Evaluating Workforce Mental Health and Well-Being: A Review of Assessments

OBJECTIVE

Given the importance of mental health and well-being assessments to employers' efforts to optimize employee health and well-being, this paper reviews mental health assessments that have utility in the workplace.

DATA SOURCE

A review of publicly available mental health and well-being assessments was conducted with a primary focus on burnout, general mental health and well-being, loneliness, psychological safety, resilience, and stress.

INCLUSION CRITERIA

Assessments had to be validated for adult populations; available in English as a stand-alone tool; have utility in an employer setting; and not have a primary purpose of diagnosing a mental health condition.

DATA EXTRACTION

All assessments were reviewed by a minimum of two expert reviewers to document number of questions, subscales, fee structure, international use, translations available, scoring/reporting, respondent (ie, employee or organization), and the target of the assessment (ie, mental health domain and organizational or individual level assessments.

DATA SYNTHESIS & RESULTS

Sixty-six assessments across the six focus areas met inclusion criteria, enabling employers to select assessments that meet their self-identified measurement needs.

CONCLUSION

This review provides employers with resources that can help them understand their workforce's mental health and well-being status across multiple domains, which can serve as a needs assessment, facilitate strategic planning of mental health and well-being initiatives, and optimize evaluation efforts.

Don't Say "Beans" When Promoting Plant Protein to Family Meal Planners

PURPOSE

To identify "headlines" that would engage recipients to consider plant protein over red meat.

DESIGN

Mail and web survey.

SETTING

Urban Minnesota community.

SUBJECTS

144 survey respondents from our health plan and community program distribution lists who live with at least 1 other person and eat meat.

INTERVENTION

We asked respondents how likely they would be to click on each of 24 headlines with a motivator (eating plant protein for health vs for environmental reasons) and a barrier (family preferences, knowledge about plant proteins, or cooking skills). 16 headlines contained the word "beans".

MEASURES

We created categorical variables for each headline construct: (1) motivator, (2) barrier, and (3) reference to beans. Using a mixed model with random effects, we compared, for each construct, respondents' self-reported likelihood to click on a headline.

RESULTS

Health-related headlines performed significantly better than environmental headlines (P = .0019, 95% CI .01, .11). Family-oriented headlines performed slightly better than skills-oriented (P = .0927, 95% CI -.01, .11) and knowledge-oriented (P = .0960, 95% CI -.01, .11) headlines. Headlines containing the word "beans" performed significantly worse than those not containing "beans" (P < .0001, 95% CI -.22, -.12).

CONCLUSIONS

The population represented by our survey respondents report being most likely to click on headlines that emphasize health and family. They report they are significantly less likely to click on headlines that promote beans.

Implementing Promising Strategies to Reduce the Risk for Viral Hepatitis and Liver Cancer Among People Who Inject Drugs

PURPOSE

To describe a 3-year demonstration project with selected Centers for Disease Control and Prevention National Comprehensive Cancer Control Program (NCCCP) award recipients to build partnerships with local organizations to improve knowledge and awareness of the association between injecting drugs and the risk for viral hepatitis and liver cancer, improve delivery of viral hepatitis services, and implement comprehensive syringe services programs.

DESIGN

A mixed-methods descriptive evaluation of selected evidence-based interventions or promising strategies that each award recipient implemented based on the needs of their population.

SETTING

Selected provider and patient populations served by NCCCP award recipients in Iowa, Minnesota (American Indian Cancer Foundation), Mississippi, and West Virginia.

SUBJECTS

Four award recipients that implemented individually-tailored strategies and activities.

MEASURES

Processes were assessed through monitoring and tracking tools. Challenges, lessons learned, and recommendations were collected via qualitative interviews.

ANALYSIS

We used descriptive statistics to analyze quantitative data. We analyzed award recipient interviews using thematic analysis.

RESULTS

Activities were implemented across four strategies. Strong public-private partnerships, ongoing technical assistance, a deep understanding of individual populations, and a shared commitment to remaining flexible were main factors.

CONCLUSION

While challenges existed, award recipients implemented key strategies and activities in their populations. Findings contribute to the scaling of best practices to the larger cancer control community especially those whose populations are at higher risk for viral hepatitis.

Quantifying Value of Worksite Well-Being Programs With a Health Equity Lens: It's Time to Raise the Bar

Calls to address workforce health inequities have been met with expanded well-being programming, without an assessment of programming relevance or evaluation of equity-related outcomes. The goal of this commentary is to summarize current practices and gaps in evaluation of well-being programs, provide evidence supporting the need for broader participation in well-being offerings, and make recommendations to incorporate health equity measures into planning and evaluation efforts conducted by both employers and vendors. Data sharing, expanded measurement, more rigorous evaluation methods, and alignment of goals are some of the recommendations to better address health inequities and differential participation among employees.

Characterizing Responses to COVID-19 Vaccine Promotion on TikTok

PURPOSE

The Alabama Department of Public Health (ADPH) sponsored a TikTok contest to improve vaccination rates among young people. This analysis sought to advance understanding of COVID-19 vaccine perceptions among ADPH contestants and TikTok commenters.

APPROACH

This exploratory content analysis characterized sentiment and imagery in the TikTok videos and comments. Videos were coded by two reviewers and engagement metrics were collected for each video.

SETTING

Publicly available TikTok videos entered into ADPH's contest with the hashtags #getvaccinatedAL and #ADPH between July 16 - August 6, 2021.

PARTICIPANTS

ADPH contestants (n = 44) and TikTok comments (n = 502).

METHOD

A content analysis was conducted; videos were coded by two reviewers and engagement metrics was collected for each video (e.g., reason for vaccination, content, type of vaccination received). Video comments were analyzed using VADER, a lexicon and rule-based sentiment analysis tool).

RESULTS

Of 44 videos tagged with #getvaccinatedAL and #ADPH, 37 were related to the contest. Of the 37 videos, most cited family/friends and civic duty as their reason to get the COVID-19 vaccine. Videos were shared an average of 9 times and viewed 977 times. 70% of videos had comments, ranging from 0-61 (mean 44). Words used most in positively coded comments included, "beautiful," "smiling face emoji with 3 hearts," "masks," and "good.;" whereas words used most in negatively coded comments included "baby," "me," "chips," and "cold."

CONCLUSION

Understanding COVID-19 vaccine sentiment expressed on social media platforms like TikTok can be a powerful tool and resource for public health messaging.

Reliability and Validity of the American Heart Association's Workplace Health Achievement Index

OBJECTIVE

To test the validity and reliability of the American Heart Association's (AHA) updated Workplace Health Achievement Index (WHAI).

METHODS

We piloted the updated WHAI with respondent pairs at 94 organizations, and examined the inter-rater reliability (percent agreement) for each item on the survey. To evaluate face and content validity, we conducted preliminary focus groups pre-survey, and follow-up cognitive interviews post-survey administration.

RESULTS

Respondents found the updated WHAI to be comprehensive and useful in identifying gaps and opportunities for improving their health and wellbeing programs. The mean percent agreement on all items was 73.1%. Only 9% (or 14 items out of 146) had poor inter-rater reliability (below 61 percent agreement), but through follow-up cognitive interviews we determined that most were due to artifacts of the study design or were resolved through minor revisions to the survey question, instructions, and/or adding examples for clarity. Only 1 question was deleted due to lack of relevance.

CONCLUSION

The updated WHAI is a valid and reliable tool for employers to assess how well they promote the health and wellbeing of their employees.

The Neighborhood Environment and Hispanic/Latino Health

PURPOSE

Hispanic/Latino adults on the Texas-Mexico border have high rates of chronic disease. Neighborhoods can influence health, though there is a limited research on neighborhood environment and health in Hispanics/Latinos. The purpose of this study was to assess the relation of neighborhood environment with health variables in Hispanic/Latino adults, including physical activity [PA], depression, anxiety, and lab-assessed conditions (type 2 diabetes, metabolic syndrome, and chronic inflammation).

METHODS

Participants were randomly-selected from a Hispanic/Latino cohort on the Texas-Mexico border. Neighborhood environment, self-reported PA, anxiety, and depression were assessed through questionnaires. Laboratory values determined Type 2 diabetes, metabolic syndrome, and C-reactive protein (CRP). We conducted multivariable linear and logistic regression analyses to assess the associations of neighborhood environment and health variables, controlling for covariates.

RESULTS

Participants (n = 495) were mostly females, without insurance. After controlling for covariates, crime (Adjusted Odds Ratio [AOR] = 1.59 (95%CI 1.06-2.38), no streetlights (AOR = 1.65, 95%CI 1.06-2.57), and traffic (AOR = 1.74, 95%CI 1.16-2.62) were all significantly associated with anxiety. Only traffic was significantly associated with depression (AOR = 1.61, 95%CI1.05-2.47). A lack of nearby shops (AOR = 0.57, 95%CI 0.38-0.84) and no one out doing PA (AOR = 0.53, 95% CI 0.34-0.83) were both significantly associated with lower odds of meeting PA guidelines. A lack of nearby shops was associated with a 26% increase in the CRP value (β = 0.26, 95%CI 0.04-0.47).

DISCUSSION

Several neighborhood environment variables were significantly associated with mental health, PA and CRP, though estimates were small. The neighborhood environment is a meaningful contextual variable to consider for health-related interventions in Hispanic/Latino adults, though more study is needed regarding the magnitude of the estimates.

TRIAL REGISTRATION

NCT01168765.

Integrating Workforce Health Into Employer Diversity, Equity and Inclusion Efforts

Our collective experience with COVID-19 and Black Lives Matter has heightened awareness of deeply embedded racial and socioeconomic disparities in American businesses. This time, perhaps, sustained change is within reach. As organizations advance diversity, equity and inclusion (DEI) initiatives, an often overlooked focus of is the health status of employees and their families, where equitable access to high-value health benefits offerings should be available to all. This commentary provides guidance for employers to expand their DEI initiatives to include employee and family health and well-being as a central outcome measure. Employers should ensure that DEI efforts incorporate equitable benefits design, and objectively assess benefit design impact on healthcare utilization and cost. Additionally, employers must appreciate the workplace as a significant determinant of health-for lower income workers, in particular-with review of policies and practices to mitigate any discriminatory negative health or well-being impact. Further, race and ethnicity data should be incorporated in health benefits data analysis to understand more clearly the differential outcomes of health management offerings on these different sub-populations. Finally, social needs data should be incorporated into strategic benefits planning to better understand gaps and opportunities to foster greater benefits equity. The provided recommendations can support employer goals of achieving greater equity and value in workforce health, measurably contributing to business success.

Community Program Activities Predict Local Tobacco Policy Adoption in Florida Counties

The Bureau of Tobacco Free Florida's community program funds county-level grantees who promote local policy change through activities that educate the public, policy-makers, and decision-makers. There is robust literature linking tobacco control policies such as smoke-free air laws and tax increases to reductions in tobacco use. There is less evidence documenting the local activities programs conduct to achieve local policy change. In the current study, we used a quantitative model to assess the relationship between community tobacco control activities and local tobacco policy adoption. Grantee activities and policy adoption for each county are recorded in a database. To evaluate the community program, we compiled inputs and used a fixed-effects negative binomial regression to examine the relationship between grantee activities and policy adoption across all 67 community-based programs in Florida from 2010 to 2017 and analyzed the data in 2018. Measures included categories of policies (organization policies and jurisdiction policies) and community-based activities associated with tobacco control programs. Organization policy (school and business policy) and jurisdiction policy (county or city ordinances, proclamations, and resolutions) were dependent on partner meetings (incident rate ratio [IRR] = 1.03, confidence interval [CI] = 1.00-1.07 and IRR = 1.04, CI = 1.01-1.07, respectively) and local decision-maker communication (IRR = 1.01, CI = 1.00-1.03 and IRR = 1.05, CI = 1.03-1.07, respectively). Jurisdiction policy was also dependent on media advocacy (IRR = 1.07, CI = 1.02-1.12) and state policy-maker education (IRR = 1.16, CI = 1.06-1.26. Community outreach was negatively associated with jurisdiction policy (IRR = 0.97, CI = 0.94-0.99), and data collection was negatively associated with organization and jurisdiction policy (IRR = 0.97, CI = 0.95-1.00 and IRR = 0.97, CI = 0.95-1.00, respectively). Results from the study demonstrate that the type and timing of community grantee activities may influence local tobacco control policy adoption.

Socioenvironmental Risk Factors for Adolescent Marijuana Use in a United States-Mexico Border Community

PURPOSE

We examined how socioenvironmental risk factors unique to the United States-Mexico border, defined as border community and immigration stress, normalization of drug trafficking, and perceived disordered neighborhood stress, contribute to tobacco, alcohol, and marijuana use among adolescents residing there.

DESIGN

Cross-sectional design.

SETTING

The study was conducted at a high school on the United States-Mexico border.

SUBJECTS

A sample of 445 primarily Hispanic students (ages 14-18).

MEASURE

Perceived Disordered Neighborhood Stress Scale, Border Community and Immigration Stress Scale, and Normalization of Drug Trafficking Scale.

ANALYSIS

Logistic regression assessed the association between the socioenvironmental risk factors and past 30-day tobacco, alcohol, and marijuana use.

RESULTS

Participants with higher border community and immigration stress scores were significantly more likely to have used tobacco (adjusted odds ratio [aOR] = 1.41, P < .01) and alcohol (aOR = 1.31, P < .01) in the past 30 days. Perceived disordered neighborhood stress also was associated with past 30-day alcohol use (aOR = 1.46, P < .00). The normalization of drug trafficking was associated with past 30-day marijuana use (aOR = 1.45, P < .05).

CONCLUSIONS

Public health practitioners, educational institutions, and policy makers should consider the economic and normative environment of the United States-Mexico border for future substance use prevention and risk reduction efforts targeting border adolescents.

Implementation of Healthy Eating Interventions in Center-Based Childcare: The Selection, Application, and Reporting of Theories, Models, and Frameworks

PURPOSE

To explore the selection, use, and reporting of theories, models, and frameworks (TMFs) in implementation studies that promoted healthy eating in center-based childcare.

DATA SOURCE

We searched 11 databases for articles published between January 1990 and October 2018. We also conducted a hand search of studies and consulted subject matter experts.

STUDY INCLUSION AND EXCLUSION CRITERIA

We included studies in center-based settings for preschoolers that addressed the development, delivery, or evaluation of interventions or implementation strategies related to healthy eating and related subjects and that explicitly used TMF. Exclusion criteria include not peer reviewed or abstracts and not in English, French, German, and Korean.

DATA EXTRACTION

The first author extracted the data using extraction forms. A second reviewer verified data extraction.

DATA SYNTHESIS

Direct content analysis and narrative synthesis.

RESULTS

We identified 8222 references. We retained 38 studies. Study designs included quasi-experimental, randomized controlled trials, surveys, case studies, and others. The criteria used most often for selecting TMFs were description of a change process (n = 12; 23%) or process guidance (n = 8; 15%). Theories, models, and frameworks used targeted different socioecological levels and purposes. The application of TMF constructs (e.g., factors, steps, outcomes) was reported 69% (n = 34) of times.

CONCLUSION

Reliance on TMFs focused on individual-level, poor TMF selection, and application and reporting for the development of implementation strategies could limit TMF utility.

Tracking Changes in US Organizations' Workplace Health Promotion Initiatives: A Longitudinal Analysis of Performance Against Quality Benchmarks

PURPOSE

To examine changes in organizations' workplace health promotion (WHP) initiatives over time associated with repeated self-assessment using the Well Workplace Checklist (WWC).

DESIGN

Well Workplace Checklist data include a convenience sample of US organizations that selected to assess their performance against quality WHP benchmarks.

SETTING

Workplaces.

SUBJECTS

In total, 577 US organizations completed the WWC in 2 or more years from 2008 to 2015.

MEASURES

The WWC is a 100-item organizational assessment that measures performance against the original set of quality benchmarks that were established by the Wellness Council of America (WELCOA).

ANALYSIS

This study examined changes in overall WWC scores as well as 7 separate benchmark scores. Multilevel modeling was used to examine changes in scores associated with repeated assessments, controlling for the year of assessment and organizational characteristics.

RESULTS

There were significant increases in overall WWC scores (β = 2.93, P < .001) associated with the repeated WWC assessments, after controlling for organizational characteristics. All 7 benchmark scores had significant increases associated with reassessment. Compared to other benchmarks, operating plan (β = 6.18, P < .001) and evaluation (β = 4.91, P < .001) scores increased more with each reassessment.

CONCLUSION

Continued reassessment may represent more commitment to and investment in WHP initiatives which could lead to improved quality. Other factors that may positively influence changes in performance against benchmarks include company size, access to outside resources for WHP, and a history with implementing WHP.

Step It Up! Prioritization of Community Supports for Walking Among US Adults

PURPOSE

Step It Up! The Surgeon General's Call to Action to Promote Walking and Walkable Communities (Call to Action) presents goals and supporting strategies to promote walking. We assessed the presence and prioritization of 4 community supports for walking related to the goals of the Call to Action from the perspective of US adults.

DESIGN

Cross-sectional web-based survey.

SETTING

US adults.

PARTICIPANTS

A total of 4043 respondents.

MEASURES

SummerStyles 2016 survey assessing the reported presence and prioritization of 4 community supports for walking.

ANALYSIS

Estimated prevalence of the presence of supports overall and by demographic characteristics, and prevalence and adjusted prevalence ratios of their prioritization.

RESULTS

The most commonly reported community supports for walking were access to walkable locations (46.5%) and safe streets (29.2%), followed by walking groups (12.9%) and promotional campaigns (9.6%). Access to walkable locations (60.0%) and safe streets (50.6%) were most often prioritized by respondents, followed by promotional campaigns (23.6%) and walking groups (18.8%). Many differences in prioritization by demographic characteristics remained significant after adjusting for presence and other demographic characteristics, such as increased prioritization of all supports with older age groups.

CONCLUSIONS

Presence and prioritization of community supports for walking varied widely by type of support and by demographic characteristics. Opportunities exist to improve access and public sentiment related to these supports to promote walking in the United States.

Measuring Participation in Employer-Sponsored Health and Well-Being Programs: A Participation Index and Its Association With Health Risk Change

PURPOSE

To develop an index of participation in workplace health and well-being programs and assess its relationship with health risk status.

DESIGN

Study design comprised a retrospective longitudinal analysis of employee health risk assessment (HRA) and program participation data.

SETTING

Data from 6 companies that implemented health and well-being programs from 2014 to 2016.

PARTICIPANTS

Employee participants (n = 95 318) from 6 companies who completed an HRA in 2014 to 2016. After matching those who completed the HRA in all 3 years, the longitudinal file included 38 789 respondents.

MEASURES

Participation indicators were created for 9 different program components. The sum of these 9 components established the total participation index.

ANALYSIS

Descriptive and correlation analyses were conducted on all participation measures. Repeated-measures analysis of variance was used to assess the impact of participation level on health risk over time.

RESULTS

Higher levels of participation were associated with a greater reduction in risks, with each participation dose yielding a reduction of 0.038 risks (P < .001).

CONCLUSION

Results suggest that employees who participate more in workplace health and well-being programs experience more health risk improvement. The study also supports a more granular definition of participation based on the number of interactions and type of program.

Condom Availability Programs in Schools: A Review of the Literature

OBJECTIVE

This review synthesizes findings from the peer-reviewed evaluation literature on condom availability programs (CAPs) in secondary schools.

DATA SOURCE

Peer-reviewed evaluation literature indexed in MEDLINE, EMBASE, PsychINFO, ERIC, CINAHL, Sociological Abstracts, SCOPUS, and POPLINE.

STUDY INCLUSION AND EXCLUSION CRITERIA

Manuscripts had to be, written in English, and report evaluation data from a US school-based CAP.

DATA EXTRACTION

Articles were coded independently by 2 authors. Discrepancies were resolved through open discussion.

DATA SYNTHESIS

We grouped findings into outcome evaluation and process evaluation findings. Outcome evaluation findings included sexually transmitted infections (STIs), pregnancy rates, condom use, contraception use, sexual risk, and substance use. Process evaluation findings included awareness of CAPs, attitudes toward CAPs, attitudes toward condoms, and receipt of education and instruction.

RESULTS

Of the 138 citations reviewed, 12 articles published between 1995 and 2012 met the inclusion criteria, representing 8 programs. Evaluations indicate CAPs yield condom acquisition rates between 23% and 48%, have mixed results related to condom use, and are not associated with increases in sexual and other risk behaviors. One program found CAPs were associated with a decrease in a combined rate of chlamydia and gonorrhea. One program found no association between CAPs and unintended pregnancy. Students' attitudes toward CAPs were favorable and awareness was high.

CONCLUSIONS

Condom availability programs are accepted by students and can be an appropriate and relevant school-based intervention for teens. Condom availability programs can increase condom use, but more evaluations are needed on CAP impact on rates of HIV, STIs, and unintended pregnancy.

Evaluation of a Worksite-Based Small Group Team Challenge to Increase Physical Activity

PURPOSE

To investigate whether participants in a small group team challenge had greater completion rates in an institution-wide step-challenge than other participants.

DESIGN

A quasi-experimental, posttest-only design with a comparison group was used to evaluate group differences in completion rates.

SETTING

A large university system provided the opportunity to participate in a physical activity challenge.

PARTICIPANTS

The study was limited to employees who participated in the physical activity challenge.

INTERVENTION

Two institutions offered participants the chance to compete as smaller groups of teams within their institution. These team-challenge participants (N = 414) were compared to participants from the same institutions that did not sign up for a team and tracked their steps individually (N = 1454).

MEASURES

Participants who reported 50 000 steps per week for 5 of the 6 weeks were classified as challenge completers. We also evaluated total step count and controlled for several potential covariates including age, gender, and body mass index.

ANALYSIS

Logistic regression was used to model the dichotomous outcome of challenge completion.

RESULTS

Team-challenge participants were more likely to complete the physical activity challenge than other participants. Team-challenge participants had 1922 more steps per day than individual participants. However, at an institution level, overall completion rates were not higher at institutions that offered a team challenge.

Qualitative Assessment of Smoke-Free Policy Implementation in Low-Income Housing: Enhancing Resident Compliance

PURPOSE

As public housing agencies and other low-income housing providers adopt smoke-free policies, data are needed to inform implementation approaches that support compliance.

DESIGN

Focused ethnography used including qualitative interviews with staff, focus groups with residents, and property observations.

SETTING

Four low-income housing properties in Massachusetts, 12 months postpolicy adoption.

PARTICIPANTS

Individual interviews (n = 17) with property staff (managers, resident service coordinators, maintenance, security, and administrators) and focus groups with resident smokers (n = 28) and nonsmokers (n = 47).

MEASURES

Informed by the social-ecological model: intrapersonal, interpersonal, organizational, and community factors relating to compliance were assessed.

ANALYSIS

Utilized MAXQDA in a theory-driven immersion/crystallization analytic process with cycles of raw data examination and pattern identification until no new themes emerged.

RESULTS

Self-reported secondhand smoke exposure (SHSe) was reduced but not eliminated. Challenges included relying on ambivalent maintenance staff and residents to report violations, staff serving as both enforcers and smoking cessation counsellors, and inability to enforce on nights and weekends. Erroneous knowledge of the policy, perception that SHSe is not harmful to neighbors, as well as believing that smokers were losing their autonomy and being unfairly singled out when other resident violations were being unaddressed, hindered policy acceptance among resident smokers. The greatest challenge to compliance was the lack of allowable outdoor smoking areas that may have reduced the burden of the policy on smokers.

CONCLUSION

Smoke-free policy implementation to support compliance could be enhanced with information about SHSe for smokers and nonsmokers, cessation support from external community partners, discussion forums for maintenance staff, resident inclusion in decision-making, and framing the policy as part of a broader wellness initiative.

The Impact of a Policy-Based Multicomponent Nutrition Pilot Intervention on Young Adult Employee's Diet and Health Outcomes

PURPOSE

Evaluate the effect of a policy-based, multicomponent workplace diet intervention on young adult employees' diet and health.

DESIGN

A 6-month, single-armed pilot study with before and after assessments.

SETTING

Insurance company in Belfast, Northern Ireland.

PARTICIPANTS

Employees who worked at the company throughout the intervention period were included. Employees were excluded if pregnant, breast-feeding, or following a strict diet.

INTERVENTION

Multicomponent diet intervention: ban of unhealthy foods brought into the premises, free fruit, education, individual advice, and further support.

MEASURES

Mixed-methods approach: Diet-, health-, and work-related measures were assessed quantitatively. The campaign was evaluated quantitatively (via questionnaire) and qualitatively (via semistructured interviews).

ANALYSIS

Changes in measures were analyzed using paired samples t tests. Interviews were analyzed using thematic analysis.

RESULTS

Sixty (75.9%) staff completed all assessments. Males reduced their sugar intake on working days (-8.7% of total energy standard deviation [SD]: 20.1; P value <.01). Systolic blood pressure reduced in males and females (-3.3 SD: 9.9; P value <.05 and -8.0 SD: 7.7; P value <.001, respectively); 85.2% of staff strongly agreed/agreed that they appreciated the healthy eating ethos. This was supported by the qualitative analysis which furthermore suggested that the education, team support, individual advice, and free fruit were beneficial.

CONCLUSION

Influencing workplace policies and offering additional dietary support could lead to meaningful changes in employees' diet and health and may change workplace culture.

The Minne-Loppet Motivation Study: An Intervention to Increase Motivation for Outdoor Winter Physical Activity in Ethnically and Racially Diverse Elementary Schools

PURPOSE

To test the effectiveness of an intervention to increase motivation for physical activity in racially diverse third- through fifth-grade students.

DESIGN

Natural experiment.

SETTING

Elementary schools in Minneapolis, Minnesota.

PARTICIPANTS

Two hundred ninety-one students in 18 Minne-Loppet Ski Program classes and 210 students in 12 control classrooms from the same schools.

INTERVENTION

The Minne-Loppet Ski Program, an 8-week curriculum in elementary schools that teaches healthy physical activity behaviors through cross-country skiing.

MEASURES

Pretest and posttest surveys measured self-determination theory outcomes: intrinsic exercise motivation, intrinsic ski motivation, autonomy, competence, and relatedness.

ANALYSIS

Hierarchical linear regression models tested treatment effects controlled for grade, race, sex, and baseline measures of the outcomes.

RESULTS

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. Treatment effects for general exercise motivation and perceived competence differed by race. 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.

CONCLUSION

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.