Using threshold messages to promote physical activity: implications for public perceptions of health effects.

BACKGROUND: The promotion of physical activity (PA) guidelines to the general public is an important issue that lacks empirical investigation. PA campaigns often feature participation thresholds that cite PA guidelines verbatim [e.g., 150 min/week moderate-to-vigorous physical activity (MVPA)]. Some campaigns instead prefer to use generic PA messages (e.g., do as much MVPA as possible). 'Thresholds' may disrupt understanding of the health benefits of modest PA participation. This study examined the perception of health benefits of PA after exposure to PA messages that did and did not contain a duration threshold. METHODS: Brief structured interviews were conducted with a convenience sample of adults (n = 1100). Participants received a threshold message (150 min/week MVPA), a message that presented the threshold as a minimum; a generic message or no message. Participants rated perceived health effects of seven PA durations. One-way analyses of variance with post hoc tests for group differences were used to assess raw perception ratings for each duration of PA. RESULTS: Recipients of all three messages held more positive perceptions of >150 min/week of MVPA relative to those not receiving any message. For MVPA durations <150 min/week, the generic PA message group perceived the greatest health benefits. Those receiving the threshold message tended to have the least positive perceptions of durations <150 min/week. CONCLUSION: Threshold messages were associated with lower perceived health benefits for modest PA durations. Campaigns based on threshold messages may be limited when promoting small PA increases at a population level.

A multi-component stair climbing promotional campaign targeting calorific expenditure for worksites; a quasi-experimental study testing effects on behaviour, attitude and intention.

BACKGROUND: Accumulation of lifestyle physical activity is a current aim of health promotion, with increased stair climbing one public health target. While the workplace provides an opportunity for regular stair climbing, evidence for effectiveness of point-of-choice interventions is equivocal. This paper reports a new approach to worksite interventions, aimed at changing attitudes and, hence, behaviour. METHODS: Pre-testing of calorific expenditure messages used structured interviews with members of the public (n = 300). Effects of multi-component campaigns on stair climbing were tested with quasi-experimental, interrupted time-series designs. In one worksite, a main campaign poster outlining the amount of calorific expenditure obtainable from stair climbing and a conventional point-of-choice prompt were used (Poster alone site). In a second worksite, additional messages in the stairwell about calorific expenditure reinforced the main campaign (Poster + Stairwell messages site). The outcome variables were automated observations of stair and lift ascent (28,854) and descent (29,352) at baseline and for three weeks after the intervention was installed. Post-intervention questionnaires for employees at the worksites assessed responses to the campaign (n = 253). Analyses employed Analysis of Variance with follow-up Bonferroni t-tests (message pre-testing), logistic regression of stair ascent and descent (campaign testing), and Bonferroni t-tests and multiple regression (follow-up questionnaire). RESULTS: Pre-testing of messages based on calorific expenditure suggested they could motivate stair climbing if believed. The new campaign increased stair climbing, with greater effects at the Poster + Stairwell messages site (OR = 1.52, 95% CI = 1.40-1.66) than Posters alone (OR = 1.24, 95% CI = 1.15-1.34). Follow-up revealed higher agreement with two statements about calorific outcomes of stair climbing in the site where they were installed in the stairwell, suggesting more positive attitudes resulted from the intervention. Future intentions for stair use were predicted by motivation by the campaign and beliefs that stair climbing would help weight control. CONCLUSIONS: Multi-component campaigns that target attitudes and intentions may substantially increase stair climbing at work.

Promoting stair climbing in public-access settings: an audit of intervention opportunities in England.

OBJECTIVE: Introducing message prompts at the 'point-of-choice' (POC) between stairs and escalators increases stair choice in 'public-access' settings (e.g. malls). For nationwide campaigns, plentiful POCs appear needed. We audited the availability of POCs in public-access settings across England. METHODS: Boundaries for 25 urban areas (population=6,829,874) were verified using Ordinance Survey maps, which showed all airports and train/tram stations. Malls and bus stations were identified from commercial listings and local authority web-pages. From September 2010-March 2011 two investigators visually inspected all venues (N=410), counting 'true' POCs and 'quasi' POCs (i.e. instances where stairs were visible from, but not adjacent to, escalators). RESULTS: 5% of venues had ≥1 true POC (quasi POC=3%). Aggregating across areas, there was a true and quasi POC for every 243,924 and 379,437 people, respectively. There were regional variations; one area had 10 true/quasi POCs, whilst 10/24 remaining areas had none. POCs were more common in airports (4/6 venues) than malls (11/85) and train stations (4/215). CONCLUSION: Although public-access POCs reach sizeable audiences, their availability in England is sporadic, precluding nationwide campaigns. Interventions should be considered locally, based on available POCs. Work/community venues (e.g. offices, hospitals), where pedestrians choose between stairs and elevators, may provide greater intervention opportunities.

Promoting physical activity in a low socioeconomic area: results from an intervention targeting stair climbing.

OBJECTIVE: To compare rates of stair climbing in a high and low socioeconomic (SE) area, and to assess the efficacy of a stair climbing intervention in each area. METHODS: From March to May 2009 ascending stair/escalator choices (N=20,315) were observed in two underground train stations located in a high, and low, SE area of Glasgow. Baseline observations preceded a 4-week intervention in which posters, promoting stair choice, were installed. Follow-up observations were collected 1 week after poster removal. RESULTS: Baseline stair climbing rates were 12.2% and 7.1% at the high and low SE stations, respectively. Overall, pedestrians at the high SE station were around twice as likely to climb the stairs as those at the low SE station (odds ratio [OR] = 1.91, 95% confidence interval [CI] = 1.70-2.15). Across sites, the rate of stair climbing was higher during the intervention relative to baseline (OR = 1.48, CI = 1.34-1.63) and remained elevated at follow-up (OR = 1.24, CI = 1.11-1.39). Absolute increase in stair climbing was similar at both stations (high SE, +4.7%; low SE, +4.5%), indicating equivalent poster effects in each area. CONCLUSION: Pedestrians in lower SE areas appear less likely to climb stairs than pedestrians in high SE areas. Nevertheless, a stair climbing intervention was equally effective in both areas.

An informational stair climbing intervention with greater effects in overweight pedestrians.

Previous interventions have successfully increased levels of stair climbing in public-access settings (e.g. malls). This study used robust methods to establish the magnitude of intervention effects among a specific target group-the overweight. Ascending stair/escalator users (N = 20 807) were observed in a mall. A 2-week baseline was followed by a 5-week intervention in which message banners, promoting stair climbing, were attached to the stair risers. Standardized silhouettes were used to code individuals as normal/overweight. Logistic regression analyses were conducted with stair/escalator choice as the outcome variable and weight status entered as a moderator alongside condition, gender, ethnicity and 'pedestrian traffic volume'. Overall, the intervention significantly increased the rate of stair climbing [odds ratio (OR) = 1.28, 95% confidence intervals (CI) = 1.08-1.53], with the effects sustained over 5 weeks. There were differential effects between weight categories, with greater increases in overweight (OR = 1.95, CI = 1.34-2.83) versus normal weight individuals (OR = 1.29, CI = 1.09-1.53). In conclusion, message prompts produced larger effects among overweight individuals, who could benefit most from stair climbing. The public health value of these interventions may, therefore, be greater than realized. The heightened effects among the overweight were likely due to the salience of the current message, which linked stair climbing with the target of weight control.

Promoting stair climbing: intervention effects generalize to a subsequent stair ascent.

PURPOSE: Studies report a significant increase in stair use when message prompts are introduced at the "point of choice" between stairs and escalators. Climbing one set of stairs, however, will not confer meaningful health dividends. Therefore, this study examined whether exposure to point of choice prompts also encouraged individuals to climb the next set of stairs that they encountered. DESIGN: Interrupted time-series design. SETTINGS: Two separate stair/escalator pairings within a U.K. shopping mall (the "intervention" site and the "generalization" site), separated by a 25-m long atrium. Subjects. Ascending pedestrians (intervention site n = 29,713; generalization site n = 47,553). INTERVENTIONS: Two weeks of baseline monitoring were followed by a 13-week intervention in which banners carrying health promotion messages were introduced at the intervention site only. MEASURES: At both sites observers inconspicuously recorded pedestrians' methods of ascent, along with their gender, age, ethnicity, and baggage. RESULTS: Banners increased stair climbing at the intervention site by 161%. Results also suggested a simultaneous increase of up to 143% at the generalization site, where no prompt was in place. At both sites stair use remained significantly elevated 5 weeks after the banners were removed. CONCLUSIONS: It appears that exposure to point of choice prompts can encourage pedestrians to climb stairs when they are encountered in a subsequent setting. Consequently stair-climbing interventions are likely to engage the public in more physical activity than previously realized.

Effects of environmental changes in a stair climbing intervention: generalization to stair descent.

PURPOSE: Visual improvements have been shown to encourage stair use in worksites independently of written prompts. This study examined whether visual modifications alone can influence behavior in a shopping mall. Climbing one flight of stairs, however, will not confer health benefits. Therefore, this study also assessed whether exposure to the intervention encouraged subsequent stair use. DESIGN: Interrupted time-series design. SETTINGS: Escalators flanked by a staircase on either side. SUBJECTS: Ascending and descending pedestrians (N = 81,948). INTERVENTIONS: Following baseline monitoring, a colorful design was introduced on the stair risers of one staircase (the target staircase). A health promotion message was superimposed later on top. The intervention was visible only to ascending pedestrians. Thus, any rise in descending stair use would indicate increased intention to use stairs, which endured after initial exposure to the intervention. MEASURES: Observers inconspicuously coded pedestrians' means of ascent/descent and demographic characteristics. RESULTS: The design alone had no meaningful impact. Addition of the message, however, increased stair climbing at the target and nontarget staircases by 190% and 52%, respectively. The message also produced a modest increase in stair descent at the target (25%) and nontarget (9%) staircases. CONCLUSIONS: In public venues, a message component is critical to the success of interventions. In addition, it appears that exposure to an intervention can encourage pedestrians to use stairs on a subsequent occasion.

Messages to promote physical activity: Are descriptors of required duration and intensity related to intentions to be more active?

INTRODUCTION: Mass-media campaigns such as, "Change4Life' in the UK and "get active America" in the US, promote physical activity (PA) recommendations of at least 150 min/week of moderate-to-vigorous PA (MVPA). We investigated whether different messages used in MVPA campaigns were associated with intention to engage in more MVPA. MATERIALS AND METHODS: Theory of planned behavior (TPB) constructs; subjective norms, affective attitudes, instrumental attitudes and perceived behavioral control (PBC) were applied to explain the associations between campaign messages and intentions to engage in more MVPA. RESULTS: A total of 1412 UK adults completed an online survey on MVPA and TPB. The sample was 70% female and 93% white with 23% reporting meeting PA guidelines. Participants received one of three messages: A walking message either with or without the 150 min/week threshold (WalkT; WalkNT); a physiological description of MVPA with the 150 min/week threshold (PhysT). ANCOVA examined group differences in intention. Path analysis evaluated mediation by TPB variables. ANCOVA identified lower intentions to increase MVPA in group PhysT relative to WalkT and WalkNT (P < 0.001). PBC mediated this relationship in WalkT (ß = 0.014, 95% confidence interval [CI] = 0.004-0.028) whereas affective attitudes mediated this relationship in WalkNT (ß = 0.059, 95% CI = 0.006-0.113). CONCLUSIONS: Campaigns promoting MVPA guidelines need to choose their messages carefully. Messages which exemplified MVPA through walking were associated with higher intentions to increase MVPA than messages using a physiological description. Further, PBC was enhanced when the 150 min/week threshold was promoted alongside the walking exemplar. Future exemplars should be investigated to inform adults how to meet MVPA guidelines.

Investigating behavioural mimicry in the context of stair/escalator choice.

OBJECTIVES: We investigated whether individuals mimic the stair/escalator choices of preceding pedestrians. Our methodology sought to separate cases where the 'model' and 'follower' were acquaintances or strangers. DESIGN: Natural experiment. METHODS: Infrared monitors provided a second-by-second log of when pedestrians ascended adjacent stairs/escalators in a mall. Manual timings established that stair climbers spent ≥ 7 s on ascent, during which time they could act as models to following pedestrians. Thus, individuals who mounted the stairs/escalator ≤ 7 s after the previous stair climber were assigned to a 'stair model' condition. A 'no stair model' condition comprised individuals with a gap to the previous stair climber of ≥ 60 s. The stair model condition was subdivided, depending if the gap between model and follower was 1-2 s or 3-7 s. It was hypothesized that the former cohort may know the model. RESULTS: Percentage stair climbing was significantly higher in the 'stair model' versus 'no stair model' condition (odds ratio [OR]= 2.08). Subgroup analyses showed greater effects in the '1-2 s' cohort (OR = 3.33) than the '3-7 s' cohort (OR = 1.39). CONCLUSIONS: Individuals appear to mimic the stair/escalator choices of fellow pedestrians, with more modest effects between strangers. People exposed to message prompts at stair/escalator sites are known to take the stairs unprompted in subsequent situations. Our results suggest that these individuals could recruit a second generation of stair climbers via mimicry. Additionally, some of the immediate behavioural effects observed in interventions may be a product of mimicry, rather than a direct effect of the messages themselves.

A statistical summary of mall-based stair-climbing interventions.

BACKGROUND: Stair climbing is an accessible activity with proven health benefits. This article summarizes the effectiveness of mall-based stair-climbing interventions, while controlling for, and examining, potential moderators of stair/escalator choice. METHODS: Six comparable studies were identified, which used poster/ banner prompts to promote stair choice. Original data were combined and analyzed using logistic regression. Pedestrians' stair/escalator choices (N=127,221) provided the dichotomous outcome variable. Demographics (eg, gender), condition (baseline vs. intervention), and 'pedestrian traffic volume' were entered as potential moderators. To examine durability of effects, the rate of stair climbing in each half of the intervention period was compared. RESULTS: Overall, stair choice was more common in men (odds ratio [OR]=1.72), under-60s (OR=1.91), Whites (OR=1.38), those without accompanying children (OR=1.53), and periods of high traffic (OR=1.55). The rate of stair climbing increased in the intervention phase relative to baseline (OR=2.09), with greater effects among women (OR=1.99) versus men (OR=1.86), and under-60s (OR=2.62) versus over-60s (OR=1.93). Intervention effects fell slightly during the second half of the intervention period (OR=0.92). CONCLUSIONS: Conventional mass media campaigns engage an extra 5.0% of people in physical activity. The current calculations indicate that comparatively simple poster/banner prompts can increase stair climbing in mall settings by 6.0%.

Promoting stair climbing: effects of message specificity and validation.

Current exercise guidelines encourage the daily accumulation of lifestyle activities, such as stair climbing. Although several studies show that visual prompts can increase stair usage, there has been little systematic assessment of the messages employed. Some of the messages used in previous interventions represent general descriptions of stair climbing (e.g. 'free exercise'), while others emphasize specific consequences of stair use (e.g. 'keeps you fit'). Twelve hundred structured interviews were conducted in order to establish which type of message is more persuasive. In addition, half of the interviewees were told that the messages were true, in order to assess how validating messages may influence their persuasive appeal. Results suggest that messages focussing on specific consequences are more persuasive than those providing general descriptions and that validating the information presented in stair-climbing interventions may increase their efficacy. Previous messages may not, therefore, have demonstrated the full potential of stair climbing as a model for increasing population activity levels.

Worksite interventions to increase stair climbing; reasons for caution.

Point-of-choice prompts to use the stairs rather than the escalator consistently increase physical activity at public access staircases such as those in shopping malls. More recently, exercise promoters have targeted stair climbing in the worksite. A review of interventions in worksites reveals little hard evidence of successful increases in stair climbing, though the increases in stair usage are encouraging. The contrast between the worksites and public access staircases, however, is not simply one of location. In a worksite, the choice is between the stairs and an elevator rather than an escalator. We reason that the availability of the elevator or the stairwell may be the major immediate determinant of stair climbing in worksites and dilute any possible effects of an intervention.

A workplace intervention to promote stair climbing: greater effects in the overweight.

OBJECTIVE: Stair climbing is a lifestyle physical activity that uses more calories per minute than jogging. This study tested an intervention designed to promote stair climbing in a workplace. Because previous studies provide only equivocal evidence of the effects of increased stair climbing in worksites, a formal comparison of the effects of the intervention on stair ascent and descent was made. RESEARCH METHODS AND PROCEDURES: In a five-story public sector building, a 2-week baseline was followed by 6 weeks of an intervention involving a 23(1/2)- x 16(1/2)-inch poster in the lobby, the same poster and six messages affixed to the stair risers between floors, and an 11(3/4)- x 8(1/4)-inch point-of-choice prompt at the elevators. Stair and elevator choices (n = 26,806) were videotaped throughout and subsequently coded for direction of travel, traveler's sex, and traveler's load. Weight status was coded using silhouettes beside the computer monitor. RESULTS: A significant effect of the intervention on stair climbing was greater in those coded as overweight (+5.4%; odds ratio = 1.33) than in individuals of normal weight (+2.5%; odds ratio = 1.12). Although stair descent was more common than ascent, the intervention had similar effects for both directions of travel. DISCUSSION: Stair climbing at work has few barriers and seems to be a type of physical activity that is acceptable to overweight individuals. The relatively weak effect of workplace interventions compared with results for public access staircases may reflect uncontrolled effects such as the immediate availability of the elevator for the traveler.

Promoting stair use: single versus multiple stair-riser messages.

Message banners attached to stair risers produced a significant increase in pedestrian stair use, exceeding effects previously reported for conventional posters. Multiple instances of the same message banner, however, were as effective as banners featuring different messages. Therefore, greater visibility, rather than message variety, appears to account for the superiority of the banner format. Our findings indicate the feasibility of simple stair-use promotion campaigns based around the repetition of a single message.