Health behavior change at the worksite: cardiovascular risk reduction

Improving cancer prevention at the worksite: how are Belgian companies dealing with smoking regulations?

Little is known about the impact of smoking policy on companies' policies related to smoking in Belgium. The study was designed in order to compare the companies' policies related to smoking (CPRS) in 1990 and in 1993. During this 3 year period, numerous information and regulation inputs (media, brochures) were aimed at companies to regulate smoking behavior in the workplace, so as to reduce the risks of passive smoking. A short questionnaire was mailed to 3543 Belgian companies in October 1990 and in June 1993 to assess: designation of smoke free areas (SFA); willingness to offer a worksite information program (WIP); willingness to offer a worksite smoking cessation program (WSCP); willingness to subsidize a WSCP; willingness to offer a WSCP during working hours; willingness to offer a meeting room for a WSCP and actual organization of a WSCP. In 1990, 773 companies (22%) and in 1993, 890 companies (25%) responded to the questionnaire. The results showed that small companies and companies with a high blue/white collar ratio were less able to implement health policy recommendations. A total of 325 (9%) companies responded to the 1990 and 1993 questionnaires. Comparison of 1990 and 1993 dataset showed that during this 3 year period, no major changes occurred for a majority of companies. Amongst the small positive changes, only the designation of smoke free areas and the organization of a small number of WSCP was observed. The conclusion is that despite inputs, little impact on smoking policies is noticeable. Strategies designed to intensify inputs and to promote implementation of regulation of WSCP should therefore further be studied.

An economic evaluation of four work site based cardiovascular risk factor interventions

We used outcome data from a randomized work site intervention trial to examine the cost-effectiveness of four cardiovascular disease (CVD) risk reduction programs: health risk assessment (HRA), risk factor education (RFE), behavioral counseling (BC), and behavioral counseling plus incentives (BCI). Composite CVD risk scores were derived from measures of serum total cholesterol, blood pressure, number of cigarettes smoked, body mass index, and aerobic capacity. The economic evaluation of the programs focused on the subset of costs most sensitive to the differences between the interventions, and a sensitivity analysis examined some of the relevant cost variations. At the 6-month follow-up (i.e., the "action" or initiation stage of lifestyle change), the RFE, BC, and BCI interventions produced a significant reduction in cardiovascular risk. Incremental analyses demonstrated RFE to be more cost-effective, but not as clinically effective as BC; BC was more cost-effective than RFE when assessment costs were included, and BCI was judged to be the least cost-effective. At the 12-month follow-up (i.e., the "maintenance" stage of lifestyle of change), BC was the only program found to produce a significant reduction in CVD risk. Individualized behavioral counseling was found to be a cost-effective strategy for the initiation and maintenance of CVD risk factor reduction.

Work-site cholesterol screening and dietary intervention: the Staff Healthy Heart Project. Steering Committee

OBJECTIVES

The Staff Healthy Heart Project was established to run a work-site cholesterol screening project and a randomized controlled trial of dietary interventions.

METHODS

Screening was offered to all staff at six Australian hospitals. Participants with blood cholesterol of 5.2 mmol/L (200 mg/dL) or above were randomly allocated to receive screening only (control group), a self-help package, or a nutrition course. Participants were seen 3 and 6 months after intervention to measure blood cholesterol and dietary changes.

RESULTS

Eighty percent of available staff (n = 2638) were screened. Of those eligible, 67% (n = 683) entered the trial. Follow-up measures of blood cholesterol and dietary intake were obtained for 63% and 38% of trial participants, respectively. A reduction in reported dietary fat was found for all groups, but there were no significant differences between groups. Reported dietary fiber rose by 0.6 g/MJ/day for those in the nutrition course. There were no changes in total blood or high-density lipoprotein cholesterol.

CONCLUSIONS

Cholesterol reduction was not demonstrated, but this result is difficult to interpret given the poor ongoing participation rates. Strategies to improve ongoing participation in work-site projects are needed to achieve adequate assessment of dietary interventions used in cholesterol screening.

Work-site cardiovascular risk reduction: a randomized trial of health risk assessment, education, counseling, and incentives

OBJECTIVES

This study reports an efficacy trial of four work-site health promotion programs. It was predicted that strategies making use of behavioral counseling would produce a greater reduction in cardiovascular disease risk factors than screening and educational strategies.

METHODS

Twenty-eight work sites were randomly allocated to a health risk assessment, risk factor education, behavioral counseling, or behavioral counseling plus incentives intervention. Participants were assessed before the intervention and at 3, 6, and 12 months.

RESULTS

Compared with the average of the health risk assessment and risk factor education conditions, there were significantly higher validated continuous smoking cessation rates and smaller increases in body mass index and estimated percentage of body fat in the two behavioral counseling conditions. The behavioral counseling condition was associated with a greater reduction in mean blood pressure than was the behavioral counseling plus incentives condition. On average among all groups, there was a short-term increase in aerobic capacity followed by a return to baseline levels.

CONCLUSIONS

Work-site interventions that use behavioral approaches can produce lasting changes in some cardiovascular risk factors and, if implemented routinely, can have a significant public health impact.

A center-based program for exercise change among black-American families

A center-based program was designed and implemented to promote aerobic physical activity among healthy Black-American families with children in the fifth through seventh grades. Ninety-four Black-American families were actively recruited and randomly assigned to an experimental or control group. Families in the experimental group were encouraged to participate in a program with the following features: one education and two fitness sessions per week for 14 weeks; educational sessions that included individual counseling, small group education, aerobic activity, and snack components; located in a convenient building cherished by the community; aerobic activity sessions in a fitness center outfitted and staffed according to modern characteristics; a variety of incentives including free transportation and babysitting and reminders to promote attendance. Percent participation was low, with about 20% participating in the desired fitness center sessions by the end of the program. As a result of low participation, no differences were detected between experimental and control groups on indicators of cardiovascular fitness. In postprogram interviews, conflicts with work and school events were the most commonly reported reasons for nonattendance. We concluded that because of difficulties in attendance, center-based programs appear to have limited value as the sole modality for intervention in public health programs for promoting physical activity among healthy, low income Black-American families with young children. More comprehensive community-based programs are likely to be needed.

Competition/cooperation in worksite smoking cessation using nicotine gum

Worksite competitions have shown promise in facilitating smoking cessation among employees, but the effectiveness of the competition component itself has not been determined. A multicomponent behavioral treatment and maintenance program plus nicotine gum were provided to competition and no-competition conditions at two large worksites. At 1-year follow-up, 100% of subjects were contacted and measurement of expired carbon monoxide validated abstinence. Recruitment rates were significantly higher in the competition group (2% of smokers) than the no-competition group (0.6% of smokers, P less than 0.001). One-year abstinence rates were 50% for the competition group and 25% for the no-competition group. This difference was not statistically significant (P less than 0.25). However, survival analysis revealed a significant difference in number of weeks abstinent during the year after treatment. Mean weeks abstinent was 35 for competition and 22 for no-competition (P less than 0.05). At the 3-month follow-up, the number of boxes of nicotine gum used predicted abstinence (P less than 0.002). At the 1-year follow-up, rated supportiveness of one's "buddy" (P less than 0.01) and number of sick days prior to starting the program predicted abstinence (P less than 0.003). It is suggested that competition, nicotine gum, and social support may enhance worksite smoking cessation program rates.