Evaluating an Insurance-Sponsored Weight Management Program With the RE-AIM Model, West Virginia, 2004-2008

Introduction: Evaluations of weight management programs in real-world settings are lacking. The RE-AIM model (reach, effectiveness, adoption, implementation, maintenance) was developed to address this deficiency. Our primary objective was to evaluate a 12-week insurance-sponsored weight management intervention by using the RE-AIM model, including short-term and long-term individual outcomes and setting-level implementation factors. Our secondary objective was to critique the RE-AIM model and its revised calculation methods. Methods: We created operational definitions for components of the 5 RE-AIM indices and used standardized effect size values from various statistical procedures to measure multiple components or outcomes within each index. We used chi(2) analysis to compare categorical variables and repeated-measures analysis of variance to assess the magnitude of outcome changes over time. Results: On the basis of data for 1,952 participants and surveys completed by administrators at 23 sites, RE-AIM indices ranging from 0 to 100 revealed low program reach and adoption (5.4 and 8.8, respectively), moderate effectiveness (43.8), high implementation (91.4), low to moderate individual maintenance (21.2), and moderate to high site maintenance (77.8). Median (interquartile range) weight loss was 13 lb (6.5-21.4 lb) among participants who completed phase I (12 weeks; 76.5%) and 15 lb (6.1-30.3 lb) among those who completed phase II (1 year; 45.7%). Conclusion: This program had a significant, positive effect on participants and has been sustainable but needs to be expanded for more public health benefit. The RE-AIM model provided a useful framework to determine program strengths and weaknesses and to present them to the insurance agency and public health decision makers

Priority of activity-friendly community issues among key decision makers in Hawaii

The U.S. Community Guide to Preventive Services strongly recommends changes in urban design, land use and accessibility to increase physical activity. To achieve these goals, policy change is often needed. This study assessed attitudes of decision makers in Hawaii to determine if physical activity related issues are among their priorities. Methods: State and county officials (n =179) were mailed surveys. Respondents listed the three most important problems (openended) in Hawaii and rated the importance of 23 specified problems, of which six directly related to physical activity. Results: The survey was completed by 126 (70.4%) respondents. The most frequently mentioned categories for the open-ended questions were affordable housing, environment/sustainability, sprawl/ traffic/population growth, and healthcare. Among the closed-ended physical activity related items, increasing traffic was ranked highest (43.9%) and fourth overall. Less than 12% of decision makers rated other physical activity issues as important. Conclusions: Future work is needed to increase the visibility and importance of physical activity related issues among policymakers

Does the environment moderate the impact of a mass media campaign to promote walking?

Purpose: To examine if a mass media campaign influenced walking differently in people in different physical environments.\ud \ud Design: Quasi-experimental study.\ud \ud Setting: Wheeling, West Virginia.\ud \ud Participants: Random sample of adults age 50 to 65 years, response rate: 72.1% (n  =  719 in intervention community, n  =  753 in comparison community).\ud \ud Intervention: Mass media campaign.\ud \ud Measures: Self-reported measures were used in before and after telephone surveys for walking and the physical environment. Measures included 11 environmental walkability items, from which two subscales (i.e., usable sidewalks/aesthetics and facilities) were extracted.\ud \ud Analysis: Multiple linear regression.\ud \ud Results: Overall, walking increased by 2.7 minutes per week (standard deviation [SD]  =  231.1, not significant [NS]). When confined to those insufficiently active at baseline (i.e., <30 minutes per day) the minutes walked increased by 92.1 minutes (SD  =  152.9, p < .001). For the insufficiently active at baseline in the top half of the environmental factor of usable sidewalks, walking increased by 19 minutes more than in the bottom half (NS). For the factor of aesthetics and facilities, people in the more walkable environment increased walking by 87 minutes more than those in the bottom half (p < .001).\ud \ud Conclusion: In this community-wide physical activity, intervention changes in walking after the campaign were significantly moderated by some environmental attributes. This contributes to the limited evidence on the impact of the environment in enhancing community physical activity interventions. This finding needs to be replicated in other community interventions with greater environmental variation

Medical Student Perceptions of Healthy Lifestyles: A Qualitative Study

Medical student’s commitment to personal and professional health promotion decreases during their 4 years of medical school. Changes in their personal health behaviors are accompanied by a congruent set of changes in their attitudes regarding health promotion. The purpose of this qualitative study was to learn more about medical student attitudes about healthy lifestyles. Focus group sessions were conducted among 45 volunteer medical students at West Virginia University School of Medicine using a 9 question script. Healthy lifestyles were defined as balancing the emotional, physical, social, and spiritual aspects of life. Although no differences were observed between basic and clinical science students with regard to their stated priorities, stark differences were observed with regard to their openness to learning about lifestyle, where basic science students were more receptive

The Cost-Effectiveness of 1% Or Less Media Campaigns Promoting Low-Fat Milk Consumption

Introduction The purpose of our study was to compare the cost-effectiveness of four strategies using components of 1% Or Less to promote population-based behavior change. 1% Or Less is a mass-media campaign that encourages switching from high-fat (whole or 2%) to low-fat (1% or skim) milk. Using a quasi-experimental design, campaigns were previously conducted in four West Virginia communities using different combinations of 1) paid advertising, 2) media relations, and 3) community-based educational activities. Telephone surveys and supermarket milk sales data were used to measure the campaigns’ effectiveness. Methods Using data from the previously completed studies, we analyzed the cost of each campaign. We then calculated the cost per person exposed to the campaign and cost per person who switched from high- to low-fat milk. Results The combination of paid advertising and media relations was the most cost-effective campaign, with a cost of $0.57 per person to elicit a switch from high- to low-fat milk, and the combination of media relations and community-based educational activities was the least cost-effective campaign, with a cost of$11.85 per person to elicit a switch. Conclusion Population-based campaigns using a combination of paid advertising and media relations strategies can be a cost-effective way to promote a behavior change in a community