Michelle M. Yore

Cost Effectiveness of Community-Based Physical Activity Interventions

BACKGROUND Physical inactivity is associated with the increased risk of many chronic diseases. Such risks decrease with increases in physical activity. This study assessed the cost-effectiveness of population-wide strategies to promote physical activity in adults and followed disease incidence over a lifetime. METHODS A lifetime cost-effectiveness analysis from a societal perspective was conducted to estimate the costs, health gains, and cost-effectiveness (dollars per quality-adjusted life year [QALY] gained, relative to no intervention) of seven public health interventions to promote physical activity in a simulated cohort of healthy U.S. adults stratified by age, gender, and physical activity level. Interventions exemplifying each of four strategies strongly recommended by the Task Force on Community Preventive Services were evaluated: community-wide campaigns, individually adapted health behavior change, community social-support interventions, and the creation of or enhanced access to physical activity information and opportunities. Each intervention was compared to a no-intervention alternative. A systematic review of disease burden by physical activity status was used to assess the relative risk of five diseases (coronary heart disease, ischemic stroke, type 2 diabetes, breast cancer, and colorectal cancer) across a spectrum of physical activity levels. Other data were obtained from clinical trials, population-based surveys, and other published literature. RESULTS Cost-effectiveness ratios ranged between

Increasing Stair Use in a Worksite Through Environmental Changes

14,000 and

Active transportation to school : Findings from a national survey

69,000 per QALY gained, relative to no intervention. Results were sensitive to intervention-related costs and effect size. CONCLUSIONS All of the evaluated physical activity interventions appeared to reduce disease incidence, to be cost-effective, and--compared with other well-accepted preventive strategies--to offer good value for money. The results support using any of the seven evaluated interventions as part of public health efforts to promote physical activity.

Self-reported risk-taking behaviors and hospitalization for motor vehicle injury among active duty army personnel

Purpose. This study assessed the impact on stair use of four sequential environmental interventions: (1) installing new carpet and painting the walls, (2) adding framed artwork on stair landings, (3) displaying motivational signs throughout the building, and (4) adding a stereo system and playing various types of music in the stairwell. Methods. We conducted a longitudinal study with no comparison group to evaluate the impact of environmental changes on stairway use. The setting was the main stairwell in the Centers for Disease Control and Preventions (CDC) Rhodes Building in Atlanta, Georgia. Proximity sensors were installed in each stairwell entry to monitor traffic. The subjects were 554 permanent CDC employees and 110 temporary employees. Changes in stairwell use by intervention were evaluated. Results. Both motivational signs and music significantly increased stair use by 8.9% over baseline (p < .05). The increase in sign use occurred in the first 3 months of the intervention, whereas the increase in music occurred after the first 3 months. Discussion. These data suggest that physical improvements to a stairwell, signage that encourages stair use, and music may increase physical activity among building occupants.

5196 Mandible Fractures Among 4381 Active Duty Army Soldiers, 1980 to 1998†

This article reports on a survey of active transportation to school, focusing on the bicycling or walking to school habits of a national sample of boys and girls in grades 4-12 (n = 1,395 parent-child pairs). The interviewers asked each parent and a randomly selected child from the same household about patterns of physical activity and characteristics thought to predict such activity. Overall, 14% of children and adolescents reported active transportation to school (ATS). ATS ws more frequent among boys (16.6%) than girls (11.1%) and among children in lower than upper grades: 20.5% in grades 4-6, 12.4% in grades 7-9, and 8.0% in grades 10-12. Hispanic race/ethnicity, living with one parent, and perceiving a safe neighborhood were associated with ATS in the unadjusted but not the adjusted logistic model. After adjustment, several characteristics remained independently associated with ATS, including gender, grade level, living in a suburb or small town, parent not currently married, moderate physical activity of the child, perception of being too overweight to do physical activities, and presence of neighborhood sidewalks. The authors conclude that the most modifiable characteristic associated with ATS is the presence of neighborhood sidewalks.

Is participation in occupational physical activity associated with lifestyle physical activity levels

BACKGROUND Motor vehicle crashes are a leading cause of injury in the Army. Behaviors increasing risk for motor vehicle crashes are also prevalent, but research has not linked these behaviors directly to injury outcomes (e.g., hospitalizations). METHODS To evaluate the relationship between behavior and motor vehicle crash injuries, 99, 981 Army personnel who completed Health Risk Appraisal surveys in 1992 were followed for up to 6 years. Cox proportional hazards modeling was used to evaluate speeding, seat belt use, drinking patterns, and demographics. RESULTS A total of 429 soldiers were hospitalized for motor vehicle injury. Unadjusted analyses revealed that heavy drinking, drinking and driving, speeding, low seat belt use, younger age, minority race/ethnicity, and enlisted rank were significantly associated with motor vehicle injury, but neither smoking nor gender was. Multivariate models showed a significant trend of increasing injury risk with younger ages. Soldiers under age 21 were injured almost five times more often than those over age 40 (HR 4.89, 2.56-9.33). Also associated with risk for hospitalizations were minority race (HR 1.78, 1.46-2.18), heaviest drinkers versus abstainers (HR 1.81, 1.11-2.94), and seat belt use of 50% or less versus 100% (HR 1.40, 1.07-1.85). Although nonsignificant, there was evidence of an age-drinking interaction where the difference in injury risk between those older and those younger than 21 was greatest at low alcohol consumption levels. CONCLUSIONS Modifiable risk factors associated with motor vehicle injuries include heavy drinking and low seat belt use. Programs targeting these behaviors that meet the needs of young and minority soldiers are needed. The high density of young, at-risk soldiers residing in base housing may provide a unique opportunity for a residential intervention program.

Take Pride in America's Health: Volunteering as a Gateway to Physical Activity

Objective We present the frequencies of various types of mandibular fractures along with associated mechanisms and injuries.

Motor vehicle fatalities among men in the U.S. Army from 1980 to 1997.

Objective: Little is known about the prevalence of lifestyle physical activity (PA) by occupational PA (mostly sitting, walking, or heavy labor). Methods: Descriptive and adjusted multivariable logistic regression analysis of lifestyle PA (regularly active, irregularly active, inactive) and occupational activity was used (N = 6,360). Results: The prevalence of regular lifestyle activity was 45.7% among those who sit/stand, 49.6% among walkers, and 59.7% among heavy laborers. The regression analysis showed that adults working in heavy labor were almost twice as likely to be regularly active as those who sit/stand. Conclusion: Contrary to expectation, adults who engage in physically demanding work appear to be more active outside the job. Those who are sedentary at work could benefit from having access to opportunities for PA during the workday and trying to engage in activity outside of work hours.

Progress toward attainment of the Healthy People 2000 objectives in the U.S. Army: Measured by health risk appraisal results

Abstract The authors discuss the role that volunteer programs may play in increasing levels of physical activity. In some cases volunteer programs may simultaneously improve individual health, benefit the environment and increase the publics opportunities for physical activity. From a survey of 2,032 respondents, results suggest that volunteers are more likely to meet physical activity recommendations than non-volunteers. Moreover, those who volunteer on environmental issues are 2.6 times as likely to meet physical activity recommendations as those who do not volunteer for these issues. Policies that support volunteer opportunities involving environmental projects such as maintaining trails, planting trees and cleaning parks, may be important for individual fitness because of their potential for high levels of physical activity. Volunteer activities that produce personal health benefits fit well within the actions of a comprehensive health promotion effort and health educators are well positioned to partner with volunteer programs. Moreover, this promising practice serves as an opportunity for health educators to be effective consumers of health promotion research. Health educators are encouraged to seek partnership opportunities on future studies to clarify the role that volunteer programs requiring physical activity may play in promoting or maintaining health.

Physical activity levels and weight control status by body mass index, among adults - National Health and Nutrition Examination Survey 1999-2004

This retrospective cohort study compared trends in motor vehicle occupant fatalities among men in the Army with men in the civilian U.S. population. Motor vehicle fatality rates from 1980 to 1997 indicated both groups showed declines in fatality rates. The overall age-adjusted motor vehicle fatality rate for 17- to 44-year-old males in the Army fell from 40.8 to 20.6 per 100,000, a 49.5% decline. In the U.S. population, the rate dropped from 38.1 to 23.3 per 100,000 for a 38.8% decline. Deaths from motor vehicle crashes fell by almost 50% in the Army during the study period; however, motor vehicle crashes remain the leading cause of death for the Army. U.S. military policies and law enforcement have the potential to make even further gains in reducing motor vehicle crashes and injuries among military personnel.