@2024 Afarand., IRAN
ISSN: 2383-2150 Journal of Education and Community Health 2018;5(3):4-12
ISSN: 2383-2150 Journal of Education and Community Health 2018;5(3):4-12
Determinants of the Regular Physical Activity among Employees of Healthcare Network: Application of Health Belief Model
ARTICLE INFO
Article Type
Descriptive & Survey StudyAuthors
Jorvand Reza (1)Tavousi Mahmoud (2)
Ghofranipour Fazlollah (3*)
(1) Public Health Department, Health Faculty, Ilam University of Medical sciences, Ilam, Iran
(2) Health Metrics Research Center, Iranian Institute for Health Sciences Research, ACECR, Tehran, Iran
(3*) Health Education Department, Medical Sciences Faculty, Tarbiat Modares University, Tehran, Iran
Correspondence
Address: Health Education Department, Medical Sciences Faculty, Tarbiat Modares University, Nasr Bridge, Jalal-Al-Ahmad Highway, Tehran, IranPhone: 02182883869
Fax: 02182883869
ghofranf@modares.ac.ir
Article History
Received: March 29, 2018Accepted: November 17, 2018
ePublished: December 20, 2018
ABSTRACT
Aims
Inactivity is one of the 10 leading causes of death in the world, doubling the risk of cardiovascular disease. Health belief model (HBM) is an effective model in predict the regular physical activity behavior. This study aimed at identifying determinants of the regular physical activity in order to prevent cardiovascular diseases, using HBM.
Instrument & Methods This descriptive-analytical cross sectional study was conducted on employees working in a healthcare network affiliated to Ilam University of Medical Sciences in 2017. 163 subjects were selected by simple random sampling method. The instruments to collect the data were standard inventory of HBM-ISCS and self-made questionnaire that were applied after reviewing and approving their validity and reliability. Eventually, the data were analyzed, by SPSS 16, using Pearson correlation coefficient, multiple regression analysis, and ETA test.
Findings The perceived severity and self-efficacy were significant predictors of daily and weekly regular physical activity. Meanwhile, multiple regression analysis predicted 23.3% of the behavior. Also, gender had the strongest relationship with the barriers of physical activity and marital status and occupation had the strongest relationship with self-efficacy. Education had no significant statistical relationship with model constructs and age had a significant statistical relationship with perceived severity and the benefits of physical activity.
Conclusion The perceived severity and self-efficacy from health belief model are the strongest determinants for daily and weekly physical activity.
Instrument & Methods This descriptive-analytical cross sectional study was conducted on employees working in a healthcare network affiliated to Ilam University of Medical Sciences in 2017. 163 subjects were selected by simple random sampling method. The instruments to collect the data were standard inventory of HBM-ISCS and self-made questionnaire that were applied after reviewing and approving their validity and reliability. Eventually, the data were analyzed, by SPSS 16, using Pearson correlation coefficient, multiple regression analysis, and ETA test.
Findings The perceived severity and self-efficacy were significant predictors of daily and weekly regular physical activity. Meanwhile, multiple regression analysis predicted 23.3% of the behavior. Also, gender had the strongest relationship with the barriers of physical activity and marital status and occupation had the strongest relationship with self-efficacy. Education had no significant statistical relationship with model constructs and age had a significant statistical relationship with perceived severity and the benefits of physical activity.
Conclusion The perceived severity and self-efficacy from health belief model are the strongest determinants for daily and weekly physical activity.
Keywords:
Regular Physical Activity,
Cardiovascular Diseases ,
Occupational Health Services ,
Biobehavioral Sciences ,
CITATION LINKS
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[2]Vahedian Shahroodi M, Amin Shokravi F, Haidarnia A, Jabbari Nooghabi H. A survey on the effects of the Pender's health promotion model on prediction of the employees' physical activity. Health Educ Health Promot. 2013;1(1):51-66.
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[6]Esteghamati A, Khalilzadeh O, Rashidi A, Kamgar M, Meysamie A, Abbasi M. Physical activity in Iran: results of the third national surveillance of risk factors of non-communicable diseases (SuRFNCD-2007). J Phys Act Health. 2011;8(1):27-35.
[7]Delavari A, Alikhani S, Alaodini F. A National Profile of Noncommunicable Disease Risk Factors in the I.R. of IRAN. Tehran: Seda Publishing Center; 2006. p.100. [Persian]
[8] Jalilian F, Emdadi Sh, Mirzaie Alavijeh M, Barati M. The survey physical activity status of employed women in Hamadan University of Medical Sciences: the relationship between the benefits, barriers, self-efficacy and stages of change. J Toloo-e-Behdasht .2011;9(4):89-98. [Persian]
[9] Mostafavi F, Pirzadeh A. Physical activity among employee women based on transtheoretical model. J Educ Health Promot. 2015;4(1):81-6.
[10]Jalilian M, Darabi M, Sharifirad Gh, Kakaei H. Interventional program based on transtheoretical model to promote regular physical activity in office workers. J Health Syst Res. 2013;9(2):188-95. [Persian]
[11] Chatripour R, Sadeghi Rad K, Ghazanfari Z, Jorvand R. The survey of teacher’s lifestyle in Dehloran boys high schools on cardiovascular disease risk factors. 2nd International and 6th National Iranian Congress on Health Education and Promotion. Kermanshah: Kermanshah University of Medical Sciences; 2015. p.86. [Persian]
[12]Farrar AR, Khani M, Jaberi Moghadam AA, Farrokhi A, Sadri K. Comparison of the level of physical activity in field dependent and field independent students. J Dev Motor Learn. 2012;4(1):93-110. [Persian]
[13]World Health Organization. How much of physical activity is recommended? [Internet]. Geneva: World Health Organization; 2018 [cited 2018 Feb 23]. Available from: http://www.who.int/en/news-room/fact-sheets/detail/physical-activity.
[14] Yamaguchi Y, Miura S, Urata H, Himeshima Y, Yamatsu K, Otsuka N, Nishida S, Saku K. The effectiveness of a multicomponent program for nutrition and physical activity change in clinical setting: short-term effects of PACE+ Japan. Int J Sport Health Sci. 2003;1(2):229-37.
[15]Martin KR, Schoster B, Shreffler JH, Meier A, Callahan LF. Perceived barriers to physical activity among North Carolinians with arthritis: findings from a mixed-methodology approach. NC Med J. 2007;68(6):404-12.
[16] Im EO, Stuifbergen AK, Walker L. A situation-specific theory of Midlife Women's Attitudes toward Physical Activity (MAPA). Nurs Outlook. 2010;58(1):52-8.
[17]Moeini B, Rahimi M, Hazaveie SM, Allahverdipour H, Moghim Beigi A, Mohammadfam I. Effect of education based on trans-theoretical model on promoting physical activity and increasing physical work capacity. Iranian J Milit Med. 2010;12(3):123-30. [Persian]
[18] Ahmadi Tabatabaei SV, Taghdisi MS, Sadeghi A, Nakhaei N, Balali F. The effect of education in physical activities on knowledge, attitude and behavior of Kerman health center’s staff. J Res Health. 2012;2(1):137-44. [Persian]
[19]Hatefnia E, Ghazivakili Z. Factors associated with regular physical activity for the prevention of osteoporosis in female employees Alborz University of Medical Sciences: Application of health belief model. Alborz Univ Med J. 2016;5(2):78-86. [Persian]
[20] Allen NA. Social cognitive theory in diabetes exercise research: an integrative literature review. Diabetes Educ. 2004;30(5):805-19
[21]Glanz K, Rimer BK, Viswanth K. Health behavior and health education: theory, research and practice. 4th Edition. San Farancisco: Josey-Bass Publisher; 2008. p. 8-30.
[22]Ebadifard Azar F, Solhi M, Zohoor AR, Ali Hosseini M. The effect of health belief model on promoting preventive behaviors of osteoporosis among rural women of Malayer. J Qazvin Univ Med Sci. 2012;16(2):58-64. [Persian]
[23]Bandura A. Health promotion by social cognitive means. Health Educ Behav. 2004; 31(2):143-64.
[24] Vahedi MS, Ahssan B, Ardalan M, Shahsavari S. Prevalence and causes of needle stick injuries, in medical personnel of Kurdistan university hospitals and dealing with such injuries due to contaminated sharp tools in 2004. Scientific J Kurdistan Univ Med Sci. 2006;11(2):43-50. [Persian]
[25]Chatripour R, Shojaeizadeh D, Tol A, Sayehmiri K. Determining health belief model constructs to prevent cardiovascular diseases among teachers of boys’ high schools in Dehloran city. J Ilam Univ Med Sci. 2017;25(2):35-41. [Persian]
[26] World Health Organization. Global recommendations on physical activity for health [Internet]. Geneva: World Health Organization; 2011 [cited 2018 July 27]. Available from: https://www.who.int/dietphysicalactivity/leaflet-physical-activity-recommendations.pdf?ua=1.
[27]Jorvand R, Tavousi M, Ghofranipour F. Impact of sport on the cardiovascular diseases scale based on health belief model: questionnaire psychometric properties. Iranian Red Crescent Med J. 2018;20(S1):e62027.
[28]Movahed E, Shojaeizadeh D, Zareipour MA, Arefi Z, Sha Ahmadi F, Ameri M. The effect of health belief model- based training (hbm) on self- medication among the male high school students. J Health Educ Health Promot. 2014;2(1):65-72. [Persian]
[29]Sajadi Hazaveyee M, Shamsi M. The effect of education based on Health Belief Model (HBM) in mothers about behavior of prevention from febrile convulsion in children. Scientific J Hamadan Nurs Midwifery Fac. 2013;21(2):37-47. [Persian]
[30]Jorvand R, Haeri Mehrizi A, Sadeghirad K, Gholami O, Ansarian Z, Ghofranipour F et al . Risk factors for cardiovascular diseases among employees of Ilam University of Medical Sciences. Health Educ Health Promot. 2018;6(4):143-47.
[31]Kessler TA. Increasing mammography and cervical cancer knowledge and screening behaviors with an educational program. Oncol Nurs Forum. 2012;39(1):61-8.
[32]World Health Organization. Recommended levels of physical activity for adults aged 18- 64 years. [Internet]. Geneva: World Health Organization; 2018 [cited 2018 July 27]. Available from: http://www.who.int/dietphysicalactivity/factsheet_adults/en/
[33]Vahedian Shahroodi M, La’l Monfared E, Esmaeili H, Tehrani H, Mohaddes Hakkak HR. Prediction of osteoporosis preventive behaviors using the health belief model. J Health Educ Health Promot. 2014;2(3):199-207. [Persian]
[34] Baghiani Moghadam MH, Khabiri F, Morovati Sharifabad MA, Dehghan A, Fallahzadeh H. Determination of social variables affected the health belief model in adopting preventive behaviors of osteoporosis. J Toloo-e-Behdasht. 2016;15(2):45-57. [Persian]
[35] Khorsandi M, Shamsi M, Jahani F. The survey of practice about prevention of osteoporosis based on health belief model in pregnant women in Arak city. J Rafsanjan Univ Med Sci. 2013;12(1):35-46. [Persian]
[36] Mazloomi Mahmoodabad SS, Roohani Tanekaboni N. Survey of some related factors to oral health in high school female students in Yazd, on the basis of health behavior model (HBM). J Birjand Univ Med Sci. 2008;15(3):40-7. [Persian]
[37]Morovati Sharifabad MA, Rouhani Tonekaboni N. The relationship between perceived benefits/barriers of self-care behaviors and self-management in diabetic patients. Hayat. 2007;13(1):17-27. [Persian]
[38]Foley L, Prapavessis H, Maddison R, Burke S, McGowan E, Gillanders L. Predicting physical activity intention and behavior in school-age children. Pediatr Exerc Sci. 2008;20(3):342-56.
[39]Kirk A, MacMillan F, Webster N. Application of the trans-theoretical model to physical activity in older adults with type 2 diabetes and/or cardiovascular disease. J Psychol Sport Exerc. 2010;11(4):320-24.
[40]Sullivan KA, White KM, Young RM, Scott CJ. Predictors of intention to reduce stroke risk among people at risk of stroke: An application of an extended Health Belief Model. Rehabil Psychol. 2008;53(4):505-12.
[41] Koch J. The role of exercise in the African- American woman with type 2 diabet mellitus: Application of the health belief model. J Am Acad Nurse Pract. 2002;14(3):126-9.
[42] Shojaei S, Rahimi T, Mousavi Miyandashti Z, Jafari Nodoushan Z, Farahabadi M. Predictors of preventive behaviors of cardiovascular diseases: Based on health belief model in women referred to health treatment centers in Qom City, 2014, Iran. Qom Univ Med Sci J. 2015;9(11):51-9. [Persian]
[43] Sadler MJ. Soy and health 2004: clinical evidence, dietetic applications. Nutr Bull. 2005;30(4):385-91.
[44]Parhoodeh Y, Khezeli M, Abbasgholizadeh N. Application of trans-theoretical model in identification of physical activity behavior determinants in university students of Gilan Gharb. J Health. 2015;6(3):281-90. [Persian]
[45]Safarzadeh S, Behbodi Moghdam Z, Saffari M. The impact of education on performing postpartum exercise based on health belief model. Med J Mashad Univ Med Sci. 2014;57(6):776-84. [Persian]
[46]Tol A, Esmaeili Shahmirzadi S, Shojaeizadeh D, Eshraghian MR, Mohebbi B. Determination of perceived barriers and benefits of adopting health-promoting behaviors in cardiovascular diseases prevention: application of preventative behavior model. J Payavard. 2012;6(3):204-14. [Persian]
[47] Panter J, Desousa C, Ogilvie D. Incorporating walking or cycling into car journeys to and from work: the role of individual, workplace and environmental characteristics. Prev Med. 2013;56(3-4):211-7.
[48]Kaczynski AT, Bopp MJ, Wittman P. Association of workplace supports with active commuting. Prev Chronic Dis. 2010;7(6):A127.
[49]McNeill LH, Stoddard A, Bennett GG, Wolin KY, Sorensen GG. Influence of individual and social contextual factors on changes in leisure-time physical activity in working-class populations: results of the Healthy Directions-Small Businesses Study. Cancer Cause Control. 2012;23(9):1475-87.
[2]Vahedian Shahroodi M, Amin Shokravi F, Haidarnia A, Jabbari Nooghabi H. A survey on the effects of the Pender's health promotion model on prediction of the employees' physical activity. Health Educ Health Promot. 2013;1(1):51-66.
[3]Rejali M, Mostajeran M. Assessment of physical activity in medical and public health students of Isfahan University of medical sciences- 2008. J Health Syst Res. 2010;6(2):173-79. [Persian]
[4]World Health Organization. Global strategy on diet, physical activity and health [Internet]. Geneva: World Health Organization; 2018 [cited 2018 July 27]. Available from: http://www.who.int/dietphysicalactivity/goals/en/
[5]Zimmermann SD, Wanner M, Zimmermann E, Martin BW. Physical activity levels and determinants of change in young adults: a longitudinal panel study. Int J Behav Nutr Phys Act. 2010;7(2):2-13.
[6]Esteghamati A, Khalilzadeh O, Rashidi A, Kamgar M, Meysamie A, Abbasi M. Physical activity in Iran: results of the third national surveillance of risk factors of non-communicable diseases (SuRFNCD-2007). J Phys Act Health. 2011;8(1):27-35.
[7]Delavari A, Alikhani S, Alaodini F. A National Profile of Noncommunicable Disease Risk Factors in the I.R. of IRAN. Tehran: Seda Publishing Center; 2006. p.100. [Persian]
[8] Jalilian F, Emdadi Sh, Mirzaie Alavijeh M, Barati M. The survey physical activity status of employed women in Hamadan University of Medical Sciences: the relationship between the benefits, barriers, self-efficacy and stages of change. J Toloo-e-Behdasht .2011;9(4):89-98. [Persian]
[9] Mostafavi F, Pirzadeh A. Physical activity among employee women based on transtheoretical model. J Educ Health Promot. 2015;4(1):81-6.
[10]Jalilian M, Darabi M, Sharifirad Gh, Kakaei H. Interventional program based on transtheoretical model to promote regular physical activity in office workers. J Health Syst Res. 2013;9(2):188-95. [Persian]
[11] Chatripour R, Sadeghi Rad K, Ghazanfari Z, Jorvand R. The survey of teacher’s lifestyle in Dehloran boys high schools on cardiovascular disease risk factors. 2nd International and 6th National Iranian Congress on Health Education and Promotion. Kermanshah: Kermanshah University of Medical Sciences; 2015. p.86. [Persian]
[12]Farrar AR, Khani M, Jaberi Moghadam AA, Farrokhi A, Sadri K. Comparison of the level of physical activity in field dependent and field independent students. J Dev Motor Learn. 2012;4(1):93-110. [Persian]
[13]World Health Organization. How much of physical activity is recommended? [Internet]. Geneva: World Health Organization; 2018 [cited 2018 Feb 23]. Available from: http://www.who.int/en/news-room/fact-sheets/detail/physical-activity.
[14] Yamaguchi Y, Miura S, Urata H, Himeshima Y, Yamatsu K, Otsuka N, Nishida S, Saku K. The effectiveness of a multicomponent program for nutrition and physical activity change in clinical setting: short-term effects of PACE+ Japan. Int J Sport Health Sci. 2003;1(2):229-37.
[15]Martin KR, Schoster B, Shreffler JH, Meier A, Callahan LF. Perceived barriers to physical activity among North Carolinians with arthritis: findings from a mixed-methodology approach. NC Med J. 2007;68(6):404-12.
[16] Im EO, Stuifbergen AK, Walker L. A situation-specific theory of Midlife Women's Attitudes toward Physical Activity (MAPA). Nurs Outlook. 2010;58(1):52-8.
[17]Moeini B, Rahimi M, Hazaveie SM, Allahverdipour H, Moghim Beigi A, Mohammadfam I. Effect of education based on trans-theoretical model on promoting physical activity and increasing physical work capacity. Iranian J Milit Med. 2010;12(3):123-30. [Persian]
[18] Ahmadi Tabatabaei SV, Taghdisi MS, Sadeghi A, Nakhaei N, Balali F. The effect of education in physical activities on knowledge, attitude and behavior of Kerman health center’s staff. J Res Health. 2012;2(1):137-44. [Persian]
[19]Hatefnia E, Ghazivakili Z. Factors associated with regular physical activity for the prevention of osteoporosis in female employees Alborz University of Medical Sciences: Application of health belief model. Alborz Univ Med J. 2016;5(2):78-86. [Persian]
[20] Allen NA. Social cognitive theory in diabetes exercise research: an integrative literature review. Diabetes Educ. 2004;30(5):805-19
[21]Glanz K, Rimer BK, Viswanth K. Health behavior and health education: theory, research and practice. 4th Edition. San Farancisco: Josey-Bass Publisher; 2008. p. 8-30.
[22]Ebadifard Azar F, Solhi M, Zohoor AR, Ali Hosseini M. The effect of health belief model on promoting preventive behaviors of osteoporosis among rural women of Malayer. J Qazvin Univ Med Sci. 2012;16(2):58-64. [Persian]
[23]Bandura A. Health promotion by social cognitive means. Health Educ Behav. 2004; 31(2):143-64.
[24] Vahedi MS, Ahssan B, Ardalan M, Shahsavari S. Prevalence and causes of needle stick injuries, in medical personnel of Kurdistan university hospitals and dealing with such injuries due to contaminated sharp tools in 2004. Scientific J Kurdistan Univ Med Sci. 2006;11(2):43-50. [Persian]
[25]Chatripour R, Shojaeizadeh D, Tol A, Sayehmiri K. Determining health belief model constructs to prevent cardiovascular diseases among teachers of boys’ high schools in Dehloran city. J Ilam Univ Med Sci. 2017;25(2):35-41. [Persian]
[26] World Health Organization. Global recommendations on physical activity for health [Internet]. Geneva: World Health Organization; 2011 [cited 2018 July 27]. Available from: https://www.who.int/dietphysicalactivity/leaflet-physical-activity-recommendations.pdf?ua=1.
[27]Jorvand R, Tavousi M, Ghofranipour F. Impact of sport on the cardiovascular diseases scale based on health belief model: questionnaire psychometric properties. Iranian Red Crescent Med J. 2018;20(S1):e62027.
[28]Movahed E, Shojaeizadeh D, Zareipour MA, Arefi Z, Sha Ahmadi F, Ameri M. The effect of health belief model- based training (hbm) on self- medication among the male high school students. J Health Educ Health Promot. 2014;2(1):65-72. [Persian]
[29]Sajadi Hazaveyee M, Shamsi M. The effect of education based on Health Belief Model (HBM) in mothers about behavior of prevention from febrile convulsion in children. Scientific J Hamadan Nurs Midwifery Fac. 2013;21(2):37-47. [Persian]
[30]Jorvand R, Haeri Mehrizi A, Sadeghirad K, Gholami O, Ansarian Z, Ghofranipour F et al . Risk factors for cardiovascular diseases among employees of Ilam University of Medical Sciences. Health Educ Health Promot. 2018;6(4):143-47.
[31]Kessler TA. Increasing mammography and cervical cancer knowledge and screening behaviors with an educational program. Oncol Nurs Forum. 2012;39(1):61-8.
[32]World Health Organization. Recommended levels of physical activity for adults aged 18- 64 years. [Internet]. Geneva: World Health Organization; 2018 [cited 2018 July 27]. Available from: http://www.who.int/dietphysicalactivity/factsheet_adults/en/
[33]Vahedian Shahroodi M, La’l Monfared E, Esmaeili H, Tehrani H, Mohaddes Hakkak HR. Prediction of osteoporosis preventive behaviors using the health belief model. J Health Educ Health Promot. 2014;2(3):199-207. [Persian]
[34] Baghiani Moghadam MH, Khabiri F, Morovati Sharifabad MA, Dehghan A, Fallahzadeh H. Determination of social variables affected the health belief model in adopting preventive behaviors of osteoporosis. J Toloo-e-Behdasht. 2016;15(2):45-57. [Persian]
[35] Khorsandi M, Shamsi M, Jahani F. The survey of practice about prevention of osteoporosis based on health belief model in pregnant women in Arak city. J Rafsanjan Univ Med Sci. 2013;12(1):35-46. [Persian]
[36] Mazloomi Mahmoodabad SS, Roohani Tanekaboni N. Survey of some related factors to oral health in high school female students in Yazd, on the basis of health behavior model (HBM). J Birjand Univ Med Sci. 2008;15(3):40-7. [Persian]
[37]Morovati Sharifabad MA, Rouhani Tonekaboni N. The relationship between perceived benefits/barriers of self-care behaviors and self-management in diabetic patients. Hayat. 2007;13(1):17-27. [Persian]
[38]Foley L, Prapavessis H, Maddison R, Burke S, McGowan E, Gillanders L. Predicting physical activity intention and behavior in school-age children. Pediatr Exerc Sci. 2008;20(3):342-56.
[39]Kirk A, MacMillan F, Webster N. Application of the trans-theoretical model to physical activity in older adults with type 2 diabetes and/or cardiovascular disease. J Psychol Sport Exerc. 2010;11(4):320-24.
[40]Sullivan KA, White KM, Young RM, Scott CJ. Predictors of intention to reduce stroke risk among people at risk of stroke: An application of an extended Health Belief Model. Rehabil Psychol. 2008;53(4):505-12.
[41] Koch J. The role of exercise in the African- American woman with type 2 diabet mellitus: Application of the health belief model. J Am Acad Nurse Pract. 2002;14(3):126-9.
[42] Shojaei S, Rahimi T, Mousavi Miyandashti Z, Jafari Nodoushan Z, Farahabadi M. Predictors of preventive behaviors of cardiovascular diseases: Based on health belief model in women referred to health treatment centers in Qom City, 2014, Iran. Qom Univ Med Sci J. 2015;9(11):51-9. [Persian]
[43] Sadler MJ. Soy and health 2004: clinical evidence, dietetic applications. Nutr Bull. 2005;30(4):385-91.
[44]Parhoodeh Y, Khezeli M, Abbasgholizadeh N. Application of trans-theoretical model in identification of physical activity behavior determinants in university students of Gilan Gharb. J Health. 2015;6(3):281-90. [Persian]
[45]Safarzadeh S, Behbodi Moghdam Z, Saffari M. The impact of education on performing postpartum exercise based on health belief model. Med J Mashad Univ Med Sci. 2014;57(6):776-84. [Persian]
[46]Tol A, Esmaeili Shahmirzadi S, Shojaeizadeh D, Eshraghian MR, Mohebbi B. Determination of perceived barriers and benefits of adopting health-promoting behaviors in cardiovascular diseases prevention: application of preventative behavior model. J Payavard. 2012;6(3):204-14. [Persian]
[47] Panter J, Desousa C, Ogilvie D. Incorporating walking or cycling into car journeys to and from work: the role of individual, workplace and environmental characteristics. Prev Med. 2013;56(3-4):211-7.
[48]Kaczynski AT, Bopp MJ, Wittman P. Association of workplace supports with active commuting. Prev Chronic Dis. 2010;7(6):A127.
[49]McNeill LH, Stoddard A, Bennett GG, Wolin KY, Sorensen GG. Influence of individual and social contextual factors on changes in leisure-time physical activity in working-class populations: results of the Healthy Directions-Small Businesses Study. Cancer Cause Control. 2012;23(9):1475-87.