Self-initiated Changes Research Articles

The Relationship Between Job Crafting and Job Satisfaction Among Teachers in Secondary Schools of Kampala District, Uganda

Job crafting refers to the self-initiated changes that employees make to their tasks, relationships, and work environment to enhance their job satisfaction and overall well-being. This study examined the relationship between job crafting and job satisfaction among teachers in Kampala District schools in Uganda. The study assessed relationships between (i) task crafting and teacher’s job satisfaction; (ii) relational crafting and teacher’s job satisfaction; and (iii) cognitive crafting and teacher’s job satisfaction. This study adopted a quantitative research design with a survey methodology. Data was collected from 180 teachers from 6 secondary schools in Kampala District in Uganda. SPSS software was used to analyse the data. The study findings showed a strong positive correlation (r = 0.65, p < 0.01) between job crafting and teacher’s job satisfaction. The coefficient for job crafting behaviors (B = 0.35, p < 0.0001) indicated a positive impact on job satisfaction. It is therefore concluded that job crafting plays a significant role in enhancing job satisfaction. The school administrators are therefore urged to regularly create an environment that supports teachers’ autonomy to craft their jobs, provide training on job crafting, offer support for job crafting through prompt mentorship and feedback and put more emphasis on relational crafting.

Development and Validation of a Short Broad Job Crafting Scale

The dominant perspectives in the job crafting literature have different views on “what elements of their job employees craft” and “why employees craft their jobs”. To better grasp both perspectives, we developed and validated a short 4-item instrument (BJCS) to capture job crafting as the self-initiated changes made to one’s job with the intention to optimize one’s functioning. We validated the BJCS through five phases: (1) we developed the BJCS and conducted a qualitative study to establish content validity, (2) we establish its reliability and psychometric properties, (3) we demonstrated discriminant and convergent validity of the BJCS in relation to existing job crafting measures, and (4 & 5) the BJCS showed to be predictive and incrementally valid over and above existing measures in relation to indicators of optimal and dysfunctional functioning. Taken together, we demonstrated the validity of a broad short measure for job crafting which is especially relevant for the use in repeated measurement research.

Job crafting interventions: what works, for whom, why, and in which contexts? Research protocol for a systematic review with coincidence analysis

BackgroundRecent challenges in the working world that resulted from the pandemic and technological advances have underlined the importance of flexibility in how jobs are designed. Job crafting (JC) refers to self-initiated changes that employees introduce to their jobs to optimize their job design and increase the fit between the job and their needs and preferences. These behaviors can be stimulated by job crafting training interventions, which aim to change how individual employees design, organize, or manage their work. However, since the interventions are implemented in various ways, we do not know which context and intervention factors are necessary or sufficient to achieve desired outcomes. Without this knowledge, benefitting from the potential of job crafting interventions is limited. The overall aim of this project will be to investigate what combinations of context, intervention, and mechanism factors are linked with effective JC interventions. Specifically, we will detect what factors are minimally sufficient and/or necessary to produce a successful JC intervention, how they combine, as well as what are the multiple alternative paths to their success.MethodsWe will perform a systematic review of the JC interventions literature combined with coincidence analysis (CNA). We will search electronic databases of journals and utilize Rayyan software to make decisions regarding inclusion. Data regarding context (e.g., fit), intervention (e.g., types of activities), mechanisms (e.g., intention implementation), and outcomes (e.g., employee well-being, job performance) will be extracted using a pre-piloted form and coded into a crisp-set (factor present vs. absent). Analyses will be carried out using the CNA package in R.DiscussionThis review will address gaps in knowledge about the context, intervention, and mechanism-related factors that may impact the effects of JC interventions. Consequently, this review will help develop a program theory for JC interventions that explains what works, how and under which circumstances. Applying CNA to synthesize these complex solutions across multiple studies provides an innovative method that may be used in future review attempts evaluating the implementation of interventions. Finally, our synthesis will provide knowledge relevant to organizational practitioners and scholars who want to implement JC interventions.Trial registrationhttps://osf.io/2g6yx

Teachers’ Perceptions of Their Goals: Toward Pro-SEL Pedagogy

The switch to online teaching that the global COVID-19 crisis necessitated has been discussed in many studies. Few papers, however, have investigated teachers’ perceptions and the self-initiated changes they made due to such a transition. This study adopted a mixed methods design to determine the perceptions of teachers and the changes they made during the crisis. For this undertaking, a purposive snowball sampling of thirty in-service teachers in Israel was used. The study revealed that considerable changes were made in the participants’ pedagogical practices, and there was a significant correlation between these changes and teachers’ perceptions of their teaching profession. The changes essentially applied to two main categories: teaching goals and teaching strategies. In addition, the findings showed that the revised teaching goals and strategies were executed to the teachers’ own volition and were consistent with Social Emotional Learning (SEL) pedagogy. To enhance the social-emotional competence and well-being of teachers and students, the researchers recommend elevating and enhancing the teaching profession by establishing SEL pedagogy in all schools, not only in times of crisis but as a policy empowered by advocacy.

Needs-based off-job crafting across different life domains and contexts: Testing a novel conceptual and measurement approach.

Shaping off-job life is becoming increasingly important for workers to increase and maintain their optimal functioning (i.e., feeling and performing well). Proactively shaping the job domain (referred to as job crafting) has been extensively studied, but crafting in the off-job domain has received markedly less research attention. Based on the Integrative Needs Model of Crafting, needs-based off-job crafting is defined as workers’ proactive and self-initiated changes in their off-job lives, which target psychological needs satisfaction. Off-job crafting is posited as a possible means for workers to fulfill their needs and enhance well-being and performance over time. We developed a new scale to measure off-job crafting and examined its relationships to optimal functioning in different work contexts in different regions around the world (the United States, Germany, Austria, Switzerland, Finland, Japan, and the United Kingdom). Furthermore, we examined the criterion, convergent, incremental, discriminant, and structural validity evidence of the Needs-based Off-job Crafting Scale using multiple methods (longitudinal and cross-sectional survey studies, an “example generation”-task). The results showed that off-job crafting was related to optimal functioning over time, especially in the off-job domain but also in the job domain. Moreover, the novel off-job crafting scale had good convergent and discriminant validity, internal consistency, and test–retest reliability. To conclude, our series of studies in various countries show that off-job crafting can enhance optimal functioning in different life domains and support people in performing their duties sustainably. Therefore, shaping off-job life may be beneficial in an intensified and continually changing and challenging working life.

Clinical Experiences of People With a Laryngectomy During the SARS COVID-19 Pandemic.

Purpose This study described the clinical experiences of patients with a total laryngectomy (TL) during the COVID-19 pandemic and identified changes in communication, tracheostoma care, and heat-moisture exchange (HME) use that were recommended or self-implemented. Method An online survey addressing the study aims was completed by 173 people with a TL who live in the United States. The survey was open from July 5 to August 10, 2020. Results In-person clinic visits, appointment cancellations, and contact from their speech-language pathologists (SLPs) were reported by 42%, 19%, and 54% of the TL respondents, respectively. At clinic visits, 78% were required to wear a mask over their nose/mouth, and 73% were required to wear a mask over their tracheostoma. Masks, gloves, and face shields worn by the SLP at these visits were reported by 84%, 82%, and 70% of the TL patients, respectively. Alaryngeal communication changes were recommended by the SLP for 7%-18% of TL patients, depending on their method of communication, whereas 43%-45% implemented changes on their own. Changes in tracheostoma care and HME use were recommended by the SLP for 27% and 21% of the TL respondents, respectively, whereas 54% and 47% made changes on their own. Conclusions Individuals with a TL will require in-person care even during a pandemic, as reflected in this study. Many had not been contacted by their SLP or otolaryngologist about TL guidelines that were becoming available. Notably, larger percentages of TL patients reported self-initiated changes to their communication, tracheostoma care, and HME use because of the pandemic than their SLP had advised. The types of communication changes varied in part, depending on the method of alaryngeal speech a respondent used. Supplemental Material https://doi.org/10.23641/asha.16807270.

Self-initiated changes in physical activity and incidence of Metabolic Syndrome: A longitudinal follow-up study

AimThe aim of this study was to analyze the association between longitudinal physical activity patterns (persistently inactive, became active, became inactive, and persistently active) and the incidence of Metabolic Syndrome (MS) among adults. MethodsOur cohort included 5766 adults (18-59y) undergoing repeated routine health screening examinations, with a mean follow-up period of three years. Only subjects without MS at baseline were included in the study. MS was defined according to the ATP III definition, including assessments of fasting blood samples for the collection of HDL-C, triglycerides and glucose, blood pressure, and waist circumference. Physical activity was estimated using the international physical activity questionnaire and four patterns were created (persistently active, became active, became inactive, and persistently inactive). Information on tobacco smoking and alcohol consumption (through structured validated questionnaires), age, interval between baseline and follow-up, anti-hypertensive drugs, statin, anti-diabetic drugs were used as covariates. Logistic regression was conducted. ResultsThe mean age of participants at baseline was 41.6 ± 7.9 years. We identified 1701 subjects who were active at both moments, 1246 who became active, 709 who became inactive, and 2210 who were inactive at both moments. Persistently inactive subjects presented a higher incidence of MS [10.4% (95%CI = 9.2–11.8%)]. In the adjusted logistic regression analyses, subjects that became active [OR = 0.55(95%CI = 0.40–0.74)] and persistently active [OR = 0.35(95%CI = 0.26–0.46)] were less likely to develop MS when compared with persistently inactive subjects. ConclusionPersistently active subjects demonstrated the lowest likelihood of developing MS, while subjects who became active presented an attenuated risk.

Personality and boredom at work: the mediating role of job crafting

PurposeBoredom at work is associated with negative consequences, therefore it is important to investigate whether employees engage in job crafting behaviors that reduce boredom and what are the individual differences associated with these behaviors. The paper aims to discuss these issues.Design/methodology/approachA questionnaire study was designed to examine the mediating role of job crafting in the relationship between conscientiousness and emotional stability and boredom among 252 employees (Study 1) and in the relationship between Machiavellianism and psychopathy and boredom among 216 employees (Study 2).FindingsThe results showed that conscientiousness is negatively related to work-related boredom. This relationship is mediated by job crafting. Neuroticism and psychopathy are positively associated with boredom at work, but these relationships are not mediated by job crafting behaviors.Research limitations/implicationsThe study was based on self-reported measures, which might raise questions of common-method bias, and the research samples contained mostly women and young employees, which raises questions about generalizability of our findings. At the same time, the cross-sectional design does not allow causal inferences.Practical implicationsOrganizations can select employees based on their personality for jobs that predispose to boredom and give them enough autonomy to be able to craft them. Moreover, they can identify employees who need support to manage their boredom and include them in job crafting interventions.Originality/valueTraditionally, boredom at work has been considered as resulting from characteristics of tasks and jobs. The findings indicate that some employees can make self-initiated changes to their work in order to reduce their boredom and possibly its negative consequences.

Robotic Intervention Program for Enhancement of Social Engagement among Children with Autism Spectrum Disorder

This study investigated the effectiveness of a robotic intervention in enhancing the social engagement of children with autism spectrum disorder (ASD). The clinical use of social or interactive robots is promising for enhancing the social skills of children with ASD. Teaching and intervention programs using humanoid robots for children with ASD are developing rapidly. In this study, a repeated-measures design was adopted to test the treatment effectiveness of a robotic intervention program; 14 students with ASD were recruited in this study. An individual-based social skills training program using the NAO robot was administered to each participant. Video recording was performed throughout the course of training. Systematic video analysis was conducted for the pre-intervention, mid-intervention, end of intervention and maintenance phases regarding 3 variables: frequency of eye contact, duration of eye contact, and frequency of verbal initiation. One-way analysis of variance for repeated measures was employed to demonstrate that the robotic intervention program significantly enhanced the eye contact (both frequency and duration) and verbal initiation of children with ASD. The robot served as a role model and facilitating agent to enable a therapeutic transaction between the child, environment, and activities to elicit self-initiated changes in the children with ASD.

Is new generation employees’ job crafting beneficial or detrimental to organizations in China? Participative decision-making as a moderator

Chinese ‘new generation’ employees have a strong desire to make self-initiated changes in their jobs (that is to say, job crafting). However, whether such crafting is beneficial or detrimental to their organizations is an issue that remains largely unexplored. To address this question, we employed a ‘social exchange’ framework to build a more nuanced understanding of the boundary conditions favourable versus unfavourable consequences of Chinese new generation employees’ job crafting. Multisource data from 289 pairs of new generation employees and their immediate supervisors reveal a positive relationship between job crafting and leader–member exchange when employees have greater opportunities to participate in decision-making and a negative relationship when employees’ participation in decision-making is low. Via leader–member exchange, therefore, employee job crafting ultimately contributes to the promotion or decline of employees’ task performance, respectively. Our findings provide insights into how new generation employees and their organizations can benefit from their self-initiated changes at work, and these insights have important implications for Chinese new generation employee management.

High Job Demands, Still Engaged and Not Burned Out? The Role of Job Crafting.

Traditionally, employee well-being has been considered as resulting from decent working conditions arranged by the organization. Much less is known about whether employees themselves can make self-initiated changes to their work, i.e., craft their jobs, in order to stay well, even in highly demanding work situations. The aim of this study was to use the job demands-resources (JD-R model) to investigate whether job crafting buffers the negative impacts of four types of job demands (workload, emotional dissonance, work contents, and physical demands) on burnout and work engagement. A questionnaire study was designed to examine the buffering role of job crafting among 470 Finnish dentists. All in all, 11 out of 16 possible interaction effects of job demands and job crafting on employee well-being were significant. Job crafting particularly buffered the negative effects of job demands on burnout (7/8 significant interactions) and to a somewhat lesser extent also on work engagement (4/8 significant interactions). Applying job crafting techniques appeared to be particularly effective in mitigating the negative effects of quantitative workload (4/4 significant interactions). By demonstrating that job crafting can also buffer the negative impacts of high job demands on employee well-being, this study contributed to the JD-R model as it suggests that job crafting may even be possible under high work demands, and not only in resourceful jobs, as most previous studies have indicated. In addition to the top-down initiatives for improving employee well-being, bottom-up approaches such as job crafting may also be efficient in preventing burnout and enhancing work engagement.

Self-initiated changes in physical activity levels improve cardiometabolic profiles: A longitudinal follow-up study

Background and aimsWhile studies have described the importance of higher physical activity levels (PAL) in weight loss, the impact of self-initiated PAL on health status warrants further study. We aimed to prospectively examine the effects of self-initiated longitudinal PAL changes on body mass index (BMI) and cardiometabolic parameters in normal weight, overweight and obese adults. Methods and resultsWe included 4840 adults (mean age 41.6 ± 7.9 years, 79% male) undergoing routine health screening examinations. Self-reported PAL, height, weight, blood pressure and blood samples were collected at baseline and after a mean (95% confidence interval) follow up of 536 (531–541) days. Subjects were stratified according to BMI [39.8% normal weight (<25 kg/m2), 45.1% overweight (25.0–29.9 kg/m2), and 19.1% obese (≥30 kg/m2)]. In normal weight individuals, BMI increased from baseline to follow-up, irrespective of PAL changes. On the other hand, overweight and obese individuals that increased PAL experienced a decrease in BMI by −0.9% and −3.1%, respectively (p < 0.05). Overweight and obese individuals that increased PAL also experienced a decrease in −5.8% -4.6% in non-HDL concentrations from baseline to follow-up (p < 0.05). Finally, in overweight individuals, LDL cholesterol concentrations decreased from baseline to follow-up, irrespective of PAL changes whereas in obese individuals, a maintenance or increased PAL were associated with a decrease in −4.7% and −6.1% (p < 0.05), respectively. ConclusionsIn a large cohort of screening patients, longitudinal self-initiated PAL is associated with improved BMI and cardiometabolic profile in overweight and obese individuals.

Job crafting and job performance: A longitudinal study

In this three-wave study (N = 288), we examined whether job crafting intentions and work engagement led to actual job crafting behaviours and, in turn, to higher levels of prospective work engagement and job performance. We used the Job Demands-Resources model as a theoretical framework and defined job crafting as the self-initiated changes that employees make in their job demands and resources. One month after reporting their job crafting intentions, respondents rated their actual job crafting behaviours. Again one month later, they rated their levels of work engagement, in-role performance, and organizational citizenship behaviour towards individuals (OCBI). Results of structural equation modelling showed that job crafting intentions and work engagement significantly related to actual job crafting, which, in turn, related to higher levels of work engagement, while controlling for job characteristics. Results further showed that engaged employees performed better on their in-role tasks but did not perform more OCBIs. The findings suggest that employees can increase their own work engagement and job performance through job crafting.

The way one thinks affects the way one drinks: Subjective evaluations of alcohol consequences predict subsequent change in drinking behavior.

Heavy alcohol use and related consequences are common during the college years and are associated with deleterious outcomes for both the students themselves and the college community. Some college students make self-initiated changes to their drinking to avoid such outcomes, but little is known about how such adjustments occur, or characteristics that are associated with making these adjustments. Based on Social Learning Theory (SLT), one cognitive factor that may predict within-person changes in drinking is the subjective evaluations of alcohol consequences (i.e., the extent to which consequences are perceived as negative, aversive, or severe). The aim of the present study was to investigate whether subjective evaluations of recently experienced consequences influence within-person changes in drinking behavior. In 10 weekly, web-based surveys, regularly drinking college students (N = 96, 50 female) reported on their previous week alcohol use and experience of 24 alcohol-related consequences, as well as their subjective evaluations of those consequences. Results demonstrated that evaluations across the consequences varied, and that in addition to differing from one another, students' evaluations of consequences differed at the within-person level over time. Most important, hierarchical linear model tests revealed that students drank less and experienced fewer consequences following weeks in which they rated their consequences as more negative (relative to their own typical subjective evaluations), suggesting that viewing one's recent consequences as aversive prompts self-initiated behavior change. Findings of the present study have potential to inform interventions for college drinking, particularly those that target how individuals think about their behavior and its consequences.

Development and validation of the job crafting scale

We developed and validated a scale to measure job crafting behavior in three separate studies conducted in The Netherlands (total N = 1181). Job crafting is defined as the self-initiated changes that employees make in their own job demands and job resources to attain and/or optimize their personal (work) goals. In Study 1 and 2 the Dutch job crafting scale (JCS) was developed and tested for its factor structure, reliability, and convergent validity. The criterion validity of the JCS was examined in Study 3. The results indicated that there are four independent job crafting dimensions, namely increasing social job resources, increasing structural job resources, increasing challenging job demands, and decreasing hindering job demands. These dimensions could be reliably measured with 21 items. The JCS shows convergent validity when correlated with the active constructs proactive personality (+), personal initiative (+), and the inactive construct cynicism (−). In addition, results indicated that self-reports of job crafting correlated positively with colleague-ratings of work engagement, employability, and performance — thus supporting the criterion validity of the JCS. Finally, self-rated job crafting behaviors correlated positively with peer-rated job crafting behaviors.

Continual Quality Improvement Process for Undergraduate Programs

The Outcome Based Education (OBE) practice requires that the continual quality improvement (CQI) process is implemented in order to continuously improve the quality of teaching and learning of an education program. In purpose of implementing CQI processes, the inputs from the program stakeholders consist of external assessors, industry advisory panel (IAP), students as well as accreditation panel should be considered, weighted and implemented as deemed appropriate by the department. The program external assessors’ inputs also will determine the quality of the program's curriculum and contents as benchmarked with other top international universities. Thus, this paper describes the current CQI processes and self-initiated changes exercised by the Department of Electrical, Electronic and System Engineering, Faculty of Engineering & Built Environment, Universiti Kebangsaan Malaysia based on the inputs from accreditation panels, industry advisory panels, external assessors and students which are gathered periodically by means of visits, meetings and discussions. The stakeholders’ and accreditation panel inputs are mainly on the aspects of teaching and learning, program objectives, program outcomes, curriculum structure, staff, student assessment, facilities and the system quality management as a whole. The department scrutinizes each input before appropriate CQI processes and changes are implemented. Evidently, the CQI and changes made by the JKEES department are not only implemented based on these inputs but some of them are self-initiated. It is highly affirmed that the continuous improvement process carried out at this department level has significantly improve students’ learning.

Bone health screening, education, and referral project in northwest Iowa: Creating a model for community pharmacies

ObjectiveTo identify women 60 years of age or older at risk for osteoporosis, provide education, and refer at-risk women to physicians through a community pharmacy screening program and to develop a model in community pharmacies for this service. DesignCross-sectional study. SettingNorthwest Iowa between August 2005 and October 2005. Participants159 women 60 years of age or older screened at five pharmacies. InterventionsFive pharmacies completed education on osteoporosis, received training on use of the Achilles InSight by GE Lunar, and screened women 60 years of age or older for osteoporosis. Patients received education on osteoporosis and risk factors during the screening and were stratified as low, moderate, or high risk based on a T-score. Patients at risk were referred to their physician for further evaluation. Pharmacists telephoned patients at 3 and 6 months after screening to determine self-initiated or provider-initiated changes in their treatment plan. Main outcome measuresDescriptive population characteristics, proportion of participants with medical risk factors for osteoporosis, proportion of patients screened at risk, and proportion of physician or patient self-initiated changes instituted as a result of the screening. ResultsOf the 159 women screened, 53% were rated as moderate or severe risk and referred to their physicians. Three- and 6-month follow-up results revealed a high proportion of self-initiated lifestyle or medication changes and a small proportion of physician-initiated changes. ConclusionThe majority of women 60 years of age or older who attended a community pharmacy osteoporosis screening were at moderate or high risk for osteoporosis. A fee-for-service model was created for community pharmacists to improve recognition and treatment of patients at risk. A toolkit will be created for pharmacists to promote their role in improving the bone health of older patients.

Multiple factors influence compliance with colorectal cancer staging recommendations: an exploratory study.

BackgroundFor patients with colorectal cancer (CRC) retrieval by surgeons, and assessment by pathologists of at least 12 lymph nodes (LNs) predicts the need for adjuvant treatment and improved survival. Different interventions (educational presentation, engaging clinical opinion leaders, performance data sent to hospital executives) to improve compliance with this practice had variable results. This exploratory study examined factors hypothesized to have influenced the outcome of those interventions.MethodsSemi-structured interviews were conducted with 26 surgeons and pathologists at eleven hospitals. Clinicians were identified by intervention organizers, public licensing body database, and referral from interviewees. An interview guide incorporating open-ended questions was pilot-tested on one surgeon and pathologist. A single investigator conducted all interviews by phone. Transcripts were analyzed independently by two investigators using a grounded approach,ho then compared findings to resolve differences.ResultsImprovements in LN staging practice may have occurred largely due to educational presentations that created awareness, and self-initiated changes undertaken by pathologists. Executives that received performance data may not have shared this with staff, and opinion leaders engaged to promote compliance may not have fulfilled their roles. Barriers to change that are potentially amenable to quality improvement included perceptions about the practice (perceived lack of evidence for the need to examine at least 12 LNs) and associated responsibilities (blaming other profession), technical issues (need for pathology assistants, better clearing solutions and laboratory facilities), and a lack of organizational support for multidisciplinary interaction (little communication between surgeons and pathologists) or quality improvement (no change leaders or capacity for monitoring).ConclusionUse of an exploratory approach provided an in-depth view of the way that numerous factors amenable to quality improvement influenced the adoption of new CRC LN staging recommendations. Continued interventions targeting physicians and executives, in the absence of a receptive organizational infrastructure, may be fruitless. Individualized rather than regional or punitive performance data, coupled with increased organizational capacity for change may stimulate greater surgical and organizational response to quality improvement. Descriptive or experimental studies are needed to test these hypotheses.

Cancer prevention in schools: Design and pilot testing of a nutritional curriculum for mid-adolescents

Adolescents at schools ought to be easy to reach for dietary cancer prevention programs. Yet, traditional school health education interventions, however, do not affect behavior. We have a developed short-term (10 hour) program that supports adolescents in adopting a low-fat, high-fiber diet. The aim has been achieved by making the classroom activities work as part of a community intervention program and by including elements derived from Bandura's social learning theory and the self-efficacy construct. Following the theoretical constructs, the students are exposed to peers reporting on appropriate dietary behavior. In order to enhance self-efficacy, students are given the opportunity to experience successful self-initiated dietary changes. Thus, they set up an individual dietary goal and carry out changes based on this. A pilot test indicated that the program process works as planned. However, in order to evaluate behavioral effects, further studies are required.

The multiple risk factor intervention trial (MRFIT): IV. Intervention on blood lipids

The results are presented for the first 4 years of the Multiple Risk Factor Intervention Trial (MRFIT) nutrition intervention program. Study participants were at high risk (upper 10–15%) for Coronary Heart Disease (CHD). The Special Intervention (SI) group reached and sustained the goals of an eating pattern originally designed to limit cholesterol intake to less than 300 mg/day, with less than 10% of calories as saturated fat and not more than 10% as polyunsaturated fat. By the end of the first year, mean serum total cholesterol had fallen by 6.3% from the mean initial value of 254 mg/dl. The magnitude of the decrease became slightly greater in the ensuing years, reaching 7.4% by the fourth annual visit. Substantially larger decreases in mean serum cholesterol level were observed in the subgroups with the highest baseline level, greatest weight loss, in those who did not smoke, and in those who had normal blood pressure on entry. The changes in cholesterol level were accompanied by parallel changes in mean plasma LDL cholesterol, which also fell by 6.6% over the 4 years, but mean HDL cholesterol was not substantially altered. Comparison with earlier population data suggests that the overall responses to the MRFIT eating pattern were limited by the apparent fact that participants had already made self-initiated changes toward the fatcontrolled dietary pattern before they entered the study.