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Paul E. Terry	1657	Editorial On Being Optimizers: Are We Health Promotion Professionals Living up to Our Potential? How do we judge whether our profession is meeting its potential when, according to time honored definitions of health promotion, we consider health to be a byproduct of culture and we deem some aspects of culture to be prerequisites to health? If our profession falls short, is it because we are not doing enough to change the world? This editorial previews a new model for health promotion called “collective well-being.” Collective well-being is less about how I cope with society to reach my potential and more about how we co-create a society that enables us all to thrive. Some argue that cultural relativism means that we should not stand in judgement of cultures but can we do this without diminishing the prime role of culture in the pursuit of happiness or our innate desire to achieve optimal experience? A professional challenge for the health promotion field is to forge routes to an optimal life where personal goals and societal aspirations are one and the same.
the Science of lifestyle change
Elizabeth A. Lundeen Sohyun Park Stephen Onufrak Solveig Cunningham Heidi M. Blanck	1661	Quantitative Research Adolescent Sugar-Sweetened Beverage Intake is Associated With Parent Intake, Not Knowledge of Health Risks This study used cross-sectional data from the 2014 SummerStyles survey to examine associations of adolescent sugar-sweetened beverage (SSB) intake with parent SSB intake and parent- and adolescent-knowledge of SSB-related health risks. Subjects included 990 parent and adolescent (12–17 y) pairs. Separate multinomial logistic regression models were used to estimate adjusted odds ratios (aOR) for adolescent SSB intake ≥1 time/d (ref: 0 times/d), according to 1) parent SSB intake, and 2) parent- and 3) adolescent-knowledge. The results showed that adolescent and parent knowledge that SSB intake was related to health conditions ranged from 60.7% to 80.4%: weight gain (75.0% and 80.4%, respectively), diabetes (60.7% and 71.4%, respectively), and dental caries (77.5% and 72.9%, respectively). In adjusted models, adolescent SSB intake ≥1 time/d was associated with parent intake ≥2 times/d (aOR=3.30; 95% CI=1.62–6.74), but not with parent or adolescent knowledge of health risks. Based on these results, the authors concluded that parental SSB intake may be an important factor in understanding adolescent behavior, and knowledge of SSB-related health conditions alone may not influence adolescent SSB behavior.
Daniel V. Gaz Thomas M. Rieck Nolan W. Peterson Jennifer A. Ferguson Darrell R. Schroeder Heather A. Dunfee Jill M. Henderzahs-Mason Philip T. Hagen	1671	Quantitative Research Determining the Validity and Accuracy of Multiple Activity Tracking Devices in Controlled and Free-Walking Conditions The study sought to evaluate commercially available activity-tracking devices for step and distance accuracy in common exercise settings. Ten (10) men and 22 women participated in the study. Researchers manually counted steps and measured distance for all trials while participants wore 6 different activity-tracking devices simultaneously, either on their hips or their wrists, that measured steps and distance. Analyses showed that both the device and walking trials (steps vs distance) affected the accuracy of the results. Hip-based devices were more accurate and consistent for measuring step count. No significant differences were found among devices or locations for the distance measured. The authors conclude that hip-based activity tracking devices varied in accuracy but performed better than their wrist-based counterparts for step accuracy. Distance measurements for both types of devices were more consistent but lacked accuracy. The implications of this work are that clinician may want to be aware of the conditions that impact device accuracy in making recommendations of devices and evaluating the data they yield. The study was limited to walking trials and did not include running trials because methodological concerns. Due to weather constraints, less than half of the study participants performed the free-walking trial outside. Physical therapists’ assessments of both walking style and arm movement showed substantial variation among participants and may influence accuracy.
Kimberly A. Watson Doris G. Gammon Brett R. Loomis Harlan R. Juster Elizabeth Anker	1679	Quantitative Research Trends in Cigarette Advertising, Price-Reducing Promotions, and Policy Compliance in New York State Licensed Tobacco Retailers, 2004 to 2015 Annual surveys of tobacco advertising from random samples of licensed tobacco retailers (LTRs) in New York State from 2004 to 2015 were analyzed to describe the presence of LTRs, cigarette advertisements, price-reducing promotions, and compliance with tobacco control policies. Measures included the presence and number of cigarette advertisements, price-reducing promotions, required age-of-sale signage, and self-service tobacco displays. The analyses involved examining differences over time for all outlets combined and stratified by outlet type. Results showed the number of LTRs decreased 22.9% from 2004 to 2015. Also, the prevalence and number of cigarette advertisements and the prevalence of cigarette price-reducing promotions decreased significantly over time. Compliance with posting age-of-sale signs increased significantly and compliance with the ban on self-service tobacco displays was consistently near 100%. The authors concluded that tobacco retail environment in New York State improved between 2004 and 2015. Since the study was conducted in New York State, generalizability is limited.
Amanda H. Wilkerson Stuart L. Usdan Adam P. Knowlden James L. Leeper David A. Birch Elizabeth E. Hibberd	1688	Quantitative Research Ecological Influences on Employees' Workplace Sedentary Behavior: A Cross-Sectional Study This article explores the relationship between ecological factors and occupational sedentary behavior (SB) with a cross-sectional online survey. Participants were employees recruited from a large, public university in the Southeastern United States from August to November 2016. The final sample included 527 employees (56% response rate). Data were collected through an 87-item survey using previously validated scales that assessed occupational SB, perceived behavioral control, barrier self-efficacy, self-regulation strategies, organizational social norms, office environment, and worksite climate. One-way analysis of variance analyses were used to determine differences in occupational SB by demographic factors. A multivariate regression model was used to determine significant ecological determinants of occupational SB. Mean SB was 342.45 (standard deviation = 133.25) minutes. Significant differences in SB were found by gender, education, and employment classification. Barrier self-efficacy and workplace connectivity, which evaluates the spatial layout of the office setting that may impact mobility within the workplace, were significant predictors of SB in the multivariate model.
Deborah G. Passey Kristen Hammerback Aaron Huff Jeffrey R. Harris Peggy A. Hannon	1697	Quantitative Research The Role of Managers in Employee Wellness Programs: A Mixed-Methods Study The role of managers is widely acknowledged in the Total Worker Health framework as a critical factor for implementing and evaluating wellness programs and policies, but there is limited evidence on how to increase managers’ support. We interviewed and surveyed executive, middle, and line managers in 4 state agencies about the barriers and facilitators to supporting their employees’ participation. We found that managers are supportive of the wellness program but face challenges with accommodating employees’ participation due to lack of training about the program, workload, scheduling inflexibility, lack of self-efficacy to discuss wellness with direct reports and lack of formal expectations. Several strategies may assist managers to support their employees’ participation in wellness programs: the provision of training, targeted messages, formal expectations, and encouragement (from the manager above) to support employees’ participation.
Jonathan M. Miller Julian Wolfson Melissa N. Laska Toben F. Nelson Mark A. Pereira	1706	Quantitative Research The Minne-Loppet Motivation Study: An Intervention to Increase Motivation for Outdoor Winter Physical Activity in Ethnically and Racially Diverse Elementary Schools This study used data on 291 students in 18 Minne-Loppet Ski Program classes and 210 students in 12 control classrooms from elementary schools in Minneapolis, Minnesota to test the effectiveness of an intervention to increase motivation for physical activity in racially diverse third- through fifth-grade students. The intervention is an 8-week curriculum in elementary schools that teaches healthy physical activity behaviors through cross-country skiing. The results showed that the Minne-Loppet program students showed significantly greater motivation to ski (β = 0.95, 95% confidence interval [CI]: 0.15 -1.75) and significantly greater perceived competence (β = 0.78, 95% CI: 0.06 -1.50) than students in control classrooms. African American students in Minne-Loppet classes showed significantly greater general exercise motivation (β = 1.08, 95% CI: 0.03-2.14) and perceived competence (β = 1.95, 95% CI: 0.91-2.99) than African American students in control classes. The authors concluded that the Minne-Loppet program promoted perceived competence and motivation to ski. Future improvements to the Minne-Loppet and similar interventions should aim to build general motivation and provide support needed to better engage all participants.
Minjie Xu Chia-Yuan Yu Chanam Lee Lawrence D. Frank	1714	Quantitative Research Single Family Housing Value Resilience of Walkable Versus Unwalkable Neighborhoods during a Market Downturn: Causal Evidence and Policy Implications Great enthusiasm has been motivated by recent literature and initiatives to promote walking and walkable neighborhoods. This study employed a natural experimental design to compare single-family (SF) home value resilience over time in walkable versus unwalkable neighborhoods during the Great Recession in Dallas, Texas. On average, the SF homes in walkable neighborhoods retained $4566 (2.08%) more on its value than their counterparts in unwalkable neighborhoods. This study aims to help planners and decision-makers by documenting the unmet demand for walkable communities and their sustained economic benefit. Increased awareness of the sustained value of walkable communities can be used by lenders who finance and policy makers who regulate placemaking. Results from this study can be integrated with research that demonstrates health-care cost savings of walkable environments to create an even more comprehensive set of evidence-based interventions to increase their supply.
Jordan A. Carlson Lawrence D. Frank Jared Ulmer Terry L. Conway Brian E. Saelens Kelli L. Cain James F. Sallis	1723	Quantitative Research Work and Home Neighborhood Design and Physical Activity This article investigates relations of perceived worksite neighborhood environments to total physical activity and active transportation, over and above home-neighborhood-built environment. It is an observational epidemiologic study conducted in Baltimore, Maryland-Washington, DC, and Seattle-King County, Washington metropolitan areas. One thousand eighty-five adults (mean age = 45.0 [10.2]; 46% women) were recruited from 32 neighborhoods stratified by high/low neighborhood income and walkability. The Neighborhood Environment Walkability Survey assessed perceptions of worksite and home neighborhood environments. Accelerometers assessed total moderate-to-vigorous physical activity (MVPA). The International Physical Activity Questionnaire assessed total active transportation and active transportation to and around work. Mixed effects regression tested relations of home and worksite neighborhood environments to each physical activity outcome, adjusted for demographics. Home and worksite mixed land use and street connectivity had the most consistent positive associations with physical activity outcomes. Worksite traffic and pedestrian safety were also associated with multiple physical activity outcomes. The worksite neighborhood explained additional variance in physical activity outcomes than explained by the home neighborhood. Worksite and home neighborhood environments interacted in explaining active transportation to work, with the greatest impacts occurring when both neighborhoods were activity supportive.
Scott P. Stumbo Bobbi Jo H. Yarborough Micah T. Yarborough Carla A. Green	1730	Qualitative Research Perspectives on Providing And Receiving Preventive Health Care From Primary Care Providers and Their Patients With Mental Illnesses The study sought to examine factors that influence the degree to which individuals with mental illness diagnoses receive differential levels of care focused on prevention of serious illness from providers. Interviews (n = 30) and surveys (n = 249) with primary care providers as well as interviews (n = 158) and surveys (n = 160) with patients diagnosed with a major mental illness were conducted. The results indicated that more than half of clinicians believed patients with mental illnesses care less about preventive care than the general population, yet 88 of patients reported interest in improving health. Most providers lacked confidence that patients with mental illnesses would follow preventive recommendations; 82% of patients reported they would try to change lifestyles if their doctor recommended. Clinicians reported that their perception of patients’ chaotic lives and lack of interest in preventive care contributed to their fatalistic attitudes on care delivery to this population. Clinicians reported providing informational support by keeping messages simple; patients reported a desire for more detailed information on reasons to complete preventive care. Patients also detailed the need for assistive and tangible support to manage behavioral health changes. The implications of the findings are that there are clinically relevant differences in perspectives between clinicians and patients about the importance of delivering and following through on preventive care with a clear need for a greater focus on clinician–patient collaboration on realistic goal setting, and increasing educational and tangible patient support services.
Patricia A. McDaniel Ruth E. Malone	1740	Qualitative Research “You Want Your Guests to Be Happy in This Business”: Hoteliers' Decisions to Adopt Voluntary Smoke-Free Guest-Room Policies The authors sought to explore the reasons that some hotels have implemented 100% smoke-free policies voluntarily, what they view as the perceived consequences of doing so, and the resulting media responses. Employing a qualitative design, including content analyses of media coverage of smoke-free hotels, 11 representatives of 5 independent and 4 chain hotels were interviewed for approximately 30 minutes each. The results indicated that the primary motivations for implementing 100% smoke-free policies were business considerations, including customer demand, competitor action, and cost savings, particularly with regard to cleaning. Health concerns played a minimal role, including concerns about employee exposure to secondhand smoke. Hotels received positive feedback from customers and employees. Media coverage was favorable emphasizing positive aspects of going smoke-free while the overall slant of news items was positive or neutral. Because hotel owners/managers knew that customer demand for smoke-free rooms was strong, most were unconcerned that going smoke-free would have a negative impact. Few hotels, however, marketed the change. Limitations include the representativeness of the sample, including the lack of hotels that considered going smoke-free but elected not to.
Scott J. Dankel Jeremy P. Loenneke Paul D. Loprinzi	1747	Interventions The Impact of Overweight/Obesity Duration and Physical Activity on Medical Multimorbidity: Examining the WATCH Paradigm The “fat-but-fit” paradigm has been evaluated. However, the duration of overweight/obesity within the “fat-but-fit” paradigm (ie, assessing body mass at more than 1 time point) has not been extensively evaluated, which was this study’s purpose.Physical activity assessed via accelerometry. Medical multimorbidity was assessed via physician diagnosis of 13 chronic diseases. Height and body mass were directly measured for current body mass index (BMI), and 10-year prior BMI was calculated using current height and self-reported weight 10 years prior. Six mutually exclusive groups were created: (1) active, normal weight now and 10 years ago; (2) inactive, normal weight now and 10 years ago; (3) active, overweight/obese now but not 10 years ago; (4) active, overweight/obese now and 10 years ago; (5) inactive, overweight/obese now but not 10 years ago; and (6) inactive, overweight/obese now and 10 years ago.
Roy F. Oman Kristen Clements-Nolle Minggen Lu Taylor Lensch	1751	Interventions An Investigation of Youth Assets and Physical Activity and BMI Using a Longitudinal Cohort Design Youth assets protect youth from many risk behaviors including substance use, violence, and early initiation of sexual intercourse and there is some evidence that youth assets are also associated with positive outcomes such as successful transition to early adulthood. The results of this study suggest that assets are also prospectively associated with an important behavior that may prevent chronic disease - participation in physical activity. Asset-based health promotion programming may help to prevent chronic disease, by increasing participation in physical activity.
Jennifer Posa Flynn Gregg Gascon Stephen Doyle Dyann M. Matson Koffman Colleen Saringer Jessica Grossmeier Valeria Tivnan Paul Terry	1755	Literature Review Supporting a Culture of Health in the Workplace: A Review of Evidence-Based Elements This paper identifies and evaluates the evidence base for culture of health elements. It uses multiple databases to systematically search to identify research studies published between 1990 and 2015. Researchers included studies based on the following criteria: (1) conducted in a worksite setting, (2) applied and evaluated one or more culture of health elements; (3) reported one or more health or safety factors. Eleven researchers screened the identified studies with abstraction conducted by a primary and secondary reviewer. Of the 1,023 articles identified, 10 research reviews and 95 standard studies were eligible and abstracted. Data synthesis focused on research approach, design, and culture of health elements evaluated. The majority of published studies reviewed were identified as quantitative studies (62), whereas fewer were qualitative (27), research reviews (10) or other study approaches. Three of the most frequently studied elements were built environment (25), policies and procedures (28), and communications (27). Although all studies included a health or safety factor, not all reported a statistically significant outcome.
Deborah G. Passey Meagan C. Brown Kristen Hammerback Jeffrey R. Harris Peggy A. Hannon	1789	Literature Review Managers' Support for Employee Wellness Programs: An Integrative Review This literature review synthesized evidence regarding managers’ support for employee wellness programs. The final sample included 21 articles for analysis that were independently rated per the quality of the articles. Researchers synthesized data into a summary table by study design, sample, data collected, key findings, and quality rating. This reviews shows that factors that may influence managers’ support include their organization’s management structure, senior leadership support, their expected roles, training on health topics, and their beliefs and attitudes toward wellness programs and employee health. Managers’ support may influence the organizational culture, employees’ perception of support, and employee behaviors, so interventions need to include explicit measures of managers’ support as part of the evaluation plan.
Brita Roy Carley Riley Lindsay Sears Elizabeth Y. Rula	1800	Literature Review Collective Well-Being to Improve Population Health Outcomes: An Actionable Conceptual Model and Review of the Literature We introduce a novel, comprehensive, theory-driven, actionable model centered around a multidimensional, holistic construct of the health of a group or community—collective well-being—and demonstrate how community policies, programs, and cultural factors influence collective well-being and its impact on downstream health outcomes. We define 5 domains of collective well-being: vitality, opportunity, connectedness, contribution, and inspiration. We highlight environmental, psychosocial, systems and institutional, and economic characteristics of a community that influence collective well-being as well as the policy and social levers for creating community change in these community characteristics.The presented model provides a common framework for action with a focus on high-impact areas for well-being improvement initiatives and for practice and measurement that can lead to the greatest collective impact on health outcomes.
Jessica Grossmeier	TAHP-1814	Editor’s Desk: Addressing Subcultures: This issue of TAHP examines the role of subcultures in wellness initiatives, including a proposed definition of subcultures, how to identify and measure them, and case studies demonstrating how organizations are addressing subculture differences.
Judd Allen	TAHP-1815	The Role of Subcultures in Wellness Initiatives: This commentary defines subcultures, discusses why they are important, outlines approaches to measurement, and suggests strategies for fostering wellness subcultures.
Mary Marzec	TAHP-1817	Measuring Subcultures and Leveraging Data to Optimize Well-being Initiatives: This article discusses the need for and approaches to measurement of organizational subcultures. Suggestions are offered for identification of subcultures and a case example demonstrates how one organization used a culture assessment tool to tailor a broader health and well-being initiative to subculture needs.
Mary Marzec Nathan Barleen	TAHP-1820	Why Variety Matters for Well-being Offerings: This analysis examines the role of individual characteristics on health and well-being program preferences, offering insights into how demographic information can be used in combination with other types of data to develop strategies to meet subculture needs.
Richard Safeer Wendy Bowen	TAHP-1821	Creating a Culture of Health at Johns Hopkins Medicine: This article describes the processes enacted within entity, job responsibility, team, and peer subcultures to create a sustainable culture of health, along with a description of Johns Hopkins Medicine measurement strategies.
Megan Amaya Lauren Battista Bernadette Melnyk	TAHP-1823	The Ohio State University’s Strategic Approach to Improving Total Population Health: There are a myriad of subcultures at The Ohio State University, and one of the strategies used to meet subculture needs among faculty and staff is the Buckeye Wellness Innovator (BWI) program. This article describes the features of the BWI program and how it fosters peer support, employee engagement in initiatives, and outcomes measurement.