Encouraging Stair Use: Stair-Riser Banners Are Better Than Posters

Abstract

Increasing physical activity levels among a largely sedentary public is a health priority.1 Lifestyle exercise, such as walking or stair climbing, has been recommended because it provides substantial health benefits and fits easily into daily routines.2 Opportunities for stair climbing in workplaces, public buildings, and the home are frequently available to most population groups. Studies conducted in both the United States and the United Kingdom have shown that posters at the “point of choice” between escalators and stairs can increase stair use.3–6 As a result, physical activity promoters have championed the use of such posters. In a recent study, however, messages placed as banners on alternate stair risers were associated with a greater increase in shoppers' stair use than that typically observed with posters.7 To confirm the superiority of these banners in promoting stair climbing, we systematically compared the use of poster prompts and stair-riser banners. The study was conducted at 2 shopping malls; both sites had 28-step staircases with adjacent escalators. Following a coding system,3 an observer recorded the number of people using the escalators and stairs on alternate days at each location. Observations were made between 11 am and 1 pm to include day and lunchtime shoppers. At the control site, a 2-week baseline period was followed by 4 weeks during which a poster that read “Stay healthy, use the stairs” was displayed. Use of this poster had been found to be effective in previous research.3 At the experimental site, 2 weeks of baseline observation and 2 weeks of the poster intervention were followed by 2 weeks during which banners, containing mulitple messages, were placed on the stair risers, as in our earlier study.7 Logistic regression analyses were conducted with escalator–stair use as the dichotomous outcome variable. Overall pedestrian traffic volume, a potential confounding variable,3 was calculated as the total number of people using the escalators and stairs during each half-hour period. Traffic volume was entered into the logistic regression models as a continuous variable. Sex, age, and ethnicity were also added to the models, in that previous research had demonstrated their importance.3–6 Figure 1 ▶ illustrates the effects of the poster and banner conditions in the 2 shopping malls. At the control site (n = 12 018), the rate of stair use increased from 2.2% at baseline to 4.8% during the first 2 weeks of the poster exposure but fell slightly to 4.1% during the second 2 weeks. At the experimental site (n = 11 961), stair use increased from 2.4% at baseline to 4.0% when the poster was in place and rose to 6.7% when the banners were displayed on the stair risers. FIGURE 1— Stair use at baseline in poster and banner conditions in the control and experimental shopping malls. Logistic regression analyses revealed that stair use increased at both sites during the first 2 weeks in which the poster was displayed (odds ratio [OR] = 2.18, 95% confidence interval [CI] = 1.69, 2.80), with no significant differences between the sites. During the second intervention period, there was an interaction between the sites (OR = 2.06, 95% CI = 1.48, 2.87) such that rates of stair use were higher with the banners at the experimental site than with the poster at the control site. There are several reasons why the banners were more effective than the poster in encouraging stair use. First, the banners were highly visible. In our earlier studies, 76% of interviewees reported seeing these banners,7 whereas only a third reported noticing the poster used.8 Second, while the poster included only one health-related message, the banners contained multiple messages, such as “Keep fit,” “Be active,” and “Free exercise.” As such, they are likely to appeal to a broader population range.9 Regular stair climbing has been associated with discernible health gains.10 Accordingly, if large population groups are regularly exposed to motivating stair banners instead of the posters currently used by health promoters, the public health dividends could be considerable.