A four-year observational study to examine the dietary impact of the North Carolina Healthy Food Small Retailer Program, 2017-2020.

BACKGROUND: The North Carolina (NC) Healthy Food Small Retailer Program (HFSRP) was passed into law with a $250,000 appropriation (2016-2018) providing up to $25,000 in funding to small food stores for equipment to stock healthier foods and beverages. This paper describes an observational natural experiment documenting the impact of the HFSRP on store food environments, customers' purchases and diets. METHODS: Using store observations and intercept surveys from cross-sectional, convenience customer samples (1261 customers in 22 stores, 2017-2020; 499 customers in 7 HFSRP stores, and 762 customers in 15 Comparison stores), we examined differences between HFSRP and comparison stores regarding: (1) change in store-level availability, quality, and price of healthy foods/beverages; (2) change in healthfulness of observed food and beverage purchases ("bag checks"); and, (3) change in self-reported and objectively-measured (Veggie Meter®-assessed skin carotenoids) customer dietary behaviors. Differences (HFSRP vs. comparison stores) in store-level Healthy Food Supply (HFS) and Healthy Eating Index-2010 scores were assessed using repeated measure ANOVA. Intervention effects on diet were assessed using difference-in-difference models including propensity scores. RESULTS: There were improvements in store-level supply of healthier foods/beverages within 1 year of program implementation (0 vs. 1-12 month HFS scores; p = 0.055) among HFSRP stores only. Comparing 2019 to 2017 (baseline), HFSRP stores' HFS increased, but decreased in comparison stores (p = 0.031). Findings indicated a borderline significant effect of the intervention on self-reported fruit and vegetable intake (servings/day), though in the opposite direction expected, such that fruit and vegetable intake increased more among comparison store than HFSRP store customers (p = 0.05). There was no significant change in Veggie Meter®-assessed fruit and vegetable intake by customers shopping at the intervention versus comparison stores. CONCLUSIONS: Despite improvement in healthy food availability, there was a lack of apparent impact on dietary behaviors related to the HFSRP, which could be due to intervention dose or inadequate statistical power due to the serial cross-sectional study design. It may also be that individuals buy most of their food at larger stores; thus, small store interventions may have limited impact on overall eating patterns. Future healthy retail policies should consider how to increase intervention dose to include more product marketing, consumer messaging, and technical assistance for store owners.

Associations of Small Business Closure and Reduced Urban Mobility with Mental Health Problems in COVID-19 Pandemic: a National Representative Sample Study.

It is suggested that the nationwide social distancing due to coronavirus disease 2019 (COVID-19) has adverse mental health consequences despite its necessity. We investigated the associations of social distancing measures with mental health problems. Using national representative sample of 509,062 adults in the USA, we examined the associations of small business closure and reduced urban mobility with generalized anxiety disorder (GAD) and major depression disorder (MDD). Multilevel regression models were fitted with individual, household, and state-level covariates, in addition to state and census-region-level random effects. Living in state with the highest quartile of small business closures was associated with increased prevalence of GAD (OR: 1.06; CI: 1.03-1.11) compared to lowest quartile, but had no association with MDD. Living in the highest quartile of urban mobility was associated with lower prevalence of both GAD (OR: 0.88; CI: 0.85-0.93) and MDD (OR: 0.90; CI: 0.86-0.95) relative to the lowest quartile. Our findings suggest that small business closures and reduced mobility during COVID-19 pandemic were negatively associated with the two mental health outcomes in the USA, despite their important roles in preventing the infection.

Point-of-sale marketing of little cigars and cigarillos on and near California Tribal lands.

INTRODUCTION: American Indians have the highest cigarette smoking prevalence of any racial/ethnic group in the USA. Tobacco marketing at point-of-sale is associated with smoking, possibly due to easy access to cheap tobacco products. The sale of novel tobacco products like little cigars/cigarillos (LCCs) has increased in recent years which may further increase combustible tobacco use among American Indians. METHODS: Between October 2015 and February 2017, trained community health workers collected LCC product and price information by conducting audits of tobacco retailers on Tribal lands (n=53) and retailers within a 1-mile radius of Tribal lands (n=43) in California. Χ2 analyses were performed to examine associations among the availability and advertising of LCCs, including indoor price promotions and store location. RESULTS: Overall, 85.4% of stores sold LCCs, 76.0% sold flavoured LCCs and 51.0% sold LCCs for less than $1. Indoor price promotions were displayed at 45 (46.9%) stores. Stores within a 1-mile radius of Tribal lands sold significantly more LCC (p<0.01) and flavoured LCCs (p=0.01) than stores on Tribal lands. Stores within a 1-mile radius of Tribal lands also displayed significantly more LCCs priced at less than $1 (p<0.01) than stores on Tribal lands. CONCLUSIONS: LCCs are widely available in stores on and near California Tribal lands. Stores located a short distance away from Tribal lands were more likely to sell LCCs, including flavoured versions, more likely to sell LCCs priced below $1, and more likely to advertise little LCC price promotions than stores on Tribal lands. Policy-makers and Tribal leaders should consider regulations that would limit access to LCCs at point of sale to help prevent youth initiation and reduce smoking-related morbidity and mortality among American Indians.

Disseminating Evidence-Based Interventions in Small, Low-Wage Worksites: A Randomized Controlled Trial in King County, Washington (2014-2017).

Objectives. To determine whether (1) participating in HealthLinks, and (2) adding wellness committees to HealthLinks increases worksites' evidence-based intervention (EBI) implementation.Methods. We developed HealthLinks to disseminate EBIs to small, low-wage worksites. From 2014 to 2017, we conducted a site-randomized trial in King County, Washington, with 68 small worksites (20-200 employees). We assigned worksites to 1 of 3 arms: HealthLinks, HealthLinks plus wellness committee (HealthLinks+), or delayed control. At baseline, 15 months, and 24 months, we assessed worksites' EBI implementation on a 0% to 100% scale and employees' perceived support for their health behaviors.Results. Postintervention EBI scores in both intervention arms (HealthLinks and HealthLinks+) were significantly higher than in the control arm at 15 months (51%, 51%, and 23%, respectively) and at 24 months (33%, 37%, and 24%, respectively; P < .001). Employees in the intervention arms perceived greater support for their health at 15 and 24 months than did employees in control worksites.Conclusions. HealthLinks is an effective strategy for disseminating EBIs to small worksites in low-wage industries.Public Health Implications. Future research should focus on scaling up HealthLinks, improving EBI maintenance, and measuring impact of these on health behavior.

Physical and mental health problems of self-employed small business owners in South Korea.

BACKGROUND: Self-employed business owners in Korea make up one-quarter of the working population, and half of those who are self-employed are in micro and small businesses. Compared to the significant research interest in business management and economics, to date, there has been little interest in the health of small business owners. We investigated the health status of self-employed small business owners compared to standard workers. METHODS: The third Korean Working Conditions Survey, which included a total of 32 630 adults aged 20 to 59 years, was analyzed. A small business was defined as an enterprise with between 0 and 4 workers. Standard employment included full-time employment with a permanent or 1-year contract. Health outcomes included eight types of physical health and mental health problems assessed using the WHO-5 Wellbeing Index. RESULTS: Small business groups were found to have an increased prevalence of depression after controlling for all potential covariates (odds ratio [OR] = 1.37; 95% confidence interval [CI] 1.29-1.47). In addition, the prevalence of work-related physical health problems was significantly higher among self-employed small business owners in a full adjusted model: backache (OR = 1.16; 95% CI, 1.06-1.26), muscular pains in upper limbs (OR = 1.19; 95% CI, 1.12-1.27), and muscular pains in lower limbs (OR = 1.14; 95% CI, 1.07-1.22). CONCLUSION: We found a positive association between small business entrepreneurs and increased prevalence of mental and physical illness in adults in the Republic of Korea.

The Health of the Small-Group Insurance Market.

Issue: There has been relatively little discussion about the small-group employer insurance market since the implementation of reforms under the Affordable Care Act. It is important to understand the condition of this market before the impact of recent regulatory changes from the Trump administration. Goal: To understand how the ACA's market reforms have affected prices, enrollment, and competition in the small-group market. Methods: Analysis of financial data filed by small-group insurers with the federal government, along with relevant published literature. Findings and Conclusions: Enrollment has declined in the small-group market, although this is largely a continuation of a trend in place prior to the ACA. Substantially more small-business owners and workers now have coverage than prior to the ACA because many have been able to take advantage of subsidized individual plans through the marketplaces. For those who remain in the small-group market, price increases have been similar to those in the large-group market. The ACA has not reduced the cost of small-group insurance, but has made it more accessible and comprehensive without harming the market. It will be important to continue monitoring the small-group market to ensure that recent regulatory changes do not worsen market conditions.

The Affordable Care Act's Impact on Small Business.

Issue: Small-business owners have seen significant gains in health care coverage for themselves and their employees thanks to the Affordable Care Act. Though efforts to repeal the law failed in 2017, the current administration continues to take steps that undermine the law's progress. In recent months, new rules have been announced that allow more groups to establish association health plans and extend the length of short-term health insurance plans. These changes are likely to impact the stability of the marketplaces and coverage rates for the small-business community. Goal: Examine the Affordable Care Act's impact on small businesses, solo entrepreneurs, and small-business employees. Methods: Analysis of ACA small-business enrollment data from established sources, including federal agencies and nonpartisan health care research foundations, supplemented by analysis of U.S. Census data. Findings and Conclusions: Because of the creation of the individual marketplaces and the expansion of Medicaid, more entrepreneurs and small-business employees have health coverage than before the ACA was implemented. Indeed, the uninsured rate for small-business employees fell by almost 10 percentage points post-ACA. The ACA also has helped stabilize health costs for many small businesses that provide coverage, with the rate of small-business premium increases falling by half following implementation of the law.

Client Perceptions of Occupational Health and Safety Management System Assistance Provided by OSHA On-Site Consultation: Results of a Survey of Colorado Small Business Consultation Clients.

The Occupational Safety and Health Administration (OSHA) On-Site Consultation Service provides assistance establishing occupational health and safety management systems (OHSMS) to small businesses. The Safety and Health Program Assessment Worksheet (Revised OSHA Form 33) is the instrument used by consultants to assess an organization's OHSMS and provide feedback on how to improve a system. A survey was developed to determine the usefulness of the Revised OSHA Form 33 from the perspective of Colorado OSHA consultation clients. One hundred and seven clients who had received consultation services within a six-year period responded to the survey. The vast majority of respondents indicated that the Revised OSHA Form 33 accurately reflected their OHSMS and that information provided on the Revised OSHA Form 33 was helpful for improving their systems. Specific outcomes reported by the respondents included increased safety awareness, reduced injuries, and improved morale. The results indicate that the OHSMS assistance provided by OSHA consultation is beneficial for clients and that the Revised OSHA Form 33 can be an effective tool for assessing and communicating OHSMS results to business management. Detailed comments and suggestions provided on the Revised OSHA Form 33 are helpful for clients to improve their OHSMS.

[Self-employed and small business owners diagnosed with cancer: effect on entrepreneurial survival]. / Travailleurs indépendants et dirigeants de très petites entreprises atteints d'un cancer: effet sur la survie entrepreneuriale.

AIM: When self-employed andsmall business owners are diagnosed with cancer what is the effect on their small-firm survival duration? METHODS: Data Sources: secondary data for 3,587 subjects, 18-65 years, working when diagnosed with cancer in 1995-2009 and a comparison group of 27,688 subjects matched for gender, age and occupation. Study design: a comprehensive population-based longitudinal study. A Cox model described time to failures of small businesses and terminations ofself-employment. Data Collection Methods: extraction from the statutory mandatory self-employed social security scheme database. RESULTS: Findings were that age, cancer prognosis and very intense physical workload occupation were independent predictors of enterprise failure for cancer-exposed subjects. Compared with unexposed subjects, their global hazard ratio was 1.59 (95% CI = 1.50 - 1.70). However, the difference atfiveyears after cancer diagnosis became non-significant: hazard ratio 1.11 (95% CI = 0.95 - 1.30). CONCLUSION: These findings demonstrate that beyond 5 years of maintenance of activity, the economic cost of cancer supported by very small businesses and self-employed is not important. However, support is required to pass through these first 5 years. The authors describe the various possible aids that could be implemented.

Fatal falls in the U.S. residential construction industry.

BACKGROUND: Falls from heights remain the most common cause of workplace fatalities among residential construction workers in the United States. METHODS: This paper examines patterns and trends of fall fatalities in U.S. residential construction between 2003 and 2010 by analyzing two large national datasets. RESULTS: Almost half of the fatalities in residential construction were from falls. In the residential roofing industry, 80% of fatalities were from falls. In addition, about one-third of fatal falls in residential construction were among self-employed workers. Workers who were older than 55 years, were Hispanic foreign-born, or employed in small establishments (1-10 employees) also had higher proportions of fatal falls in residential construction compared to those in nonresidential construction. CONCLUSIONS: The findings suggest that fall safety within the residential construction industry lags behind commercial construction and industrial settings. Fall prevention in residential construction should be enhanced to better protect construction workers in this sector.

Mapping ergonomics application to improve SMEs working condition in industrially developing countries: a critical review.

In industrially developing countries (IDC), small and medium enterprises (SMEs) account for the highest proprotion of employment. Unfortunately, the working conditions in SMEs are often very poor and expose employees to a potentially wide range of health and safety risks. This paper presents a comprehensive review of 161 articles related to ergonomics application in SMEs, using Indonesia as a case study. The aim of this paper is to investigate the extent of ergonomics application and identify areas that can be improved to promote effective ergonomics for SMEs in IDC. The most urgent issue found is the need for adopting participatory approach in contrast to the commonly implemented top-down approach. Some good practices in ergonomics application were also revealed from the review, e.g. a multidisciplinary approach, unsophisticated and low-cost solutions, and recognising the importance of productivity. The review also found that more work is still required to achieve appropriate cross-cultural adaptation of ergonomics application.

The economic impact of state cigarette taxes and smoke-free air policies on convenience stores.

OBJECTIVES: To investigate whether increasing state cigarette taxes and/or enacting stronger smoke-free air (SFA) policies have negative impact on convenience store density in a state, a proxy that is determined by store openings and closings, which reflects store profits. METHODS: State-level business count estimates for convenience stores for 50 states and District of Columbia from 1997 to 2009 were analysed using two-way fixed effects regression techniques that control for state-specific and year-specific determinants of convenience store density. The impact of tax and SFA policies was examined using a quasi-experimental research design that exploits changes in cigarette taxes and SFA policies within a state over time. RESULTS: Taxes are found to be uncorrelated with the density of combined convenience stores and gas stations in a state. Taxes are positively correlated with the density of convenience stores; however, the magnitude of this correlation is small, with a 10% increase in state cigarette taxes associated with a 0.19% (p<0.05) increase in the number of convenience stores per million people in a state. State-level SFA policies do not correlate with convenience store density in a state, regardless whether gas stations were included. These results are robust across different model specifications. In addition, they are robust with regard to the inclusion/exclusion of other state-level tobacco control measures and gasoline prices. CONCLUSIONS: Contrary to tobacco industry and related organisations' claims, higher cigarette taxes and stronger SFA policies do not negatively affect convenience stores.

A health and environmental profile of the dry cleaning industry in King County, Washington.

Workers in the dry cleaning industry are exposed to a variety of harmful solvents, and poor work practices can result in extensive environmental contamination. Of particular concern is perchloroethylene (PERC), which is the most commonly used cleaning solvent. This chlorinated hydrocarbon is a pervasive environmental contaminant and a probable human carcinogen. PERC is also a neurotoxin and is toxic to the liver and kidneys. The study described here was comprised of key informant interviews, site visits, and a countywide business survey. The 64% response rate to the survey suggests that the results are likely representative of King County's dry cleaning industry. Dry cleaning was determined to be dominated by small, Korean-owned, family-run businesses. Although the use of PERC as the primary dry cleaning agent has decreased in recent years, this solvent is still used by the majority of businesses. This industry would benefit from regulatory intervention in concert with an educational campaign and enhanced technical and financial assistance. For any intervention to be effective, however, it must account for the unique financial and demographic characteristics of this industry.

Jobs without benefits: the health insurance crisis faced by small businesses and their workers.

The share of U.S. workers in small firms who were offered, eligible for, and covered by health insurance through their jobs has declined over the past decade. Less than half of workers in companies with fewer than 50 employees were both offered and eligible for health insurance through their jobs in 2010, down from 58 percent in 2003. In contrast, about 90 percent of workers in companies with 100 or more employees were offered and eligible for their employer's health plans in both 2003 and 2010. Workers in the smallest firms--and those with the lowest wages--continue to be less likely to get coverage from their employers and more likely to be uninsured than workers in larger firms or with higher wages. The Affordable Care Act includes new subsidies that will lower the cost of health insurance for small businesses and workers who must purchase coverage on their own.

[Study on engagement in health promotion at the workplace of non-public health providers in Poland]. / Badanie zaangazowania firm oferujacych pracownikom opieik medyczna w promowanie zdrowia w miejscu pracy w Polsce.

UNLABELLED: Increasing life expectancy in Europe impose a necessity to extend a work ability span. Appropriate health status of working population requires not merely curative care in case of diagnosed diseases but also comprehensive preventive care. AIM: The article provides results of a study on engagement of the Polish companies that are covered by a private employee health plans in certain workplace health promotion activities. MATERIAL AND METHODS: [corrected] 411 companies out of invited 3512 (11,7% participation rate) took part in the study performed in 2011. The majority of study group were large companies (over 50 employees--74%), and smaller, privately owned (less than 50 employees--77%). Companies were asked questions using ENWHP checklist tool on supporting employees in physical activity, smoking cessation, healthy diet and coping with stress. RESULTS: In general, 44% of the companies declared any engagement in employee health promotion. Results showed that companies support mainly physical activity (27% of a study group) and quitting smoking (19%). Researched employers rarely offered support in healthy diet (8%) or stress reduction (5%). There is also a significant relation between higher engagement rate in health promotion among companies that have implemented a special health policy and detailed action plans. However, small enterprises were less likely to provide any preventive action to employees. Even if small enterprises decide to implement any health promotion they usually were based on a single action without broader planning.

[Health management in small and medium-sized enterprises: results of a representative survey]. / Gesundheitsmanagement in kleinen und mittleren Unternehmen - Ergebnisse einer repräsentativen Unternehmensbefragung.

PURPOSE: The prevalence of workplace health promotion in small and medium-sized enterprises (SME) in Germany as well as age management were investigated. METHODS: Representative data were collected by computer assisted telephone interviews in 1 441 SME (1-250 employees) in 7 regions of Germany. RESULTS: One-third of the SME have a system of health promotion. Disability management is known only in one third of the enterprises, another third of them knew the legal obligations. About half of the enterprises have a system to collect data about health-related absenteeism in business. Effects caused by the demographic change in Germany are feared by nearly 50% of the enterprises, but only 20% have taken action against it. The implementation of work health promotion is higher in enterprises with more employees. CONCLUSION: The study shows that workplace health promotion (WHP) in German small and medium-sized enterprises is not yet installed to a wide extent. The smaller the enterprises the less WHP is found. The results are verified by similar studies. Small and medium-sized enterprises have a need for consultation in cases of illness or health prevention. But there is not yet an organised structure available for getting advice. The study is the basis for a national project "Gesunde Arbeit", which will establish these consulting structures.

Swedish entrepreneurs' use of occupational health services.

Small-scale enterprises are less often covered by occupational health services and have insufficient awareness about health and risks in the work environment. This study investigated how Swedish entrepreneurs in small-scale enterprises use occupational health services. The study used a questionnaire sent in two waves, 5 years apart. At baseline, 496 entrepreneurs responded, and 251 participated 5 years later. The questionnaire included items about affiliation with and use of occupational health services, physical and psychosocial work environments, work environment management, sources of work environment information, and membership in professional networks. Only 3% of entrepreneurs without employees and 19% of entrepreneurs with employees were affiliated with an occupational health service. Entrepreneurs affiliated with occupational health services were more active in work environment management and gathering information about the work environment. The occupational health services most used were health examinations, health care, and ergonomic risk assessments. Affiliation with occupational health services was 6% at both measurements, 4% at baseline, and 10% 5 years later.

Dynamic capabilities, value creation and value capture: Evidence from SMEs under Covid-19 lockdown in Poland.

Dynamic capabilities, resulting from activities that allow conscious and skillful modification of a firm's strategic potential, are seen as one of the key drivers of a firm's value creation, competitive advantage and above-average performance in changing environments. However, little is known about how dynamic capabilities can shape business survival and performance during crises. The research objective of this paper is twofold. First, through a literature review, we seek to identify which first-order dynamic capabilities-managerial decisions under uncertainty-are vital for rapid response to a crisis. Second, we present the results of research carried out among 151 small and medium-sized companies in Poland immediately after the beginning of the economic lockdown (April 2020). The survey that we developed identifies which dynamic capabilities were essential for businesses to survive during this unexpected black swan event. We also present dependence and regression analyses showing the links between the identified dynamic capabilities and value creation, understood as retaining employees and production levels, as well as value capture, understood as maintaining cash flow and current revenues.

Increasing fresh fruit and vegetable availability in a low-income neighborhood convenience store: a pilot study.

Changing the food environment in low-income communities may be an effective way to increase the consumption of fruits and vegetables by low-income consumers. This study examines the impacts of a pilot study that increases the availability of fresh produce in a convenience store in a low-income neighborhood not served by a supermarket. Two hypotheses based on theories of technology adoption are tested regarding the lack of fresh produce in low-income neighborhood stores: the first is that high fixed costs present a barrier for store owners in developing produce sections; the second is that there is insufficient consumer demand to cover the variable costs of a fresh produce section. The impacts of changing the food environment on store owners and the consumer response to environmental change are measured through weekly inventories of fresh produce. The results show that fixed costs are one barrier for store owners and that although the consumer response is sufficient to cover the direct costs of operating the produce case, it is not enough to cover variable management costs. Consequently, alternative management paradigms or venues may offer a better method to meet the demand for fresh produce by low-income consumers to promote better health through healthier diets in low-income communities.

Change in frontline supervisors' safety leadership practices after participating in a leadership training program: Does company size matter?

INTRODUCTION: The majority of construction companies are small businesses and small business often lack the resources needed to ensure that their supervisors have the safety leadership skills to build and maintain a strong jobsite safety climate. The Foundations for Safety Leadership (FSL) training program was designed to provide frontline leaders in all sized companies with safety leadership skills. This paper examines the impact of the FSL training by size of business. METHODS: Leaders, defined as foremen or other frontline supervisors, from small, medium, and large construction companies were recruited to participate in a study to evaluate the degree to which the FSL changed their understanding and use of the leadership skills, safety practices and crew reporting of safety-related conditions. We used linear mixed modeling methods to analyze pre-post training survey data. RESULTS: Prior to the training, leaders from small and medium sized companies reported using safety leadership skills less frequently than those from large ones. After the training, regardless of business size, we observed that the FSL training improved leaders understanding of safety leadership skills from immediately before to immediately after the training. Additionally, leaders reported greater use of safety leadership skills, safety practices, and crew reporting of safety-related conditions from before to two-weeks after the training. However, those from small and medium sized companies reported the greatest improvement in their use of safety leadership skills. CONCLUSIONS: The FSL training improves safety leadership outcomes regardless of the size company for which the leader worked. However, the FSL may be even more effective at improving the safety leadership skills of leaders working for smaller sized construction companies or those with lower baseline levels of safety leadership skills. Practical applications: The majority of construction companies employ a small number of employees and therefore may not have the resources to provide their frontline leaders with the leadership training they need to be effective leaders who can create a strong jobsite safety climate. The Foundations for Safety Leadership (FSL) training can help fill this gap.