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.

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.

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.

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.

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.

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.

State legislators' work on public health-related issues: what influences priorities?

CONTEXT: Policies are an effective way to influence population health and prevent disease. Unfortunately, public health research is often not well translated for policy audiences. Furthermore, researchers seeking to influence policy face an incomplete understanding of what influences legislators' decisions regarding which issues will receive their limited time and focus. OBJECTIVE: The objective of this analysis was to examine various factors that may influence state legislators' decisions about which health issues they address. DESIGN: Cross-sectional analysis of data collected from a randomized trial. SETTING: State legislatures. PARTICIPANTS: State-level legislators. MAIN OUTCOME MEASURE(S): Measures included a rating of the influence of various factors on health policy priorities. A 7-point scale was used to measure political ideology on social and fiscal issues. Standard demographic questions were included on age, gender, and level of education. RESULTS: Seventy-five legislators completed surveys. Sixty-three percent were aged 55 years or older, and 76% male. When they were asked to rate factors according to importance in determining what health issues to work on, the top-rated factor was constituents' needs or opinions followed by evidence of scientific effectiveness. Ratings were also examined by subgroups. CONCLUSIONS: These findings point to several important applications for public health practitioners and researchers. Because legislators value constituents' opinions, it is critical to inform and educate constituents about public health issues as well as policy options that may be effective in addressing problems. The results also highlight the importance of public health researchers and practitioners improving dissemination efforts to ensure that evidence-based scientific information is shared with policymakers in an effective and timely manner.

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.

Methods of generating state revenue for breast cancer prevention and early detection: an analysis of pink dollars.

OBJECTIVE: We assessed income tax check-offs, specialty license plates, and lottery tickets as ways states raise funds for the early detection and prevention of breast cancer. METHODS: We conducted an inventory of state legislation allowing these revenue-generating methods, and collected and compared information on each initiative. We conducted logistic regression analyses to compare these methods with state breast cancer mortality rates. RESULTS: Eighteen states had programs for contributions through an income tax check-off. Revenue for tax check-offs and plates is influenced by state population. The median annual revenue for the income tax check-off was $115,000. Twenty-six states had breast cancer license plates generating more than $4.1 million in revenue. The extra cost of the plates ranged from $20 to 75 (mean = $37). Only Illinois offered a state breast cancer lottery ticket, which raised $4 million from 2005 to 2009. States with medium or high breast cancer mortality rates were 2.5 times more likely to offer breast cancer specialty license plates than states with low breast cancer mortality rates; however, we found no statistically significant difference in breast cancer mortality tertiles by income tax check-off. CONCLUSION: Revenue-generating breast cancer initiatives can be successful strategies for states to raise funds for breast cancer prevention and early detection programs. Although these initiatives can generate revenue, amounts are variable due to population differences, the number of other plates/check-offs/lotteries offered, and the choice to decrease donations during difficult economic times. State breast cancer mortality rates may influence the availability of these initiatives.

Barriers to evidence-based decision making in public health: a national survey of chronic disease practitioners.

OBJECTIVE: Existing knowledge of evidence-based chronic disease prevention is not systematically disseminated or applied. This study investigated state and territorial chronic disease practitioners' self-reported barriers to evidence-based decision making (EBDM). METHODS: In a nationwide survey, participants indicated the extent to which they agreed with statements reflecting four personal and five organizational barriers to EBDM. Responses were measured on a Likert scale from 0 to 10, with higher scores indicating a larger barrier to EBDM. We analyzed mean levels of barriers and calculated adjusted odds ratios for barriers that were considered modifiable through interventions. RESULTS: Overall, survey participants (n=447) reported higher scores for organizational barriers than for personal barriers. The largest reported barriers to EBDM were lack of incentives/rewards, inadequate funding, a perception of state legislators not supporting evidence-based interventions and policies, and feeling the need to be an expert on many issues. In adjusted models, women were more likely to report a lack of skills in developing evidence-based programs and in communicating with policy makers. Participants with a bachelor's degree as their highest degree were more likely than those with public health master's degrees to report lacking skills in developing evidence-based programs. Men, specialists, and individuals with doctoral degrees were all more likely to feel the need to be an expert on many issues to effectively make evidence-based decisions. CONCLUSIONS: Approaches must be developed to address organizational barriers to EBDM. Focused skills development is needed to address personal barriers, particularly for chronic disease practitioners without graduate-level training.

Use of evidence-based interventions in state health departments: a qualitative assessment of barriers and solutions.

OBJECTIVE: Existing knowledge on chronic disease prevention is not systematically disseminated and applied. State-level public health practitioners are in positions to implement programs and services related to chronic disease control. To advance dissemination science, this study sought to evaluate how and why evidence-based decision making (EBDM) is occurring. Specifically, it identified barriers to using EBDM commonly faced by state-level chronic disease practitioners and solutions for increasing the use of EBDM. DESIGN: Descriptive research using online survey methods. SETTING: State health departments. PARTICIPANTS: Members of the National Association of Chronic Disease Directors. MAIN OUTCOME MEASURES: Barriers to using EBDM and solutions to increase the use of EBDM. RESULTS: In total, 469 people completed the survey (64% response rate). More than 60% of respondents described their position as project managers or coordinators. Nearly 80% of respondents were women, and 39% reported at least a master's degree as their highest degree. The survey elicited responses from every US state and the District of Columbia. Commonly-cited barriers to using EBDM included lack of time, resources, funding, and data. Participants noted that promising solutions to increase the use of EBDM include improved leadership, training, and collaboration. CONCLUSIONS: These results identify several modifiable barriers to EBDM among state-level public health practitioners. This information may improve state health departments' abilities to facilitate and encourage EBDM. In turn, this may assist chronic disease practitioners in implementing chronic disease interventions that have been proven effective. The use of such interventions will improve public health through the prevention of chronic diseases.

Preventing childhood obesity through state policy: qualitative assessment of enablers and barriers.

As the prevalence of obesity rapidly climbs among youth in the United States, public health practitioners and policymakers seek effective means of slowing and reversing these trends. Recently, many state laws and regulations addressing childhood obesity have been introduced and enacted. Understanding determinants of such legislation may inform the development and passage of future policies. For this study, key-informant interviews were conducted with 16 legislators and staffers from 11 states in 2005-2006 to examine qualitative factors that enable and impede state-level childhood obesity prevention legislation. Commonly cited factors positively influencing the passage of childhood obesity prevention legislation included national media exposure, introduction of the policy by senior legislators, and gaining the support of key players including parents, physicians, and schools. Noteworthy barriers included powerful lobbyists of companies that produce unhealthy foods and misconceptions about legislating foods at schools. Although the total number of informants was modest, their valuable insights provide policymakers and practitioners with a set of enablers and barriers to be considered when pursuing state-level policy.

Worksite policies and environments supporting physical activity in midwestern communities.

PURPOSE: To examine the association of worksite policies and environments to physical activity. METHODS: Between 2001 and 2003, 977 adults from Missouri, Tennessee, and Arkansas participated in two random-digit-dialed telephone surveys regarding physical activity behaviors and worksite policies supporting physical activity. Logistic regression was used to investigate relationships between meeting national physical activity recommendations and supportive policies or environmental conditions (e.g., facilities, equipment, financial rewards) at worksites. RESULTS: Having multiple policies at worksites was associated with meeting physical activity recommendations, specifically the provision of accessible stairways and personal services (e.g., fitness testing, counseling). Meeting recommendations through walking was associated with having exercise facilities (e.g., gym, shower) and equipment (e.g., treadmill, weights). DISCUSSION: This study highlights the importance of supplementing health promotion information in workplaces with policies and environmental interventions. Particular consideration should be given to accessible stairways for onsite exercise and provision of exercise facilities and equipment. Future interventions should combine policy change with program delivery.

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.