title: Associations between Poor Sleep Quality and Stages of Change of Multiple Health Behaviors among Participants of Employee Wellness Program.
abstract: OBJECTIVE
  Using the Transtheoretical Model of behavioral change, this study evaluates the relationship between sleep quality and the motivation and maintenance processes of healthy behavior change.
  
  
  METHODS
  The current study is an analysis of data collected in 2008 from an online health risk assessment (HRA) survey completed by participants of the Kansas State employee wellness program (N=13,322). Using multinomial logistic regression, associations between self-reported sleep quality and stages of change (i.e. precontemplation, contemplation, preparation, action, maintenance) in five health behaviors (stress management, weight management, physical activities, alcohol use, and smoking) were analyzed.
  
  
  RESULTS
  Adjusted for covariates, poor sleep quality was associated with an increased likelihood of contemplation, preparation, and in some cases action stage when engaging in the health behavior change process, but generally a lower likelihood of maintenance of the healthy behavior.
  
  
  CONCLUSIONS
  The present study demonstrated that poor sleep quality was associated with an elevated likelihood of contemplating or initiating behavior change, but a decreased likelihood of maintaining healthy behavior change. It is important to include sleep improvement as one of the lifestyle management interventions offered in EWP to comprehensively reduce health risks and promote the health of a large employee population.
authors.affiliation: Cancer Prevention and Control Program, Fox Chase Cancer Center, Philadelphia, PA.
authors.forename: Siu-Kuen Azor
authors.initials: SK
authors.lastname: Hui
authors.affiliation: Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Grandner
keywords: Employee wellness programs; Multiple health behaviors change; Sleep quality; Transtheoretical model