Effectively communicating with local policymakers: a randomized trial of policy brief dissemination to address obesity.

Introduction: Evidence-based policies are a powerful tool for impacting health and addressing obesity. Effectively communicating evidence to policymakers is critical to ensure evidence is incorporated into policies. While all public health is local, limited knowledge exists regarding effective approaches for improving local policymakers' uptake of evidence-based policies. Methods: Local policymakers were randomized to view one of four versions of a policy brief (usual care, narrative, risk-framing, and narrative/risk-framing combination). They then answered a brief survey including questions about their impressions of the brief, their likelihood of using it, and how they determine legislative priorities. Results: Responses from 331 participants indicated that a majority rated local data (92%), constituent needs/opinions (92%), and cost-effectiveness data (89%) as important or very important in determining what issues they work on. The majority of respondents agreed or strongly agreed that briefs were understandable (87%), believable (77%), and held their attention (74%) with no brief version rated significantly higher than the others. Across the four types of briefs, 42% indicated they were likely to use the brief. Logistic regression models showed that those indicating that local data were important in determining what they work on were over seven times more likely to use the policy brief than those indicating that local data were less important in determining what they work on (aOR = 7.39, 95% CI = 1.86,52.57). Discussion: Among local policymakers in this study there was no dominant format or type of policy brief; all brief types were rated similarly highly. This highlights the importance of carefully crafting clear, succinct, credible, and understandable policy briefs, using different formats depending on communication objectives. Participants indicated a strong preference for receiving materials incorporating local data. To ensure maximum effect, every effort should be made to include data relevant to a policymaker's local area in policy communications.

Municipal officials' perspectives on policymaking for addressing obesity and health equity.

Background: Obesity evidence-based policies (EBPs) can make a lasting, positive impact on community health; however, policy development and enactment is complex and dependent on multiple forces. Aims and objectives: This study investigated key factors affecting municipal officials' policymaking for obesity and related health disparities. Methods: Semi-structured interviews were conducted with 20 local officials from a selection of municipalities with high obesity or related health disparities across the United States between December 2020 and April 2021. Findings: Policymakers follow a general decision-making process with limited distinction between health and other policy areas. Factors affecting policymaking included: being informed about other local, state, and federal policy, conducting their own research using trustworthy sources, and seeking constituent and stakeholder perspectives. Key facilitators included the need for timely, relevant local data, and seeing or hearing from those impacted. Key local policymaking barriers included constituent opposition, misinformation, controversial issues with contentious solutions, and limited understanding of the connection between issues and obesity/health. Policymakers had a range of understanding about causes of health disparities, including views of individual choices, environmental influences on behaviors, and structural factors impacting health. To address health disparities, municipal officials described: a variety of roles policymakers can take, limitations based on the scope of government, challenges with intergovernmental collaboration or across government levels, ability of policymakers and government employees to understand the problem, and the challenge of framing health disparities given the social-political context. Discussion and conclusion: Understanding factors affecting the uptake of EBPs can inform local-level interventions that encourage EBP adoption.

Legislators' Sources of Behavioral Health Research and Preferences for Dissemination: Variations by Political Party.

OBJECTIVES: This study sought to characterize primary sources of behavioral health research and dissemination preferences of state legislators and assess differences by political party. METHODS: A 2017 cross-sectional survey of state legislators (N=475) assessed where legislators seek, and the most important features of, behavioral health research. Bivariate analyses and multivariate logistic regression were conducted. RESULTS: Advocacy organizations (53%), legislative staff (51%), and state agencies (48%) were identified most frequently as sources of behavioral health research. Universities were identified by significantly more Democrats than Republicans (34% versus 19%; adjusted odds ratio=1.79). Data about budget impact and cost-effectiveness were most frequently rated as very important, but by significantly fewer Democrats than Republicans (77% versus 87% and 76% versus 89%, respectively). CONCLUSIONS: To reach legislators and satisfy their information preferences, behavioral health researchers should target diverse audiences, partner with intermediary organizations, and craft messages that include economic evaluation data.

Does Availability of Worksite Supports for Physical Activity Differ by Industry and Occupation?

PURPOSE: To explore combinations of worksite supports (WSS) for physical activity (PA) that may assist employees in meeting PA recommendations and to investigate how availability of WSS differs across industries and occupations. DESIGN: Cross-sectional. SETTING: Several Missouri metropolitan areas. PARTICIPANTS: Adults employed >20 h/wk outside the home. MEASURES: Survey utilized existing self-reported measures (eg, presence of WSS for PA) and the International Physical Activity Questionnaire. ANALYSIS: Logistic regression was conducted for 2 outcome variables: leisure and transportation PA. Independent variables included 16 WSS. Of particular interest were interaction effects between WSS variables. Analyses were stratified by 5 occupation and 7 industry types. RESULTS: Overall, 2013 people completed the survey (46% response rate). Often, availability of 1 WSS did not increase the likelihood of meeting PA recommendations, but several pairs of WSS did. For example, in business occupations, the odds of meeting PA recommendations through transportation PA increased when employees had access to showers and incentives to bike/walk (odds ratio [OR] = 1.6; 95% confidence interval [CI] = 1.16-2.22); showers and maps (OR = 1.25; 1.02-1.55); maps and incentives to bike/walk (OR = 1.48; 1.04-2.12). CONCLUSION: Various combinations of WSS may increase the likelihood that employees will meet PA recommendations. Many are of low or no cost, including flexible time for exercise and maps of worksite-adjacent walk/bike routes. Findings may be instructive for employers seeking to improve employee health through worksite PA.

Mixed methods analysis of eighteen worksite policies, programs, and environments for physical activity.

BACKGROUND: This study examined whether specific worksite supports for physical activity (PA) were associated with total and domain-specific PA. METHODS: A cross-sectional, telephone-based study was conducted in four Missouri, USA, metropolitan areas in 2012 and 2013. Outcome variables included total PA and sub-domains (leisure, work, travel) measured using the International Physical Activity Questionnaire. Logistic regression determined odds of meeting PA recommendations, given access to and use of 18 unique PA worksite supports. A subsample of 119 participants also wore hip accelerometry for seven consecutive days and maintained a wear-time diary. Access to worksite supports were associated with odds of meeting objective moderate and vigorous (MV) PA above 150 min per week. RESULTS: Among 2013 survey participants, meeting PA recommendations while performing work-related tasks was significantly associated with several supports (e.g., walking maps, stair prompts), as was meeting recommendations during travel (e.g., flextime for PA, incentives for public transportation, walking/bicycling to work). Access to 11 worksite supports increased odds of meeting PA recommendations through leisure-time PA; five supports were associated with total PA. There were significant differences between access to and use of supports. Using objective MVPA, access to worksite challenges and bike storage were significantly associated with five and three times greater odds of meeting 150 min of MVPA per week, respectively. CONCLUSIONS: Worksite wellness plans are increasing across the US and employers are eager for evidence-based supports for increasing PA. This study provides insights into the utility of multiple worksite supports for PA to increase odds that employees meet PA recommendations.

Work-related correlates of occupational sitting in a diverse sample of employees in Midwest metropolitan cities.

The worksite serves as an ideal setting to reduce sedentary time. Yet little research has focused on occupational sitting, and few have considered factors beyond the personal or socio-demographic level. The current study i) examined variation in occupational sitting across different occupations, ii) explored whether worksite level factors (e.g., employer size, worksite supports and policies) may be associated with occupational sitting. Between 2012 and 2013, participants residing in four Missouri metropolitan areas were interviewed via telephone and provided information on socio-demographic characteristics, schedule flexibility, occupation, work related factors, and worksite supports and policies. Occupational sitting was self-reported (daily minutes spent sitting at work), and dichotomized. Occupation-stratified analyses were conducted to identify correlates of occupational sitting using multiple logistic regressions. A total of 1668 participants provided completed data. Those employed in business and office/administrative support spent more daily occupational sitting time (median 330 min) compared to service and blue collar employees (median 30 min). Few worksite supports and policies were sitting specific, yet factors such as having a full-time job, larger employer size, schedule flexibility, and stair prompt signage were associated with occupational sitting. For example, larger employer size was associated with higher occupational sitting in health care, education/professional, and service occupations. Work-related factors, worksite supports and policies are associated with occupational sitting. The pattern of association varies among different occupation groups. This exploratory work adds to the body of research on worksite level correlates of occupational sitting. This may provide information on priority venues for targeting highly sedentary occupation groups.

Comparison of Research Framing Preferences and Information Use of State Legislators and Advocates Involved in Cancer Control, United States, 2012-2013.

INTRODUCTION: Evidence-based policy plays an important role in prevention of cancer and other chronic diseases. The needs of actors involved in policy decision-making should inform knowledge translation strategies. This study examines the differences between state legislators and advocates in how they seek and use information and what their preferences are for how research information is framed. METHODS: We conducted a cross-sectional comparison of survey responses by US advocates (n = 77) and state legislators (n = 265) working on issues related to cancer control. RESULTS: Advocates differed significantly from legislators on all demographic characteristics. Advocates reported seeking and using information more frequently than legislators, though legislators used legislative research bureaus more often (0.45 point difference, P = .004). Both legislators and advocates prioritized the presentation and timeliness of research information similarly but reported different preferences for source (information bias, information relevance, delivery of information by trusted person) of research information. Several differences between advocates and legislators were modified by participant age. CONCLUSION: Our study provides insights for development of knowledge translation strategies to enhance evidence-based policy making for cancer control that are tailored to state-level legislators and advocates. Additional research efforts should evaluate the effectiveness of such knowledge translation strategies, particularly among advocates.

Exploring associations between perceived home and work neighborhood environments, diet behaviors, and obesity: Results from a survey of employed adults in Missouri.

Dietary behaviors are associated with obesity, and may be influenced by the environment. The objective of the current work was to investigate whether perceptions of built environment factors related to eating in the residential neighborhood will have different, independent associations with BMI and dietary behaviors than perceived built environment factors in the worksite neighborhood. In 2012-2013, a cross-sectional telephone-survey of Missouri adults (n = 2015) assessed perceptions of home and workplace built environment factors related to eating, dietary behaviors, and height and weight. Logistic regression models explored associations between perceived neighborhood built environment variables, diet, and obesity. The only variable associated with any of the outcomes explored in the fully adjusted models was the home neighborhood composite scale. None of the work environment variables were significantly associated with any of the health/behavior outcomes after adjustment. Few associations were found after adjustment for personal and job-related characteristics, and none were identified with the workplace neighborhood environment. While few home environment associations were found after adjustment, and none were identified with the perceived workplace neighborhood environment, the current study adds to the limited literature looking at associations between the perceived neighborhood around the workplace neighborhood and the perceived neighborhood around the home and dietary behaviors and obesity in adults. Future studies are needed to determine whether relationships between these environments and behavior exist, and if so, if they are causal and warrant intervention attempts.

Uses of Research Evidence by State Legislators Who Prioritize Behavioral Health Issues.

OBJECTIVE: Disseminating behavioral health (BH) research to elected policy makers is a priority, but little is known about how they use and seek research evidence. This exploratory study aimed to identify research dissemination preferences and research-seeking practices of legislators who prioritize BH issues and to describe the role of research in determining policy priorities. The study also assessed whether these legislators differ from those who do not prioritize BH issues. METHODS: A telephone-based survey was conducted with 862 state legislators (response rate, 46%). A validated survey instrument assessed priorities and the factors that determined them, research dissemination preferences, and research-seeking practices. Bivariate analyses were used to characterize and compare the two groups. RESULTS: Legislators who prioritized BH issues (N=125) were significantly more likely than those who did not to identify research evidence as a factor that determined policy priorities (odds ratio=1.91, 95% confidence interval=1.25-2.90, p=.002). Those who prioritized BH issues also attributed more importance to ten of 12 features of research, and the difference was significant for four features (unbiased, p=.014; presented in a concise way, p=.044; delivered by someone known or respected, p=.033; and tells a story, p=.030). Those who prioritized BH issues also engaged more often in eight of 11 research-seeking and utilization practices, and a significance difference was found for one (attending research presentations, p=.012). CONCLUSIONS: Legislators who prioritized BH issues actively sought, had distinct preferences for, and were particularly influenced by research evidence. Testing legislator-focused BH research dissemination strategies is an area for future research.

Framing research for state policymakers who place a priority on cancer.

PURPOSE: Despite the potential for reducing the cancer burden via state policy change, few data exist on how best to disseminate research information to influence state legislators' policy choices. We explored: (1) the relative importance of core framing issues (source, presentation, timeliness) among policymakers who prioritize cancer and those who do not prioritize cancer and (2) the predictors of use of research in policymaking. METHODS: Cross-sectional data were collected from US state policymakers (i.e., legislators elected to state houses or senates) from January through October 2012 (n = 862). One-way analysis of variance was performed to investigate the association of the priority of cancer variable with outcome variables. Multivariate logistic regression models examined predictors of the influence of research information. RESULTS: Legislators who prioritized cancer tended to rate characteristics that make research information useful higher than those who did not prioritize cancer. Among differences that were statistically significant were three items in the "source" domain (relevance, delivered by someone respected, supports one's own position), one item in the "presentation" domain (telling a story related to constituents) and two items in the "timeliness" domain (high current state priority, feasible when information is received). Participants who prioritized cancer risk factors were 80 % more likely to rate research information as one of their top reasons for choosing an issue on which to work. CONCLUSIONS: Our results suggest the importance of narrative forms of communication and that research information needs to be relevant to the policymakers' constituents in a brief, concise format.

State legislators' sources and use of information: bridging the gap between research and policy.

Research can inform policymakers of public health issues and shape policy decisions, hopefully benefiting public health; thus, improving dissemination of research to policymakers is important for developing effective public health policies that improve health and health equity. However, the utilization of research among policymakers is often not fully realized. This study builds upon current knowledge about what types of information legislators seek when working on health issues and where they go for information. Further, it explores what kinds of information legislators find most helpful and if there are ways researchers could better provide this evidence. Key-informant interviews were conducted with 25 U.S. state legislators holding health committee leadership positions between July and November, 2010. Regarding types of information sought, most legislators discussed their desire for data and statistics when working on health-related issues. When asked about their most trusted sources of information, participants mentioned government sources as well as advocacy, lobby and industry groups. A few mentioned universities and healthcare professionals. Results from this study offer public health researchers and practitioners' insights into the types of information that may be most helpful to policymakers. Insights gathered may improve the dissemination of research and bridge the gap between knowledge users and knowledge producers.

Getting research to the policy table: a qualitative study with public health researchers on engaging with policy makers.

INTRODUCTION: Little attention has been given to how researchers can best provide evidence to policy makers so that it informs policy making. The objectives of this study were to increase understanding about the current state of public health nutrition and obesity researcher practices, beliefs, barriers, and facilitators to communicating and engaging with policy makers, and to identify best practices and suggest improvements. METHODS: Eighteen semistructured interviews were conducted from 2011 to 2013 with public health nutrition and obesity researchers who were highly involved in communicating research to policy makers. Interviews were transcribed verbatim, coded, and analyzed to identify common themes. RESULTS: Study participants described wide variation in practices for communicating and engaging with policy makers and had mixed beliefs about whether and when researchers should engage. Besides a lack of formal policy communication training, barriers noted were promotion and tenure processes and a professional culture that does not value communicating and engaging with policy makers. Study participants cited facilitators to engaging with policy makers as ranging from the individual level (eg, desire to make a difference, relationships with collaborators) to the institutional level (eg, training/mentorship support, institutional recognition). Other facilitators identified were research- and funding-driven. Promising strategies suggested to improve policy engagement were more formal training, better use of intermediaries, and learning how to cultivate relationships with policy makers. CONCLUSION: Study findings provide insights into the challenges that will need to be overcome and the strategies that might be tried to improve communication and engagement between public health researchers and policy makers.

"Hearing from all sides" How legislative testimony influences state level policy-makers in the United States.

BACKGROUND: This paper investigates whether state legislators find testimony influential, to what extent testimony influences policy-makers' decisions, and defines the features of testimony important in affecting policy-makers' decisions. METHODS: We used a mixed method approach to analyze responses from 862 state-level legislators in the United States (U.S.). Data were collected via a phone survey from January-October, 2012. Qualitative data were analyzed using a general inductive approach and codes were designed to capture the most prevalent themes. Descriptive statistics and cross tabulations were also completed on thematic and demographic data to identify additional themes. RESULTS: Most legislators, regardless of political party and other common demographics, find testimony influential, albeit with various definitions of influence. While legislators reported that testimony influenced their awareness or encouraged them to take action like conducting additional research, only 6% reported that testimony changes their vote. Among those legislators who found testimony influential, characteristics of the presenter (e.g., credibility, knowledge of the subject) were the most important aspects of testimony. Legislators also noted several characteristics of testimony content as important, including use of credible, unbiased information and data. CONCLUSION: Findings from this study can be used by health advocates, researchers, and individuals to fine tune the delivery of materials and messages to influence policy-makers during legislative testimony. Increasing the likelihood that information from scholars will be used by policy-makers may lead to the adoption of more health policies that are informed by scientific and practice-based evidence.

Racial differences in parental perceptions of the neighborhood as predictors of children's physical activity and sedentary behavior.

OBJECTIVE: Most U.S. children engage in insufficient physical activity (PA) and spend too much time in sedentary behaviors (SBs), leading to increased risk of obesity and chronic disease. Evidence remains inconsistent on relationships between parental perceptions of the neighborhood and children's PA and SB. This study examines parental neighborhood perceptions, stratified by race, as predictors of children's PA and SB. METHODS: Relationships were tested with regressions stratified by parental race. The sample included 196 parents, residing in St. Louis, Missouri with a child at home. Participants responded to a mailed survey in 2012. Parental neighborhood perceptions were examined by mean composite scores and individual items. RESULTS: For parents of all races, perceived barriers negatively predicted the number of days in a week children engaged in ≥ 60 min of PA. Examining parental neighborhood perceptions by individual item, the perception that drivers exceed neighborhood speed limits was a positive predictor of their children's SB only among white parents. Only among minority-race parents was perceived neighborhood crime rate a positive predictor of their children's SB. CONCLUSIONS: While predictors of children's PA did not differ widely, several distinct predictors of children's SB by parental race lend support toward further examination of this topic.

Home and workplace built environment supports for physical activity.

BACKGROUND: Physical inactivity has been associated with obesity and related chronic diseases. Understanding built environment (BE) influences on specific domains of physical activity (PA) around homes and workplaces is important for public health interventions to increase population PA. PURPOSE: To examine the association of home and workplace BE features with PA occurring across specific life domains (work, leisure, and travel). METHODS: Between 2012 and 2013, telephone interviews were conducted with participants in four Missouri metropolitan areas. Questions included sociodemographic characteristics, home and workplace supports for PA, and dietary behaviors. Data analysis was conducted in 2013; logistic regression was used to examine associations between BE features and domain-specific PA. RESULTS: In home neighborhoods, seven of 12 BE features (availability of fruits and vegetables, presence of shops and stores, bike facilities, recreation facilities, crime rate, seeing others active, and interesting things) were associated with leisure PA. The global average score of home neighborhood BE features was associated with greater odds of travel PA (AOR=1.99, 95% CI=1.46, 2.72); leisure PA (AOR=1.84, 95% CI=1.44, 2.34); and total PA (AOR=1.41, 95% CI=1.04, 1.92). Associations between workplace neighborhoods' BE features and workplace PA were small but in the expected direction. CONCLUSIONS: This study offers empirical evidence on BE supports for domain-specific PA. Findings suggest that diverse, attractive, and walkable neighborhoods around workplaces support walking, bicycling, and use of public transit. Public health practitioners, researchers, and worksite leaders could benefit by utilizing worksite domains and measures from this study for future BE assessments.

Training needs and supports for evidence-based decision making among the public health workforce in the United States.

BACKGROUND: Preparing the public health workforce to practice evidence-based decision making (EBDM) is necessary to effectively impact health outcomes. Few studies report on training needs in EBDM at the national level in the United States. We report competency gaps to practice EBDM based on four U.S. national surveys we conducted with the state and local public health workforce between 2008 and 2013. METHODS: We compared self-reported data from four U.S. national online surveys on EBDM conducted between 2008 and 2013. Participants rated the importance of each EBDM competency then rated how available the competency is to them when needed on a Likert scale. We calculated a gap score by subtracting availability scores from importance scores. We compared mean gaps across surveys and utilized independent samples t tests and Cohen's d values to compare state level gaps. In addition, participants in the 2013 state health department survey selected and ranked three items that "would most encourage you to utilize EBDM in your work" and items that "would be most useful to you in applying EBDM in your work". We calculated the percentage of participants who ranked each item among their top three. RESULTS: The largest competency gaps were consistent across all four surveys: economic evaluation, communicating research to policymakers, evaluation designs, and adapting interventions. Participants from the 2013 state level survey reported significantly larger mean importance and availability scores (p <0.001, d =1.00, and p <0.001, d = .78 respectively) and smaller mean gaps (p <0.01, d = .19) compared to the 2008 survey. Participants most often selected "leaders prioritizing EBDM" (67.9%) among top ways to encourage EBDM use. "EBDM training for specific areas" was most commonly ranked as important in applying EBDM (64.3%). CONCLUSION: Perceived importance and availability of EBDM competencies may be increasing as supports for EBDM continue to grow through trends in funding, training, and resources. However, more capacity building is needed overall, with specific attention to the largest competency gaps. More work with public health departments to both situate trainings to boost competency in these areas and continued improvements for organizational practices (leadership prioritization) are possible next steps to sustain EBDM efforts.

Correlates of walking for transportation and use of public transportation among adults in St Louis, Missouri, 2012.

INTRODUCTION: Attributes of the built environment can influence active transportation, including use of public transportation. However, the relationship between perceptions of the built environment and use of public transportation deserves further attention. The objectives of this study were 1) to assess the relationship between personal characteristics and public transportation use with meeting national recommendations for moderate physical activity through walking for transportation and 2) to examine associations between personal and perceived environmental factors and frequency of public transportation use. METHODS: In 2012, we administered a mail-based survey to 772 adults in St Louis, Missouri, to assess perceptions of the built environment, physical activity, and transportation behaviors. The abbreviated International Physical Activity Questionnaire was used to assess walking for transportation and use of public transportation. The Neighborhood Environment Walkability Scale was used to examine perceptions of the built environment. Associations were assessed by using multinomial logistic regression. RESULTS: People who used public transportation at least once in the previous week were more likely to meet moderate physical activity recommendations by walking for transportation. Age and employment were significantly associated with public transportation use. Perceptions of high traffic speed and high crime were negatively associated with public transportation use. CONCLUSION: Our results were consistent with previous research suggesting that public transportation use is related to walking for transportation. More importantly, our study suggests that perceptions of traffic speed and crime are related to frequency of public transportation use. Future interventions to encourage public transportation use should consider policy and planning decisions that reduce traffic speed and improve safety.

"Everyone should be able to choose how they get around": how Topeka, Kansas, passed a complete streets resolution.

BACKGROUND: Regular physical activity can help prevent chronic diseases, yet only half of US adults meet national physical activity guidelines. One barrier to physical activity is a lack of safe places to be active, such as bike paths and sidewalks. Complete Streets, streets designed to enable safe access for all users, can help provide safe places for activity. COMMUNITY CONTEXT: This community case study presents results from interviews with residents and policymakers of Topeka, Kansas, who played an integral role in the passage of a Complete Streets resolution in 2009. It describes community engagement processes used to include stakeholders, assess existing roads and sidewalks, and communicate with the public and decision-makers. METHODS: Key informant interviews were conducted with city council members and members of Heartland Healthy Neighborhoods in Topeka to learn how they introduced a Complete Streets resolution and the steps they took to ensure its successful passage in the City Council. Interviews were recorded, transcribed, and analyzed by using focused-coding qualitative analysis. OUTCOME: Results included lessons learned from the process of passing the Complete Streets resolution and advice from participants for other communities interested in creating Complete Streets in their communities. INTERPRETATION: Lessons learned can apply to other communities pursuing Complete Streets. Examples include clearly defining Complete Streets; educating the public, advocates, and decision-makers about Complete Streets and how this program enhances a community; building a strong and diverse network of supporters; and using stories and examples from other communities with Complete Streets to build a convincing case.

Development and reliability testing of the Worksite and Energy Balance Survey.

CONTEXT: Worksites represent important venues for health promotion. Development of psychometrically sound measures of worksite environments and policy supports for physical activity and healthy eating are needed for use in public health research and practice. OBJECTIVE: Assess the test-retest reliability of the Worksite and Energy Balance Survey (WEBS), a self-report instrument for assessing perceptions of worksite supports for physical activity and healthy eating. DESIGN: The WEBS included items adapted from existing surveys or new items on the basis of a review of the literature and expert review. Cognitive interviews among 12 individuals were used to test the clarity of items and further refine the instrument. A targeted random-digit-dial telephone survey was administered on 2 occasions to assess test-retest reliability (mean days between time periods = 8; minimum = 5; maximum = 14). SETTING: Five Missouri census tracts that varied by racial-ethnic composition and walkability. PARTICIPANTS: Respondents included 104 employed adults (67% white, 64% women, mean age = 48.6 years). Sixty-three percent were employed at worksites with less than 100 employees, approximately one-third supervised other people, and the majority worked a regular daytime shift (75%). MAIN OUTCOME MEASURES: Test-retest reliability was assessed using Spearman correlations for continuous variables, Cohen's κ statistics for nonordinal categorical variables, and 1-way random intraclass correlation coefficients for ordinal categorical variables. RESULTS: Test-retest coefficients ranged from 0.41 to 0.97, with 80% of items having reliability coefficients of more than 0.6. Items that assessed participation in or use of worksite programs/facilities tended to have lower reliability. Reliability of some items varied by gender, obesity status, and worksite size. Test-retest reliability and internal consistency for the 5 scales ranged from 0.84 to 0.94 and 0.63 to 0.84, respectively. CONCLUSIONS: The WEBS items and scales exhibited sound test-retest reliability and may be useful for research and surveillance. Further evaluation is needed to document the validity of the WEBS and associations with energy balance outcomes.