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Fernandez ID, Chin NP, Devine CM, Dozier AM, Martina CA, McIntosh S, Thevenet-Morrison K, Yang H. Images of a Healthy Worksite: A Group-Randomized Trial for Worksite Weight Gain Prevention With Employee Participation in Intervention Design. Am J Public Health 2015; 105:2167-74. [PMID: 25790416 DOI: 10.2105/ajph.2014.302397] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
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.
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Affiliation(s)
- I Diana Fernandez
- I. Diana Fernandez, Nancy P. Chin, Ann M. Dozier, Camille A. Martina, Scott McIntosh, and Kelly Thevenet-Morrison are with the Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, NY. Carol M. Devine is with the Division of Nutritional Sciences, Cornell University, Ithaca, NY. Hongmei Yang is with the Department of Biostatistics and Computational Biology, University of Rochester School of Medicine and Dentistry
| | - Nancy P Chin
- I. Diana Fernandez, Nancy P. Chin, Ann M. Dozier, Camille A. Martina, Scott McIntosh, and Kelly Thevenet-Morrison are with the Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, NY. Carol M. Devine is with the Division of Nutritional Sciences, Cornell University, Ithaca, NY. Hongmei Yang is with the Department of Biostatistics and Computational Biology, University of Rochester School of Medicine and Dentistry
| | - Carol M Devine
- I. Diana Fernandez, Nancy P. Chin, Ann M. Dozier, Camille A. Martina, Scott McIntosh, and Kelly Thevenet-Morrison are with the Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, NY. Carol M. Devine is with the Division of Nutritional Sciences, Cornell University, Ithaca, NY. Hongmei Yang is with the Department of Biostatistics and Computational Biology, University of Rochester School of Medicine and Dentistry
| | - Ann M Dozier
- I. Diana Fernandez, Nancy P. Chin, Ann M. Dozier, Camille A. Martina, Scott McIntosh, and Kelly Thevenet-Morrison are with the Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, NY. Carol M. Devine is with the Division of Nutritional Sciences, Cornell University, Ithaca, NY. Hongmei Yang is with the Department of Biostatistics and Computational Biology, University of Rochester School of Medicine and Dentistry
| | - Camille A Martina
- I. Diana Fernandez, Nancy P. Chin, Ann M. Dozier, Camille A. Martina, Scott McIntosh, and Kelly Thevenet-Morrison are with the Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, NY. Carol M. Devine is with the Division of Nutritional Sciences, Cornell University, Ithaca, NY. Hongmei Yang is with the Department of Biostatistics and Computational Biology, University of Rochester School of Medicine and Dentistry
| | - Scott McIntosh
- I. Diana Fernandez, Nancy P. Chin, Ann M. Dozier, Camille A. Martina, Scott McIntosh, and Kelly Thevenet-Morrison are with the Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, NY. Carol M. Devine is with the Division of Nutritional Sciences, Cornell University, Ithaca, NY. Hongmei Yang is with the Department of Biostatistics and Computational Biology, University of Rochester School of Medicine and Dentistry
| | - Kelly Thevenet-Morrison
- I. Diana Fernandez, Nancy P. Chin, Ann M. Dozier, Camille A. Martina, Scott McIntosh, and Kelly Thevenet-Morrison are with the Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, NY. Carol M. Devine is with the Division of Nutritional Sciences, Cornell University, Ithaca, NY. Hongmei Yang is with the Department of Biostatistics and Computational Biology, University of Rochester School of Medicine and Dentistry
| | - Hongmei Yang
- I. Diana Fernandez, Nancy P. Chin, Ann M. Dozier, Camille A. Martina, Scott McIntosh, and Kelly Thevenet-Morrison are with the Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, NY. Carol M. Devine is with the Division of Nutritional Sciences, Cornell University, Ithaca, NY. Hongmei Yang is with the Department of Biostatistics and Computational Biology, University of Rochester School of Medicine and Dentistry
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Abstract
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.
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Affiliation(s)
- Kate Cahill
- University of OxfordNuffield Department of Primary Care Health SciencesRadcliffe Observatory QuarterWoodstock RoadOxfordUKOX2 6GG
| | - Tim Lancaster
- University of OxfordNuffield Department of Primary Care Health SciencesRadcliffe Observatory QuarterWoodstock RoadOxfordUKOX2 6GG
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Finkelstein EA, Khavjou OA, Will JC, Farris RP, Prabhu M. Assessing the ability of cardiovascular disease risk calculators to evaluate effectiveness of trials and interventions. Expert Rev Pharmacoecon Outcomes Res 2014; 6:417-24. [DOI: 10.1586/14737167.6.4.417] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Mabry L, Elliot DL, Mackinnon DP, Thoemmes F, Kuehl KS. Understanding the durability of a fire department wellness program. Am J Health Behav 2013; 37:693-702. [PMID: 23985292 DOI: 10.5993/ajhb.37.5.13] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVES To understand the influences associated with durability and diffusion of benefits of a fire service wellness program. METHODS Qualitative assessment of group interviews. RESULTS Five years following a controlled worksite wellness trial, behavioral improvements were durable and had diffused to control participants. These findings were associated with firefighters' team orientation, enacted healthy norms and competitiveness regarding the results of annual health assessments. The original intervention trial appeared to initiate individual change that coalesced into group effects. Secondary influences included increasing public awareness about health, newly hired younger firefighters, and a modicum of administrative support. Culture shift was achieved at the workplace. CONCLUSIONS Although the fire service is a unique occupation, these findings suggest general strategies to achieve durable positive health change in other occupational settings.
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Affiliation(s)
- Linda Mabry
- Washington State University Vancouver, Department of Teaching and Learning, Vancouver, WA, USA
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Østbye T, Stroo M, Brouwer RJN, Peterson BL, Eisenstein EL, Fuemmeler BF, Joyner J, Gulley L, Dement JM. The steps to health employee weight management randomized control trial: rationale, design and baseline characteristics. Contemp Clin Trials 2013; 35:68-76. [PMID: 23648394 DOI: 10.1016/j.cct.2013.04.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2012] [Revised: 04/18/2013] [Accepted: 04/25/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND The workplace can be an important setting for addressing obesity. An increasing number of employers offer weight management programs. PURPOSE Present the design, rationale and baseline characteristics of the Steps to Health study (STH), a randomized trial to evaluate the effectiveness of two preexisting employee weight management programs offered at Duke University and Medical Center. METHODS 550 obese (BMI ≥30) employee volunteers were randomized 1:1 to two programs. Baseline data, collected between January 2011 and July 2012, included height/weight, accelerometry, workplace injuries, health care utilization, and questionnaires querying socio-cognitive factors, perceptions of health climate, physical activity, and dietary intake. In secondary analyses participants in the two programs will also be compared to a non-randomized observational control group of obese employees. RESULTS At baseline, the mean age was 45 years, 83% were female, 41% white, and 53% black. Mean BMI was 37.2. Participants consumed a mean of 2.37 servings of fruits and vegetables per day (in the past week), participated in 11.5 min of moderate-to-vigorous physical activity, and spent 620 min being sedentary. CONCLUSION STH addresses the need for evaluation of worksite interventions to promote healthy weight. In addition to having direct positive effects on workers' health, worksite programs have the potential to increase productivity and reduce health care costs.
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Affiliation(s)
- Truls Østbye
- Department of Community and Family Medicine, Duke University Medical Center, Durham, NC 27710, USA.
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Ebrahim S, Taylor F, Ward K, Beswick A, Burke M, Davey Smith G. Multiple risk factor interventions for primary prevention of coronary heart disease. Cochrane Database Syst Rev 2011:CD001561. [PMID: 21249647 DOI: 10.1002/14651858.cd001561.pub3] [Citation(s) in RCA: 179] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
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.
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Affiliation(s)
- Shah Ebrahim
- Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK, WC1E 7HT
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Soler RE, Leeks KD, Razi S, Hopkins DP, Griffith M, Aten A, Chattopadhyay SK, Smith SC, Habarta N, Goetzel RZ, Pronk NP, Richling DE, Bauer DR, Buchanan LR, Florence CS, Koonin L, MacLean D, Rosenthal A, Matson Koffman D, Grizzell JV, Walker AM. A systematic review of selected interventions for worksite health promotion. The assessment of health risks with feedback. Am J Prev Med 2010; 38:S237-62. [PMID: 20117610 DOI: 10.1016/j.amepre.2009.10.030] [Citation(s) in RCA: 179] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2009] [Revised: 08/04/2009] [Accepted: 10/27/2009] [Indexed: 11/26/2022]
Abstract
BACKGROUND Many health behaviors and physiologic indicators can be used to estimate one's likelihood of illness or premature death. Methods have been developed to assess this risk, most notably the use of a health-risk assessment or biometric screening tool. This report provides recommendations on the effectiveness of interventions that use an Assessment of Health Risks with Feedback (AHRF) when used alone or as part of a broader worksite health promotion program to improve the health of employees. EVIDENCE ACQUISITION The Guide to Community Preventive Services' methods for systematic reviews were used to evaluate the effectiveness of AHRF when used alone and when used in combination with other intervention components. Effectiveness was assessed on the basis of changes in health behaviors and physiologic estimates, but was also informed by changes in risk estimates, healthcare service use, and worker productivity. EVIDENCE SYNTHESIS The review team identified strong evidence of effectiveness of AHRF when used with health education with or without other intervention components for five outcomes. There is sufficient evidence of effectiveness for four additional outcomes assessed. There is insufficient evidence to determine effectiveness for others such as changes in body composition and fruit and vegetable intake. The team also found insufficient evidence to determine the effectiveness of AHRF when implemented alone. CONCLUSIONS The results of these reviews indicate that AHRF is useful as a gateway intervention to a broader worksite health promotion program that includes health education lasting > or =1 hour or repeating multiple times during 1 year, and that may include an array of health promotion activities. These reviews form the basis of the recommendations by the Task Force on Community Preventive Services presented elsewhere in this supplement.
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Affiliation(s)
- Robin E Soler
- National Center for Health Marketing, CDC, Atlanta, Georgia 30333, USA.
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Rothstein MA, Harrell HL. Health risk reduction programs in employer-sponsored health plans: Part I-efficacy. J Occup Environ Med 2009; 51:943-50. [PMID: 19625972 PMCID: PMC3034441 DOI: 10.1097/jom.0b013e3181b05421] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
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.
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Affiliation(s)
- Mark A Rothstein
- Institute for Bioethics, Health Policy and Law, University of Louisville School of Medicine, KY 40202, USA.
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Abstract
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.
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Affiliation(s)
- Kate Cahill
- Department of Primary Health Care, University of Oxford, Rosemary Rue Building, Old Road Campus, Oxford, UK, OX3 7LF.
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Abstract
In cluster randomized trials, intact social units such as schools, worksites or medical practices - rather than individuals themselves - are randomly allocated to intervention and control conditions, while the outcomes of interest are then observed on individuals within each cluster. Such trials are becoming increasingly common in the fields of health promotion and health services research. Attrition is a common occurrence in randomized trials, and a standard approach for dealing with the resulting missing values is imputation. We consider imputation strategies for missing continuous outcomes, focusing on trials with a completely randomized design in which fixed cohorts from each cluster are enrolled prior to random assignment. We compare five different imputation strategies with respect to Type I and Type II error rates of the adjusted two-sample t -test for the intervention effect. Cluster mean imputation is compared with multiple imputation, using either within-cluster data or data pooled across clusters in each intervention group. In the case of pooling across clusters, we distinguish between standard multiple imputation procedures which do not account for intracluster correlation and a specialized procedure which does account for intracluster correlation but is not yet available in standard statistical software packages. A simulation study is used to evaluate the influence of cluster size, number of clusters, degree of intracluster correlation, and variability among cluster follow-up rates. We show that cluster mean imputation yields valid inferences and given its simplicity, may be an attractive option in some large community intervention trials which are subject to individual-level attrition only; however, it may yield less powerful inferences than alternative procedures which pool across clusters especially when the cluster sizes are small and cluster follow-up rates are highly variable. When pooling across clusters, the imputation procedure should generally take intracluster correlation into account to obtain valid inferences; however, as long as the intracluster correlation coefficient is small, we show that standard multiple imputation procedures may yield acceptable type I error rates; moreover, these procedures may yield more powerful inferences than a specialized procedure, especially when the number of available clusters is small. Within-cluster multiple imputation is shown to be the least powerful among the procedures considered.
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Devine CM, Nelson JA, Chin N, Dozier A, Fernandez ID. "Pizza is cheaper than salad": assessing workers' views for an environmental food intervention. Obesity (Silver Spring) 2007; 15 Suppl 1:57S-68S. [PMID: 18073342 DOI: 10.1038/oby.2007.388] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE "Images of a Healthy Worksite" aims to provide easy access to healthful foods and to reduce sedentarism at the worksite-to prevent weight gain. Formative research for the nutrition intervention component was aimed at gaining a broad understanding of the sociocultural role of food and eating among workers and worker perspectives on socially feasible and culturally acceptable environmental intervention strategies. RESEARCH METHODS AND PROCEDURES Using an adapted PRECEDE health planning model, we conducted ecological, educational, environmental, and administrative assessments at the worksite. Through 15 in-depth interviews, five focus groups, and community mapping at two sites with 79 administrators, managers, workers, and food service personnel (51% men, 82% white), we assessed workers' perspectives on physical, sociocultural, economic, and policy environments. Data were coded for predisposing, enabling, and reinforcing factors related to intervention strategies in vending, cafeteria, catering, and informal food environments. After classification for reach, intensity, and sustainability, objectives and evaluation plans were developed for each highly ranked strategy. RESULTS Key sociocultural factors affecting food and eating included: stress-related eating in a downsizing workplace, enthusiasm for employer-sponsored weight gain prevention efforts that respect personal privacy, and the consequences of organizational culture on worker access to the food and eating environment. Workers supported healthier cafeteria and catering options, bringing healthful foods closer, and labeling of healthful options. DISCUSSION We provide a practical and systematic approach to formative research and assess the interrelatedness of the physical, policy, economic, and sociocultural factors that affect environmental worksite interventions to prevent weight gain among employees.
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Affiliation(s)
- Carol M Devine
- Division of Nutritional Sciences, Cornell University, 377 MVR, Ithaca, NY 14853-4401, USA.
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Benner JS, Cherry SB, Erhardt L, Fernandes M, Flammer M, Gaciong Z, Girerd X, Johnson ES, García-Puig J, Sturkenboom MCJM, Sun W. Rationale, design, and methods for the risk evaluation and communication health outcomes and utilization trial (REACH OUT). Contemp Clin Trials 2007; 28:662-73. [PMID: 17490918 DOI: 10.1016/j.cct.2007.03.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2006] [Revised: 02/28/2007] [Accepted: 03/04/2007] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To test the primary study hypothesis that a physician-delivered coronary heart disease risk evaluation and communication program can lower patients' predicted 10-year risk of myocardial infarction or death due to coronary heart disease by 10% within 6 months compared to usual care. DESIGN Prospective, parallel group, open-label, controlled, cluster-randomized multinational trial; the study site is the unit of randomization. SETTING Patients were recruited from 106 general practices located in nine European countries. PATIENTS Men and women aged 45 to 64 (N=1500) with a documented history of hypertension (treated or untreated), systolic blood pressure > or =140 mmHg (or > or =130 mmHg in the presence of renal or kidney disease), no history of cardiovascular disease, and a predicted 10-year risk of myocardial infarction or death due to coronary heart disease > or =10%. INTERVENTION Sites were randomized to deliver a physician-directed coronary heart disease risk communication and education program or usual care. The intervention program included informing patients of their 10-year risk of myocardial infarction or death due to coronary heart disease, educating patients about modifiable risk factors and their control, and three follow-up phone calls by a physician or study nurse. MAIN OUTCOME MEASURE Predicted 10-year risk of myocardial infarction or death due to coronary heart disease at 6 months. CONCLUSIONS REACH OUT will evaluate a novel, patient-focused, physician-implemented application of coronary heart disease risk equations. Results of the study will be of practical relevance to physicians, health care organizations, and those who issue clinical guidelines for the reduction of cardiovascular risk.
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Ebrahim S, Beswick A, Burke M, Davey Smith G. Multiple risk factor interventions for primary prevention of coronary heart disease. Cochrane Database Syst Rev 2006:CD001561. [PMID: 17054138 PMCID: PMC4160097 DOI: 10.1002/14651858.cd001561.pub2] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Primary prevention programmes in many countries attempt to reduce mortality and morbidity due to coronary heart disease (CHD) through risk factor modification. It is widely believed that multiple risk factor intervention using counselling and educational methods is efficacious and cost-effective and should be expanded. Recent trials examining risk factor changes have cast considerable doubt on the effectiveness of these multiple risk factor interventions. OBJECTIVES To assess the effects of multiple risk factor intervention for reducing cardiovascular risk factors, total mortality, and mortality from CHD among adults without clinical evidence of established cardiovascular disease. SEARCH STRATEGY MEDLINE was searched for the original review to 1995. This was updated by searching the Cochrane Central Register of Controlled Trials on The Cochrane Library Issue 3 2001, MEDLINE (2000 to September 2001) and EMBASE (1998 to September 2001). SELECTION CRITERIA Intervention studies using counselling or education to modify more than one cardiovascular risk factor in adults from general populations, occupational groups, or high risk groups. Trials of less than 6 months duration were excluded. DATA COLLECTION AND ANALYSIS Data were extracted by two reviewers independently. Investigators were contacted to obtain missing information. MAIN RESULTS A total of 39 trials were found of which ten reported clinical event data. In the ten trials with clinical event end-points, the pooled odds ratios for total and CHD mortality were 0.96 (95% confidence intervals (CI) 0.92 to 1.01) and 0.96 (95% CI 0.89 to 1.04) respectively. Net changes in systolic and diastolic blood pressure, and blood cholesterol were (weighted mean differences) -3.6 mmHg (95% CI -3.9 to -3.3 mmHg), -2.8 mmHg (95% CI -2.9 to -2.6 mmHg) and -0.07 mMol/l (95% CI -0.8 to -0.06 mMol/l) respectively. Odds of reduction in smoking prevalence was 20% (95% CI 8% to 31%). Statistical heterogeneity between the studies with respect to mortality and risk factor changes was due to trials focusing on hypertensive participants and those using considerable amounts of drug treatment. AUTHORS' CONCLUSIONS The pooled effects suggest multiple risk factor intervention has no effect on mortality. However, a small, but potentially important, benefit of treatment (about a 10% reduction in CHD mortality) may have been missed. Risk factor changes were relatively modest, were related to the amount of pharmacological treatment used, and in some cases may have been over-estimated because of regression to the mean effects, lack of intention to treat analyses, habituation to blood pressure measurement, and use of self-reports of smoking. Interventions using personal or family counselling and education with or without pharmacological treatments appear to be more effective at achieving risk factor reduction and consequent reductions in mortality in high risk hypertensive populations. The evidence suggests that such interventions have limited utility in the general population.
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Affiliation(s)
- S Ebrahim
- London School of Hygiene & Tropical Medicine, Department of Epidemiology & Population Health, Keppel Street, London, UK.
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Abstract
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 October 2004, MEDLINE (1966 - October 2004), EMBASE (1985 - October 2004) and PsycINFO (to October 2004). We searched abstracts from international conferences on tobacco and we checked the bibliographies of identified studies and reviews for additional references. SELECTION CRITERIA We categorized interventions into two groups: a) Interventions aimed at the individual to promote smoking cessation and b) interventions aimed at the workplace as a whole. We applied different inclusion criteria for the different types of study. For interventions aimed at helping individuals to stop smoking, we included only randomized controlled trials allocating individuals, workplaces or companies to intervention or control conditions. For studies of smoking restrictions and bans in the workplace, we also included controlled trials with baseline and post-intervention outcomes and interrupted times series studies. 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 two others. 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 Workplace interventions aimed at helping individuals to stop smoking included ten studies of group therapy, seven studies of individual counselling, nine studies of self-help materials and five studies of nicotine replacement therapy. 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.Workplace interventions aimed at the workforce as a whole included 14 studies of tobacco bans, two studies of social support, four studies of environmental support, five studies of incentives, and eight studies of comprehensive (multi-component) programmes. Tobacco bans decreased cigarette consumption during the working day but their effect on total consumption was less certain. We failed to detect an increase in quit rates from adding social and environmental support to these programmes. There was a lack of evidence that comprehensive programmes reduced the prevalence of smoking. Competitions and incentives increased attempts to stop smoking, though there was less evidence that they increased the rate of actual quitting. AUTHORS' CONCLUSIONS We found: 1. Strong evidence that interventions directed towards individual smokers increase the likelihood of quitting smoking. These include advice from a health professional, individual and group counselling and pharmacological treatment to overcome nicotine addiction. Self-help interventions are less effective. All these interventions are effective whether offered in the workplace or elsewhere. Although people taking up these interventions are more likely to stop, the absolute numbers who quit are low. 2. Limited evidence that participation in programmes can be increased by competitions and incentives organized by the employer. 3. Consistent evidence that workplace tobacco policies and bans can decrease cigarette consumption during the working day by smokers and exposure of non-smoking employees to environmental tobacco smoke at work, but conflicting evidence about whether they decrease prevalence of smoking or overall consumption of tobacco by smokers. 4. A lack of evidence that comprehensive approaches reduce the prevalence of smoking, despite the strong theoretical rationale for their use. 5. A lack of evidence about the cost-effectiveness of workplace programmes.
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Adams TB, Mowen JC. Identifying the personality characteristics of healthy eaters and exercisers: a hierarchical model approach. Health Mark Q 2005; 23:21-42. [PMID: 16891255 DOI: 10.1300/j026v23n01_03] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
A study was performed to compare the personality characteristics of healthy eating and exercise behavior. The results revealed that a hierarchical model of personality accounted for significantly more variance than a version of the Five-Factor Model. The predictors of health and exercise behaviors were similar. In each case, the need for body resources and health motivation were positively associated with the outcome variables. In addition, exercise was also positively associated with the need for activity and creativity, and negatively related to agreeableness.
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Affiliation(s)
- Troy B Adams
- Health Promotion and Wellness, Rocky Mountain University of Health Professions, Provo, UT 84604, USA.
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Bueno N, Fletcher BJ, Fletcher GF, Serra S, Cruz PDMD, Kelly D, Meirelles L, Atkinson E, Tabor LA, Ramos A, Castro I. Coronary risk factors in adult children of parents with coronary heart disease: a comparison survey of southeastern Brazil and southeastern United States. PREVENTIVE CARDIOLOGY 2005; 8:149-54. [PMID: 16034217 DOI: 10.1111/j.1520-037x.2005.2248.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
A survey was performed in southeastern Brazil and in the southeastern United States to: 1) compare coronary risk factors in adult children (>18 years old) of parents with coronary heart disease enrolled in cardiac rehabilitation programs in countries with different geographic, social, and economic factors; and 2) to assess the influence of coronary heart disease of parents on alteration of lifestyle in these adult children. There were 286 biological children available for the survey (135 Brazil, 151 United States). Of those, 142 completed the survey (78 Brazil, 64 United States) for an overall compliance rate of 50% (58% Brazil, 42% United States). The following differences were noted: blood pressure > 159/90 mm Hg (23% Brazil, 15% United States [nonsignificant]); total cholesterol > 181 mg/dL (5% Brazil, 30% United States [p < 0.001]); HDL-C < 35 mg/dL (95% Brazil, 21% United States [p < 0.001]); low-fat diet (29% Brazil, 64% United States [p < 0.001]); smoke/ever (41% Brazil, 34% United States [nonsignificant]); currently smoke (72% Brazil, 18% United States [p < 0.001]); any exercise [44% Brazil, 82% United States [p < 0.001]); exercise > 90 minute/week (18% Brazil, 20% United States [nonsignificant]); improved lifestyle habits (39% Brazil, 79% United States [p < 0.001]); improved lifestyle habits related to parent's coronary heart disease (66% Brazil, 35% United States [p < 0.05]). Such differences may reflect geographic, social, and/or economic factors.
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Affiliation(s)
- Nelia Bueno
- Institute of Cardiology of Rio Grande do Sul, Porto Alegre, Brazil
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Klar N, Donner A. Current and future challenges in the design and analysis of cluster randomization trials. Stat Med 2001; 20:3729-40. [PMID: 11782029 DOI: 10.1002/sim.1115] [Citation(s) in RCA: 111] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Randomized trials in which the unit of randomization is a community, worksite, school or family are becoming widely used in the evaluation of life-style interventions for the prevention of disease. The increasing interest in adopting a cluster randomization design is being matched by rapid methodological developments. In this paper we describe several of these developments. Brief mention is also made of issues related to economic analysis and to the planning and conduct of meta-analyses for cluster randomization trials. Recommendations for reporting are also discussed.
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Affiliation(s)
- N Klar
- Division of Preventive Oncology, Cancer Care Ontario, Toronto, Ontario, M5G 2L7, Canada.
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Gillman MW, Pinto BM, Tennstedt S, Glanz K, Marcus B, Friedman RH. Relationships of physical activity with dietary behaviors among adults. Prev Med 2001; 32:295-301. [PMID: 11277687 DOI: 10.1006/pmed.2000.0812] [Citation(s) in RCA: 118] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Physical activity and diet are important influences on health, but few data are available about the relationship between these two factors. The purpose of this study was to examine relationships between physical activity and dietary quality and to identify determinants of the combination of sedentary behavior and suboptimal diet. METHODS The design of this study was cross-sectional. The setting was a large managed-care organization and the participants were 1,322 racially diverse men and women ages 25-91 years. We categorized subjects' physical activity into vigorous, moderate, and sedentary based on answers to two validated interviewer-administered questions about intensity and duration of specified activities. Dietary assessment was by means of a validated short food frequency questionnaire. We defined suboptimal diet as consuming unhealthful quantities of at least two of the following five food groups: fruits, vegetables, whole grain foods, whole-fat dairy foods, and red and processed meats. RESULTS Seven hundred fifty-four (57%) subjects were sedentary and 617 (47%) consumed a suboptimal diet. Using multiple linear regression, we found that sedentary individuals consumed smaller amounts of foods and nutrients considered to be healthful, such as fruits and vegetables, fiber, calcium, folate, and vitamins A, C, and E, than more active participants. For nutrients considered to be harmful, such as saturated fat, trans fat, and dietary cholesterol, the association with physical activity was inverse. In multiple logistic regression analyses, the strongest sociodemographic correlates of the joint presence of inactivity and poor diet were less education [odds ratio for 1-year decrease 1.14 (95% confidence interval 1.06, 1.22)], nonwhite race [1.48 (1.05, 2.07)], and nonmarried status [1.49 (1.06, 2.10)]. CONCLUSIONS Physical activity and diet quality are correlated behaviors. Suboptimal diet and sedentary behavior tend to cluster in individuals who are less educated, not married, and of nonwhite race. Programs that target diet and activity together, informed by their joint determinants, may attain enhanced outcomes.
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Affiliation(s)
- M W Gillman
- Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, Boston, Massachusetts 02215, USA.
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Simpson JM, Oldenburg B, Owen N, Harris D, Dobbins T, Salmon A, Vita P, Wilson J, Saunders JB. The Australian National Workplace Health Project: design and baseline findings. Prev Med 2000; 31:249-60. [PMID: 10964639 DOI: 10.1006/pmed.2000.0707] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND This paper describes the study design, recruitment, measurement, and initial recruitment outcomes of Australia's largest workplace intervention trial, the National Workplace Health Project. METHODS This was a cluster-randomized trial of socio-behavioral and environmental interventions focusing on key behaviors of physical activity, healthy food choices, cigarette smoking, and alcohol consumption, as well as motivational readiness for change. Twenty worksites were randomized separately for each intervention using a two-by-two factorial design. All participants underwent a health risk appraisal and measurements were made at baseline and at 1 and 2 years. RESULTS The overall response rate for the baseline survey was 73% with 61% attending the health risk appraisal. The sample was predominantly male, English-speaking, married, blue-collar workers. Overall, 12% reported unsafe alcohol consumption, 26% were current smokers, 44% were physically inactive, 74% ate at most one piece of fruit per day, and 26% ate at most one serving of vegetables per day. Intervention and control conditions were similar at baseline for the primary outcomes, except that a higher proportion of the sociobehavioral intervention condition was more physically active (59%) than the corresponding control condition (53%). CONCLUSIONS This study will permit the rigorous evaluation of the efficacy of sociobehavioral and environ mental intervention approaches to workplace health promotion. Although participants were randomized by worksite, intervention and control conditions were similar at baseline; any differences in the primary out come variables will be controlled for in the analysis.
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Affiliation(s)
- J M Simpson
- Department of Public Health and Community Medicine, University of Sydney, 2006, Australia.
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DataBase: Research and Evaluation Results. Am J Health Promot 1999. [DOI: 10.4278/0890-1171-13.3.190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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DataBase: Research and Evaluation Results. Am J Health Promot 1998. [DOI: 10.4278/0890-1171-12.6.406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Data Base: Research and Evaluation Results. Am J Health Promot 1998. [DOI: 10.4278/0890-1171-12.5.354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Affiliation(s)
- A R Davidson
- Center for Population and Family Health, School of Public Health, Columbia University, New York, NY, USA
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Heitjan DF. Annotation: what can be done about missing data? Approaches to imputation. Am J Public Health 1997; 87:548-50. [PMID: 9146428 PMCID: PMC1380829 DOI: 10.2105/ajph.87.4.548] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- D F Heitjan
- School of Public Health, Columbia University, New York, NY, USA
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