All ETDs from UAB

Advisory Committee Chair

Kathleen C Brown

Advisory Committee Members

Karen L Heaton

Karen H Frith

Elizabeth H Maples

Jennan A Phillips

David E Vance

Document Type

Dissertation

Date of Award

2013

Degree Name by School

Doctor of Philosophy (PhD) School of Nursing

Abstract

Obesity and diabetes are major contributors to morbidity and mortality in the United States. According to the American Public Health Association and Partnership for Prevention, obesity is growing faster than any other public health problem in the United States. The prevalence of diabetes has also increased significantly with an estimated 79 million Americans aged 20 years or older suffering from prediabetes. Few studies have examined the influence of perceived stress on obesity and prediabetes among working adults. Investigations are needed to examine factors that can contribute to higher health care costs for both employees and employers. The aims of this study were to examine the relationships among obesity, prediabetes, and perceived stress in municipal workers and determine the best subset of predictors for obesity and prediabetes in this population. Investigation of a subset of data from an employee health promotion program for a large municipality in the Southeastern U.S. was conducted. The Expanded Biobehavioral Interaction Model and Karasek and Theorell's Demand Control Model guided the study. Secondary analysis of data from 3,501 municipal employees revealed that the majority of the sample was male (72.8%), African American (66.9%), 40-49 years of age (31.4%), with police officers (30.1%) being the largest group of workers. The prevalence of obesity measured by BMI was 55.8% and 53.0% when measured by waist circumference. The prevalence of prediabetes measured by HA1c was 51% of the 1,963 participants who had HA1c screening. Logistic regression analyses revealed that age, black race, HA1c, physical activity, and occupation (especially police and public works) were significant predictors of obesity in municipal workers. When public safety workers were examined for obesity, age, female gender, HA1c, and physical activity were significant predictors. Prediabetes in municipal workers was predicted by age, black race, and BMI. Perceived stress was not a significant predictor of obesity or prediabetes in municipal workers. Findings from this study should guide the development of targeted health promotion and prevention programs in this employee population. Further research is needed to validate the models and explore the relationships among obesity, prediabetes, and stress.

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