Abstract
Several studies have demonstrated that point-of-choice prompts modestly increase stair use (i.e., incidental physical activity) in many public places, but evidence of effectiveness in airport settings is weak. Furthermore, evaluating the effects of past physical activity on stair use and on point-of-choice prompts to increase stair use is lacking. The purpose of this study was to evaluate the influence of sign prompts and participant factors including past physical activity on stair ascent in an airport setting. We used a quasi-experimental design, systematically introducing and removing sign prompts daily across 22 days at the San Diego International Airport. Intercept interviewers recruited stair and escalator ascenders (N = 1091; 33.0% interview refusal rate) of the only stairs/escalators providing access to Terminal 1 from the parking lot. A 13-item questionnaire about demographics, physical activity, health behavior, and contextual factors provided data not available in nearly all other stair use studies. We examined the effects of signs and self-reported covariates using multivariable logistic regression analyses, and tested whether physical activity and other covariates modified the intervention effect. Adjusting for all significant covariates, prompts increased the odds of stair use (odds ratio 3.67; p < .001). Past participation in vigorous physical activity increased the odds of stair use by 1.62 (p = 0.001). None of the covariates moderated the intervention effect. In conclusion, vigorous physical activity and correlates of physical activity were related to stair use in expected directions, but did not modify the effect of the intervention. This indicates that the effects of point-of-choice prompts are independent of past physical activity, making them effective interventions for active adults and the higher risk population of inactive adults. Signs can prompt stair use in an airport setting and might be employed at most public stairs to increase rates of incidental physical activity and contribute to overall improvements in population health.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Adams, M. A., Hovell, M. F., Irvin, V., Sallis, J. F., Coleman, K. J., & Liles, S. (2006). Promoting stair use by modeling: An experimental application of the Behavioral Ecological Model. American Journal of Health Promotion, 21(2), 101–109. doi:10.4278/0890-1171-21.2.101.
Andersen, R. E., Bauman, A. E., Franckowiak, S. C., Reilley, S. M., & Marshall, A. L. (2008). Prompting health professionals to be activity role models—Motivating stair use at the 2001 ACSM scientific meeting. Journal of Physical Activity & Health, 5(4), 607–618. doi:10.1123/jpah.5.4.607.
Andersen, R. E., Franckowiak, S. C., Snyder, J., Bartlett, S. J., & Fontaine, K. R. (1998). Can inexpensive signs encourage the use of stairs? Results from a community intervention. Annals of Internal Medicine, 129(5), 363–369. doi:10.1097/00008483-199901000-00016.
Andersen, L. L., Sundstrup, E., Boysen, M., Due Jakobsen, M., Mortensen, O. S., & Persson, R. (2013). Cardiovascular health effects of internet-based encouragements to do daily workplace stair-walks: Randomized controlled trial. Journal of Medical Internet Research, 15(6), e127. doi:10.2196/jmir.2340.
Bellicha, A., Kieusseian, A., Fontvieille, A., Tataranni, A., Charreire, H., & Oppert, J. (2015). Stair-use interventions in worksites and public settings—A systematic review of effectiveness and external validity. Preventive Medicine, 70, 3–13. doi:10.1016/j.ypmed.2014.11.001.
Boreham, C. A. G., Wallace, W. F. M., & Nevill, A. (2000). Training effects of accumulated daily stair-climbing exercise in previously sedentary young women. Preventive Medicine, 30, 277–281. doi:10.1006/pmed.2000.0634.
Boutelle, K. N., Jeffery, R. W., Murray, D. M., & Schmitz, M. K. H. (2001). Using signs, artwork, and music to promote stair use in a public building. American Journal of Public Health, 91(12), 2004–2006. doi:10.2105/AJPH.91.12.2004.
Bureau of Transportation Statistics (2015). Summary 2014 U.S.-Based airline traffic data [press release]. http://www.rita.dot.gov/bts/press_releases/bts015_15.
Coleman, K. J., & Gonzalez, E. C. (2001). Promoting stair use in a US-Mexico border community. American Journal of Public Health, 91(12), 2007–2009. doi:10.2105/AJPH.91.12.2007.
Conway, T. L., & Cronan, T. A. (1992). Smoking, exercise and physical fitness. Preventive Medicine, 21(6), 723–734. doi:10.1016/0091-7435(92)90079-W.
Craig, C. L., Marshall, A. L., Sjöström, M., Bauman, A. E., Booth, M. L., Ainsworth, B. E., et al. (2003). International physical activity questionnaire: 12-Country reliability and validity. Medicine and Science in Sports and Exercise, 35(8), 1381–1395. doi:10.1249/01.MSS.0000078924.61453.FB.
Davies, H. T. O., Crombie, I. K., & Tavakoli, M. (1998). When can odds ratios mislead? British Medical Journal, 316, 989–991. doi:10.1136/bmj.316.7136.989.
Eves, F. F. (2010). Point-of-decision prompts to increase stair use. American Journal of Preventive Medicine, 38(5), 573–574. doi:10.1016/j.amepre.2010.02.004.
Eves, F. F., Masters, R. S. W., Mcmanus, A., Leung, M., Wong, P., & White, M. J. (2008). Contextual barriers to lifestyle physical activity interventions in Hong Kong. Medicine and Science in Sports and Exercise, 40(5), 965–971. doi:10.1249/MSS.0b013e3181659c68.
Eves, F. F., Webb, O. J., & Mutrie, N. (2006). A workplace intervention to promote stair climbing: Greater effects in the overweight. Obesity, 14(12), 2210–2216. doi:10.1038/oby.2006.259.
Flegal, K. M., Carroll, M. D., Ogden, C. L., & Curtin, L. R. (2010). Prevalence and trends in obesity among US adults, 1999–2008. Journal of the American Medical Association, 303(3), 235–241. doi:10.1001/jama.2009.2014.
Graham, D. J., Linde, J. A., Cousins, J. M., & Jeffery, R. W. (2013). Environmental modifications and 2-year measured and self-reported stair-use: A worksite randomized trial. The Journal of Primary Prevention, 34(6), 413–422. doi:10.1007/s10935-013-0323-2.
Haskell, W. L., Lee, I., Pate, R. R., Powell, K. E., Blair, S. N., Franklin, B. A., et al. (2007). Physical activity and public health: Updated recommendation for adults from the American College of Sports Medicine and the American Heart Association. Medicine and Science in Sports and Exercise, 39(8), 1423–1434. doi:10.1249/mss.0b013e3180616b27.
Hodgin, K. L., & Graham, D. J. (2016). Mirror, mirror by the stairs: The impact of mirror exposure on stair versus elevator use in college students. Frontiers in Public Health. doi:10.3389/fpubh.2016.00080.
Hotez, P. J., & Daar, A. S. (2008). The CNCDs and the NTDs: Blurring the lines dividing noncommunicable and communicable chronic diseases. PLoS Neglected Tropical Diseases, 2(10), e312. doi:10.1371/journal.pntd.0000312.
Hovell, M. F., Adams, M. A., Hofstetter, C. R., Martinez-Donate, A. P., Gonzalez-Perez, G. J., Rovniak, L. S., et al. (2013). Complete home smoking bans and antitobacco contingencies: A natural experiment. Nicotine & Tobacco Research, 16(2), 186–196. doi:10.1093/ntr/ntt130.
Hovell, M. F., & Hughes, S. C. (2009). The behavioral ecology of secondhand smoke exposure: A pathway to complete tobacco control. Nicotine & Tobacco Research, 11(11), 1254–1264. doi:10.1093/ntr/ntp133.
Hovell, M. F., Wahlgren, D. R., & Adams, M. A. (2009). The logical and empirical basis for the Behavioral Ecological Model. In R. DiClemente, R. Crosby, & M. Kegler (Eds.), Emerging theories in health promotion practice and research (2nd ed., pp. 415–450). San Francisco: Jossey-Bass Inc.
Kennedy, R. A., Boreham, C. A. G., Murphy, M. H., Young, I. S., & Mutrie, N. (2007). Evaluating the effects of a low volume stairclimbing programme on measures of health-related fitness in sedentary office workers. Journal of Sports Science and Medicine, 6(4), 448–454.
Kerr, J., Eves, F., & Carroll, D. (2000). Posters can prompt less active people to use the stairs. Journal of Epidemiology and Community Health, 54(12), 942–943. doi:10.1136/jech.54.12.942.
Kerr, J., Eves, F. F., & Carroll, D. (2001). The influence of poster prompts on stair use: The effects of setting, poster size and content. British Journal of Health Psychology, 6(4), 397–405. doi:10.1348/135910701169296.
Kerr, N. A., Yore, M. M., Ham, S. A., & Dietz, W. H. (2004). Increasing stair use in a worksite through environmental changes. American Journal of Health Promotion, 18(4), 312–315. doi:10.4278/0890-1171-18.4.312.
Lavizzo-Mourey, R., & McGinnis, J. M. (2003). Making the case for active living communities. American Journal of Public Health, 93(9), 1386–1388. doi:10.2105/AJPH.93.9.1386.
Lee, K., Perry, A., Wolf, S., Agarwal, R., Rosenblum, R., Fischer, S., et al. (2012). Promoting routine stair use: Evaluating the impact of a stair prompt across buildings. American Journal of Preventive Medicine, 42(2), 136–141. doi:10.1016/j.amepre.2011.10.005.
Macfarlane, D. J., Taylor, L. H., & Cuddihy, T. F. (2006). Very short intermittent vs continuous bouts of activity in sedentary adults. Preventive Medicine, 43(4), 332–336. doi:10.1016/j.ypmed.2006.06.002.
McGann, S., Jancey, J., & Tye, M. (2013). Taking the stairs instead: The impact of workplace design standards on health promotion strategies. Australasian Medical Journal, 6(1), 23–28. doi:10.4066/AMJ.2013.1584.
Physical Activity Guidelines Advisory Committee (2008). Physical activity guidelines advisory committee report, 2008. Washington, DC. http://health.gov/paguidelines/Report/pdf/CommitteeReport.pdf.
Prentice, A., & Jebb, S. (1995). Obesity in Britain: Gluttony or sloth? British Medical Journal, 311, 437–439. doi:10.1136/bmj.311.7002.437.
Prentice, A., & Jebb, S. (2004). Energy intake/physical activity interactions in the homeostasis of body weight regulation. Nutrition Reviews, 62(7), S98–S104. doi:10.1111/j.1753-4887.2004.tb00095.x.
Rose, G. A. (1992). The strategy of preventive medicine. Oxford [England]. New York: Oxford University Press.
Russell, W. D., & Hutchinson, J. (2000). Comparison of health promotion and deterrent prompts in increasing use of stairs over escalators. Perceptual and Motor Skills, 91(1), 55–61. doi:10.2466/pms.2000.91.1.55.
Sallis, J., Cervero, R., Henderson, K., Kraft, M., & Kerr, J. (2006). An ecological approach to creating active living communities. Annual Review Public Health, 27, 297–322.
Sattelmair, J., Pertman, J., Ding, E. L., Kohl, H. W., Haskell, W., & Lee, I. M. (2011). Dose response between physical activity and risk of coronary heart disease: A meta-analysis. Circulation, 124(7), 789–795. doi:10.1161/circulationaha.110.010710.
Soler, R. E., Leeks, K. D., Buchanan, L. R., Brownson, R. C., Heath, G. W., & Hopkins, D. H. (2010). Point-of-decision prompts to increase stair use: A systematic review update. American Journal of Preventive Medicine, 38(2S), S292–S300. doi:10.1016/j.amepre.2009.10.028.
Teh, K. C., & Aziz, A. R. (2002). Heart rate, oxygen uptake, and energy cost of ascending and descending the stairs. Medicine and Science in Sports and Exercise, 34(4), 695–699. doi:10.1097/00005768-200204000-00021.
Tucker, J. M., Welk, G. J., & Beyler, N. K. (2011). Physical activity in U.S.: Adults compliance with the Physical activity guidelines for Americans. American Journal of Preventive Medicine, 40(4), 454–461. doi:10.1016/j.amepre.2010.12.016.
Warburton, D. E. R., Nicol, C. W., & Bredin, S. S. D. (2006). Health benefits of physical activity: The evidence. Canadian Medical Association Journal, 174(6), 801–809. doi:10.1503/cmaj.051351.
Ward, B. W., Schiller, J. S., Freeman, G., & Peregoy, J. A. (2013). Early release of selected estimates based on data from the January–September 2012 National Health Interview Survey. http://www.cdc.gov/nchs/nhis/released201303.htm#3.
Webb, O. J., & Eves, F. F. (2007). Promoting stair climbing: Intervention effects generalize to a subsequent stair ascent. American Journal of Health Promotion, 22(2), 114–119. doi:10.4278/0890-1171-22.2.114.
Webb, O. J., Eves, F. F., & Smith, L. (2011). Investigating behavioural mimicry in the context of stair/escalator choice. British Journal of Health Psychology, 16(2), 373–385. doi:10.1348/135910710X510395.
Acknowledgements
Dr. Hovell and other authors were supported in part by National Institutes of Health grant R01 CA138192-01A2 (Hovell)—Clinician Promotion of Healthy Diet and Activity to Reduce Obesity Among Adolescents (Project Healthy Smiles). We thank the San Diego Airport Administration that made this study possible as well as Vian Oraha and Elsie Campa for assistance with synthesis of the literature.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of Interest
The authors declare that they have no conflicts of interest.
Research Involving Human Participants and/or Animals
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. We obtained approval for all study procedures from airport authorities and the San Diego State University Institutional Review Board.
Informed Consent
Verbal consent was obtained from all individual participants included in the study. No personally identifying information was obtained.
Rights and permissions
About this article
Cite this article
Bellettiere, J., Liles, S., BenPorat, Y. et al. And She’s Buying a Stairway to Health: Signs and Participant Factors Influencing Stair Ascent at a Public Airport. J Primary Prevent 38, 597–611 (2017). https://doi.org/10.1007/s10935-017-0491-6
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10935-017-0491-6