Lisa M. Quintiliani

Work experiences and tobacco use: findings from the gear up for health study.

Objective: To examine the relationships between the work environment and amount smoked, intention to quit, and participation in a health promotion intervention. Methods: Cross-sectional data were collected from unionized truck drivers and dockworkers (N = 542; response rate = 78%) employed in eight trucking terminals as part of a larger intervention study targeting tobacco use cessation and weight management. Results: Prevalence of tobacco use was 40% (n = 216). Multivariable analyses of amount smoked and coworker norms encouraging cessation found significant associations with intention to quit and negative social consequences of tobacco use. Program participation was significantly associated with concern about job exposures, working the day shift, and intention to quit. Conclusions: Work experiences represented in the social contextual model may help explain how the work environment affects tobacco-use behaviors and interest in quitting, and maybe guide interventions among blue-collar workers.

Enhancing physical and social environments to reduce obesity among public housing residents: Rationale, trial design, and baseline data for the Healthy Families study

Intervention programs that change environments have the potential for greater population impact on obesity compared to individual-level programs. We began a cluster randomized, multi-component multi-level intervention to improve weight, diet, and physical activity among low-socioeconomic status public housing residents. Here we describe the rationale, intervention design, and baseline survey data. After approaching 12 developments, ten were randomized to intervention (n=5) or assessment-only control (n=5). All residents in intervention developments are welcome to attend any intervention component: health screenings, mobile food bus, walking groups, cooking demonstrations, and a social media campaign; all of which are facilitated by community health workers who are residents trained in health outreach. To evaluate weight and behavioral outcomes, a subgroup of female residents and their daughters age 8-15 were recruited into an evaluation cohort. In total, 211 households completed the survey (RR=46.44%). Respondents were Latino (63%), Black (24%), and had ≤ high school education (64%). Respondents reported ≤2 servings of fruits & vegetables/day (62%), visiting fast food restaurants 1+ times/week (32%), and drinking soft drinks daily or more (27%). The only difference between randomized groups was race/ethnicity, with more Black residents in the intervention vs. control group (28% vs. 19%, p=0.0146). Among low-socioeconomic status urban public housing residents, we successfully recruited and randomized families into a multi-level intervention targeting obesity. If successful, this intervention model could be adopted in other public housing developments or entities that also employ community health workers, such as food assistance programs or hospitals.

Advances in multiple health behavior change research

In the USA, national surveys have long demonstrated that adults tend to have multidimensional patterns of health behaviors (e.g., smoking, poor diet, sedentary activity, risky drinking, etc.), rather than any one of these health behaviors in isolation [1, 2]. This trend results in not only higher rates of premature mortality, but also morbidity and disability [3, 4]. In addition, this trend is not limited to adult populations, but has been shown to start in adolescence. Pronk and colleagues [5] found that less than a third of adolescents are at criteria for having a healthy weight, physical activity, diet, and not smoking. Multiple risk behaviors also have been shown to have incremental increases in disability, pharmaceutical, and overall medical costs in large worksite samples. Research has shown that by treating two behaviors effectively, an individuals medical costs decrease by approximately

Physically active, low-income African American women: an exploration of activity maintenance in the context of sociodemographic factors associated with inactivity.

2,000 per year [6]. The benefits of impacting on multiple behaviors are therefore important for a variety of reasons.

Patient Navigation to Promote Smoking Cessation among Low-Income Primary Care Patients: A Pilot Randomized Controlled Trial

Increasing physical activity among low-income African American women is an important target for addressing racial and economic disparities in chronic conditions and related risk factors. While barriers to physical activity for women have been examined empirically, successful strategies for navigating those barriers among physically active, low-income women have not been thoroughly explored. Informed by grounded theory, we conducted in-depth individual interviews between 2007–2010 with 14 low-income African American women who were physically active at nationally recommended levels for one year or more. We analyzed the data using thematic analysis techniques. Key themes emerged in three main categories: motivation for maintaining active lifestyle, strategies for maintaining physical activity, and challenges to maintaining physical activity. Important motivations included getting or staying healthy, social connections, and gratification. Two planning strategies emerged: flexibility and freedom. Critical challenges included financial constraints, physical strain and history of sedentary relapse. The motivations, strategies and challenges reported by low-income African American women who successfully maintained an active lifestyle provided important information for developing effective health promotion strategies for their inactive and underactive counterparts. A qualitative, asset-based approach to physical activity research contributes rich data to bridge the gap between epidemiological knowledge and community health improvement.

Factors across home, work, and school domains influence nutrition and physical activity behaviors of nontraditional college students.

We conducted a pilot randomized controlled trial to determine the feasibility and acceptability of a patient navigation intervention. Forty-seven smokers from one safety-net hospital were randomized to either a control group, in which they received a smoking cessation brochure and a list of smoking cessation resources, or a navigation group, in which they received the smoking cessation brochure, a list of smoking cessation resources, and patient navigation. Follow-up data were obtained for 33 participants. Nine (47.4%) of 19 of navigation group participants had engaged in smoking cessation treatment by 3 months versus 6 (42.9%) of 14 control group participants (chi-square p = ns). Patient navigation to promote engagement in smoking cessation treatment was feasible and acceptable to participants.

Society of Behavioral Medicine (SBM) position statement: SBM supports increased efforts to integrate community health workers into the patient-centered medical home

Nontraditional college students (older, part-time, and/or working) have less healthful nutrition and physical activity behaviors compared to traditional students, yet few health promotion efforts focus on nontraditional students. The purpose of this study was to use qualitative methods to explore factors affecting nutrition and physical activity behaviors of nontraditional students. Fourteen semi-structured individual interviews were conducted with nontraditional undergraduate students attending a large university. The sample had a median age of 25 (range, 21-64), 57% were men, 43% were racial/ethnic minorities, and 57% were employed (mean 22 hours/week). Data were coded using a systematic team-based approach. Consistent themes (mentioned by 4+ students) were identified and categorized into three domains: home, work, and school. Home (themes: neighborhood characteristics, family, partners), work (theme: work environment), and school (themes: cafeteria, vending machines) factors consistently influenced positive nutrition behaviors. Similarly, home (themes: neighborhood including safety, friends from home, partner,), work (theme: work environment), and school (themes: not having a car, campus structure, campus gym, friends at school) factors consistently influenced positive physical activity. Financial resources and perceptions of autonomy had influence across domains. Results indicate consistent influences on nutrition and physical activity behaviors across home, work, and school domains for nontraditional college students. Study findings suggest possible, and sometimes unconventional, intervention strategies to promote healthful eating and physical activity. For example, when cafeteria meal plans are not offered and financial constraints limit eating at the cafeteria, encouraging healthful choices from vending machines could be preferable to not eating at all.

The Impact of Student Diversity on Interest, Design, and Promotion of Web-based Tailored Nutrition and Physical Activity Programs for Community Colleges

Integrating community health workers (CHWs) into health care systems has been associated with enhanced patient experience, improved population health, and reduced costs and unnecessary utilization of resources. Under the Affordable Care Act (ACA), care provided by CHWs is eligible for reimbursement. However, optimal integration of CHWs into health care requires purposeful implementation. This health policy brief is focused on the benefits of integrating CHWs specifically into the patient-centered medical home (PCMH). CHWs in the PCMH can serve as primary providers of culturally relevant information and advocacy, assist providers in understanding the influence of patients’ environment on disease management, and enhance motivation for self-care management among patients with chronic diseases. Despite the important role of CHWs, there are some barriers to integration into existing systems of care. The Society of Behavioral Medicine (SBM) recommends overcoming these barriers by establishing standards that ensure a skilled CHW workforce, clearly defining roles for CHWs, and expanding the scope of reimbursable prevention and primary care services to include those provided by CHWs.

Effect of Patient Navigation and Financial Incentives on Smoking Cessation Among Primary Care Patients at an Urban Safety-Net Hospital: A Randomized Clinical Trial

OBJECTIVE To examine an organizational level perspective of the process of adopting Web-based tailored nutrition and physical activity programs for community college students. METHODS In this qualitative study, 21 individual key informant interviews of community college student services and health center administrators were used to examine organizational-level perceptions of interest in, design characteristics of, and ways to promote health programs. A cross-classification matrix of a priori and emergent themes related to student diversity was created to describe cross-cutting patterns. RESULTS Findings revealed 5 emergent themes for consideration in program development related to student diversity: (1) multiple roles played by students, (2) limited access to financial resources, (3) varied student demographics, (4) different levels of understanding, and (5) commuting to campus. CONCLUSIONS AND IMPLICATIONS Nutrition and physical activity programs for community colleges need to specifically address the diverse nature of their students to increase the potential of adoption.

The Strategies to Reduce Injuries and Develop Confidence in Elders Intervention: Falls Risk Factor Assessment and Management, Patient Engagement, and Nurse Co-management

Importance While the proportion of adults who smoke cigarettes has declined substantially in the past decade, socioeconomic disparities in cigarette smoking remain. Few interventions have targeted low socioeconomic status (SES) and minority smokers in primary care settings. Objective To evaluate a multicomponent intervention to promote smoking cessation among low-SES and minority smokers. Design, Setting, and Participants For this prospective, unblinded, randomized clinical trial conducted between May 1, 2015, and September 4, 2017, adults 18 years and older who spoke English, smoked 10 or more cigarettes per day in the past week, were contemplating or preparing to quit smoking, and had a primary care clinician were recruited from general internal medicine and family medicine practices at 1 large safety-net hospital in Boston, Massachusetts. Interventions Patients were randomized to a control group that received an enhancement of usual care (n = 175 participants) or to an intervention group that received up to 4 hours of patient navigation delivered over 6 months in addition to usual care, as well as financial incentives for biochemically confirmed smoking cessation at 6 and 12 months following enrollment (n = 177 participants). Main Outcomes and Measures The primary outcome determined a priori was biochemically confirmed smoking cessation at 12 months. Results Among 352 patients who were randomized (mean [SD] age, 50.0 [11.0] years; 191 women [54.3%]; 197 participants who identified as non–Hispanic black [56.0%]; 40 participants who identified as Hispanic of any race [11.4%]), all were included in the intention-to-treat analysis. At 12 months following enrollment, 21 participants [11.9%] in the navigation and incentives group, compared with 4 participants [2.3%] in the control group, had quit smoking (odds ratio, 5.8; 95% CI, 1.9-17.1; number needed to treat, 10.4; P < .001). In prespecified subgroup analyses, the intervention was particularly beneficial for older participants (19 [19.8%] vs 1 [1.0%]; P < .001), women (17 [16.8%] vs 2 [2.2%]; P < .001), participants with household yearly income of