Intervention Worksites Research Articles

The effects of a controlled worksite environmental intervention on determinants of dietary behavior and self-reported fruit, vegetable and fat intake

BackgroundEating patterns in Western industrialized countries are characterized by a high energy intake and an overconsumption of (saturated) fat, cholesterol, sugar and salt. Many chronic diseases are associated with unhealthy eating patterns. On the other hand, a healthy diet (low saturated fat intake and high fruit and vegetable intake) has been found important in the prevention of health problems, such as cancer and cardio-vascular disease (CVD). The worksite seems an ideal intervention setting to influence dietary behavior. The purpose of this study is to present the effects of a worksite environmental intervention on fruit, vegetable and fat intake and determinants of behavior.MethodsA controlled trial that included two different governmental companies (n = 515): one intervention and one control company. Outcome measurements (short-fat list and fruit and vegetable questionnaire) took place at baseline and 3 and 12 months after baseline. The relatively modest environmental intervention consisted of product information to facilitate healthier food choices (i.e., the caloric (kcal) value of foods in groups of products was translated into the number of minutes to perform a certain (occupational) activity to burn these calories).ResultsSignificant changes in psychosocial determinants of dietary behavior were found; subjects at the intervention worksite perceived more social support from their colleagues in eating less fat. But also counter intuitive effects were found: at 12 months the attitude and self-efficacy towards eating less fat became less positive in the intervention group. No effects were found on self-reported fat, fruit and vegetable intake.ConclusionThis environmental intervention was modestly effective in changing behavioral determinant towards eating less fat (social support, self-efficacy and attitude), but ineffective in positively changing actual fat, fruit and vegetable intake of office workers.

Factors Related to Participatory Employee Advisory Boards in Small, Blue-Collar Worksites

To identify factors related to formation, participation, and characteristics of employee advisory boards (EABs) in blue-collar worksites. This study used a nonexperimental qualitative design to assess EAB formation, activity, and enthusiasm levels and examined those factors relative to employee participation in worksite-wide health promotion activities. Twenty-two blue-collar worksites with a total of 113 EAB members in the greater Seattle area. Individuals who agreed to serve on EABs in the intervention worksites. Participants received training in involving employees in the 5-A-Day project intervention activities. Measures include type of worksite, number of EAB members, method of EAB recruitment, and variables describing EAB functioning, including attendance at meetings, assistance at project activities, and level of enthusiasm. All worksites formed EABs. There was no association between the way the EAB was formed and subsequent EAB attendance at meetings, participation in project activities, representativeness of the EAB, or level of EAB enthusiasm. Enthusiasm of the EAB was associated with employee participation, and EABs with a higher level of enthusiasm showed more participation by employees than worksites with less enthusiastic EABs. It is possible to develop participatory structures in small, blue-collar worksites. More information is needed about factors related to levels of enthusiasm of EABs.

Effectiveness of annual interventions for smoking cessation in an occupational setting in Japan

To examine the effectiveness of a small-scale smoking cessation intervention program conducted annually for ten years in an occupational setting in Japan. We conducted an annual intervention program promoting smoking cessation in male smokers from 1993 to 2002 in an occupational setting in Hyogo, Japan. Trends in smoking prevalence in this worksite were compared with a control group from two similar worksites of the same company. The intervention program was carried out by medical students (the fourth year of a six-year course) who received training on the protocol prior to the intervention. This protocol consisted of one initial group session, followed by periodical correspondence for two months. Successful cessation of smoking was determined by self-declaration of abstinence for longer than four weeks after intervention, confirmed by an expiratory carbon monoxide concentration of less than nine ppm. Smoking prevalence was determined by a self-administered questionnaire provided at the annual health checkup. The proportion of smokers who participated in the program was 3.47% on average. Abstinence rates following each intervention ranged from 13.3% to 60.0%, with the prevalence of male smokers at the intervention worksite decreasing from 56.2% in 1993 to 47.0% in 2002. In contrast, the smoking prevalence of the control worksites remained largely unchanged, being 60.2% in 1995 and 57.6% in 2002. At the end of the study, the intervention worksite had a significantly lower prevalence of smokers in either the crude or age-adjusted rate. A small-scale but repeated smoking cessation intervention program at a worksite can reduce smoking prevalence more efficiently than the natural trends.

Seattle 5 a Day Worksite Program to Increase Fruit and Vegetable Consumption

Background. 5 a Day for Better Health is a simple message encouraging people to eat more fruits and vegetables. The Seattle 5 a Day worksite investigators designed and evaluated an intervention, organized on stages of behavioral change, to increase worksitewide fruit and vegetable consumption.Methods. We recruited 28 worksites with cafeterias and randomized 14 to intervention and 14 to control. The intervention addressed both changes in the work environment and individual level behavior change. In each worksite, an employee advisory board, with study interventionist assistance, implemented the program. By surveying cross-sectional samples of 125 employees per worksite, we compared worksite mean fruit and vegetable consumption at 2-year follow-up with that at baseline. Unobtrusive site-level indicators including plate observation and cafeteria checklist were also used.Results. The difference at 2 years was 0.5 for the intervention worksites and 0.2 for the control worksites, with an intervention effect of 0.3 daily serving (P < 0.05). Other measures of fruit and vegetable consumption, including unobtrusive indicators, supported the effectiveness of the intervention.Conclusions. This simple 5 a Day intervention is feasible and acceptable for use in worksites with cafeterias. There was a significant differential increase in fruit and vegetable consumption in the intervention worksites. This kind of worksite intervention can achieve important health benefits on a population basis, because of its potential to reach large numbers of people.

Trying and buying locally grown produce at the workplace: Results of a marketing intervention

AbstractAlthough consumers have a high opinion of locally grown produce, they do not consider origin as important as other factors in produce selection. Inconvenience is a major barrier to purchasing local produce. In a rural community in Maine, the Farm Fresh Project tested an intervention designed to exploit consumers' high regard for locally grown produce and also overcome the inconvenience of buying it. Each week for six weeks in the summer of 1997, employees at three worksites were offered tastings of locally grown produce, information about the produce, and an opportunity to order it at their workplaces. Changes in purchases of locally grown produce were compared with changes among employees at three matched control worksites. More than a quarter of workers at intervention worksites ordered produce through the project. Significant numbers of employees at intervention worksites who had not bought locally grown produce earlier in the summer bought it at outlets in the community during the four weeks following the intervention. Visits to the community farmers' market, purchases at roadside stands, pick-your-own purchases, and purchases of locally grown produce, both overall and at locations other than at the farmers' market, increased significantly in the intervention group. Among workers at control sites, only roadside stand purchases increased significantly. It appears that the opportunity to taste and purchase locally grown produce at a convenient venue, the workplace, motivated consumers to overcome barriers to purchasing locally grown produce at less convenient venues outside of the workplace. Temporary farm stands at workplaces may offer a promising new direct market for farmers.

The Next Step Trial: Impact of a Worksite Colorectal Cancer Screening Promotion Program

Background.The Next Step Trial was a randomized trial of worksite colorectal cancer screening promotion and nutrition interventions for automobile industry employees at increased risk of colorectal cancer. Interventions were tested at 28 worksites with 5,042 employees. This report describes results of the screening promotion intervention.Methods.Worksites randomized to the control group received a standard program including rectal examination, fecal occult blood testing, and flexible sigmoidoscopy. Intervention worksites received an enhanced program (i.e., standard program plus an educational booklet/telephone call). Compliance (i.e., completion of all recommended screening examinations) and coverage (i.e., completion of at least one screening examination), the primary and secondary outcomes, were measured over 2 years.Results.In the 2 years prior to baseline, 61% of employees had been screened. After random assignment, baseline differences in several employee characteristics and worksite screening procedures were detected, including more past history of screening in control worksites. After adjusting for differences, we found modest, but higher, compliance and coverage in intervention compared with control worksites (odds ratio [95% confidence limits] = 1.46 [1.1–2.0] and 1.33 [1.1, 1.6], respectively).Conclusions:Adding a personally tailored behavioral intervention to a standard colorectal cancer screening program can promote continued employee participation in screening as measured by compliance. Further research is needed to assess intervention effects in other populations.

Durability and Diffusion of the Nutrition Intervention in the Working Well Trial: For the Working Well Research Group

Background.The Working Well Trial (WWT) emphasized employee participation in the planning and implementation of the health promotion intervention. These participatory strategies were intended to promote institutionalization of the health promotion program and thereby encourage maintenance of the intervention activities. We used data from 107 worksites in the WWT to test whether the nutrition intervention activities were maintained after the research program (i.e., durability) or were adopted by control sites (i.e., diffusion).Methods.At baseline, upon the completion of the 2-year intervention, and 2 years later, we conducted organization surveys regarding worksite health promotion activities. A nutrition activity score from 0 to 3 was calculated based on availability of nutrition-related programs, self-help manuals or guides, and videos, tapes, brochures, or posters.Results.From baseline to the end of the intervention, there was a significant increase in the nutrition activity score in intervention worksites compared with the controls (P< 0.001). However, 2 years later, there was no difference between intervention and control worksites. In addition, there was no significant increase in the nutrition activity score in control site 2 years after they received the intervention protocols and materials.Conclusions.Research is needed to develop and test worksite-based interventions to promote institutionalization, durability, and diffusion.

Worksite Health and Safety Climate: Scale Development and Effects of a Health Promotion Intervention

Background.Environmental influences on health and health behavior have an important place in research on worksite health promotion. We tested the validity and internal consistency of a new measure of organizational health and safety climate that was used in a large randomized trial of a worksite cancer prevention program (the Working Well Trial). The resulting scales then were applied to assess intervention effects.Method.This study uses data from a subset of 40 worksites in the Working Well Trial. Employees at 20 natural gas pipeline worksites and 20 rural electrical cooperatives completed a cross-sectional questionnaire at baseline and 3-year follow-up.Results.A factor analysis of this self-report instrument produced a two-factor solution. The resulting health and safety climate scales had good internal consistency (Cronbach's α = 0.74 and 0.82, respectively) and concurrent validity. The health climate scale was correlated more highly with organizational measures that were indicative of a supportive health climate than those indicating supportive safety climate, while the reverse was true of the safety climate scale. Changes in health climate were associated with the number of smoking and smokeless tobacco programs offered at the worksites at the time of the 3-year follow-up (r= 0.46 and 0.42, respectively). The scales were not correlated with most employee health behaviors. The health climate scores increased at intervention worksites, compared with scores at control worksites (F[1,36] = 7.57,P= 0.009).Conclusions.The health and safety climate scales developed for this study provide useful instruments for measuring organizational change related to worksite health promotion activities. The Working Well Intervention resulted in a significant improvement in worksite health climate.

Components of the Working Well Trial Intervention Associated With Adoption of Healthful Diets

This report examines whether variability in the type and amount of the nutrition intervention in a worksite-based intervention could explain dietary outcomes. Data are from 55 intervention worksites in the Working Well Trial, a randomized controlled trial of worksite-based health promotion. The components of the nutrition intervention were kickoff event, direct education, interactive activities (e.g., food sampling), contests, printed information picked up by employees, and materials distributed to employees. We measured delivery of the nutrition intervention (i.e., dose) by determining the amount of workforce participation in each intervention component. Diet outcomes were changes in intakes of fat, fiber, and servings of fruits and vegetables (reported on food frequency questionnaires). All variables were aggregated to the worksite level. We correlated the dose variables with indices of receipt of the intervention and with the dietary outcomes. Contests were associated with employee awareness of and participation in the nutrition intervention (r = 0.49 and 0.28, respectively), and interactive activities were associated with intervention participation (r = 0.43). Contests were associated with increased fiber intake and fruit and vegetable consumption (r = 0.36 and 0.31, respectively), and direct education was associated with fruit and vegetable consumption (r = 0.38). All the above correlation coefficients were statistically significant (P < .05). Intervention dose was not associated with changes in fat intake. It appears that longer, interactive intervention efforts (contests and classes) resulted in more positive outcomes than did one-time activities (such as the kickoffs) or more passive efforts (use of printed materials). There is a need for studies designed to test worksite- and community-based nutrition intervention methods.

Take Heart II: replication of a worksite health promotion trial.

The purpose of this study was to evaluate the effects of a revised worksite health promotion program that featured an employee steering committee/menu approach to intervention. The "Take Heart II" program was evaluated using a quasi-experimental matched-pair design with worksite as the unit of analysis. Experimental and control worksites did not differ on baseline organizational or employee demographic variables or on baseline levels of dependent variables. Outcome and process results revealed consistent, but modest effects favoring intervention worksites on most measures. Cross-sectional analyses generally failed to produce statistically significant intervention effects, but cohort analyses revealed significant beneficial effects of the Take Heart II intervention on eating patterns, behavior change attempts, and perceived social support. Neither analysis detected a beneficial effect of intervention on cholesterol levels.

Feasibility of a worksite-wide nutrition intervention

AbstractRecently, worksites have become an important avenue for health promotion activities due to the number of people that can be reached at work places. The worksite is a good channel through which many types of intervention can be delivered, rather than merely a location for holding groups or classes on a particular health promotion topic. This paper presents the results of a feasibility study for a worksite-wide nutrition intervention using worksites as an intervention channel. Four public sector worksites were recruited to participate in the feasibility study. Two of the worksites were randomized to an intervention condition, and the other two were randomized to a comparison condition. As part of an ongoing worksite health promotion programme, the intervention worksites received a multicomponent worksite-wide nutrition intervention aimed at reducing fat and increasing fruit and vegetable consumption. Nutrition-related and demographic variables were measured at baseline and at two years post-randomiz...

Results of a One-Year Worksite and Mass Media Based Intervention on Health Behaviour and Chronic Disease Risk Factors

The North Karelia Worksite Intervention Study was carried out to assess the effectiveness of worksite-based innovative intervention on chronic disease risk factors. The one-year intervention combined use of mass media, worksite opinion leaders, risk assessment and counselling and other health education measures. The study used eight medium sized intervention worksites (IW) and eight matched reference worksites (RW). Of the 715 workers 91% participated in the initial survey, and out of these 89% in the one-year follow-up survey. The proportion of current smokers changed from 39% to 30% (p less than 0.05) at the IWs while no change took place at the RWs (33%). The effect on smoking was confirmed by serum thiocyanate analyses. An additive score of the three main CHD risk factors changed from 3.1 to 2.7 at the IWs and from 3.2 to 3.0 at the RWs (p less than 0.05 for the net change). The results and experiences showed the feasibility of the intervention and significant, although modest, effects on risk factors and health behaviour, notably smoking.