Sandra J. Winter, PhD, MHA, is currently the Director of the Wellness Living Laboratory (WELL) and a Social Science Research Scholar at the Stanford Prevention Research Center. The goal of the WELL for Life initiative is to build the scientific evidence base about wellbeing by engaging thousands of participants from various parts of the world to help improve our understanding of the key determinants of wellbeing. In addition to measuring the factors that impact wellbeing over time, researchers on the WELL team will conduct interventions and experiments designed to improve wellbeing. Bio-samples will be gathered from some WELL participants to determine potential genetic components of wellbeing. WELL for Life investigators will work closely with community members and organizational partners who will be engaged as citizen scientists to inform the development and testing of lifestyle and environmental changes aimed at lowering risk for chronic diseases and promoting health and quality of life among all segments of the population.

Sandi 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 at the University of Kentucky. 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's research areas of interest include wellbeing, community-based interventions among under resourced populations; reducing health disparities (particularly in a global context); the role the environments in which we live, work and play affect our ability to lead healthy active lives; and how we can use technology to encourage and support health behavior improvements.

Current Role at Stanford

Senior Research Scholar with the Stanford Prevention Research Center
Director: Well Living Laboratory
Director: Our Voice Global Initiative

Honors & Awards

  • Selected participant, SBM Leadership Institute., Society of Behavioral Medicine (2017)
  • 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 Administration (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

  • Board Member: Senior Coastsiders, Half Moon Bay


    Half Moon Bay, California



Professional Affiliations and Activities

  • Member: Scientific and Professional Liaison Council, Society of Behavioral Medicine (2017 - Present)
  • Co-chair of the Health Policy and Advocacy Topic Area, Society of Behavioral Medicine (2016 - Present)
  • Co-Chair, Aging Special Interest Group, Society of Behavioral Medicine (2015 - 2017)


All Publications

  • Maximizing the promise of citizen science to advance health and prevent disease. Preventive medicine King, A. C., Winter, S. J., Chrisinger, B. W., Hua, J., Banchoff, A. W. 2018

    View details for DOI 10.1016/j.ypmed.2018.12.016

    View details for PubMedID 30593793

  • Acting locally while thinking globally to promote physical activity, address inequalities and achieve population change Winter, S., Rosas, L., Buman, M., Sheats, J., Salvo, D., Garber, R., Sarmiento, O., Broderick, B., Banchoff, A., King, A. HUMAN KINETICS PUBL INC. 2018: S1–S2
  • DIET: PERCEPTIONS AND BEHAVIORS, AND THE ASSOCIATION WITH WELL-BEING Winter, S., Hedlin, H., Balasubramanian, V., Heaney, C. SPRINGER. 2018: S83
  • Employing the Our Voice citizen science model to support age- and activity-friendly communities in Chile, Brazil, Canada, England, and USA Stathi, A., Aguilar-Farias, N., Porter, M., King, D., Banchoff, A. W., Winter, S. J., King, A. C. HUMAN KINETICS PUBL INC. 2018: S1
  • Utilising the Our Voice citizen science model to support and promote active environments at schools and universities in Colombia, New Zealand, South Africa, and the USA Hinckson, E., Schneider, M., Sarmiento, O., Lambert, E., Triana, C., Banchoff, A., Winter, S., King, A. HUMAN KINETICS PUBL INC. 2018: S1
  • Physical activity: Perceptions and behaviours, and the association with well-being Winter, S., Hedlin, H., Balasubramanian, V., Heaney, C. HUMAN KINETICS PUBL INC. 2018: S172–S173
  • Building activity-promoting environments that support health across the lifecourse through global citizen science research King, A., Banchoff, A., Winter, S., Hua, J., Dueaas, O., Dagan, A., Aguilar-Farias, N., Stathi, A. HUMAN KINETICS PUBL INC. 2018: S88
  • WELL-BEING ACROSS THE LIFE COURSE Ahuja, N., Winter, S. J., Heaney, C., Kaimal, R., Hedlin, H. OXFORD UNIV PRESS INC. 2018: S358
  • The built environment and older adults: A literature review and an applied approach to engaging older adults in built environment improvements for health INTERNATIONAL JOURNAL OF OLDER PEOPLE NURSING Tuckett, A. G., Banchoff, A. W., Winter, S. J., King, A. C. 2018; 13 (1)

    View details for DOI 10.1111/opn.12171

    View details for Web of Science ID 000425184600007

  • Leveraging Citizen Science for Healthier Food Environments: A Pilot Study to Evaluate Corner Stores in Camden, New Jersey Frontiers in Public Health Chrisinger, B. W., Ramos, A., Shaykis, F., Martinez, T., Banchoff, A. W., Winter, S. J., King, A. C. 2018: 89


    Over the last 6 years, a coordinated "healthy corner store" network has helped an increasing number of local storeowners stock healthy, affordable foods in Camden, New Jersey, a city with high rates of poverty and unemployment, and where most residents have little or no access to large food retailers. The initiative's funders and stakeholders wanted to directly engage Camden residents in evaluating this effort to increase healthy food access. In a departure from traditional survey- or focus group-based evaluations, we used an evidence-based community-engaged citizen science research model (called Our Voice) that has been deployed in a variety of neighborhood settings to assess how different features of the built environment both affect community health and wellbeing, and empower participants to create change. Employing the Our Voice model, participants documented neighborhood features in and around Camden corner stores through geo-located photos and audio narratives. Eight adult participants who lived and/or worked in a predefined neighborhood of Camden were recruited by convenience sample and visited two corner stores participating in the healthy corner store initiative (one highly-engaged in the initiative and the other less-engaged), as well as an optional third corner store of their choosing. Facilitators then helped participants use their collected data (in total, 134 images and 96 audio recordings) to identify and prioritize issues as a group, and brainstorm and advocate for potential solutions. Three priority themes were selected by participants from the full theme list (n = 9) based on perceived importance and feasibility: healthy product selection and display, store environment, and store outdoor appearance and cleanliness. Participants devised and presented a set of action steps to community leaders, and stakeholders have begun to incorporate these ideas into plans for the future of the healthy corner store network. Key elements of healthy corner stores were identified as positive, and other priorities, such as improvements to safety, exterior facades, and physical accessibility, may find common ground with other community development initiatives in Camden. Ultimately, this pilot study demonstrated the potential of citizen science to provide a systematic and data-driven process for public health stakeholders to authentically engage community residents in program evaluation.

    View details for DOI 10.3389/fpubh.2018.00089

    View details for PubMedCentralID PMC5879453

  • Citizen science applied to building healthier community environments: advancing the field through shared construct and measurement development INTERNATIONAL JOURNAL OF BEHAVIORAL NUTRITION AND PHYSICAL ACTIVITY Hinckson, E., Schneider, M., Winter, S. J., Stone, E., Puhan, M., Stathi, A., Porter, M. M., Gardiner, P. A., dos Santos, D., Wolff, A., King, A. C. 2017; 14: 133


    Physical inactivity across the lifespan remains a public health issue for many developed countries. Inactivity has contributed considerably to the pervasiveness of lifestyle diseases. Government, national and local agencies and organizations have been unable to systematically, and in a coordinated way, translate behavioral research into practice that makes a difference at a population level. One approach for mobilizing multi-level efforts to improve the environment for physical activity is to engage in a process of citizen science. Citizen Science here is defined as a participatory research approach involving members of the public working closely with research investigators to initiate and advance scientific research projects. However, there are no common measures or protocols to guide citizen science research at the local community setting.We describe overarching categories of constructs that can be considered when designing citizen science projects expected to yield multi-level interventions, and provide an example of the citizen science approach to promoting PA. We also recommend potential measures across different levels of impact.Encouraging some consistency in measurement across studies will potentially accelerate the efficiency with which citizen science participatory research provides new insights into and solutions to the behaviorally-based public health issues that drive most of morbidity and mortality. The measures described in this paper abide by four fundamental principles specifically selected for inclusion in citizen science projects: feasibility, accuracy, propriety, and utility. The choice of measures will take into account the potential resources available for outcome and process evaluation. Our intent is to emphasize the importance for all citizen science participatory projects to follow an evidence-based approach and ensure that they incorporate an appropriate assessment protocol.We provided the rationale for and a list of contextual factors along with specific examples of measures to encourage consistency among studies that plan to use a citizen science participatory approach. The potential of this approach to promote health and wellbeing in communities is high and we hope that we have provided the tools needed to optimally promote synergistic gains in knowledge across a range of Citizen Science participatory projects.

    View details for DOI 10.1186/s12966-017-0588-6

    View details for Web of Science ID 000412009300001

    View details for PubMedID 28962580

    View details for PubMedCentralID PMC5622546

  • Impacts of a Temporary Urban Pop-Up Park on Physical Activity and Other Individual- and Community-Level Outcomes JOURNAL OF URBAN HEALTH-BULLETIN OF THE NEW YORK ACADEMY OF MEDICINE Salvo, D., Banda, J. A., Sheats, J. L., Winter, S. J., dos Santos, D., King, A. C. 2017; 94 (4): 470–81


    Physical inactivity is a known risk factor for obesity and a number of chronic diseases. Modifying the physical features of neighborhoods to provide residents with equitable and convenient access to spaces for physical activity (PA) is a promising strategy for promoting PA. Public urban recreation spaces (e.g., parks) play an important role in promoting PA and are potentially an important neighborhood element for optimizing social capital and liveability in cities. Most studies examining the effects of park availability and use on PA have focused on traditional, permanent parks. The aims of this study were to (1) document patterns of park use and park-based PA at a temporary urban pop-up park implemented in the downtown business district of Los Altos, California during July-August 2013 and May-June 2014, (2) identify factors associated with park-based PA in 2014, and (3) examine the effects of the 2014 pop-up park on additional outcomes of potential benefit for park users and the Los Altos community at large. Park use remained high during most hours of the day in 2013 and 2014. Although the park attracted a multigenerational group of users, children and adolescents were most likely to engage in walking or more vigorous PA at the park. Park presence was significantly associated with potentially beneficial changes in time-allocation patterns among users, including a reduction in screen-time and an increase in overall park-time and time spent outdoors. Park implementation resulted in notable use among people who would otherwise not be spending time at a park (85% of surveyed users would not be spending time at any other park if the pop-up park was not there-2014 data analysis). Our results (significantly higher odds of spending time in downtown Los Altos due to park presence) suggest that urban pop-up parks may also have broader community benefits, such as attracting people to visit downtown business districts. Pending larger, confirmatory studies, our results suggest that temporary urban pop-up parks may contribute to solving the limited access to public physical activity recreation spaces many urban residents face.

    View details for DOI 10.1007/s11524-017-0167-9

    View details for Web of Science ID 000406482700002

    View details for PubMedID 28646369

    View details for PubMedCentralID PMC5533666

  • FEAST: Empowering Community Residents to Use Technology to Assess and Advocate for Healthy Food Environments. Journal of urban health : bulletin of the New York Academy of Medicine Sheats, J. L., Winter, S. J., Romero, P. P., King, A. C. 2017


    Creating environments that support healthy eating is important for successful aging, particularly in light of the growing population of older adults in the United States. There is an urgent need to identify innovative upstream solutions to barriers experienced by older adults in accessing and buying healthy food. FEAST (Food Environment Assessment STudy) is an effort that is part of the global Our Voice initiative, which utilizes a combination of technology and community-engaged methods to empower citizen scientists (i.e., community residents) to: (1) use the Healthy Neighborhood Discovery Tool (Discovery Tool) mobile application to collect data (geocoded photos, audio narratives) about aspects of their environment that facilitate or hinder healthy living; and (2) use findings to advocate for change in partnership with local decision and policy makers. In FEAST, 23 racially/ethnically diverse, low-income, and food-insecure older adults residing in urban, North San Mateo County, CA, were recruited to use the Discovery Tool to examine factors that facilitated or hindered their access to food as well as their food-related behaviors. Participants collectively reviewed data retrieved from the Discovery Tool and identified and prioritized important, yet feasible, issues to address. Access to affordable healthy food and transportation were identified as the major barriers to eating healthfully and navigating their neighborhood food environments. Subsequently, participants were trained in advocacy skills and shared their findings with relevant decision and policymakers, who in turn dispelled myths and discussed and shared resources to address relevant community needs. Proximal and distal effects of the community-engaged process at 3, 6, 12, and 24 months were documented and revealed individual-, community-, and policy-level impacts. Finally, FEAST contributes to the evidence on multi-level challenges that low-income, racially/ethnically diverse older adults experience when accessing, choosing and buying healthy foods.

    View details for DOI 10.1007/s11524-017-0141-6

    View details for PubMedID 28247054

    View details for PubMedCentralID PMC5391337

  • Risk profile of coronary heart disease among the staff members of Qassim University, Saudi Arabia. International journal of health sciences Nohair, S. A., Mohaimeed, A. A., Sharaf, F., Naeem, Z., Midhet, F., Homaidan, H. A., Winter, S. J. 2017; 11 (1): 1-5


    To estimate the risk profile of coronary heart disease (CHD) among the staff members of Qassim University and assess their knowledge in a screening campaign in Qassim region, Saudi Arabia.A cross-sectional study was conducted among male and female staff at Qassim University campus. All employees of Qassim University were invited to participate in the study. Data were collected through a self-administered questionnaire. The study sample size was 233 staff and employees. The data were entered and analyzed using SPSS version 18. The data analysis focused on providing point estimates for the risk factors.The study found that 30% of participants have one or more risk factors for CHD, namely obesity 20.6%, diabetes 10.3%, hypertension 12.4%, dyslipidemia 10.7%, and smokers (11.6%). About 54% of the participants have a family history of at least one chronic disease as a risk factor for CHD.The most common risk factor of CHD among the staff members is obesity by 20.6%. Risk factors for CHD are quite common among Qassim University staff. These findings need to increase the health education and disease promotion program as an important intervention to reduce the occurrence and severity of CHD risk factors and to improve the quality of the life of the staff members of Qassim University.

    View details for PubMedID 28293152

  • Exploring the Objective and Perceived Environmental Attributes of Older Adults' Neighborhood Walking Routes: A Mixed Methods Analysis. Journal of aging and physical activity Moran, M. R., Werner, P., Doron, I., HaGani, N., Benvenisti, Y., King, A. C., Winter, S. J., Sheats, J. L., Garber, R., Motro, H., Egron, S. 2016: 1-36


    Walking is a central form of physical activity among older adults that is associated with the physical environment at various scales. This mixed-methods study employs a concurrent nested design to explore objective and perceived environmental characteristics of older adults' local walking routes. This was achieved by integrating quantitative Geographic Information System (GIS) data with qualitative data obtained using the Stanford Discovery Tool (DT). Fifty-nine community-dwelling middle-aged and older adults (14 men and 45 women aged 50+) were recruited in a snowball approach through community centers in the city of Haifa (Israel). Four neighborhood environment themes were identified: pedestrian infrastructure, access to destinations, aesthetics, and environmental quality. Both geometrical traits (i.e., distance, slope) and urban features (i.e., land-uses, greenery) of the route may impact the experience of walking. The findings thus highlight the importance of micro-scale environmental elements in shaping environmental perceptions, which may consequently influence the choice of being active.

    View details for PubMedID 27992252

  • Harnessing Technology and Citizen Science to Support Neighborhoods that Promote Active Living in Mexico. Journal of urban health : bulletin of the New York Academy of Medicine Rosas, L. G., Salvo, D., Winter, S. J., Cortes, D., Rivera, J., Rodriguez, N. M., King, A. C. 2016: -?


    Middle- and low-income countries bear 80 % of the global chronic disease burden. Population-level, multi-sectoral approaches to promoting healthful lifestyles that take into local physical, socioeconomic, and sociocultural characteristics of both the environment and the population are needed. The "Nuestra Voz (Our Voice)" is one such approach that involves neighborhood residents acting as "citizen scientists" to systematically gather information on the barriers and facilitators of physical activity in their neighborhoods and then use their data to collectively advocate for local environmental- and policy-level changes to support active living. We pilot tested this approach in Cuernavaca, Mexico with adults and adolescents. This community-engaged and participatory approach is driven by residents, who utilize a GPS-enabled electronic tablet-based application with simple audio-based instructions to take photographs and record audio narratives of facets of their neighborhood that promote or hinder active living. After collecting these data, the citizen scientists come together in a community meeting and use their data to prioritize realistic, multi-level changes for promoting active living in their neighborhoods. A survey assessed participants' acceptability of the approach. Participating citizen scientists included 32 adults and 9 adolescents. The citizen scientists rated the acceptability of five of the nine acceptability survey items with an average of 4.0 or higher out of 5.0, indicating they thought it was "fun," were comfortable carrying the tablet, were likely to use it again, and would recommend it to friends and family. Items with average scores of less than 4 were all related to safety concerns. The most common barriers reported by citizen scientists using the tablet were poor sidewalk quality, presence of trash, negative characteristics of the streets, unpleasant aesthetics (e.g., graffiti), and presence of parks and recreational facilities. The Our Voice citizen scientist approach using the Discovery Tool has high potential for assisting communities in diverse settings to begin to identify both local barriers to active living as well as potentially useful strategies for promoting physical activity in culturally congruent ways that are appropriate and feasible in the local context.

    View details for PubMedID 27752825

    View details for PubMedCentralID PMC5126018

  • Using Citizen Scientists to Gather, Analyze, and Disseminate Information About Neighborhood Features That Affect Active Living. Journal of immigrant and minority health Winter, S. J., Goldman Rosas, L., Padilla Romero, P., Sheats, J. L., Buman, M. P., Baker, C., King, A. C. 2016; 18 (5): 1126-1138


    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

  • 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. 2016; 61 (6): 641-649


    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

  • Effects of Three Motivationally Targeted Mobile Device Applications on Initial Physical Activity and Sedentary Behavior Change in Midlife and Older Adults: A Randomized Trial 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. 2016; 11 (6)


    While there has been an explosion of mobile device applications (apps) promoting healthful behaviors, including physical activity and sedentary patterns, surprisingly few have been based explicitly on strategies drawn from behavioral theory and evidence.This study provided an initial 8-week evaluation of three different customized physical activity-sedentary behavior apps drawn from conceptually distinct motivational frames in comparison with a commercially available control app.Ninety-five underactive adults ages 45 years and older with no prior smartphone experience were randomized to use an analytically framed app, a socially framed app, an affectively framed app, or a diet-tracker control app. Daily physical activity and sedentary behavior were measured using the smartphone's built-in accelerometer and daily self-report measures.Mixed-effects models indicated that, over the 8-week period, the social app users showed significantly greater overall increases in weekly accelerometry-derived moderate to vigorous physical activity relative to the other three arms (P values for between-arm differences = .04-.005; Social vs. Control app: d = 1.05, CI = 0.44,1.67; Social vs. Affect app: d = 0.89, CI = 0.27,1.51; Social vs. Analytic app: d = 0.89, CI = 0.27,1.51), while more variable responses were observed among users of the other two motivationally framed apps. Social app users also had significantly lower overall amounts of accelerometry-derived sedentary behavior relative to the other three arms (P values for between-arm differences = .02-.001; Social vs. Control app: d = 1.10,CI = 0.48,1.72; Social vs. Affect app: d = 0.94, CI = 0.32,1.56; Social vs. Analytic app: d = 1.24, CI = 0.59,1.89). Additionally, Social and Affect app users reported lower overall sitting time compared to the other two arms (P values for between-arm differences < .001; Social vs. Control app: d = 1.59,CI = 0.92, 2.25; Social vs. Analytic app: d = 1.89,CI = 1.17, 2.61; Affect vs. Control app: d = 1.19,CI = 0.56, 1.81; Affect vs. Analytic app: d = 1.41,CI = 0.74, 2.07).The results provide initial support for the use of a smartphone-delivered social frame in the early induction of both physical activity and sedentary behavior changes. The information obtained also sets the stage for further investigation of subgroups that might particularly benefit from different motivationally framed apps in these two key health promotion NCT01516411.

    View details for DOI 10.1371/journal.pone.0156370

    View details for Web of Science ID 000378858900002

    View details for PubMedID 27352250

  • Leveraging Citizen Science and Information Technology for Population Physical Activity Promotion. Translational journal of the American College of Sports Medicine King, A. C., Winter, S. J., Sheats, J. L., Rosas, L. G., Buman, M. P., Salvo, D., Rodriguez, N. M., Seguin, R. A., Moran, M., Garber, R., Broderick, B., Zieff, S. G., Sarmiento, O. L., Gonzalez, S. A., Banchoff, A., Dommarco, J. R. 2016; 1 (4): 30-44


    While technology is a major driver of many of society's comforts, conveniences, and advances, it has been responsible, in a significant way, for engineering regular physical activity and a number of other positive health behaviors out of people's daily lives. A key question concerns how to harness information and communication technologies (ICT) to bring about positive changes in the health promotion field. One such approach involves community-engaged "citizen science," in which local residents leverage the potential of ICT to foster data-driven consensus-building and mobilization efforts that advance physical activity at the individual, social, built environment, and policy levels.The history of citizen science in the research arena is briefly described and an evidence-based method that embeds citizen science in a multi-level, multi-sectoral community-based participatory research framework for physical activity promotion is presented.Several examples of this citizen science-driven community engagement framework for promoting active lifestyles, called "Our Voice", are discussed, including pilot projects from diverse communities in the U.S. as well as internationally.The opportunities and challenges involved in leveraging citizen science activities as part of a broader population approach to promoting regular physical activity are explored. The strategic engagement of citizen scientists from socio-demographically diverse communities across the globe as both assessment as well as change agents provides a promising, potentially low-cost and scalable strategy for creating more active, healthful, and equitable neighborhoods and communities worldwide.

    View details for PubMedID 27525309

    View details for PubMedCentralID PMC4978140

  • 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. 2016; 58 (6): 605-612


    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 Web of Science ID 000376552200005

    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 PubMedID 24956064

  • 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
  • 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
  • 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
  • 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)

    View details for DOI 10.1371/journal.pone.0062613

    View details for PubMedID 23638127

  • 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 Web of Science ID 000209412400019

    View details for PubMedCentralID PMC3717885

  • 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
  • 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