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Paul E. Terry	1486	Editorial Is Health Promotion a Journey or a Destination? Recent data on our progress in workplace-based health promotion should keep us grounded as we consider whether we are on track to planned destinations. One recent survey suggests employees view worksite wellness as a valuable employee benefit but another survey suggests employees are dissatisfied with their employers' wellness offerings. What explains these differences? Is the program driven by a plan? Is the plan relevant to the company's priorities? Was the plan developed using participatory planning principles? A participant centered health promotion initiative means deciding a destination and planning how to get there alongside those you aspire to serve. This approach is far more likely to lead to alternative routes and, often, untested sources of data for finding the way. The urgent opportunity for workplace-based program planners is that of strategic planning that is guided by a continuous review of credible metrics such as those offered in best practices scorecards.
the Science of lifestyle change
Fang Xu Sohyun Park Karen R. Siegel	1489	Quantitative Research Factors Associated With Frequency of Sugar-Sweetened Beverage Consumption Among US Adults With Diabetes or Prediabetes This study assessed the associations between sociodemographic and behavioral characteristics and sugar-sweetened beverage (SSB) intake among US adults with diabetes or prediabetes. Employing secondary analyses of the 2013 National Behavioral Risk Factor Surveillance System that included 13 268 adults with diabetes and 9330 adults with SSB intake was examined. Results indicated that in 2013, 22.0% of adults with diabetes and 38.2% of adults with prediabetes and 34.7% of adults without diabetes or prediabetes consumed SSBs ≥1 time/day. Consuming SSBs ≥1 time/day was significantly greater for those who had shorter duration of diabetes, who less frequently self-checked blood, and who had not participated in a course on the self-management of diabetes. The authors argue that the findings can inform efforts to decrease SSB intake among high-risk populations.
Ritabelle Fernandes Chuan C. Chinn Dongmei Li Timothy Halliday Timothy B. Frankland Christina M. B. Wang Zi Wang Misha Morioka Robin G. Arndt Rebecca Rude Ozaki	1498	Quantitative Research Financial Incentives for Medicaid Beneficiaries With Diabetes: Lessons Learned From HI-PRAISE, an Observational Study and Randomized Controlled Trial In this study, the authors used an observational pre–post study and randomized controlled trial (RCT) to examine the impact of financial incentives on Medicaid beneficiaries with diabetes from the Hawaii Patient Reward and Incentives to Support Empowerment (HI-PRAISE) project. The participants included 2003 Medicaid beneficiaries with diabetes from federally qualified health centers and the RCT included 320 participants from Kaiser Permanente. The intervention arm participants earned up to $320/year of financial incentives for a minimum of 1 year. The results indicated that changes in clinical outcomes in the observational study were statistically significant. Mean hemoglobin A1c decreased from 8.56% to 8.24% (P < .0001) and low-density lipoprotein decreased from 106.17 mg/dL to 98.55 mg/dL (P < .0001). No significant differences were found between groups in the RCT. Improved American Diabetes Association compliance was observed. No reduction in total health cost during the project period was demonstrated. Based on these results, the authors concluded that HI-PRAISE found no evidence that financial incentives had beneficial effect on diabetes clinical outcomes or cost saving measures.
Kaija Appelqvist-Schmidlechner Jani Vaara Arja Häkkinen Tommi Vasankari Juha Mäkinen Matti Mäntysaari Heikki Kyröläinen	1502	Quantitative Research Relationships Between Youth Sports Participation and Mental Health in Young Adulthood Among Finnish Males In this study, the authors employed a cross-sectional study using self-administered questionnaires conducted prior to compulsory military refresher training course in Finland to examine whether retrospectively assessed sports participation (SP) and competitive sports (CS) at the age of 12 years were associated with mental health and health behavior in young adulthood among males. The participants were geographically representative sample of 680 males aged between 20 and 35 years. The results indicated that SP at the age of 12 was associated with better mental health in young adulthood, with both mental well-being (odds ratio [OR] = 1.86, 95% confidence interval [CI]: 1.11-3.11) and mental distress (OR = 0.61, 95% CI: 0.41-0.90). Higher level of intensity of SP and the level of CS in childhood were associated with lower level of mental distress in adulthood. No association was found between the level of CS in childhood and mental well-being in adulthood. Further, youth SP seemed to be a risk factor for increased alcohol consumption and use of snuff in adulthood. The authors concluded that despite the negative outcomes related to health behavior, their findings provide support for the association between youth sports participation and positive mental health outcomes in adulthood among males.
Uma S. Nair Ryan C. Reikowsky Betsy C. Wertheim Cynthia A. Thomson Judith S. Gordon	1510	Quantitative Research Quit Outcomes and Program Utilization by Mode of Entry Among Clients Enrolling in a Quitline A retrospective analysis was conducted (n = 18,650) to investigate how mode of entry into a quitline influences program utilization and quit outcomes among clients seeking cessation services. Measures included referral mode of entry, tobacco cessation medication use, number of coaching sessions completed, and 30-day tobacco abstinence at 7 month follow-up. Logistic regression was used to analyze tobacco abstinence after controlling for potential confounders. Results showed that compared to self-referred clients, proactively referred clients were least likely (OR, 0.88; 95% CI, 0.81-0.97) while passively referred clients were most likely (OR, 1.14; 95% CI, 1.00-1.30) to report tobacco abstinence. Also, proactively referred (OR, 0.79; 95% CI, 0.70-0.88) but not passively referred clients were 21% less likely to report tobacco cessation medication use than self-referred clients. The authors concluded that proactive referrals are associated with lower utilization of tobacco cessation medication and less successful quit outcomes. Since this was an observational study ability to control for other factors as well as generalizability is limited.
Eveleen Sng Emily Frith Paul D. Loprinzi	1518	Quantitative Research Temporal Effects of Acute Walking Exercise on Learning and Memory Function Eighty-eight young adults participated in a study designed to evaluate the temporal effects of acute exercise on memory. Experimental groups were evaluated exercising prior to memory encoding, exercising during encoding, and exercising during memory consolidation. Participants completed the Rey Auditory Verbal Learning Test to assess learning and memory. Prospective memory was assessed using the Red Pen Task, and long-term memory was assessed 20 minutes and 24 hours after exercising. Repeated-measures analysis of variance (ANOVA), 1-way ANOVA, and χ2 tests were used to analyze data. Results showed, regarding learning, the group that exercised before encoding did better than the group that exercised during encoding and consolidation. The authors concluded that engaging in a 15-minute bout of moderate-intensity walking before a learning task was effective in influencing long-term episodic memory. Since a homogenous sample participated in this study, results may only be generalizable to a college student population.
L. Omar Rivera Jessica Danielle Ford Meredith Marie Hartzell Todd Allan Hoover	1526	Quantitative Research An Evaluation of Army Wellness Center Clients' Health-Related Outcomes This study used a pre-post-test outcome evaluation design to examine whether Army community members participating in a best-practice based workplace health promotion program (WHPP) experience goal-moderated improvements in health-related outcomes using data from Army Wellness Center (AWC) facilities on nineteen Army installations. The subjects included Army community members (N = 5,703), mostly Active Duty Soldiers (64%). Health risks assessments with feedback were conducted once a month for 3-12 months. The results indicated that clients experienced significant improvements in body fat (−2% change), perceived stress (−6 to −12% change), cardiorespiratory fitness (+6% change), and blood pressure (−1% change) regardless of health-related goal. Only clients with a weight loss goal experienced BMI improvement (−1% change). Follow-up outcome assessment rates ranged from 44% (N = 2,509) for BMI to 6% (N = 342) for perceived stress. The authors concluded that AWC clients with at least one follow-up outcome assessment experienced improvements in chronic disease risk factors. Evaluation design and follow-up related issues notwithstanding, results suggest that best practices in WHPPs can effectively serve the military.
Eric M. VanEpps Andrea B. Troxel Elizabeth Villamil Kathryn A. Saulsgiver Jingsan Zhu Jo-Yu Chin Jacqueline Matson Joseph Anarella Patrick Roohan Foster Gesten Kevin G. Volpp	1537	Quantitative Research Financial Incentives for Chronic Disease Management: Results and Limitations of 2 Randomized Clinical Trials With New York Medicaid Patients This article identifies whether financial incentives promote improved disease management in Medicaid recipients diagnosed with hypertension or diabetes, respectively. Between 2013 and 2016, New York State Medicaid managed care members diagnosed with hypertension (N = 920) or with diabetes (N = 959) were used. Participants in each 6-month trial were randomly assigned to 1 of 4 arms: (1) process incentives—earned by attending primary care visits and/or receiving prescription medication refills, (2) outcome incentives—earned by reducing systolic blood pressure (hypertension) or hemoglobin A1c (HbA1c; diabetes) levels, (3) combined process and outcome incentives, and (4) control (no incentives). Systolic blood pressure (hypertension) and HbA1c (diabetes) levels, primary care visits, and medication prescription refills were used. At 6 months, there were no statistically significant differences between intervention arms and the control arm in the change in systolic blood pressure, P = .531. Similarly, there were no significant differences in blood glucose control (HbA1c) between the intervention arms and control after 6 months, P = .939. Most participants had acceptable systolic blood pressure (<140 mm Hg) or blood glucose (<8.0%) levels at baseline and throughout the study. Financial incentives have a negligible impact on health outcomes for Medicaid recipients diagnosed with either hypertension or diabetes in 2 studies in which most recipients had relatively well-controlled diseases at enrollment time.
Brooke J. Cull David A. Dzewaltowski Justin M. Guagliano Sara K. Rosenkranz Cassandra K. Knutson Richard R. Rosenkranz	1544	Quantitative Research Wellness-Promoting Practices Through Girl Scouts: A Pragmatic Superiority Randomized Controlled Trial With Additional Dissemination The purpose of this 2-phase study was to (1) evaluate the effectiveness of in-person versus online Girl Scout leader wellness training for implementation of wellness-promoting practices during group meetings (phase I) and (2) assess training adoption and current practices across the council (phase II). Measures included a wellness-promoting practice implementation questionnaire at baseline and postintervention (phase I), and completion of a survey focused on typical troop practices and interest in further training (phase II). Generalized linear mixed modeling was used to analyze phase I data and descriptive statistics and chi-square analyses was used to analyze phase II data. Results showed in-person training increased wellness-promoting practice implementation more than online training and 56% of leaders adopted the training. The authors concluded that in-person training was superior to online training for improvements in wellness-promoting practices. Since the study was conducted in low-income Midwestern counties, generalizability to higher income groups is not possible.
Julianne Payne Laurie Cluff Jason Lang Dyann Matson-Koffman Antonio Morgan-Lopez	1555	Quantitative Research Elements of a Workplace Culture of Health, Perceived Organizational Support for Health, and Lifestyle Risk This article investigated the impact of elements of a workplace culture of health (COH) on employees’ perceptions of employer support for health and lifestyle risk. It uses 2013 and 2015 survey data from the National Healthy Worksite Program, a CDC-led initiative to help workplaces implement health-promoting interventions. Forty-one employers completed the CDC Worksite Health Scorecard to document organizational changes. Eight hundred twenty-five employees provided data to evaluate changes in their health and attitudes. Elements of the COH include environmental, policy, and programmatic supports; leadership and coworker support; employee engagement (motivational interventions); and strategic communication. Outcomes included scores of employees’ perceptions of employer support for health and lifestyle risk derived from self-reported physical activity, nutrition, and tobacco use. Effects were estimated using multilevel regression models. At the employee level and across time, regression coefficients show positive associations between leadership support, coworker support, employee engagement, and perceived support for health (P < .05). Coefficients suggest a marginally significant negative association between lifestyle risk and the presence of environmental and policy supports (P < .10), and significant associations with leadership support in 2015 only (P < .05).
Mitesh S. Patel Kevin G. Volpp Roy Rosin Scarlett L. Bellamy Dylan S. Small Jack Heuer Susan Sproat Chris Hyson Nancy Haff Samantha M. Lee Lisa Wesby Karen Hoffer David Shuttleworth Devon H. Taylor Victoria Hilbert Jingsan Zhu Lin Yang Xingmei Wang David A. Asch	1568	Quantitative Research A Randomized, Controlled Trial of Lottery-Based Financial Incentives to Increase Physical Activity Among Overweight and Obese Adults This study used a randomized controlled trial in an academic institution setting to evaluate the effect of lottery-based financial incentives in increasing physical activity. Participants included 209 adults with BMI 3 27. All participants used smartphones to track activity, were given a goal of 7000 steps per day, and received daily feedback on performance for 26 weeks. Participants were randomly assigned to 1 of the 3 intervention arms received a financial incentive for 13 weeks and then were followed for 13 weeks without incentives. The results indicated that the unadjusted mean proportion of participant-days that goal was achieved was 0.26 in the control arm, 0.32 in the higher frequency, smaller reward lottery arm, 0.29 in the jackpot arm, and 0.38 in the combined lottery arm. In adjusted models, only the combined lottery arm was significantly greater than control (P = .01). The jackpot arm had a significant decline of 0.13 (P < .001) compared to control. There were no significant differences during follow-up. Based on these results, the authors concluded that combined lottery incentives were the most effective in increasing physical activity.
Pooja Agrawal Andrew Mercer Jamila Hassanali Chakema Carmack Darleesa Doss Rosenda Murillo	1576	Quantitative Research Gender Differences in the Association Between Alcohol Use and Sedentary Behavior Among Adults Data from the 2007-2014 administrations of the National Health and Nutrition Examination Survey (NHANES) was analyzed to determine whether alcohol consumption is associated with sedentary behavior. The sample inclusion criteria were 20 years of age or older and identifying as Hispanic, white, or black. The final analytic sample included 18,441 men and women. Multinominal logistic regression analysis was used to estimate associations of alcohol use with categories of sedentary behavior by gender. Results showed that women who were heavy drinkers were significantly more likely to engage in high sedentary activity (odds ratio: 1.47; 95% confidence interval: 1.16 -1.87) relative to low levels of activity. No significant associations between alcohol use and sedentary activity among men were found. The authors concluded that alcohol consumption should be considered in health promotion efforts targeting sedentary behavior among women. Since this was a cross-sectional study, generalizability is limited.
Steffani R. Bailey Victor J. Stevens Stephen P. Fortmann Stephen E. Kurtz Mary Ann McBurnie Elisa Priest Jon Puro Leif I. Solberg Rebecca Schweitzer Andrew L. Masica and Brian Hazlehurst	1582	Quantitative Research Long-Term Outcomes From Repeated Smoking Cessation Assistance in Routine Primary Care This article tests the association between repeated clinical smoking cessation support and long-term cessation using a retrospective, observational cohort study with structured and free-text data from electronic health records from 6 diverse health systems in the United States. Patients aged 18 years who were smokers in 2007 and had 1 primary care visit in each of the following 4 years (N = 33 691) were included. Primary exposure was a composite categorical variable (comprised of documentation of smoking cessation medication, counseling, or referral) classifying the proportions of visits for which patients received any cessation assistance (<25% (reference), 25%-49%, 50%-74%, 75% of visits). The dependent variable was long-term quit (LTQ; yes/no), defined as no indication of being a current smoker for 365 days following a visit where nonsmoker or former smoker was indicated. Mixed-effects logistic regression analysis adjusted for age, sex, race, and comorbidities, with robust standard error estimation to account for within site correlation. Overall, 20% of the cohort achieved LTQ status. Patients with 75% of visits with any assistance had almost 3 times the odds of achieving LTQ status compared to those with <25% visits with assistance (odds ratio = 2.84; 95% confidence interval: 1.50-5.37). Results were similar for specific assistance types.
Rebecca A. Seguin Urshila Sriram Leah M. Connor Ashley E. Silver Beining Niu Alexis N. Bartholomew	1591	Qualitative Research A Civic Engagement Approach to Encourage Healthy Eating and Active Living in Rural Towns: The HEART Club Pilot Project This study assessed the feasibility and effectiveness of a civic engagement curriculum (Healthy Eating and Activity in Rural Towns [HEART] Club) designed to engage rural residents in improving their local food or physical activity environment. Rural residents from 3 Northeastern towns in the United States were interviewed, and online surveys were used to assess outcomes related to feasibility, satisfaction, effectiveness, and group efficacy for community change. Focus group data were thematically examined to identify barriers to and facilitators of HEART Club progress. Meeting attendance and program satisfaction were high, and all HEART Clubs accomplished 3 or more project benchmarks after 6 months of implementation. Important facilitators of success included stakeholder support, effective leadership, and positive group dynamics. Study findings suggest that resident-driven initiatives that build upon local resources and establish feasible goals can successfully foster environmental change in rural communities.
Marco Maselli Philip B. Ward Erica Gobbi Attilio Carraro	1602	Literature Review Promoting Physical Activity Among University Students: A Systematic Review of Controlled Trials University study is often accompanied by a decline in physical activity (PA) levels, but can offer the opportunity to promote a lifelong active lifestyle. This review summarizes controlled trials of interventions promoting PA among university students, describing the quality of the evidence, effective strategies, and deficiencies in the interventions employed, to provide directions for future research and for practical implementations. Studies from PubMed, PsychINFO, Cochrane Library, Education Source, SPORTDiscus that used randomized or non-randomized controlled trial, describing an intervention to promote PA in university students, where PA was one of the outcomes, and results were published in English were used. Data were synthetized considering study characteristics, strategies used, and outcomes. 2585 articles were identified. Twenty-seven studies met inclusion criteria. Sixteen studies reported an increase in PA levels. PA-promotion interventions should address a range of behavioral determinants. Personalized approaches and PA sessions should be considered in future studies. The high risk of bias of many studies (mainly due to attrition and poor reporting) and missing information about intervention components, limit the strength of conclusions about the most effective strategies.
Meysam Pirbaglou Joel Katz Mehras Motamed Sarah Pludwinski Krista Walker Paul Ritvo	1613	Literature Review Personal Health Coaching as a Type 2 Diabetes Mellitus Self-Management Strategy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials This article evaluates the impact of personal health coaching (PHC) programs on glycemic management and related psychological outcomes. These types of programs are increasingly utilized as a type 2 diabetes mellitus (T2DM) self-management intervention strategy. Data sources used are electronic databases (CINAHL, MEDLINE, PubMed, PsycINFO, and Web of Science). Randomized controlled trials (RCT) published between January 1990 and September 2017 and focused on the effectiveness of PHC interventions in adults with T2DM were examined using prespecified format guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework. Quantitative synthesis for primary (ie, HbA1c) and qualitative synthesis for selected psychological outcomes was performed. Meta-analyses of 22 selected publications showed PHC interventions favorably impact HbA1c levels in studies with follow-ups at: ≤3 months (−0.32% [95% confidence interval, CI = −0.55 to −0.09%]), 4 to 6 months (−0.50% [95% CI = −0.65 to −0.35%], 7 to 9 months (−0.66% [95% CI = −1.04 to −0.28%]), and 12 to 18 months (−0.24% [95% CI = −0.38 to −0.10%]). Subsequent subgroup analyses led to no conclusive patterns, except for greater magnitude of effect size in studies with conventional (2-arm) RCT design. The PHC appears effective in improving glycemic control.
Sara S. Johnson	TAHP-1627	Editor's Desk: Sleep: A Fundamental Building Block for the Health and Well-Being of Individuals and Organizations: Though sleep is often sacrificed in an effort to increase productivity, poor sleep health not only undermines that very goal, but is costly—to health and well-being; performance; safety; and profitability. This issue provides a comprehensive review of sleep health and illustrates a variety of practical strategies that can be implemented on a population basis.
Michael A. Grandner	TAHP-1629	The Cost of Sleep Lost: Implications for Health, Performance, and the Bottom Line: Sleep has been increasingly identified as a key indicator of workplace health. Population data show that unhealthy sleep is associated with weight gain and obesity, high blood pressure, high cholesterol, cardiovascular risk, diabetes, inflammation, insulin resistance, poor diet, inactivity, smoking, alcohol use, poor mental health, as well as shorter lifespan. Unhealthy sleep has also been related to sleepiness, impaired attention and decision making, suicide, and workplace outcomes such as decreased productivity, absenteeism, occupational injuries, and increased healthcare costs. This brief review summarizes some of these findings and presents some recommendations for workplace sleep health initiatives.
Joseph Ojile	TAHP-1635	Everyone Sleeps!—(Poorly) or Not Enough: Sleep as a Priority and Vital Sign: Sleep is as essential to an individual's total well-being as diet and exercise. Yet more than one-third of American adults are not getting enough sleep on a regular basis. Furthermore, awareness of the pervasiveness of sleep disorders among health care professionals and the general public is relatively low considering that an estimated 50-70 million adults in the United States chronically suffer from a sleep or circadian disorder. This article explores (1) sleep as a public health challenge, (2) common sleep disorders and treatments, and (3) how elevating sleep to a vital sign of life will move us individually and together toward true health.
Alyssa B. Schultz Wayne N. Burton	TAHP-1639	Sleep: An Integral Component of Employee Well-Being Programs: There are numerous compelling reasons for employers to address sleep, including workplace productivity and safety. Employee well-being programs intended to improve sleep have the potential to improve the quality and quantity of sleep for the majority of sleep-deprived employees.
Rebecca Robbins Girardin Jean-Louis	TAHP-1641	Sleep at Work: The Economic and Societal Argument for Workplace-Based Health Promotion Tailored to Shift Workers: Shift work is common in the US: Approximately 17% of the employed Americans work on-call, overnight, and/or rotating shifts. The data presented in this article from a sample of transportation shift workers highlight a potential critical gap in the identification and treatment of OSA and excessive daytime sleepiness that could significantly increase the risk of injury, accidents, and lost productivity. Furthermore, there is a high prevalence of hypertension that far exceeds that of the overall US population. The results of this study suggest several opportunities for future worksite health promotion programs tailored to shift workers.
Dominic Munafo Derek Loewy Karen Reuben Gary Kavy Bretton Hevener	TAHP-1644	Sleep Deprivation and the Workplace: Prevalence, Impact, and Solutions: Online cognitive behavior therapy (CBT) has been demonstrated to be an effective treatment for insomnia. Given the high prevalence of sleep deprivation in the general population and in the workforce, this article presents data on the broader application of online CBT to both insomnia and sleep deprivation.