Purpose: Evaluate the incremental impact of environmental stairwell enhancements on stair usage in addition to prompts.
Design: Phased, nonrandomized, quasi-experimental intervention.
Setting: Two 6-story and one 8-story municipal government office buildings-each with 2 stairwells.
Participants: Approximately 2800 municipal employees and 1000 daily visitors.
Intervention: All stairwells received door wraps and point-of-decision and wayfinding prompts. Environmental enhancements were installed in 1 stairwell in each of the 2 buildings: wall paint, upgraded stair treads and handrails, artwork, light-emitting diode (LED) lighting, fire-rated glass doors, and removal of security locks on at least the ground floor.
Measures: Staff surveys and focus groups, electronic and direct measures of stair and elevator use occurred at baseline and over 3 years of phased implementation and follow-up.
Analysis: Change in the proportion of vertical movement by stairs using χ2 analysis.
Results: The prompts were associated with a significant increase in stair use (odds ratio [OR] = 1.36; 95% confidence interval [CI]: 1.31-1.41), with an average absolute increase of 3.2%. Environmental enhancements were associated with an additional significant increase in stair use (OR = 1.31; 95% CI: 1.25-1.37) beyond prompts alone with an average absolute increase of a further 3.5% that was sustained for 1 year. The initial increases in stair use with prompts alone were not sustained.
Conclusion: Implementing environmental stairwell enhancements in office buildings increased stair usage in a sustained manner beyond that achieved by prompts alone.
Keywords: facility design and construction; physical activity; point-of-decision prompts; stair-use interventions; worksites.