Sandra J Winter was born and raised in Zimbabwe, then moved to Cape Town in South Africa where she was a successful entrepreneur, owning and operating a number of businesses in the advertising industry. In 2003 Sandra moved with her family from Cape Town, South Africa to Lexington, Kentucky where she completed a Master of Health Administration in May, 2006 and a PhD in Public Administration (Health Policy Track) in December, 2009. Her graduate research work focused on the health care that is provided to prison inmates in Kentucky.

In 2009 Sandra moved from Kentucky to California where she started working at the Stanford Prevention Research Center (SPRC). At SPRC Sandra has held a number of positions including Fitness assessor, biometric screener and wellness advisor with the BeWell program; Social Science Research Assistant with Abby King’s Healthy Aging Research and Technology Solutions (HARTS) lab; Project Manager for the SPRC/Qassim University College of Medicine, Saudi Arabia collaboration,and Postdoctoral Research Fellow with the National Heart Lung and Blood Institute.

Sandra is currently the Director of the Wellness Living Laboratory (WELL). The scientific goal of WELL is to generate novel hypothesis-driven inquiries, tested at the population level, to build the evidence-base of wellness. A dual research focus on observation and intervention will establish best practices for wellness. A community based approach that engages community members as citizen scientists will be used to develop and test lifestyle and environmental changes aimed at lowering risk for chronic diseases and promoting health and quality of life among all segments of the population.

Sandra's research areas of interest include community-based interventions among under resourced populations. particularly in a global context. She is also interested in the role the environments in which we live, work and play affect our ability to lead healthy active lives.

Current Role at Stanford

Research Associate with the Stanford Prevention Research Center
Director of the Well Living Laboratory

Honors & Awards

  • Winner: Excellence Award - for research using the Stanford Healthy Neighborhood Discovery Tool, Center for Active Design, New York (2015)
  • 1st place overall winner for a poster presentation, Active Living Research Annual Conference, San Diego (2014)
  • 3rd place for an oral presentation. (Sheats JL, Winter SJ.), International SenseCam & Pervasive Imaging Conference, San Diego (2013)
  • Honorable Mention - Erickson Foundation Award for Excellence in Research, American Public Health Association, San Francisco (2012)
  • Tuition Scholarship, Built Environment Assessment Training Institute, Boston (2012)
  • 1st Place – Graduate Student Poster Session, American Correctional Association Conference, Charlotte, North Carolina (2008)
  • Distinction in Healthcare Administration, Honor Society Award of Upsilon Phi Delta, Lexington, Kentucky (2008)
  • Most Outstanding Graduating Student, Martin School of Public Policy and Administration, University of Kentucky (2006)

Education & Certifications

  • PhD, University of Kentucky, Public Administrtion (Health Policy Track) (2009)
  • MHA, University of Kentucky, Health Administration (2006)
  • Prof Cert Online Teaching, University of Wisconsin-Madison, Division of Continuing Studies (2012)

Service, Volunteer and Community Work

  • Volunteer: RotcCare, Half Moon Bay, California, Rotacare Bay Area, Inc (March 1, 2010 - 8/31/2015)

    RotaCare Bay Area is a volunteer alliance of medical professionals, organizations and community members dedicated to providing free primary, quality healthcare services to uninsured families and individuals with limited ability to pay for medical care. RotaCare is entirely volunteer driven and supported solely through locally based philanthropy.


    Half Moon Bay

  • Board Member: Senior Coastsiders, Half Moon Bay


    Half Moon Bay, California


Professional Affiliations and Activities

  • Co-Chair, Aging Special Interest Group, Society of Behavioral Medicine (2015 - Present)


All Publications

  • The Use of Behavior Change Techniques and Theory in Technologies for Cardiovascular Disease Prevention and Treatment in Adults: A Comprehensive Review. Progress in cardiovascular diseases Winter, S. J., Sheats, J. L., King, A. C. ; 58 (6): 605-12


    This review examined the use of health behavior change techniques and theory in technology-enabled interventions targeting risk factors and indicators for cardiovascular disease (CVD) prevention and treatment. Articles targeting physical activity, weight loss, smoking cessation and management of hypertension, lipids and blood glucose were sourced from PubMed (November 2010-2015) and coded for use of 1) technology, 2) health behavior change techniques (using the CALO-RE taxonomy), and 3) health behavior theories. Of the 984 articles reviewed, 304 were relevant (240=intervention, 64=review). Twenty-two different technologies were used (M=1.45, SD=+/-0.719). The most frequently used behavior change techniques were self-monitoring and feedback on performance (M=5.4, SD=+/-2.9). Half (52%) of the intervention studies named a theory/model - most frequently Social Cognitive Theory, the Trans-theoretical Model, and the Theory of Planned Behavior/Reasoned Action. To optimize technology-enabled interventions targeting CVD risk factors, integrated behavior change theories that incorporate a variety of evidence-based health behavior change techniques are needed.

    View details for DOI 10.1016/j.pcad.2016.02.005

    View details for PubMedID 26902519

  • A qualitative study of shopper experiences at an urban farmers' market using the Stanford Healthy Neighborhood Discovery Tool PUBLIC HEALTH NUTRITION Buman, M. P., Bertmann, F., Hekler, E. B., Winter, S. J., Sheats, J. L., King, A. C., Wharton, C. M. 2015; 18 (6): 994-1000


    To understand factors which enhance or detract from farmers' market shopper experiences to inform targeted interventions to increase farmers' market utilization, community-building and social marketing strategies.A consumer-intercept study using the Stanford Healthy Neighborhood Discovery Tool to capture real-time perceptions via photographs and audio narratives.An urban farmers' market in a large metropolitan US city. Participants Thirty-eight farmers' market shoppers, who recorded 748 unique coded elements through community-based participatory research methods.Shoppers were primarily women (65 %), 18-35 years of age (54 %), non-Hispanic (81 %) and white (73 %). Shoppers captured 291 photographs (7·9 (sd 6·3) per shopper), 171 audio narratives (5·3 (sd 4·7) per shopper), and ninety-one linked photograph + audio narrative pairs (3·8 (sd 2·8) per shopper). A systematic content analysis of the photographs and audio narratives was conducted by eight independent coders. In total, nine common elements emerged from the data that enhanced the farmers' market experience (61·8 %), detracted from the experience (5·7 %) or were neutral (32·4 %). The most frequently noted elements were freshness/abundance of produce (23·3 %), product presentation (12·8 %), social interactions (12·4 %) and farmers' market attractions (e.g. live entertainment, dining offerings; 10·3 %).While produce quality (i.e. freshness/abundance) was of primary importance, other contextual factors also appeared important to the shoppers' experiences. These results may inform social marketing strategies to increase farmers' market utilization and community-building efforts that target market venues.

    View details for DOI 10.1017/S136898001400127X

    View details for Web of Science ID 000351243900006

  • Validation of Physical Activity Tracking via Android Smartphones Compared to ActiGraph Accelerometer: Laboratory-Based and Free-Living Validation Studies. JMIR mHealth and uHealth Hekler, E. B., Buman, M. P., Grieco, L., Rosenberger, M., Winter, S. J., Haskell, W., King, A. C. 2015; 3 (2)


    There is increasing interest in using smartphones as stand-alone physical activity monitors via their built-in accelerometers, but there is presently limited data on the validity of this approach.The purpose of this work was to determine the validity and reliability of 3 Android smartphones for measuring physical activity among midlife and older adults.A laboratory (study 1) and a free-living (study 2) protocol were conducted. In study 1, individuals engaged in prescribed activities including sedentary (eg, sitting), light (sweeping), moderate (eg, walking 3 mph on a treadmill), and vigorous (eg, jogging 5 mph on a treadmill) activity over a 2-hour period wearing both an ActiGraph and 3 Android smartphones (ie, HTC MyTouch, Google Nexus One, and Motorola Cliq). In the free-living study, individuals engaged in usual daily activities over 7 days while wearing an Android smartphone (Google Nexus One) and an ActiGraph.Study 1 included 15 participants (age: mean 55.5, SD 6.6 years; women: 56%, 8/15). Correlations between the ActiGraph and the 3 phones were strong to very strong (ρ=.77-.82). Further, after excluding bicycling and standing, cut-point derived classifications of activities yielded a high percentage of activities classified correctly according to intensity level (eg, 78%-91% by phone) that were similar to the ActiGraph's percent correctly classified (ie, 91%). Study 2 included 23 participants (age: mean 57.0, SD 6.4 years; women: 74%, 17/23). Within the free-living context, results suggested a moderate correlation (ie, ρ=.59, P<.001) between the raw ActiGraph counts/minute and the phone's raw counts/minute and a strong correlation on minutes of moderate-to-vigorous physical activity (MVPA; ie, ρ=.67, P<.001). Results from Bland-Altman plots suggested close mean absolute estimates of sedentary (mean difference=-26 min/day of sedentary behavior) and MVPA (mean difference=-1.3 min/day of MVPA) although there was large variation.Overall, results suggest that an Android smartphone can provide comparable estimates of physical activity to an ActiGraph in both a laboratory-based and free-living context for estimating sedentary and MVPA and that different Android smartphones may reliably confer similar estimates.

    View details for DOI 10.2196/mhealth.3505

    View details for PubMedID 25881662

  • Rural Food and Physical Activity Assessment Using an Electronic Tablet-Based Application, New York, 2013-2014. Preventing chronic disease Seguin, R. A., Morgan, E. H., Connor, L. M., Garner, J. A., King, A. C., Sheats, J. L., Winter, S. J., Buman, M. P. 2015; 12: E102-?


    A community's built environment can influence health behaviors. Rural populations experience significant health disparities, yet built environment studies in these settings are limited. We used an electronic tablet-based community assessment tool to conduct built environment audits in rural settings. The primary objective of this qualitative study was to evaluate the usefulness of the tool in identifying barriers and facilitators to healthy eating and active living. The second objective was to understand resident perspectives on community features and opportunities for improvement.Participants were recruited from 4 rural communities in New York State. Using the tool, participants completed 2 audits, which consisted of taking pictures and recording audio narratives about community features perceived as assets or barriers to healthy eating and active living. Follow-up focus groups explored the audit experience, data captured, and opportunities for change.Twenty-four adults (mean age, 69.4 y (standard deviation, 13.2 y), 6 per community, participated in the study. The most frequently captured features related to active living were related to roads, sidewalks, and walkable destinations. Restaurants, nontraditional food stores, and supermarkets were identified in the food environment in relation to the cost, quality, and selection of healthy foods available. In general, participants found the assessment tool to be simple and enjoyable to use.An electronic tablet-based tool can be used to assess rural food and physical activity environments and may be useful in identifying and prioritizing resident-led change initiatives. This resident-led assessment approach may also be helpful for informing and evaluating rural community-based interventions.

    View details for DOI 10.5888/pcd12.150147

    View details for PubMedID 26133645

  • Nutrition Interventions for Aging Populations Handbook of Clinical Nutrition and Aging Sheats, J. L., Winter, S. J., King, A. C. Springer. 2015; 3rd: 3-19
  • Climate-driven migration: an exploratory case study of Maasai health perceptions and help-seeking behaviors. International journal of public health Heaney, A. K., Winter, S. J. 2015


    By 2050, over 250 million people will be displaced from their homes by climate change. This exploratory case study examines how climate-driven migration impacts the health perceptions and help-seeking behaviors of Maasai in Tanzania. Increasing frequency and intensity of drought is killing livestock, forcing Maasai to migrate from their rural homelands to urban centers in search of ways to support their families. Little existing research investigates how this migration changes the way migrants think about health and make healthcare decisions.This study used semi-structured qualitative interviews to explore migrant and non-migrant beliefs surrounding health and healthcare. Migrant and non-migrant participants were matched on demographic characteristics and location.Migrants emphasized the importance of mental health in their overall health perceptions, whereas non-migrants emphasized physical health. Although non-migrants perceived more barriers to accessing healthcare, migrant and non-migrant help-seeking behaviors were similar in that they only sought help for physical health problems, and utilized hospitals as a last option.These findings have implications for improving Maasai healthcare utilization, and for future research targeting other climate-driven migrant populations in the world.

    View details for DOI 10.1007/s00038-015-0759-7

    View details for PubMedID 26552667

  • Using Citizen Scientists to Gather, Analyze, and Disseminate Information About Neighborhood Features That Affect Active Living. Journal of immigrant and minority health / Center for Minority Public Health Winter, S. J., Goldman Rosas, L., Padilla Romero, P., Sheats, J. L., Buman, M. P., Baker, C., King, A. C. 2015


    Many Latinos are insufficiently active, partly due to neighborhoods with little environmental support for physical activity. Multi-level approaches are needed to create health-promoting neighborhoods in disadvantaged communities. Participant "citizen scientists" were adolescent (n = 10, mean age = 12.8 ± 0.6 years) and older adult (n = 10, mean age = 71.3 ± 6.5 years), low income Latinos in North Fair Oaks, California. Citizen scientists conducted environmental assessments to document perceived barriers to active living using the Stanford Healthy Neighborhood Discovery Tool, which records GPS-tracked walking routes, photographs, audio narratives, and survey responses. Using a community-engaged approach, citizen scientists subsequently attended a community meeting to engage in advocacy training, review assessment data, prioritize issues to address and brainstorm potential solutions and partners. Citizen scientists each conducted a neighborhood environmental assessment and recorded 366 photographs and audio narratives. Adolescents (n = 4), older adults (n = 7) and community members (n = 4) collectively identified reducing trash and improving personal safety and sidewalk quality as the priority issues to address. Three adolescent and four older adult citizen scientists volunteered to present study findings to key stakeholders. This study demonstrated that with minimal training, low-income, Latino adolescent and older adult citizen scientists can: (1) use innovative technology to gather information about features of their neighborhood environment that influence active living, (2) analyze their information and identify potential solutions, and (3) engage with stakeholders to advocate for the development of healthier neighborhoods.

    View details for DOI 10.1007/s10903-015-0241-x

    View details for PubMedID 26184398

  • Harnessing the potential of older adults to measure and modify their environments: long-term successes of the Neighborhood Eating and Activity Advocacy Team (NEAAT) Study Translational Behavioral Medicine Winter, S. J., Buman, M. P., Sheats, J. L., Hekler, E. B., Otten, J. J., Baker, C., Cohen, D., Butler, B. A., King, A. C. 2014
  • Harnessing Different Motivational Frames via Mobile Phones to Promote Daily Physical Activity and Reduce Sedentary Behavior in Aging Adults PLOS ONE King, A. C., Hekler, E. B., Grieco, L. A., Winter, S. J., Sheats, J. L., Buman, M. P., Banerjee, B., Robinson, T. N., Cirimele, J. 2013; 8 (4)
  • The stanford healthy neighborhood discovery tool: a computerized tool to assess active living environments. American journal of preventive medicine Buman, M. P., Winter, S. J., Sheats, J. L., Hekler, E. B., Otten, J. J., Grieco, L. A., King, A. C. 2013; 44 (4): e41-7


    The built environment can influence physical activity, particularly among older populations with impaired mobility. Existing tools to assess environmental features associated with walkability are often cumbersome, require extensive training, and are not readily available for use by community residents.This project aimed to develop and evaluate the utility of a computerized, tablet-based participatory tool designed to engage older residents in identifying neighborhood elements that affect active living opportunities.Following formative testing, the tool was used by older adults (aged ?65 years, in 2011) to record common walking routes (tracked using built-in GPS) and geocoded audio narratives and photographs of the local neighborhood environment. Residents (N=27; 73% women; 77% with some college education; 42% used assistive devices) from three low-income communal senior housing sites used the tool while navigating their usual walking route in their neighborhood. Data were analyzed in 2012.Elements (from 464 audio narratives and photographs) identified as affecting active living were commensurate with the existing literature (e.g., sidewalk features, aesthetics, parks/playgrounds, crosswalks). However, within each housing site, the profile of environmental elements identified was distinct, reflecting the importance of granular-level information collected by the tool. Additionally, consensus among residents was reached regarding which elements affected active living opportunities.This tool serves to complement other assessments and assist decision makers in consensus-building processes for environmental change.

    View details for DOI 10.1016/j.amepre.2012.11.028

    View details for PubMedID 23498112

  • Comparison of passive versus active photo capture of built environment features by technology naïve Latinos using the SenseCam and Stanford Healthy Neighborhood Discovery Tool Association for Computing Machinery Digital Library Sheats, J. L., Winter, S. J., Padilla-Romero, P., Goldman Rosas, L., Grieco, L. A., King, A. C. 2013
  • Physical Activity Behavior Handbook for Health Behavior Change Grieco, L. A., Sheats, J. L., Winter, S. J., King, A. C. Springer. 2013; 4th: 155-179
  • Neighborhood Eating and Activity Advocacy Teams (NEAAT): engaging older adults in policy activities to improve food and physical environments. Translational behavioral medicine Buman, M. P., Winter, S. J., Baker, C., Hekler, E. B., Otten, J. J., King, A. C. 2012; 2 (2): 249-253


    Local food and physical activity environments are known to impact health, and older adults are generally more vulnerable to health-related environmental impacts due to poorer physical function and mobility impairments. There is a need to develop cost-conscious, community-focused strategies that impact local food and physical activity environment policies. Engaging older adult community residents in assessment and advocacy activities is one avenue to address this need. We describe the Neighborhood Eating and Activity Advocacy Team project, a community-based participatory project in low-income communal housing settings in San Mateo County, CA, as one method for engaging older adults in food and physical activity environment and policy change. Methods and strategies used by the "community action teams" to generate relevant neighborhood environmental data, build coalitions, prioritize complex issues, and advocate for change are presented. Advocacy groups are feasible among older adults to improve food and physical activity environments.

    View details for DOI 10.1007/s13142-011-0100-9

    View details for PubMedID 24073118

  • Promoting culturally targeted chronic disease prevention research through an adapted participatory research approach: The Qassim-Stanford Universities project TRANSLATIONAL BEHAVIORAL MEDICINE Winter, S. J., King, A. C., Stafford, R. S., Winkleby, M. A., Haskell, W. L., Farquhar, J. W. 2011; 1 (2): 289-298


    The Kingdom of Saudi Arabia (KSA), similar to other countries in the Eastern Mediterranean, has been experiencing a recent rapid increase in the prevalence of chronic diseases and associated risk factors. To begin to take advantage of the chronic disease prevention and health promotion (CDPHP) knowledge available from other nations, researchers at a newly established University in the Qassim Province of the KSA have partnered with Stanford University in the United States of America. To ensure that CDPHP research and interventions are culturally relevant and appropriate, a participatory research approach has been adopted where local researchers are the target "community." Contextual challenges of conducting CDPHP research in the KSA, at the individual, social/cultural, organizational and environmental/policy levels, are identified, as well as examples of CDPHP intervention strategies that may be culturally appropriate at each level.

    View details for DOI 10.1007/s13142-011-0033-3

    View details for Web of Science ID 000209412000013

  • A Comparison of Acuity and Treatment Measures of Inmate and Noninmate Hospital Patients With a Diagnosis of Either Heart Disease or Chest Pain JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION Winter, S. J. 2011; 103 (2): 109-115


    This paper used the Healthcare Cost and Utilization Project National Inpatient Survey for the period 1998-2004 to examine whether California male inmate hospital patients with a primary diagnosis of heart disease or chest pain receive poorer quality of care (measures = number and type of procedures and time from admission to first procedure) or are sicker (measures = length of stay, risk of mortality, severity of illness, and number of diagnoses) compared to noninmate patients.Differences between inmates and noninmates were examined using a t test for continuous variables and a chi2 test for categorical variables. Multiple linear regression, logistic regression, and ordered logistic regression were used to investigate relationships between the outcome variables and inmate/noninmate status, controlling for age, race, expected payer, hospital, and total charges.Being an inmate was not statistically significantly associated with acuity or quality of care for patients with chest pain. For patients with heart disease, being an inmate was statistically significantly associated with a decrease in time to first procedure of 0.464 days (standard error = 0.189, p = .015) and an increase in length of stay of 0.81 days (standard error = 0.256, p = .002).The provision of health care to prison inmates is required by law, paid for by taxpayers, and increasing as the inmate population increases. The findings that, on average, inmate patients with heart disease stay in the hospital longer and receive treatment sooner compared to noninmate patients do not indicate that inmates receive poorer quality of care compared to noninmates.

    View details for Web of Science ID 000287910000003

    View details for PubMedID 21443062

  • Improving the Quality of Health Care Delivery in a Corrections Setting Journal of Correctional Health Care Winter, S. J. 2007; 14 (3): 168 - 182
  • Participative Planning to Enhance Offender Wellness: Preliminary Report of a Correctional Wellness Program Journal of Correctional Health Care Curd, P. R., Winter, S. J., Connell, A. 2007; 13 (4): 298-308