The Working Healthy Project: a worksite health-promotion trial targeting physical activity, diet, and smoking

Workplace wellness programs for working mothers: A systematic review

BACKGROUND

This systematic review aimed to uncover the evidence and benefits of employers' commitment to delivering workplace wellness programs for working mothers.

METHODS

The articles published in PubMed, Embase, Scopus, and AgeLine-Medline databases between 2012 and 2021 were searched to evaluate the workplace wellness programs for working mothers with at least one resultant wellness or wellbeing (e.g., physical health, less stress, mental health, burnout, depression, smoking, bullying, alcohol consumption, overweight), work-life balance outcome, or job satisfaction.

RESULTS

Eight studies that met the criteria were retrieved from databases. They showed some effective workplace wellness programs that can reduce depression, stress, and burnout, improve mental health, healthy behaviors, work-family balance and work-life balance. Working mothers participating in a workplace wellness program generally gain some benefits; one of which is reduced stress typically related to childcare, economic, and personal health issues.

CONCLUSIONS

The implementation of workplace wellness programs for working mothers showed positive effects on their health problems and health costs. These eight studies revealed that workplace wellness programs specifically designed for working mothers can lead to time efficiency by holding the programs in or near the workplace and implementing them during the workdays. This greatly suits the conditions of many working mothers whose limited time and energy to balance the household, family and work tasks.

Effectiveness of workplace wellness programmes for dietary habits, overweight, and cardiometabolic health: a systematic review and meta-analysis

Background

The workplace offers a unique opportunity for effective health promotion. We aimed to comprehensively study the effectiveness of multicomponent worksite wellness programmes for improving diet and cardiometabolic risk factors.

Methods

We did a systematic literature review and meta-analysis, following PRISMA guidelines. We searched PubMed-MEDLINE, Embase, the Cochrane Library, Web of Science, and Education Resources Information Center, from Jan 1, 1990, to June 30, 2020, for studies with controlled evaluation designs that assessed multicomponent workplace wellness programmes. Investigators independently appraised the evidence and extracted the data. Outcomes were dietary factors, anthropometric measures, and cardiometabolic risk factors. Pooled effects were calculated by inverse-variance random-effects meta-analysis. Potential sources of heterogeneity and study biases were evaluated.

Findings

From 10 169 abstracts reviewed, 121 studies (82 [68%] randomised controlled trials and 39 [32%] quasi-experimental interventions) met the eligibility criteria. Most studies were done in North America (57 [47%]), and Europe, Australia, or New Zealand (36 [30%]). The median number of participants was 413·0 (IQR 124·0–904·0), and median duration of intervention was 9·0 months (4·5–18·0). Workplace wellness programmes improved fruit and vegetable consumption (0·27 servings per day [95% CI 0·16 to 0·37]), fruit consumption (0·20 servings per day [0·11 to 0·28]), body-mass index (−0·22 kg/m² [−0·28 to −0·17]), waist circumference (−1·47 cm [−1·96 to −0·98]), systolic blood pressure (−2·03 mm Hg [−3·16 to −0·89]), and LDL cholesterol (−5·18 mg/dL [−7·83 to −2·53]), and to a lesser extent improved total fat intake (−1·18% of daily energy intake [−1·78 to −0·58]), saturated fat intake (−0·70% of daily energy [−1·22 to −0·18]), bodyweight (−0·92 kg [−1·11 to −0·72]), diastolic blood pressure (−1·11 mm Hg [−1·78 to −0·44]), fasting blood glucose (−1·81 mg/dL [−3·33 to −0·28]), HDL cholesterol (1·11 mg/dL [0·48 to 1·74]), and triglycerides (−5·38 mg/dL [−9·18 to −1·59]). No significant benefits were observed for intake of vegetables (0·03 servings per day [95% CI −0·04 to 0·10]), fibre (0·26 g per day [−0·15 to 0·67]), polyunsaturated fat (−0·23% of daily energy [−0·59 to 0·13]), or for body fat (−0·80% [−1·80 to 0·21]), waist-to-hip ratio (−0·00 ratio [−0·01 to 0·00]), or lean mass (1·01 kg [−0·82 to 2·83]). Heterogeneity values ranged from 46·9% to 91·5%. Between-study differences in outcomes were not significantly explained by study design, location, population, or similar factors in heterogeneity analyses.

Interpretation

Workplace wellness programmes are associated with improvements in specific dietary, anthropometric, and cardiometabolic risk indicators. The heterogeneity identified in study designs and results should be considered when using these programmes as strategies to improve cardiometabolic health.

Workplace cafeteria and other multicomponent interventions to promote healthy eating among adults: A systematic review

The objective of this review is to evaluate evidence for the effectiveness of workplace cafeteria and other supporting multicomponent interventions to promote healthy eating and reductions in health risks among adults. We conducted an electronic search in EMBASE, CINAHL, EconLit, Ovid, Cochrane, Web of Science and PubMed for English-language articles published from 1985 to July 2019. Studies were original articles reporting the results of workplace cafeteria interventions to promote healthy eating and reduction in health risks. Outcomes were classified as changes in fruit and vegetable intake, health risk indicators, dietary intake, and food sales. Interventions were categorized as interventions targeting food quality or quantity, targeting price, targeting food choice at point of purchase, targeting improved supply, targeting client's information, education or motivation and targeting organization policies. Behavioral change conditions used in interventions were identified using the COM-B system of behavioral change. Results were presented in a narrative summary. A total of 55 studies out of 6285 articles were identified for this review. Several studies used multicomponent interventions and the most featured interventions included interventions targeting food quality or quantity, targeting client's information, education or motivation and targeting food choice at point of purchase. There is evidence that workplace cafeteria and other supporting multicomponent interventions resulted in higher intake of fruit and vegetables, improved dietary intake, improved health outcomes and healthy food sales. The findings of this review have the potential to inform future cafeteria-based and other supporting multicomponent workplace health interventions. The review protocol was not registered in a repository.

Adolescent Behavioral Cancer Prevention in the United States: Creating a Composite Variable and Ranking States' Performance

Preventive behaviors established during adolescence can reduce cancer throughout the life span. Understanding the combinations of multiple behaviors, and how these behaviors vary across states, is important for identifying where additional interventions are needed. Using data on 2011-2015 vaccination, energy balance, and substance use from national surveys, we created state-level composite scores for adolescent cancer prevention. Hierarchical Bayesian linear mixed models were used to predict estimates for states with no data on select behaviors. We used a Monte Carlo procedure with 100,000 simulations to generate states' ranks and 95% confidence intervals. Across states, hepatitis B vaccination was 84.3% to 97.1%, and human papillomavirus vaccination was 41.8% to 78.0% for girls and 19.0% to 59.3% for boys. For energy balance, 20.2% to 34.6% of adolescents met guidelines for physical activity, 4.1% to 15.8% for fruit and vegetable consumption, and 66.4% to 82.0% for healthy weight. For substance use, 82.5% to 93.5% reported abstaining from binge alcohol use, 84.3% to 95.4% from cigarette smoking, and 62.9% to 92.8% from marijuana use. (1) Rhode Island, (2) Colorado, (4) Hawaii and New Hampshire (tied), and (5) Vermont performed the best for adolescent cancer prevention, and (47) Missouri, (48) Arkansas, Mississippi, and South Carolina (tied), and (51) Kentucky performed the worst. However, 95% CIs around ranks often overlapped, indicating lack of statistical differences. Adolescent cancer prevention behaviors clustered into a composite index. States varied on their performance on this index, especially for states at the high and low extremes, but most states did not differ statistically. These findings can inform decision makers about where and how to intervene to improve cancer prevention among adolescents.

Strategies to improve the implementation of workplace-based policies or practices targeting tobacco, alcohol, diet, physical activity and obesity

BACKGROUND

Given the substantial period of time adults spend in their workplaces each day, these provide an opportune setting for interventions addressing modifiable behavioural risk factors for chronic disease. Previous reviews of trials of workplace-based interventions suggest they can be effective in modifying a range of risk factors including diet, physical activity, obesity, risky alcohol use and tobacco use. However, such interventions are often poorly implemented in workplaces, limiting their impact on employee health. Identifying strategies that are effective in improving the implementation of workplace-based interventions has the potential to improve their effects on health outcomes.

OBJECTIVES

To assess the effects of strategies for improving the implementation of workplace-based policies or practices targeting diet, physical activity, obesity, tobacco use and alcohol use.Secondary objectives were to assess the impact of such strategies on employee health behaviours, including dietary intake, physical activity, weight status, and alcohol and tobacco use; evaluate their cost-effectiveness; and identify any unintended adverse effects of implementation strategies on workplaces or workplace staff.

SEARCH METHODS

We searched the following electronic databases on 31 August 2017: CENTRAL; MEDLINE; MEDLINE In Process; the Campbell Library; PsycINFO; Education Resource Information Center (ERIC); Cumulative Index to Nursing and Allied Health Literature (CINAHL); and Scopus. We also handsearched all publications between August 2012 and September 2017 in two speciality journals: Implementation Science and Journal of Translational Behavioral Medicine. We conducted searches up to September 2017 in Dissertations and Theses, the WHO International Clinical Trials Registry Platform, and the US National Institutes of Health Registry. We screened the reference lists of included trials and contacted authors to identify other potentially relevant trials. We also consulted experts in the field to identify other relevant research.

SELECTION CRITERIA

Implementation strategies were defined as strategies specifically employed to improve the implementation of health interventions into routine practice within specific settings. We included any trial with a parallel control group (randomised or non-randomised) and conducted at any scale that compared strategies to support implementation of workplace policies or practices targeting diet, physical activity, obesity, risky alcohol use or tobacco use versus no intervention (i.e. wait-list, usual practice or minimal support control) or another implementation strategy. Implementation strategies could include those identified by the Effective Practice and Organisation of Care (EPOC) taxonomy such as quality improvement initiatives and education and training, as well as other strategies. Implementation interventions could target policies or practices directly instituted in the workplace environment, as well as workplace-instituted efforts encouraging the use of external health promotion services (e.g. gym membership subsidies).

DATA COLLECTION AND ANALYSIS

Review authors working in pairs independently performed citation screening, data extraction and 'Risk of bias' assessment, resolving disagreements via consensus or a third reviewer. We narratively synthesised findings for all included trials by first describing trial characteristics, participants, interventions and outcomes. We then described the effect size of the outcome measure for policy or practice implementation. We performed meta-analysis of implementation outcomes for trials of comparable design and outcome.

MAIN RESULTS

We included six trials, four of which took place in the USA. Four trials employed randomised controlled trial (RCT) designs. Trials were conducted in workplaces from the manufacturing, industrial and services-based sectors. The sample sizes of workplaces ranged from 12 to 114. Workplace policies and practices targeted included: healthy catering policies; point-of-purchase nutrition labelling; environmental supports for healthy eating and physical activity; tobacco control policies; weight management programmes; and adherence to guidelines for staff health promotion. All implementation interventions utilised multiple implementation strategies, the most common of which were educational meetings, tailored interventions and local consensus processes. Four trials compared an implementation strategy intervention with a no intervention control, one trial compared different implementation interventions, and one three-arm trial compared two implementation strategies with each other and a control. Four trials reported a single implementation outcome, whilst the other two reported multiple outcomes. Investigators assessed outcomes using surveys, audits and environmental observations. We judged most trials to be at high risk of performance and detection bias and at unclear risk of reporting and attrition bias.Of the five trials comparing implementation strategies with a no intervention control, pooled analysis was possible for three RCTs reporting continuous score-based measures of implementation outcomes. The meta-analysis found no difference in standardised effects (standardised mean difference (SMD) -0.01, 95% CI -0.32 to 0.30; 164 participants; 3 studies; low certainty evidence), suggesting no benefit of implementation support in improving policy or practice implementation, relative to control. Findings for other continuous or dichotomous implementation outcomes reported across these five trials were mixed. For the two non-randomised trials examining comparative effectiveness, both reported improvements in implementation, favouring the more intensive implementation group (very low certainty evidence). Three trials examined the impact of implementation strategies on employee health behaviours, reporting mixed effects for diet and weight status (very low certainty evidence) and no effect for physical activity (very low certainty evidence) or tobacco use (low certainty evidence). One trial reported an increase in absolute workplace costs for health promotion in the implementation group (low certainty evidence). None of the included trials assessed adverse consequences. Limitations of the review included the small number of trials identified and the lack of consistent terminology applied in the implementation science field, which may have resulted in us overlooking potentially relevant trials in the search.

AUTHORS' CONCLUSIONS

Available evidence regarding the effectiveness of implementation strategies for improving implementation of health-promoting policies and practices in the workplace setting is sparse and inconsistent. Low certainty evidence suggests that such strategies may make little or no difference on measures of implementation fidelity or different employee health behaviour outcomes. It is also unclear if such strategies are cost-effective or have potential unintended adverse consequences. The limited number of trials identified suggests implementation research in the workplace setting is in its infancy, warranting further research to guide evidence translation in this setting.

Optimizing Tailored Communications for Health Risk Assessment: A Randomized Factorial Experiment of the Effects of Expectancy Priming, Autonomy Support, and Exemplification

Background

Health risk assessments with tailored feedback plus health education have been shown to be effective for promoting health behavior change. However, there is limited evidence to guide the development and delivery of online automated tailored feedback.

Objective

The goal of this study was to optimize tailored feedback messages for an online health risk assessment to promote enhanced user engagement, self-efficacy, and behavioral intentions for engaging in healthy behaviors. We examined the effects of three theory-based message factors used in developing tailored feedback messages on levels of engagement, self-efficacy, and behavioral intentions.

Methods

We conducted a randomized factorial experiment to test three different components of tailored feedback messages: tailored expectancy priming, autonomy support, and use of an exemplar. Individuals (N=1945) were recruited via Amazon Mechanical Turk and randomly assigned to one of eight different experimental conditions within one of four behavioral assessment and feedback modules (tobacco use, physical activity [PA], eating habits, and weight). Participants reported self-efficacy and behavioral intentions pre- and postcompletion of an online health behavior assessment with tailored feedback. Engagement and message perceptions were assessed at follow-up.

Results

For the tobacco module, there was a significant main effect of the exemplar factor (P=.04); participants who received exemplar messages (mean 3.31, SE 0.060) rated their self-efficacy to quit tobacco higher than those who did not receive exemplar messages (mean 3.14, SE 0.057). There was a three-way interaction between the effect of message conditions on self-efficacy to quit tobacco (P=.02), such that messages with tailored priming and an exemplar had the greatest impact on self-efficacy to quit tobacco. Across PA, eating habits, and weight modules, there was a three-way interaction among conditions on self-efficacy (P=.048). The highest self-efficacy scores were reported among those who were in the standard priming condition and received both autonomy supportive and exemplar messages. In the PA module, autonomy supportive messages had a stronger effect on self-efficacy for PA in the standard priming condition. For PA, eating habits, and weight-related behaviors, the main effect of exemplar messages on behavioral intentions was in the hypothesized direction but did not reach statistical significance (P=.08). When comparing the main effects of different message conditions, there were no differences in engagement and message perceptions.

Conclusions

Findings suggest that tailored feedback messages that use exemplars helped improve self-efficacy related to tobacco cessation, PA, eating habits, and weight control. Combining standard priming and autonomy supportive message components shows potential for optimizing tailored feedback for tobacco cessation and PA behaviors.

A multi-level intervention in worksites to increase fruit and vegetable access and intake: Rationale, design and methods of the 'Good to Go' cluster randomized trial

BACKGROUND

Fruit and vegetable (F&V) consumption is an important contributor to chronic disease prevention. However, most Americans do not eat adequate amounts. The worksite is an advantageous setting to reach large, diverse segments of the population with interventions to increase F&V intake, but research gaps exist. No studies have evaluated the implementation of mobile F&V markets at worksites nor compared the effectiveness of such markets with or without nutrition education.

METHODS

This paper describes the protocol for Good to Go (GTG), a cluster randomized trial to evaluate F&V intake change in employees from worksites randomized into three experimental arms: discount, fresh F&V markets (Access Only arm); markets plus educational components including campaigns, cooking demonstrations, videos, newsletters, and a web site (Access Plus arm); and an attention placebo comparison intervention on physical activity and stress reduction (Comparison). Secondary aims include: 1) Process evaluation to determine costs, reach, fidelity, and dose as well as the relationship of these variables with changes in F&V intake; 2) Applying a mediating variable framework to examine relationships of psychosocial factors/determinants with changes in F&V consumption; and 3) Cost effectiveness analysis of the different intervention arms.

DISCUSSION

The GTG study will fill important research gaps in the field by implementing a rigorous cluster randomized trial to evaluate the efficacy of an innovative environmental intervention providing access and availability to F&V at the worksite and whether this access intervention is further enhanced by accompanying educational interventions. GTG will provide an important contribution to public health research and practice. Trial registration number NCT02729675, ClinicalTrials.gov.

Effectiveness of a Worksite Intervention for Male Construction Workers on Dietary and Physical Activity Behaviors, Body Mass Index, and Health Outcomes: Results of a Randomized Controlled Trial

Purpose:

To evaluate the effectiveness of an individually tailored intervention for improvement in lifestyle behavior, health indicators, and prevention and reduction of overweight among construction workers.

Design:

Randomized controlled trial.

Setting:

Various blue-collar departments of a large construction company in the Netherlands.

Participants:

Blue-collar workers randomized to an intervention (n = 162) or a control group (n = 152).

Intervention:

The intervention group received individual coaching sessions, tailored information, and materials to improve lifestyle behavior during a 6-month period, and the control group received usual care.

Measures:

Body weight, body mass index (BMI), waist circumference, physical activity (PA) levels, dietary behavior, blood pressure, and blood cholesterol were assessed.

Analysis:

Effectiveness of the intervention on outcome measures at 6- and 12-month follow-up was assessed by using linear and logistic regression models adjusting for baseline levels.

Results:

After 6 months, a statistically significant intervention effect was found on body weight ( B = −1.06, P = .010), BMI ( B = −0.32, P = .010), and waist circumference ( B = −1.38, P = .032). At 6 months, the percentage of those meeting public health guidelines for PA increased significantly in the intervention group compared to the control group ( B = 2.06, P = .032), and for sugar-sweetened beverages, an intervention effect was found at 6 months as well ( B = −2.82, P = .003). At 12 months, for weight-related outcomes, these differences were slightly smaller and no longer statistically significant. The intervention was not effective on the total amount of moderate to vigorous PA and other dietary and health outcomes.

Conclusion:

Intervention participants showed positive changes in vigorous PA and intake of sugar-sweetened beverages compared to controls, as well as effects on weight-related outcomes at 6 months. Long-term effects were still promising but not statistically significant.

A 3-Year Workplace-Based Intervention Program to Control Noncommunicable Disease Risk Factors in Sousse, Tunisia

OBJECTIVE

To assess the effectiveness of a 3-year workplace-based intervention program on the control of the main noncommunicable disease risk factors (poor nutrition, physical inactivity, and tobacco use) among the employees of Sousse, Tunisia.

METHODS

We conducted a quasi-experimental study (pre- and postassessments with intervention and control groups) in six companies of the governorate of Sousse in Tunisia.The intervention program consisted of health education programs (eg, workshops, films and open sensitization days). We also scheduled free physical activity sessions and free smoking cessation consultations.

RESULTS

Our intervention program showed meaningful improvement among the employees toward dietary and physical activity behaviors but not for tobacco use.

CONCLUSIONS

Workplace is a crucial setting for health promotion, and future programs should consider a multisectoral approach to control the main noncommunicable disease risk factors.

Work Site Health Promotion Research: To what Extent can we Generalize the Results and what is Needed to Translate Research to Practice?

Information on external validity of work site health promotion research is essential to translate research findings to practice. The authors provide a literature review of work site health behavior interventions. Using the RE-AIM framework, they summarize characteristics and results of these studies to document reporting of intervention reach, adoption, implementation, and maintenance. The authors reviewed a total of 24 publications from 11 leading health behavior journals. They found that participation rates among eligible employees were reported in 87.5% of studies; only 25% of studies reported on intervention adoption. Data on characteristics of participants versus nonparticipants were reported in fewer than 10% of studies. Implementation data were reported in 12.5% of the studies. Only 8% of studies reported any type of maintenance data. Stronger emphasis is needed on representativeness of employees, work site settings studied, and longer term results. Examples of how this can be done are provided.

Design and Evaluation of a Workplace Intervention to Promote Organ Donation

Background

A number of efforts have been made to improve rates of deceased organ donation. However, few have been specifically designed for implementation in the workplace.

Objectives

To design and evaluate a workplace intervention to increase documentation of intention to be posthumous organ donors, communication of donation intention to families, and family members' documentation of their donation intentions.

Methods

The study was a randomized controlled trial of corporate employees. Within each corporation, worksites were randomized to a control condition or 1 of 2 educational interventions. Measures included baseline and 1-month postintervention measures of stage of organ donation intention, stage of family notification, and family members' organ donation intention.

Results

Across 12 corporations, 40 worksites with a total of 754 participants were randomized. At 1-month follow-up, 495 participants (66%) completed a posttreatment questionnaire. The percentage of participants who signed organ donor cards increased in the 2 intervention groups (29%, P < .001, and 31%, P < .002) but not in the control group (17%, P = .454). The percentage who discussed their donation intentions with family members increased significantly across all 3 arms (39%-47%, P < .001). The mean percentage of participants' family members who signed organ donor cards increased by 14% in the control group ( P = .016) and by 17% in the 2 intervention groups ( P < .001).

Conclusions

Educational interventions in the corporate workplace setting can be effective in increasing organ donation intention, family notification, and recruitment of family members as potential organ donors.

Increasing fruit and vegetable intake among manufacturing workers

Purpose

– Blue-collar manufacturing workers are more likely to have lifestyle risk factors, including a lower intake of fruit and vegetables, for the development of chronic diseases. The purpose of this paper is to assess the effects of worksite health-promotion interventions on fruit and vegetable intake among manufacturing workers.

Design/methodology/approach

– This paper reviews the evidence for the effectiveness of interventions and makes recommendations on best practices. Types of interventions and theoretical frameworks used in the workplace are reviewed, and findings are presented through research examples. Research for this paper was conducted using PubMed, Cumulative Index to Nursing and Allied Health Literature, and PsycINFO.

Findings

– Positive results were found for the effectiveness of interventions to increase fruit and vegetable consumption. Multiple levels of intervention, an emphasis on employee participation in planning, higher self-efficacy, and social support were found to be effective.

Research limitations/implications

– Limitations of this review included self-reported data on fruit and vegetable intake. Also, determining if one intervention was more efficacious than another was difficult when multiple interventions were used within a study. Questions have been raised regarding the long-term impact of increased fruit and vegetable intake among employees.

Practical implications

– When planning programs, multiple levels of intervention will be needed to increase fruit and vegetable intake among workers. Also, employee participation should be emphasized when planning and implementing programs.

Originality/value

– The use of manufacturing companies should be considered as a platform for health-promotion programs. Increasing fruit and vegetable intake has the potential to impact numerous blue-collar workers to help reduce the risk of chronic disease.

The impact of home, work, and church environments on fat intake over time among rural residents: a longitudinal observational study

Background

Dietary behaviors are influenced by many individual and environmental factors. This study explores how dietary fat intake in high-risk midlife adults living in the rural south is influenced by three behavior settings, i.e. in the home, at work, and at church.

Methods

Self-report data were collected from rural African American or Caucasian adults age 40–70 at three time points at baseline, 6, and 12 months post baseline. Multilevel analyses investigated the impact of determinants of fat intake over time.

Results

Home and work environments varied significantly over time in regard to healthy eating while church environments remained stable. Age, gender, and self-efficacy for healthy eating were individual factors associated with fat intake. In the home, presence of more high fat items, a time-varying variable, was significant. In the work environment, having access to healthy foods as well as healthy eating programs has positive impact as did hearing healthy eating messages and availability of healthy foods at church.

Conclusions

Understanding stability and variability of dietary fat intake from a social ecologic perspective will aid in identifying targets of change for intervention. Understanding which components of key behavior settings are dynamic and which are relatively stable will help to disentangle the complexity of multi-level determinants of dietary behavior.

Preventing Obesity in the USA: Impact on Health Service Utilization and Costs

BACKGROUND

With more than two-thirds of the US population overweight or obese, the obesity epidemic is a major threat for population health and the financial sustainability of the healthcare service. Whether, and to what extent, effective prevention interventions may offer the opportunity to 'bend the curve' of rising healthcare costs is still an object of debate.

OBJECTIVE

This study evaluates the potential economic impact of a set of prevention programmes, including education, counselling, long-term drug treatment, regulation (e.g. of advertising or labelling) and fiscal measures, on national healthcare expenditure and use of healthcare services in the USA.

STUDY DESIGN AND METHOD

The study was carried out as a retrospective evaluation of alternative scenarios compared with a 'business as usual' scenario. An advanced econometric approach involving the use of logistic regression and generalized linear models was used to calculate the number of contacts with key healthcare services (inpatient, outpatient, drug prescriptions) and the associated cost. Analyses were carried out on the Medical Expenditure Panel Survey (1997-2010).

RESULTS

In 2010, prevention interventions had the potential to decrease total healthcare expenditure by up to $US2 billion. This estimate does not include the implementation costs. The largest share of savings is produced by reduced use and costs of inpatient care, followed by reduced use of drugs. Reduction in expenditure for outpatient care would be more limited. Private insurance schemes benefit from the largest savings in absolute terms; however, public insurance schemes benefit from the largest cost reduction per patient. People in the lowest income groups show the largest economic benefits.

CONCLUSION

Prevention interventions aimed at tackling obesity and associated risk factors may produce a significant decrease in the use of healthcare services and expenditure. Savings become substantial when a long-term perspective is taken.

Images of a Healthy Worksite: A Group-Randomized Trial for Worksite Weight Gain Prevention With Employee Participation in Intervention Design

OBJECTIVES

We assessed the effects of a worksite multiple-component intervention addressing diet and physical activity on employees' mean body mass index (BMI) and the percentage of employees who were overweight or obese.

METHODS

This group-randomized trial (n = 3799) was conducted at 10 worksites in the northeastern United States. Worksites were paired and allocated into intervention and control conditions. Within- and between-groups changes in mean BMIs and in the percentage of overweight or obese employees were examined in a volunteer sample.

RESULTS

Within-group mean BMIs decreased by 0.54 kilograms per meter squared (P = .02) and 0.12 kilograms per meter squared (P = .73) at the intervention and control worksites, respectively, resulting in a difference in differences (DID) decrease of 0.42 kilograms per meter squared (P = .33). The within-group percentage of overweight or obese employees decreased by 3.7% (P = .07) at the intervention worksites and increased by 4.9% (P = .1) at the control worksites, resulting in a DID decline of 8.6% (P = .02).

CONCLUSIONS

Our findings support a worksite population strategy that might eventually reduce the prevalence of overweight and obesity by minimizing environmental exposures to calorically dense foods and increasing exposures to opportunities for energy expenditure within worksite settings.

Effects of environmental intervention in workplace cafeterias on vegetable consumption by male workers

OBJECTIVE

To assess the effects of an environmental intervention based on the transtheoretical model to increase access to nutritional information about vegetable consumption in workplace cafeterias.

DESIGN

Nonrandomized controlled trial.

SETTING

Sixteen workplaces with cafeterias in Niigata, Japan, were assigned to intervention (n = 8) or comparison sites (n = 8).

PARTICIPANTS

A total of 349 Japanese male workers aged 20-59 years, who visited the cafeterias ≥ 3 times/wk.

INTERVENTION

For the intervention group, 12 types of table tents containing information on increasing vegetable consumption, based on the transtheoretical model stages and processes of change, were distributed to cafeterias for 24 weeks in 2009. Information was presented according to the sequence suggested by the stages of change.

MAIN OUTCOME MEASURES

Vegetable consumption in the cafeteria and per day and stage of change were assessed using self-administered questionnaires.

ANALYSIS

Differences between groups were tested using a generalized linear model adjusted for age, work environment, and position.

RESULTS

The difference in the stage of change was not statistically significantly different (P = .05), but the intervention group (n = 181) had increased vegetable consumption in the cafeteria (+0.18 servings; P = .01) and per day (+0.32 servings; P = .01) vs the comparison group.

CONCLUSIONS AND IMPLICATIONS

The findings suggest a beneficial effect of providing access to nutrition information about vegetable consumption as an environmental intervention in workplace cafeterias.

Worksite Environmental Interventions for Obesity Prevention and Control: Evidence from Group Randomized Trials

Worksites provide multiple advantages to prevent and treat obesity and to test environmental interventions to tackle its multiple causal factors. We present a literature review of group-randomized and non-randomized trials that tested worksite environmental, multiple component interventions for obesity prevention and control paying particular attention to the conduct of formative research prior to intervention development. The evidence on environmental interventions on measures of obesity appears to be strong since most of the studies have a low (4/8) and unclear (2/8) risk of bias. Among the studies reviewed whose potential risk of bias was low, the magnitude of the effect was modest and sometimes in the unexpected direction. None of the four studies describing an explicit formative research stage with clear integration of findings into the intervention was able to demonstrate an effect on the main outcome of interest. We present alternative explanation for the findings and recommendations for future research.

Workplace interventions for smoking cessation

BACKGROUND

The workplace has potential as a setting through which large groups of people can be reached to encourage smoking cessation.

OBJECTIVES

1. To categorize workplace interventions for smoking cessation tested in controlled studies and to determine the extent to which they help workers to stop smoking.2. To collect and evaluate data on costs and cost effectiveness associated with workplace interventions.

SEARCH METHODS

We searched the Cochrane Tobacco Addiction Group Specialized Register (July 2013), MEDLINE (1966 - July 2013), EMBASE (1985 - June 2013), and PsycINFO (to June 2013), amongst others. We searched abstracts from international conferences on tobacco and the bibliographies of identified studies and reviews for additional references.

SELECTION CRITERIA

We selected interventions conducted in the workplace to promote smoking cessation. We included only randomized and quasi-randomized controlled trials allocating individuals, workplaces, or companies to intervention or control conditions.

DATA COLLECTION AND ANALYSIS

One author extracted information relating to the characteristics and content of all kinds of interventions, participants, outcomes and methods of the studies, and a second author checked them. For this update we have conducted meta-analyses of the main interventions, using the generic inverse variance method to generate odds ratios and 95% confidence intervals.

MAIN RESULTS

We include 57 studies (61 comparisons) in this updated review. We found 31 studies of workplace interventions aimed at individual workers, covering group therapy, individual counselling, self-help materials, nicotine replacement therapy, and social support, and 30 studies testing interventions applied to the workplace as a whole, i.e. environmental cues, incentives, and comprehensive programmes. The trials were generally of moderate to high quality, with results that were consistent with those found in other settings. Group therapy programmes (odds ratio (OR) for cessation 1.71, 95% confidence interval (CI) 1.05 to 2.80; eight trials, 1309 participants), individual counselling (OR 1.96, 95% CI 1.51 to 2.54; eight trials, 3516 participants), pharmacotherapies (OR 1.98, 95% CI 1.26 to 3.11; five trials, 1092 participants), and multiple intervention programmes aimed mainly or solely at smoking cessation (OR 1.55, 95% CI 1.13 to 2.13; six trials, 5018 participants) all increased cessation rates in comparison to no treatment or minimal intervention controls. Self-help materials were less effective (OR 1.16, 95% CI 0.74 to 1.82; six trials, 1906 participants), and two relapse prevention programmes (484 participants) did not help to sustain long-term abstinence. Incentives did not appear to improve the odds of quitting, apart from one study which found a sustained positive benefit. There was a lack of evidence that comprehensive programmes targeting multiple risk factors reduced the prevalence of smoking.

AUTHORS' CONCLUSIONS

1. We found strong evidence that some interventions directed towards individual smokers increase the likelihood of quitting smoking. These include individual and group counselling, pharmacological treatment to overcome nicotine addiction, and multiple interventions targeting smoking cessation as the primary or only outcome. All these interventions show similar effects whether offered in the workplace or elsewhere. Self-help interventions and social support are less effective. Although people taking up these interventions are more likely to stop, the absolute numbers who quit are low.2. We failed to detect an effect of comprehensive programmes targeting multiple risk factors in reducing the prevalence of smoking, although this finding was not based on meta-analysed data. 3. There was limited evidence that participation in programmes can be increased by competitions and incentives organized by the employer, although one trial demonstrated a sustained effect of financial rewards for attending a smoking cessation course and for long-term quitting. Further research is needed to establish which components of this trial contributed to the improvement in success rates.4. Further research would be valuable in low-income and developing countries, where high rates of smoking prevail and smoke-free legislation is not widely accepted or enforced.

Treadmill workstations: the effects of walking while working on physical activity and work performance

We conducted a 12-month-long experiment in a financial services company to study how the availability of treadmill workstations affects employees' physical activity and work performance. We enlisted sedentary volunteers, half of whom received treadmill workstations during the first two months of the study and the rest in the seventh month of the study. Participants could operate the treadmills at speeds of 0-2 mph and could use a standard chair-desk arrangement at will. (a) Weekly online performance surveys were administered to participants and their supervisors, as well as to all other sedentary employees and their supervisors. Using within-person statistical analyses, we find that overall work performance, quality and quantity of performance, and interactions with coworkers improved as a result of adoption of treadmill workstations. (b) Participants were outfitted with accelerometers at the start of the study. We find that daily total physical activity increased as a result of the adoption of treadmill workstations.

A systematic review of workplace health promotion interventions for increasing physical activity

PURPOSE

The benefits of an active lifestyle are widely documented, yet studies show that only a small proportion of adults engage in sufficient levels of physical activity. The workplace presents an ideal avenue for delivering initiatives to promote physical activity, overcoming commonly cited barriers such as a 'lack of time' and providing access to a large intersection of society. The purpose of this study was to (1) explore the types of interventions workplaces implement to promote physical activity among staff, (2) describe the characteristics of those interventions, (3) understand whether these interventions positively impact on activity levels, and (4) assess the methodological quality of studies.

METHODS

A systematic review of workplace physical activity interventions published up to April 2011 was conducted to identify types of interventions and their outcomes.

RESULTS

Of the 58 studies included, the majority utilized health promotion initiatives. There were six physical activity/exercise interventions, 13 counselling/support interventions, and 39 health promotion messages/information interventions. Thirty-two of these studies showed a statistically significant increase in a measure of physical activity against a control group at follow-up.

CONCLUSIONS

While the studies included in this review show some evidence that workplace physical activity interventions can be efficacious, overall the results are inconclusive. Despite the proliferation of research in this area, there is still a need for more well-designed studies to fully determine the effectiveness of workplace interventions for increasing physical activity and to identify the types of interventions that show the most promise.

Factors associated with choice of web or print intervention materials in the healthy directions 2 study

BACKGROUND

Many U.S. adults have multiple behavioral risk factors, and effective, scalable interventions are needed to promote population-level health. In the health care setting, interventions are often provided in print, although accessible to nearly everyone, are brief (e.g., pamphlets), are not interactive, and can require some logistics around distribution. Web-based interventions offer more interactivity but may not be accessible to all. Healthy Directions 2 was a primary care-based cluster randomized controlled trial designed to improve five behavioral cancer risk factors among a diverse sample of adults (n = 2,440) in metropolitan Boston. Intervention materials were available via print or the web. Purpose. To (a) describe the Healthy Directions 2 study design and (b) identify baseline factors associated with whether participants opted for print or web-based materials.

METHODS

Hierarchical regression models corrected for clustering by physician were built to examine factors associated with choice of intervention modality.

RESULTS

At baseline, just 4.0% of participants met all behavioral recommendations. Nearly equivalent numbers of intervention participants opted for print and web-based materials (44.6% vs. 55.4%). Participants choosing web-based materials were younger, and reported having a better financial status, better perceived health, greater computer comfort, and more frequent Internet use (p < .05) than those opting for print. In addition, Whites were more likely to pick web-based material than Black participants.

CONCLUSIONS

Interventions addressing multiple behaviors are needed in the primary care setting, but they should be available in web and print formats as nearly equal number of participants chose each option, and there are significant differences in the population groups using each modality.

Design of a randomized controlled trial for multiple cancer risk behaviors among Spanish-speaking Mexican-origin smokers

BACKGROUND

Smoking, poor diet, and physical inactivity account for as much as 60% of cancer risk. Latinos experience profound disparities in health behaviors, as well as the cancers associated with them. Currently, there is a dearth of controlled trials addressing these health behaviors among Latinos. Further, to the best of our knowledge, no studies address all three behaviors simultaneously, are culturally sensitive, and are guided by formative work with the target population. Latinos represent 14% of the U.S. population and are the fastest growing minority group in the country. Efforts to intervene on these important lifestyle factors among Latinos may accelerate the elimination of cancer-related health disparities.

METHODS/DESIGN

The proposed study will evaluate the efficacy of an evidence-based and theoretically-driven Motivation And Problem Solving (MAPS) intervention, adapted and culturally-tailored for reducing cancer risk related to smoking, poor diet, and physical inactivity among high-risk Mexican-origin smokers who are overweight/obese (n = 400). Participants will be randomly assigned to one of two groups: Health Education (HE) or MAPS (HE + up to 18 MAPS counseling calls over 18 months). Primary outcomes are smoking status, servings of fruits and vegetables, and both self-reported and objectively measured physical activity. Outcome assessments will occur at baseline, 6 months, 12 months, and 18 months.

DISCUSSION

The current study will contribute to a very limited evidence base on multiple risk factor intervention studies on Mexican-origin individuals and has the potential to inform both future research and practice related to reducing cancer risk disparities. An effective program targeting multiple cancer risk behaviors modeled after chronic care programs has the potential to make a large public health impact because of the dearth of evidence-based interventions for Latinos and the extended period of support that is provided in such a program.

TRIAL REGISTRATION

National Institutes of Health Clinical Trials Registry # NCT01504919.

The relationship between shift work and body mass index among Canadian nurses

AIM

The aim of this study was to examine the relationship between shift schedule and body mass index (BMI) among a sample of Canadian Nurses.

BACKGROUND

Higher BMI values have been reported for employees working non-standard shifts compared to those working a regular daytime schedule. Little is known about the pathways through which shift work is associated with higher BMI.

METHODS

This study was a secondary analysis of a sample from National Survey on the Work and Health of Nurses (N=9291).

RESULTS

We found a small, but statistically significant, difference in BMI scores across shift schedule categories with higher BMI scores reported among female nurses working night or mixed shift schedules, compared with those working a regular daytime schedule. Adjustment for working conditions and employer supported facilities did not attenuate the association between shift work and BMI scores.

CONCLUSIONS

The potential public health importance of this relationship requires further investigation given the small, but statistically significant, differences observed in this sample.

Making Healthy Behaviors the Easy Choice for Employees

As employers look for ways to reduce rising health care costs, worksite health promotion interventions are increasingly being used to improve employee health behaviors. An alternative approach to traditional worksite health promotion programs is the implementation of environmental and/or policy changes to encourage employees to adopt healthier behaviors. This review examines the evidence for the effectiveness of worksite health promotion programs using environmental and/or policy changes either alone or in combination with individually focused health behavior change strategies. A review of the relevant literature, published between 1995 and 2010, identified 27 studies that met all inclusion criteria. Limited evidence was found for the effectiveness of environmental and/or policy changes alone ( n = 11) to change employee behavior, but more promising results were identified with multicomponent interventions ( n = 16). There is a strong need for improvement in the design and evaluation of future health promotion programs focusing solely on environmental and/or policy changes at the worksite.

The ACTIVATE Study: Results from a Group-Randomized Controlled Trial Comparing a Traditional Worksite Health Promotion Program with an Activated Consumer Program

Purpose.

This study compares a traditional worksite-based health promotion program with an activated consumer program and a control program

Design.

Group randomized controlled trial with 18-month intervention.

Setting.

Two large Midwestern companies.

Subjects.

Three hundred and twenty employees (51% response).

Intervention.

The traditional health promotion intervention offered population-level campaigns on physical activity, nutrition, and stress management. The activated consumer intervention included population-level campaigns for evaluating health information, choosing a health benefits plan, and understanding the risks of not taking medications as prescribed. The personal development intervention (control group) offered information on hobbies. The interventions also offered individual-level coaching for high risk individuals in both active intervention groups.

Measures.

Health risk status, general health status, consumer activation, productivity, and the ability to evaluate health information.

Analysis.

Multivariate analyses controlled for baseline differences among the study groups.

Results.

At the population level, compared with baseline performance, the traditional health promotion intervention improved health risk status, consumer activation, and the ability to recognize reliable health websites. Compared with baseline performance, the activated consumer intervention improved consumer activation, productivity, and the ability to recognize reliable health websites. At the population level, however, only the activated consumer intervention improved any outcome more than the control group did; that outcome was consumer activation. At the individual level for high risk individuals, both traditional health coaching and activated consumer coaching positively affected health risk status and consumer activation. In addition, both coaching interventions improved participant ability to recognize a reliable health website. Consumer activation coaching also significantly improved self-reported productivity.

Conclusion.

An effective intervention can change employee health risk status and activation both at the population level and at the individual high risk level. However, program engagement at the population level was low, indicating that additional promotional strategies, such as greater use of incentives, need to be examined. Less intensive coaching can be as effective as more intensive, albeit both interventions produced modest behavior change and retention in the consumer activation arm was most difficult. Further research is needed concerning recruitment and retention methods that will enable populations to realize the full potential of activated consumerism.

Willingness to pay for wholesome canteen takeaway

The primary objective of this study was to estimate the willingness to pay (WTP) for a new intervention at the workplace: wholesome canteen takeaways (CTA), i.e. a low fat meal with a large amount of vegetables prepared at the workplace canteen that only requires re-heating. The contingent valuation method was used to elicit the WTP. Two surveys were carried out in Denmark; one large-scale Internet based survey and one survey at a workplace that introduced CTA. The results from the large-scale survey suggest that this concept attracts relevant target groups; groups of individuals with a less healthy diet, low physical activity and a high body mass index. For males and individuals with low education, who also constitute relevant target groups, the results suggest no significant difference in WTP between males and females, whereas low educated individuals have a significantly lower WTP than highly educated individuals. However, the workplace study, carried out at a hospital, found that females have a significantly higher WTP for CTA compared with males. In conclusion, the concept appears to attract relevant target groups, although for a given price a smaller fraction of low educated individuals compared to high educated individuals would be willing to buy CTA.

Healthy workplaces: the effects of nature contact at work on employee stress and health

OBJECTIVES

Cultivating healthy workplaces is a critical aspect of comprehensive worksite health promotion. The influence of healthy workplace exposures on employee health outcomes warrants research attention. To date, it is unknown if nature contact in the workplace is related to employee stress and health. This study was designed to examine the effects of nature contact experienced at work on employee stress and health.

METHODS

Office staff at a southeastern university (n = 503, 30% response rate) participated in the cross-sectional study. We used a 16-item workplace environment questionnaire, the Nature Contact Questionnaire, to comprehensively measure, for the first time, nature contact at work. The Perceived Stress Questionnaire and 13 established health and behavioral items assessed the dependent variables, general perceived stress, stress-related health behaviors, and stress-related health outcomes.

RESULTS

There was a significant, negative association between nature contact and stress and nature contact and general health complaints. The results indicate that as workday nature contact increased, perceived stress and generalized health complaints decreased.

CONCLUSIONS

The findings suggest that nature contact is a healthy workplace exposure. Increasing nature contact at work may offer a simple population-based approach to enhance workplace health promotion efforts. Future researchers should test the efficacy of nature-contact workplace stress interventions.

Integrating results from smoking cessation drug research and development into clinical occupational health practice

This article documents evidence-based pharmacologic interventions to promote successful smoking cessation among employees who smoke. The article also highlights supporting evidence for the use of pharmacologic agents to treat tobacco dependence and can guide successful, personalized, pharmacologic smoking cessation interventions in occupational clinical practice. Prescribing clinicians will also find information about the latest research and development of medications to promote smoking cessation, including recently implemented black box warnings by the U.S. Food and Drug Administration.

Multiple risk factor interventions for primary prevention of coronary heart disease

BACKGROUND

Multiple risk factor interventions using counselling and educational methods assumed to be efficacious and cost-effective in reducing coronary heart disease (CHD) mortality and morbidity and that they should be expanded. Trials examining risk factor changes have cast doubt on the effectiveness of these interventions.

OBJECTIVES

To assess the effects of multiple risk factor interventions for reducing total mortality, fatal and non-fatal events from CHD and cardiovascular risk factors among adults assumed to be without prior clinical evidence CHD..

SEARCH STRATEGY

We updated the original search BY SEARCHING CENTRAL (2006, Issue 2), MEDLINE (2000 to June 2006) and EMBASE (1998 to June 2006), and checking bibliographies.

SELECTION CRITERIA

Randomised controlled trials of more than six months duration using counselling or education to modify more than one cardiovascular risk factor in adults from general populations, occupational groups or specific risk factors (i.e. diabetes, hypertension, hyperlipidaemia, obesity).

DATA COLLECTION AND ANALYSIS

Two authors extracted data independently. We expressed categorical variables as odds ratios (OR) with 95% confidence intervals (CI). Where studies published subsequent follow-up data on mortality and event rates, we updated these data.

MAIN RESULTS

We found 55 trials (163,471 participants) with a median duration of 12 month follow up. Fourteen trials (139,256 participants) with reported clinical event endpoints, the pooled ORs for total and CHD mortality were 1.00 (95% CI 0.96 to 1.05) and 0.99 (95% CI 0.92 to 1.07), respectively. Total mortality and combined fatal and non-fatal cardiovascular events showed benefits from intervention when confined to trials involving people with hypertension (16 trials) and diabetes (5 trials): OR 0.78 (95% CI 0.68 to 0.89) and OR 0.71 (95% CI 0.61 to 0.83), respectively. Net changes (weighted mean differences) in systolic and diastolic blood pressure (53 trials) and blood cholesterol (50 trials) were -2.71 mmHg (95% CI -3.49 to -1.93), -2.13 mmHg (95% CI -2.67 to -1.58 ) and -0.24 mmol/l (95% CI -0.32 to -0.16), respectively. The OR for reduction in smoking prevalence (20 trials) was 0.87 (95% CI 0.75 to 1.00). Marked heterogeneity (I(2) > 85%) for all risk factor analyses was not explained by co-morbidities, allocation concealment, use of antihypertensive or cholesterol-lowering drugs, or by age of trial.

AUTHORS' CONCLUSIONS

Interventions using counselling and education aimed at behaviour change do not reduce total or CHD mortality or clinical events in general populations but may be effective in reducing mortality in high-risk hypertensive and diabetic populations. Risk factor declines were modest but owing to marked unexplained heterogeneity between trials, the pooled estimates are of dubious validity. Evidence suggests that health promotion interventions have limited use in general populations.

Effects of a Tailored Health Promotion Program to Reduce Cardiovascular Disease Risk Factors Among Middle-Aged and Advanced-Age Bus Drivers

A tailored health promotion program was developed and applied to reduce cardiovascular disease risk factors among middle-aged and advanced-age bus drivers. The participants were 248 bus drivers from 2 transportation companies, in whom the authors surveyed health behaviors (physical activity, diet, smoking habit, and alcohol consumption), health status (body mass index, systolic blood pressure, triglycerides, total cholesterol, high-density lipoprotein, and low-density lipoprotein), and job stress. The tailored health promotion program consisted of exercise, diet, temperance, and smoking cessation education; the program was developed to reduce cardiovascular disease risk factors and was administered for 6 months. After the program, health behaviors, such as physical activity, dietary habits, smoking habits, and alcohol consumption, and health status indicators, such as blood pressure, had significantly improved ( P < .05). The authors did not find an association between job stress and health behavior and status. This suggests that a tailored health promotion program for middle-aged and advanced-age bus drivers was effective.

Cost-effectiveness of interventions to promote fruit and vegetable consumption

Background

Fruits and vegetables are an essential part of the human diet, but many people do not consume the recommended serves to prevent cardiovascular disease and cancer. In this research, we evaluate the cost-effectiveness of interventions to promote fruit and vegetable consumption to determine which interventions are good value for money, and by how much current strategies can reduce the population disease burden.

Methods/Principal Findings

In a review of published literature, we identified 23 interventions for promoting fruit and vegetable intake in the healthy adult population that have sufficient evidence for cost-effectiveness analysis. For each intervention, we model the health impacts in disability-adjusted life years (DALYs), the costs of intervention and the potential cost-savings from averting disease treatment, to determine cost-effectiveness of each intervention over the lifetime of the population, from an Australian health sector perspective. Interventions that rely on dietary counselling, telephone contact, worksite promotion or other methods to encourage change in dietary behaviour are not highly effective or cost-effective. Only five out of 23 interventions are less than an A$50,000 per disability-adjusted life year cost-effectiveness threshold, and even the most effective intervention can avert only 5% of the disease burden attributed to insufficient fruit and vegetable intake.

Conclusions/Significance

We recommend more investment in evaluating interventions that address the whole population, such as changing policies influencing price or availability of fruits and vegetables, to see if these approaches can provide more effective and cost-effective incentives for improving fruit and vegetable intake.

Changes in skinfold thickness and waist circumference after 12 and 24 months resulting from the NHF-NRG In Balance-project

Background

More knowledge is needed regarding the effectiveness of weight gain prevention programmes. The present study tested the 12-and 24-month effectiveness of the 'Netherlands Research programme weight Gain prevention' (NHF-NRG)-In Balance-project, a worksite-based intervention aimed at the prevention of weight gain.

Methods

Twelve worksites (n = 553 participants) were matched and assigned to either intervention or control group. The worksites and employees of the intervention group received individual (i.e. pedometer, computer-tailored advice) and environmental (i.e. changes in worksite canteen) interventions, directed at physical activity and food intake over 1-year. Differences between the intervention and control group in changes in body weight, BMI, skinfold thickness and waist circumference at 12 and 24 months were examined using multilevel linear regression analyses adjusting for various baseline characteristics (age, gender, BMI, marital status, education and smoking status).

Results

A significant greater reduction in skinfold thickness was found in the intervention group than in the control group, both after 12-and 24 months (Unstandardized regression coefficients (B) = -2.52, 95% C.I. -4.58, -0.45; p = 0.018; B = -4.83, 95% C.I. 6.98, -2.67; p < 0.001 respectively). Significant differences were also observed for changes in waist circumferences both at 12 months (B = -1.50, 95% C.I. -2.35, -0.65; p < 0.001) and at 24 months (B = -1.30, 95% C.I. -2.18, -0.42; p = 0.005). No significant changes were observed for weight and BMI.

Conclusions

The project was effective with regard to changes in skinfold thickness and waist circumference both at 12 and 24 months. It supports the usefulness of worksite-based prevention, especially regarding maintenance of behavioral changes.

Förderung von körperlicher Aktivität im betrieblichen Kontext

Zusammenfassung. Theoriebasierte Interventionen zur Förderung von körperlicher Aktivität können auf Stadien der Verhaltensänderung maßgeschneidert werden. Die Grundlage hierfür liefern Stadienmodelle. Diese nehmen an, dass für den erfolgreichen Übergang von einem Stadium zum nächsten unterschiedliche sozial-kognitive Variablen bedeutsam sind. Ziel der Studie war es, stadienspezifische Effekte von stadienpassenden Interventionen auf körperliche Aktivität und sozial-kognitive Prädiktoren im betrieblichen Kontext zu untersuchen. 839 Mitarbeiter eines Großunternehmens wurden randomisiert einer stadienpassenden Intervention und einer stadien-unspezifischen Standardmaßnahme zugewiesen. Vor der Intervention sowie vier Wochen später wurden Zielsetzung, Planung und körperliche Aktivität erfasst. Die Datenanalyse erfolgte mittels Varianzanalyse mit Messwiederholung. Die stadienpassenden Interventionen erhöhten die stadienspezifischen Variablen effektiver als die Standardmaßnahme. Stadienpassende Interventionen scheinen effektiver zu sein als stadien-unspezifische Standardmaßnahmen. Neben Verhaltensmaßen sollten auch Veränderungen in sozial-kognitiven Variablen zur Evaluation von Interventionen herangezogen werden.

Priorities in health: what do they mean to Brazilian adults?

We aimed to evaluate how Brazilian adults rank seven well-known health-related factors in terms of importance for health. A population-based study was undertaken in Pelotas, Rio Grande do Sul State, Brazil (N = 3,100; response rate: 96.5%). Individuals ranked three out of seven factors that, in their opinion, were the most important for health. The factors investigated were: "controlling stress", "practicing physical activity regularly", "avoiding drinking in excess", "avoiding smoking", "visiting a doctor regularly", "keeping the ideal weight", and "having a healthy diet". Healthy diet (73.9%), physical activity (59.9%), and visiting a doctor regularly (45.7%) were the most frequently reported factors. Younger subjects and those with higher socioeconomic status were more likely to report physical activity and stress as important factors for health than their counterparts. The importance attributed to health-related factors changes markedly among population subgroups.

Telephone intervention promoting weight-related health behaviors

OBJECTIVE

Recent national surveys have documented that the majority of adults in the United States do not meet the recommended levels of healthy lifestyle-related behaviors. The Nutrition and Physical Activity (NuPA) study was designed to promote fruit and vegetable consumption, physical activity, and weight management for a working population.

METHOD

Data were collected nationwide, USA, from 2005 to 2007 and analyzed in 2008. A total of 2470 employed participants were randomized into the self-help (SH: n=1191) or self-help plus telephone counseling (SH+C: n=1279) group. The SH+C group received nine structured telephone counseling sessions in addition to the print materials.

RESULTS

A series of hierarchical regression analyses for each of the health behavior outcomes in the present-at-follow-up subsample (n=1098-1148) revealed that the SH+C was effective in increasing fruit and vegetable consumption. Among the overweight and obese participants, weight loss was significant in both the SH and SH+C groups.

CONCLUSION

Using a theory-based behavioral change counseling technique and targeting multiple health behaviors among employed individuals, our findings demonstrate that the addition of telephone counseling to mailed self-help materials is effective in promoting healthy diet and weight management.

Effects of worksite health promotion interventions on employee diets: a systematic review

Background

Public health strategies place increasing emphasis on opportunities to promote healthy behaviours within the workplace setting. Previous research has suggested worksite health promotion programmes have positive effects on physical activity and weight loss, yet little is known regarding their effects on dietary behaviour. The aim of this review was to assess the effects of worksite interventions on employee diets.

Methods

Electronic databases (MEDLINE, The Cochrane Library, PsycINFO, EMBASE, LexisNexis) were searched for relevant articles published between 1995 and April 2009. Studies were eligible for inclusion if they were peer-reviewed English language publications describing a worksite-based health promotion intervention with minimum study duration of eight weeks. All study designs were eligible. Studies had to report one or more diet-related outcome (energy, fat, fruit, or vegetable intakes). Methodological quality was assessed using a checklist that included randomisation methods, use of a control group, and study attrition rates.

Results

Sixteen studies were included in the review. Eight programmes focussed on employee education, and the remainder targeted change to the worksite environment, either alone or in combination with education. Study methodological quality was moderate. In general, worksite interventions led to positive changes in fruit, vegetable and total fat intake. However, reliance on self-reported methods of dietary assessment means there is a significant risk of bias. No study measured more robust outcomes such as absenteeism, productivity, or healthcare utilisation.

Conclusions

The findings of this review suggest that worksite health promotion programmes are associated with moderate improvement in dietary intake. The quality of studies to date has been frequently sub-optimal and further, well designed studies are needed in order to reliably determine effectiveness and cost-effectiveness. Future programmes to improve employee dietary habits should move beyond individual education and aim to intervene at multiple levels of the worksite environment.

Are physical activity and nutrition indicators of the checklist of health promotion environments at worksites (CHEW) associated with employee obesity among hotel workers?

OBJECTIVE

Worksites provide opportunities to reach more than 60% of adults in the United States, including populations diverse in race, ethnicity, gender, age, occupation, income, and health status. Employers that provide worksite weight management interventions have the potential to reduce sick leave, health care costs, and workers compensation costs, and increase employee morale and worker efficiency. Hotels specifically, represent a broad cross-section of job categories, and most hotels are staffed and operated similarly around the world. However, from our literature review, there have been no investigations of the association between the hotel environment and employees' obesity.

METHODS

For this study, we tested the relationship between environmental factors in hotels and employees' body mass index (BMI).

RESULTS

Overall no substantial correlations were found on any environmental variable. However, hotel size affected some relationships. Higher BMI was related to greater number of stairs, stair facilitation, and the healthy eating facilitation variables (excluding nutrition signs or posters) in medium sized hotels. Lower BMI was found with greater stair facilitation in small hotels; and with greater number of physical activity (PA) signs, lunch room nutrition signs, and hotel nutrition signs in large hotels. Unionized status affected only two environmental variables. For unionized hotels, BMI was negatively correlated with PA signs and positively correlated with the healthy eating facilitation.

CONCLUSIONS

No logical pattern of association was found between workplace environmental factors and hotel employee BMI levels. Further research should investigate the interaction of the size and structure of the workplace with the impact of environmental efforts to reduce overweight and obesity.

Factors associated with non-participation and drop-out in a lifestyle intervention for workers with an elevated risk of cardiovascular disease

BACKGROUND

Non-response and drop-out are problems that are commonly encountered in health promotion trials. Understanding the health-related characteristics of non-participants and drop-outs and the reasons for non-participation and drop-out may be beneficial for future intervention trials.

METHODS

Male construction workers with an elevated risk of cardiovascular disease (CVD) were invited to participate in a lifestyle intervention study. In order to investigate the associations between participation and CVD risk factors, and drop-out and CVD risk factors, crude and multiple logistic regression analyses were performed. The reasons for non-participation and drop-out were assessed qualitatively.

RESULTS

20% of the workers who were invited decided to participate; 8.6% of the participants dropped out before the first follow-up measurement. The main reasons for non-participation were 'no interest', 'current (para-)medical treatment', and 'feeling healthy', and for drop-out they were 'lack of motivation', 'current (para-)medical treatment', and 'disappointment'. Participants were 4.2 years older, had a higher blood pressure, higher total cholesterol, and lower HDL cholesterol than non-participants, and were more likely to report 'tiredness and/or stress' and 'chest pain and/or shortness of breath'. After adjusting for age, most risk factors were not significantly associated with participation. Drop-outs were 4.6 years younger than those who completed the study. The prevalence of smoking was higher among non-participants and drop-outs.

CONCLUSION

Participants had a worse CVD risk profile than non-participants, mainly because of the difference in age. Non-participants and drop-outs were younger and more likely to be smokers. The main reasons for non-participation and drop-out were health-related. Investigators in the field of health promotion should be encouraged to share comparable information.

TRIAL REGISTRATION

Current Controlled Trials ISRCTN60545588.

Health risk reduction programs in employer-sponsored health plans: Part I-efficacy

OBJECTIVE

We sought to determine whether workplace health risk reduction programs (HRRPs) using health risk assessments (HRAs), individually focused risk reduction, and financial incentives succeeded in improving employee health and reducing employer health benefit costs.

METHODS

We reviewed the proprietary HRA available to us and conducted a literature review to determine the efficacy of HRRPs using HRAs, individualized employee interventions, and financial incentives for employee participation.

RESULTS

There is some evidence that HRRPs in employer-sponsored programs improve measures of employee health, but the results of these studies are somewhat equivocal.

CONCLUSION

Employer-sponsored HRRPs may have some benefits, but problems in plan design and in the studies assessing their efficacy complicate drawing conclusions.

Worksite Opportunities for Wellness (WOW): effects on cardiovascular disease risk factors after 1 year

OBJECTIVE

To evaluate the effectiveness of a worksite health promotion program on improving cardiovascular disease risk factors.

METHODS

In St Louis, Missouri from 2005 to 2006, 151 employees (134 F, 17 M, 81% overweight/obese) participated in a cohort-randomized trial comparing assessments + intervention (worksite A) with assessments only (worksite B) for 1 year. All participants received personal health reports containing their assessment results. The intervention was designed to promote physical activity and favorable dietary patterns using pedometers, healthy snack cart, WeightWatchers(R) meetings, group exercise classes, seminars, team competitions, and participation rewards. Outcomes included BMI, body composition, blood pressure, fitness, lipids, and Framingham 10-year coronary heart disease risk.

RESULTS

123 participants, aged 45+/-9 yr, with BMI 32.9+/-8.8 kg/m(2) completed 1 year. Improvements (P< or =0.05) were observed at both worksites for fitness, blood pressure, and total-, HDL-, and LDL-cholesterol. Additional improvements occurred at worksite A in BMI, fat mass, Framingham risk score, and prevalence of the metabolic syndrome; only the changes in BMI and fat mass were different between worksites.

CONCLUSION

A multi-faceted worksite intervention promoted favorable changes in cardiovascular disease risk factors, but many of the improvements were achieved with worksite health assessments and personalized health reports in the absence of an intervention.

Move to Improve: a randomized workplace trial to increase physical activity

BACKGROUND

Workplaces are important settings for interventions to increase physical activity, but effects have been modest.

PURPOSE

To evaluate the efficacy of Move to Improve, a social-ecologic intervention delivered at the workplace to increase leisure-time physical activity.

METHODS

A group-randomized 12-week intervention consisting of organizational action and personal and team goal-setting was implemented in Fall 2005, with a multi-racial/ethnic sample of 1442 employees at 16 worksites of The Home Depot, Inc. Change in physical activity was analyzed in Fall 2007 using latent growth modeling and latent transition analysis.

RESULTS

Participants in the intervention had greater increases in moderate and vigorous physical activity and walking compared to participants in a health education control condition. The proportion of participants that met the Healthy People 2010 recommendation for regular participation in either moderate or vigorous physical activity remained near 25% at control sites during the study but increased to 51% at intervention sites. During the last 6 weeks of the study, intervention participants exceeded 300 weekly minutes of self-reported moderate-to-vigorous physical activity and 9000 daily pedometer steps.

CONCLUSIONS

The results support the feasibility and efficacy of the Move to Improve intervention and the role of goal-setting for attaining increased physical activity levels.

Worksite Wellness

A 7-month intervention was undertaken to determine the impact of education and coaching on lifestyle choices and lipid values among employees with hyperlipidemia. Four classes over 2 months at the worksite during work time and two telephone interventions were provided with pre, mid, and post data collection. Total cholesterol and low-density lipoprotein values improved during the intervention. Positive lifestyle changes were made involving exercise and diet. Appropriate physician visits and continuous health care increased. Lipid-based interventions at the worksite can elicit positive changes in lifestyle, appropriate health care use, and improved lipid values.

Workplace interventions for smoking cessation

BACKGROUND

The workplace has potential as a setting through which large groups of people can be reached to encourage smoking cessation.

OBJECTIVES

To categorize workplace interventions for smoking cessation tested in controlled studies and to determine the extent to which they help workers to stop smoking or to reduce tobacco consumption.

SEARCH STRATEGY

We searched the Cochrane Tobacco Addiction Group Specialized Register in April 2008, MEDLINE (1966 - April 2008), EMBASE (1985 - Feb 2008) and PsycINFO (to March 2008). We searched abstracts from international conferences on tobacco and the bibliographies of identified studies and reviews for additional references.

SELECTION CRITERIA

We selected interventions conducted in the workplace to promote smoking cessation. We included only randomized and quasi-randomized controlled trials allocating individuals, workplaces or companies to intervention or control conditions.

DATA COLLECTION AND ANALYSIS

Information relating to the characteristics and content of all kinds of interventions, participants, outcomes and methods of the study was abstracted by one author and checked by another. Because of heterogeneity in the design and content of the included studies, we did not attempt formal meta-analysis, and evaluated the studies using qualitative narrative synthesis.

MAIN RESULTS

We include 51 studies covering 53 interventions in this updated review. We found 37 studies of workplace interventions aimed at individual workers, covering group therapy, individual counselling, self-help materials, nicotine replacement therapy and social support. The results were consistent with those found in other settings. Group programmes, individual counselling and nicotine replacement therapy increased cessation rates in comparison to no treatment or minimal intervention controls. Self-help materials were less effective. We also found 16 studies testing interventions applied to the workplace as a whole. There was a lack of evidence that comprehensive programmes reduced the prevalence of smoking. Incentive schemes increased attempts to stop smoking, though there was less evidence that they increased the rate of actual quitting.

AUTHORS' CONCLUSIONS

1. We found strong evidence that interventions directed towards individual smokers increase the likelihood of quitting smoking. These include individual and group counselling and pharmacological treatment to overcome nicotine addiction. All these interventions show similar effects whether offered in the workplace or elsewhere. Self-help interventions and social support are less effective. Although people taking up these interventions are more likely to stop, the absolute numbers who quit are low.2. There was limited evidence that participation in programmes can be increased by competitions and incentives organized by the employer.3. We failed to detect an effect of comprehensive programmes in reducing the prevalence of smoking.

Chronic disease risk factors, healthy days and medical claims in South African employees presenting for health risk screening

Background

Non-communicable diseases (NCD) accounts for more than a third (37%) of all deaths in South Africa. However, this burden of disease can be reduced by addressing risk factors. The aim of this study was to determine the health and risk profile of South African employees presenting for health risk assessments and to measure their readiness to change and improve lifestyle behaviour.

Methods

Employees (n = 1954) from 18 companies were invited to take part in a wellness day, which included a health-risk assessment. Self-reported health behaviour and health status was recorded. Clinical measures included cholesterol finger-prick test, blood pressure and Body Mass Index (BMI). Health-related age was calculated using an algorithm incorporating the relative risk for all case mortality associated with smoking, physical activity, fruit and vegetable intake, BMI and cholesterol. Medical claims data were obtained from the health insurer.

Results

The mean percentage of participation was 26% (n = 1954) and ranged from 4% in transport to 81% in the consulting sector. Health-related age (38.5 ± 12.9 years) was significantly higher than chronological age (34.9 ± 10.3 yrs) (p < 0.001). Both chronological and risk-related age were significantly different between the sectors (P < 0.001), with the manufacturing sector being the oldest and finance having the youngest employees. Health-related age was significantly associated with number of days adversely affected by mental and physical health, days away from work and total annual medical costs (p < 0.001). Employees had higher rates of overweight, smoking among men, and physical inactivity (total sample) when compared the general SA population. Increased health-related expenditure was associated with increased number of risk factors, absenteeism and reduced physical activity.

Conclusion

SA employees' health and lifestyle habits are placing them at increased risk for NCD's, suggesting that they may develop NCD's earlier than expected. Inter-sectoral differences for health-related age might provide insight into those companies which have the greatest need for interventions, and may also assist in predicting future medical expenditure. This study underscores the importance of determining the health and risk status of employees which could assist in identifying the appropriate interventions to reduce the risk of NCD's among employees.

Multiple health risk behaviors in German first year university students

Multiple health risk behaviors have been identified as a problem in young adults which includes university students. The goals of this study included assessing the prevalence of major health risk behaviors in a cohort of German first year university students, analyzing the clustering of these behaviors and assessing readiness to change across multiple behaviors. A total of 1262 students from the schools of law, teaching and medicine at a German university participated in a voluntary and anonymous survey in 2005. The study assessed indicators and readiness for change regarding fruit and vegetable consumption, exercise, smoking and binge drinking as well as sociodemographic variables. Confirming the hypotheses, prevalences for risk behaviors were high; over 95% ate less than five servings of fruits and vegetables, 60% did not exercise sufficiently, 31% were current smokers and 62% reported binge drinking. Only 2% had none, 10.5% had one, 34.5% had two, 34.8% had three, and 18.2% showed all four risk behaviors. Readiness for behavior change was very low across multiple risk behavior combinations, especially for reducing binge drinking and increasing fruit and vegetable consumption. Medical students showed slightly more positive patterns than other students. The results indicate the need for addressing health behaviors in the student population of this university. If these findings can be replicated in other universities, programs that promote individual behavior change as well as changes in environmental conditions in the university environment are necessary to address this urgent problem.