evidence-based falls prevention strategies is critically important across the lifespan. We tested the feasibility of conducting a falls risk assessment and awareness program among customers who attend beauty salons. We enrolled 78 customers from 2 beauty salons who completed a written questionnaire as well as several biometric and functional balance tests designed to assess falls risk. On average, enrolled participants were 56 years of age (range: 19-90), female (n = 70, 91%), and Black (n = 47, 62%). Eleven percent of enrolled customers were classified as at high risk of falls because they had reported two or more falls in the last 6 months. We found that younger age, higher education, employment, moderate physical activity, and decreased frequency of salon visits were associated with fewer falls. Results demonstrated initial interest in, and the feasibility of recruiting and enrolling customers into a beauty salon-based falls risk assessment and awareness program. Beauty salons, which are in all communities, represent an innovative setting for reaching people of all ages with life-saving falls prevention information and services.
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http://dx.doi.org/10.1007/s10935-017-0486-3DOI Listing
December 2017