Understanding lactation policies and resources across a university system: survey and document review.

BACKGROUND: In the U.S., employees often return to work within 8-12 weeks of giving birth, therefore, it is critical that workplaces provide support for employees combining breastfeeding and work. The Affordable Care Act requires any organization with more than 50 employees to provide a space other than a restroom to express breastmilk and a reasonable amount of time during the workday to do so. States and worksites differ in the implementation of ACA requirements and may or may not provide additional support for employees combining breastfeeding and work. The purpose of this study was to conduct an analysis of the policies and resources available at 26 institutions within a state university system to support breastfeeding when employees return to work after giving birth. METHODS: Survey data was collected from Well-being Liaisons in the human resources departments at each institution. In addition, we conducted a document review of policies and online materials at each institution. We used univariate statistics to summarize survey results and an inductive and deductive thematic analysis to analyze institutional resources available on websites and in policies provided by the liaisons. RESULTS: A total of 18 (65.3%) liaisons participated in the study and revealed an overall lack of familiarity with the policies in place and inconsistencies in the resources offered to breastfeeding employees across the university system. Only half of the participating liaisons reported a formal breastfeeding policy was in place on their campus. From the document review, six major themes were identified: placing the burden on employees, describing pregnancy or postpartum as a "disability," having a university-specific policy, inclusion of break times for breastfeeding, supervisor responsibility, and information on lactation policies. CONCLUSION: The review of each institution's online resources confirmed the survey findings and highlighted the burden placed on employees to discover the available resources and advocate for their needs. This paper provides insight into how institutions support breastfeeding employees and provides implications on strategies to develop policies at universities to improve breastfeeding access for working parents.

Mind Your Heart: A Mindful Eating and Diet Education eHealth Program.

OBJECTIVE: Examine user perceptions of the Mind Your Heart (MYH) program, a mindful eating and nutrition education program delivered via an eHealth system. METHODS: Sixteen participants (41.5 ± 13.1 years) completed sample MYH lessons over 3 weeks. We examined changes in mindfulness from the State Mindfulness Scale via text messages sent 3 times per week. We assessed MYH user perceptions in a semistructured interview after 3 weeks. Analyses included Spearman's correlation, repeated measures ANOVA, and thematic analysis. RESULTS: State Mindfulness Scale scores were significantly improved (F[1,15] = 5.35, P = 0.01) from week 1 (M = 2.28 ± 0.80) to week 3 (M = 2.75 ± 1.04). Four themes emerged: (1) MYH is supportive of health goals, (2) text messages act as an intervention, (3) facilitators or inhibitors of use, and (4) enhancing engagement. CONCLUSIONS AND IMPLICATIONS: Based on participant feedback, the final version of MYH should include example-based learning to translate abstract concepts like mindful eating into action.

Experiences With Work-Family Conflict, Breastfeeding, and Perinatal Mental Health Among Women Returning to Work After Giving Birth: A Mixed Methods Study.

OBJECTIVE: This study aimed to examine working mothers' experiences with returning to work after giving birth, work-family conflict, breastfeeding, and mental health. METHODS: A sequential, mixed methods design was used to administer an online survey to capture job characteristics and perceptions of work-family conflict among first-time mothers in Georgia who gave birth within the previous year ( N = 26). Then, interviews were conducted to understand their experiences with returning to work, work-family conflict, breastfeeding, and mental health. RESULTS: Many participants worked in educational settings and returned to full-time work after giving birth. Qualitative themes from 12 interviews captured the context of participants' work environments, types of work-family conflict, and factors that alleviated work-family conflict. CONCLUSIONS: Employers need to incorporate support for work-family conflict and perinatal mental health into workplace breastfeeding programs and maternity leave policies.

Depression and anxiety among college students at Historically Black and Predominantly White universities during the COVID-19 pandemic: A cross-sectional study.

OBJECTIVE: To assess depression and anxiety among college students during the COVID-19 pandemic and its association with race. PARTICIPANTS: Using a cross-sectional survey, depression and anxiety among college students at a Predominantly White (PWU) and a Historically Black University (HBU) during 2021 were evaluated. METHODS: The patient health questionnaire-9 (PHQ-9), general anxiety disorder-7 (GAD-7), and self-reported sociodemographic characteristics were collected. Chi-square and logistic regression tests examined differences in depression and anxiety based on race. RESULTS: Depression and anxiety among 3,102 students (87% female) were analyzed. Minority racial groups were associated with anxiety (p < 0.01) but not depression in the PWU. Moderately severe and severe depression was higher among the minority race at both the universities (1.76% compared to 0.53% at PWU, and 11.1% compared to 2.4% at HBU). CONCLUSIONS: Depression and anxiety among college students is influenced by racial status. First-generation students were more likely to report depression in both HBU and PWU.

Community Gardens: A Catalyst for Community Change.

Community gardens are increasing in popularity and are associated with extensive physical and mental health benefits, increased access to fresh produce, and increased social connections. However, evidence is primarily from research in urban and school settings, and little is known about the role of community gardens in rural settings as part of policy, systems, and environmental (PSE) changes to promote health. This study explores the implementation of community gardens as part of an obesity prevention project, titled Healthier Together (HT), in five rural Georgia counties with limited food access and high obesity prevalence (>40%) using a mixed-methods research design that included data from project records, a community survey, interviews, and focus groups with county coalition members. Nineteen community gardens were implemented across five counties, 89% distributed produce direct to consumers, and 50% were integrated into the food system. Few (8.3%) of the survey respondents (n = 265) identified gardens as a food source, but 21.9% reported using an HT garden in the past year. Themes emerging from interviews (n = 39) and five focus groups suggested community gardens were a catalyst for broader community health change by increasing awareness of the value and absence of healthy food and generating excitement for future PSE initiatives to more comprehensively address food and physical activity access. Practitioners should consider placement of rural community gardens to optimize access to and distribution of produce as well as communication and marketing strategies to increase engagement and leverage gardens as gateways for PSE approaches to improve rural health.

Examining the Relationship Between Return to Work After Giving Birth and Maternal Mental Health: A Systematic Review.

INTRODUCTION: The negative impacts of mental health disorders on the well-being of women and their infants are clear. However, less is known about the relationship between returning to work after giving birth and mental health. Previous reviews examined the relationship between maternity leave and mental health, but we defined return to work as the process of returning to part-time or full-time work after giving birth and caring for infant. This systematic review aims to: (1) describe operational definitions for return to work and (2) describe the evidence on the relationship between return to work and maternal mental health. METHODS: We searched PubMed, PsycINFO, CINAHL, and Web of Science for peer-reviewed studies. Articles were selected if they were published within the past 20 years, examined at least one mental health condition (e.g., depression, anxiety), and included a study sample of U.S. working mothers. RESULTS: We identified 20 articles published between 2001 and 2020. We found conflicting evidence from longitudinal and cross-sectional data demonstrating that return to work was associated with improvements and negative consequences to mental health. Work-related predictors of mental health included: access to paid maternity leave, work-family conflict, total workload, job flexibility, and coworker support. DISCUSSION: This review provides evidence that return to work and mental health are related, though the study samples have limited generalizability to all U.S. working mothers. More research is needed to understand the direction of this relationship throughout the perinatal period and how return to work affects other mental health conditions (e.g., anxiety, stress).

Evaluating the impact of the live healthy, work healthy program on organizational outcomes: A randomized field experiment.

The prevalence of chronic health conditions is increasing, with over half the current workforce attempting to manage one or more chronic conditions. The Live Healthy, Work Healthy (LHWH) program is a version of the Chronic Disease Self-Management Program translated to the workplace, with the goal of improving and sustaining the health, well-being, and productivity of employees living with chronic health conditions. Using organizational support theory as a theoretical framework and a clustered randomized controlled trial design, this article demonstrates how the LHWH program positively impacts work-related quality of life, orientations toward the organization, and organizational cognitions and behaviors. Participants in the program experienced increases in perceived organizational support (POS), with a large intervention effect. Direct intervention effects were also found for burnout, work engagement, work ability, affective organizational commitment, and organizational citizenship behaviors. Within-person changes in POS during the intervention was a key mechanism through which participants of the program experienced changes in organizationally relevant outcomes. Finally, offering the program on work time strengthened these effects indirectly through greater changes in POS during the intervention period. This article provides evidence to researchers and organizational decision-makers that offering the LHWH program not only improves the health and well-being of employees but also improves important organizational outcomes. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Using Influenza Vaccination Location Data from the 2018 Behavioral Risk Factor Surveillance System (BRFSS) to Expand COVID-19 Vaccination Coverage.

Effective COVID-19 vaccine distribution requires prioritizing locations that are accessible to high-risk target populations. However, little is known about the vaccination location preferences of individuals with underlying chronic conditions. Using data from the 2018 Behavioral Risk Factor Surveillance System (BRFSS), we grouped 162,744 respondents into high-risk and low-risk groups for COVID-19 and analyzed the odds of previous influenza vaccination at doctor's offices, health departments, community settings, stores, or hospitals. Individuals at high risk for severe COVID-19 were more likely to be vaccinated in doctor's offices and stores and less likely to be vaccinated in community settings.

Examining the Implementation of Physical Activity and Healthy Eating Policies in a Large, Public Health Organization.

OBJECTIVE: To examine the implementation of physical activity and healthy eating policies in eighteen locations of a large, public health organization. METHODS: We used a mixed-methods design that included a survey of employees to describe location characteristics (ie, number of employees, race/ethnicity of employees), a survey of wellness ambassadors to determine which policies were implemented, and semi-structured, telephone interviews with wellness ambassadors to examine the barriers and facilitators to policy implementation. RESULTS: Six locations implemented both policies, nine locations only implemented the physical activity policy, and two locations did not implement either policy. Structural characteristics and geographic spread impeded implementation, whereas leadership engagement and access to information about the policies facilitated implementation. CONCLUSIONS: Consistent and adequate policy implementation in each location of an organization is critical to providing equity in health promotion programs for employees.

Translating CDSMP to the Workplace: Results of the Live Healthy Work Healthy Program.

PURPOSE: Report the results of a randomized, controlled trial of Live Healthy, Work Healthy (LHWH), a worksite translation of the Chronic Disease Self-Management Program (CDSMP). DESIGN: 14 worksites were randomly assigned to LHWH, standard CDSMP (usual care) or no-intervention (control) group. SETTING: The diverse set of work organizations centered around a rural community in SE US. SUBJECTS: 411 participants completed baseline data with 359 being included in the final analyses. INTERVENTION: LHWH had been adapted to fit the unique characteristics of work organizations. This translated program consists of 15 sessions over 8 weeks and was facilitated by trained lay leaders. MEASURES: The primary outcomes including health risk, patient-provider communication, quality of life, medical adherence and work performance were collected pretest, posttest (6 mos.) and follow-up (12 mos.). ANALYSIS: Analyses were conducted using latent change score models in a structural equation modeling framework. RESULTS: 79% of participants reported at least one chronic condition with an average of 2.7 chronic conditions reported. Results indicated that LHWH program demonstrated positive changes in a most outcomes including significant exercise (uΔ = 0.89, p < .01), chronic disease self-efficacy (uΔ = 0.63, p < .05), fatigue (uΔ = -1.45, p < .05), stress (uΔ = -0.98, p < .01) and mentally unhealthy days (uΔ = -3.47, p < .001). CONCLUSIONS: The translation of LHWH is an effective, low cost, embeddable program that has the potential to improve the health and work life of employees.

Reach, Uptake, and Satisfaction of Three Delivery Modes of FUEL Your Life.

Background. FUEL Your Life (FYL) is a worksite translation of the Diabetes Prevention Program (DPP). In a randomized controlled trial, participants in a phone coaching condition demonstrated greater weight loss compared to participants in a group coaching or self-study condition. The purpose of this article is to describe the differences in participant reach, intervention uptake, and participant satisfaction for each delivery mode. Method. Employees who were overweight, obese, or at high risk for diabetes were recruited from city-county governments. Process evaluation data were collected from health coach records, participant surveys, and research team records. Differences between groups were tested using Pearson chi-square test and one-way analysis of variance. Results. Employee reach of targeted enrollment was highest for the self-study condition. Overall, intervention uptake was highest in the phone coaching condition. Participants who received phone coaching had increased uptake of the participant manual and self-monitoring of food compared to participants who received group coaching or self-study. Discussion. FYL demonstrated that DPP could be effectively delivered in the worksite by three different modalities. When implemented in a self-study mode, reach is greater but intervention uptake is lower. Phone health coaching was associated with greater intervention exposure.

Health behavior among working adults: Workload and exhaustion are associated with nutrition and physical activity behaviors that lead to weight gain.

The purpose of this study was to evaluate the relationship between workload, exhaustion, and key health behaviors for weight loss-nutrition and physical activity. Structural equation modeling was used to estimate the path coefficients in a sample of 953 employed adults. The results show that workload and exhaustion were positively related to emotional eating, uncontrolled eating, and percent of calories from fat. In addition, exhaustion was negatively related to physical activity levels. Workload and exhaustion are associated with nutrition and physical activity behaviors that promote weight gain and should be considered in weight management interventions for working adults.

Assessing Workplace Breastfeeding Support Among Working Mothers in the United States.

Background: Workplace breastfeeding resources (e.g., break times and private spaces) help working mothers exclusively breastfeed for 6 months. However, not every employer offers lactation resources as specified in the Affordable Care Act. This study examined working mothers' access to workplace breastfeeding resources, their barriers and facilitators to combining breastfeeding and work, and their recommendations to improve access to breastfeeding resources. Methods: Working mothers between the ages of 18 to 50 years who had given birth in the previous 2 years were recruited online to participate in the study. An online, cross-sectional survey collected qualitative and quantitative data from working mothers on their access to workplace breastfeeding resources and experiences with breastfeeding at work. Descriptive statistics were used to report the quantitative results from the survey, and the qualitative data were examined using the constant comparative method. Findings: Fifty-two participants met the inclusion criteria for the study and completed the survey. Most of the participants in the study were White, college-educated women who worked in clerical or administration support and education occupations. Approximately 78.8% of the participants reported access to private spaces and 65.4% reported access to break times for breastfeeding. Fewer participants reported access to breast pumps, lactation consultants, and support groups. Conclusions/Application to Practice: There are gaps in access to workplace breastfeeding resources, but occupational health nurses can inform and help employers implement lactation resources to reduce breastfeeding disparities.

Opioid-Related Hospitalization and Its Association With Chronic Diseases: Findings From the National Inpatient Sample, 2011-2015.

Chronic disease and opioid-related hospitalizations in the United States are increasing. We analyzed nationally representative data on patients aged 18 years or older from the 2011-2015 National Inpatient Sample to assess the association between opioid-related hospitalization and chronic diseases. We found that most patients with opioid-related hospitalization were white, aged 35-54 years, in urban hospitals, and had 2 or more comorbid conditions. Patients with 2 or more chronic conditions accounted for more than 90% of opioid-related hospitalizations in all years. The results suggest a need for targeted interventions to prevent opioid misuse in patients with multiple chronic conditions.

Impact of a workplace holiday weight gain prevention program.

BACKGROUND: The average worker gains 2-3 lb (0.9-1.4 kg) a year, about half of which is gained during the fall holiday season (Halloween through New Year's). AIM: The aim of the study was to conduct a pilot test of a weight gain prevention program that was implemented in a workplace setting during the fall holiday season. METHODS: 239 state government employees participated in a weight gain prevention program offered during the fall holiday season. The program was a 10-week, team-based program that consisted of self-monitoring, regular weigh-ins, a team challenge, and organizational support. Weight was measured at baseline, every two weeks during the program, and post-program. RESULTS: Participants lost a significant amount of weight (from 196.7 lb/89.2 kg to 192.3 lb/87.2 kg) during the program. Positive changes were observed in physical activity and eating behaviors. CONCLUSIONS: This study demonstrated that a weight gain prevention program during a high risk period (fall holiday season) can be effective.

The workplace health group: A case study of 20 years of multidisciplinary research.

The Workplace Health Group (WHG) was established in 1998 to conduct research on worker health and safety and organizational effectiveness. This multidisciplinary team includes researchers with backgrounds in psychology, health promotion and behavior, and intervention design, implementation, and evaluation. The article begins with a brief history of the team, its guiding principles, and stages of team formation and development. This section provides examples of the roles, team composition, structure, processes, cognition, leadership, and climate played in the various stages of team development, as well as how they influenced team effectiveness. The WHG formed with functional diversity-variety in knowledge, skills, and abilities-in mind, and the impact of this diversity is discussed throughout the article. Illustrations of how the functional diversity of the WHG has led to real-world impact are provided. The article concludes with some lessons learned and recommendations for creating and sustaining multidisciplinary teams based on the WHG's 20 years of experience and the team science literature. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Impact of a Translated Disease Self-Management Program on Employee Health and Productivity: Six-Month Findings from a Randomized Controlled Trial.

Disease management is gaining importance in workplace health promotion given the aging workforce and rising chronic disease prevalence. The Chronic Disease Self-Management Program (CDSMP) is an effective intervention widely offered in diverse community settings; however, adoption remains low in workplace settings. As part of a larger NIH-funded randomized controlled trial, this study examines the effectiveness of a worksite-tailored version of CDSMP (wCDSMP [n = 72]) relative to CDSMP (‘Usual Care’ [n = 109]) to improve health and work performance among employees with one or more chronic conditions. Multiple-group latent-difference score models with sandwich estimators were fitted to identify changes from baseline to 6-month follow-up. Overall, participants were primarily female (87%), non-Hispanic white (62%), and obese (73%). On average, participants were age 48 (range: 23⁻72) and self-reported 3.25 chronic conditions (range: 1⁻16). The most commonly reported conditions were high cholesterol (45%), high blood pressure (45%), anxiety/emotional/mental health condition (26%), and diabetes (25%). Among wCDSMP participants, significant improvements were observed for physically unhealthy days (uΔ = −2.07, p = 0.018), fatigue (uΔ = −2.88, p = 0.002), sedentary behavior (uΔ = −4.49, p = 0.018), soda/sugar beverage consumption (uΔ = −0.78, p = 0.028), and fast food intake (uΔ = −0.76, p = 0.009) from baseline to follow-up. Significant improvements in patient⁻provider communication (uΔ = 0.46, p = 0.031) and mental work limitations (uΔ = −8.89, p = 0.010) were also observed from baseline to follow-up. Relative to Usual Care, wCDSMP participants reported significantly larger improvements in fatigue, physical activity, soda/sugar beverage consumption, and mental work limitations (p < 0.05). The translation of Usual Care (content and format) has potential to improve health among employees with chronic conditions and increase uptake in workplace settings.

Cost Effectiveness of a Weight Management Program Implemented in the Worksite: Translation of Fuel Your Life.

OBJECTIVE: Conduct a cost-effectiveness analysis of the Fuel Your Life (FYL) program dissemination. METHODS: Employees were recruited from three workplaces randomly assigned to one of the conditions: telephone coaching, small group coaching, and self-study. Costs were collected prospectively during the efficacy trial. The main outcome measures of interest were weight loss and quality-adjusted life years (QALYs). RESULTS: The phone condition was most costly ($601 to $589/employee) and the self-study condition was least costly ($145 to $143/employee). For weight loss, delivering FYL through the small group condition was no more effective, yet more expensive, than the self-study delivery. For QALYs, the group delivery of FYL was in an acceptable cost-effectiveness range ($22,400/QALY) relative to self-study (95% confidence interval [CI]: $10,600/QALY-dominated). CONCLUSIONS: Prevention programs require adaptation at the local level and significantly affect the cost, effectiveness, and cost-effectiveness of the program.

Factors Associated With Interest in Worksite Health-Related Discussions/Events Among Employed Adults With Chronic Conditions.

OBJECTIVE: Worksite health promotion interventions have the potential to reach half of Americans nationally, but low participation rates hinder optimal intervention effectiveness. This study examines factors associated with employee interest in worksite health-related discussions/events. METHOD: We analyzed cross-sectional survey data from a representative sample of employed adults in California with one or more chronic conditions. An ordinal regression model was developed. RESULTS: Employees who reported more interest in worksite health-related discussions/events had higher coworkers support, perceived greater value from learning health-related knowledge and getting practical tips from others, and reported higher interest in health discussions/events held in community settings. CONCLUSION: Efforts are needed to enhance the culture of worksite health and encourage communication and support among workers. Practitioners should consider connecting different settings to enhance reach and accessibility, and applying multiple delivery strategies to increase employee interest and engagement.

A Prospective Programmatic Cost Analysis of Fuel Your Life: A Worksite Translation of DPP.

OBJECTIVE: An accounting of the resources necessary for implementation of efficacious programs is important for economic evaluations and dissemination. METHODS: A programmatic costs analysis was conducted prospectively in conjunction with an efficacy trial of Fuel Your Life (FYL), a worksite translation of the Diabetes Prevention Program. FYL was implemented through three different modalities, Group, Phone, and Self-study, using a micro-costing approach from both the employer and societal perspectives. RESULTS: The Phone modality was the most costly at $354.6 per participant, compared with $154.6 and $75.5 for the Group and Self-study modalities, respectively. With the inclusion of participant-related costs, the Phone modality was still more expensive than the Group modality but with a smaller incremental difference ($461.4 vs $368.1). CONCLUSIONS: This level of cost-related detail for a preventive intervention is rare, and our analysis can aid in the transparency of future economic evaluations.