Elements of external validity of tools for health: an intervention for construction laborers.

PURPOSE: To examine the external validity of an efficacious tailored smoking cessation and nutrition improvement telephone intervention. DESIGN: Comparison of characteristics of participants and nonparticipants (representativeness); examination of the extent of intervention implementation. SETTING: Cancer center collaboration with a labor union. SUBJECTS: Unionized construction laborers. INTERVENTION: Tailored feedback report, telephone counseling, and supplementary educational materials focused on smoking cessation and improved nutrition. MEASURES: Background survey identifying socio-demographic and behavioral characteristics; process evaluation data; and final efficacy survey to determine participant satisfaction. ANALYSIS: Cross-classification and the chi(2) test of homogeneity were used with categorically measured variables comparing participants and nonparticipants. We compared the means in the two groups for continuously scaled measures using the Student t-test and investigated the multivariable association of the characteristics of participation with a multiple logistic regression. For process data we present frequencies, percentages, and means. RESULTS: Characteristics associated with participation included self-efficacy to change fruit and vegetable consumption (p = .0009) and self-identification with union's problems (p = 0.05). Eighty-six percent of non-smokers and 61% of smokers completed between 1 and 4 counseling sessions. Over one-half of non-smokers (61%) and smokers (53%) completed 4 or more calls and more smokers (34%) than non-smokers (11%) completed the 5+ sessions. CONCLUSIONS: These results provide a snapshot of characteristics of construction laborers to whom this intervention can be generalized and indicators of feasibility necessary for translating research into practice.

Multiple health behavior changes in a cancer prevention intervention for construction workers, 2001-2003.

INTRODUCTION: Few multiple behavior change interventions have addressed tobacco use in conjunction with fruit and vegetable consumption, particularly among high-risk blue-collar workers. Tools for Health, a cancer prevention intervention for construction laborers, was effective in achieving behavior change for smoking cessation and fruit and vegetable consumption separately. This study examines whether addressing smoking and fruit and vegetable consumption was successful in achieving positive change for both behaviors. We also explored possible explanations for the relationship between behavior changes in these 2 behavioral domains. METHODS: We retrospectively analyzed data from a randomized controlled trial testing a smoking cessation and fruit and vegetable consumption intervention for construction workers. We used survey data from 300 intervention participants to answer our primary research question: Did participants who reported being smokers at baseline successfully quit smoking and increase their fruit and vegetable consumption by the end of the intervention? We used qualitative data from 16 small group discussions to help interpret these results. RESULTS: Tools for Health participants achieved substantial levels of smoking cessation and increased their fruit and vegetable consumption, concurrently, during the course of the intervention. CONCLUSION: This study provides evidence that pairing smoking cessation with increasing fruit and vegetable consumption can be successful in a multiple behavior change intervention designed for high-risk blue-collar workers. Further, our findings provide potential directions for examining why this pairing might be complementary.

Characteristics of participants in a cancer prevention intervention designed for multiethnic workers in small manufacturing worksites.

PURPOSE: To examine worker characteristics explicated in our social-contextual intervention model that might be associated with participation in a cancer prevention intervention. These characteristics included sociodemographic variables, mediating mechanisms, and modifying conditions. METHODS: Randomized, controlled study in 24 small multiethnic manufacturing worksites. Analyses were conducted on an embedded cohort of 456 employees in the intervention condition, incorporating the clustering of respondents in worksites using generalized linear mixed modeling methods. The intervention was based on an inclusive, comprehensive social-contextual model targeting fruit, vegetable, and red meat consumption, multivitamin use, and physical activity. RESULTS: Gender (p = .02) and self-efficacy (p < .01) were associated with participation. There were no differences in participation by race/ethnicity or occupational status. We observed no associations between participation of individual workers in intervention activities and health behavior change. CONCLUSIONS: The intervention attracted workers across racial/ethnic and occupational groups. The combination of a comprehensive intervention with wide diffusion of program messages may have been more powerful in influencing participation and behavior change than characteristics of individual employees.

Impact of intervention dose on cancer-related health behaviors among working-class, multiethnic, community health center patients.

PURPOSE: To examine the relationship between intervention dose and health behavior change in Healthy Directions-Health Centers, an intervention designed to reduce cancer risk factors. DESIGN. Analysis of intervention condition participant data from a randomized controlled trial. SETTING: Community health centers in Massachusetts. SUBJECTS: Patients residing in low-income, working-class, multiethnic neighborhoods. INTERVENTION: Components were clinician endorsement, in-person counseling session and four telephone counseling sessions with a trained health advisor, and social-contextual tailored materials. MEASURES: Intervention dose was number of six possible intervention components completed by each participant. Changes in fruit and vegetable consumption, red meat consumption, physical activity, and multivitamin intake between baseline (n=1088) and 8-month follow-up (n=967; 89% of baseline sample) were determined. ANALYSIS: Bivariate and multivariate associations between intervention dose and change in health behaviors were examined. RESULTS: In multivariate analysis, the association between intervention dose and increase in multivitamin intake approached significance (p < .07). Seventy percent of participants completed all intervention activities. In bivariate analysis, completion of four telephone counseling calls was associated with decrease in red meat consumption (p < .05). CONCLUSION: These findings indicate that future studies should examine the number, content, and length of contacts needed for behavior change. The results also suggest that health centers are a channel for reaching diverse populations, as shown by the high level of intervention implementation.

Process evaluation results from the Healthy Directions-Small Business study.

The Healthy Directions-Small Business randomized, controlled study aimed to reduce cancer risk among multiethnic workers in small manufacturing businesses by increasing fruit and vegetable consumption, physical activity, and daily multivitamin in take and decreasing consumption of red meat. The intervention incorporated participatory strategies and was built on a social-contextual framework that addressed people with varying cultural backgrounds and literacy levels. In addition, the intervention aimed to reduce worker exposure to occupational hazards. Process evaluation was conducted using quantitative and qualitative research methods. Quantitative results showed high levels of worker awareness of and participation in programs. Qualitative findings suggested that management support, worker input, and a history of social interaction between workers and management may have contributed to high participation rates. Future studies need to examine characteristics associated with participation and nonparticipation of both managers and nonmanagers to increase the likelihood of participation and ultimately improve health behavior.

Characteristics of Employees of Small Manufacturing Businesses by Occupation: Informing Evidence-Based Intervention Planning.

OBJECTIVES: We examined characteristics of employees in six occupational categories in small manufacturing businesses (20-150 employees). METHODS: We analyzed survey data from 47 businesses (n = 2577 employees; 86% response rate) and examined relationships between job type and sociodemographic, health, and organizational support characteristics. Analyses were adjusted for age and sex, and company as a random effect. RESULTS: Smoking rates were highest for production workers (33%), production managers (27%), and support staff (28%) and lowest for managers (11%) (P <0.001). Job stress was higher for production workers and support staff than managers (P < 0.0001). Managers perceived social capital (P<0.001), safety climate (P < 0.0001) and support for smoking cessation (P < 0.001) higher than production managers, production workers, and support staff. CONCLUSIONS: Differences in characteristics by occupation call for integrated interventions that target working class employees, leverage the influence of production managers, and enhance organizational support.

Cancer prevention for working class, multiethnic populations through small businesses: the healthy directions study.

OBJECTIVE: We report demographic and social contextual characteristics of multiethnic, blue-collar workers from the baseline survey of a study conducted in 24 small businesses. We discuss ways in which we incorporated these characteristics into the design of the intervention. METHODS: We used a randomized controled design, with 12 small businesses assigned to a social contextual intervention and 12 to a minimum intervention control condition. The response rates to the survey were 84% at baseline (n = 1717). Primary outcomes included reduction in red meat consumption and increase in physical activity and daily multivitamin intake. Secondary outcomes targeted reduction in smoking and occupational exposures. RESULTS: The majority of the respondents were male (67.6%). This was an ethnically diverse sample with 24.7% representing racial/ethnic groups other than white and 43.6% of participants or their parents born outside of the US. To meet study recommendations, workers needed improvement in all behaviors measured. Participants reported a smoking rate of 25.8, 86.2% ate fewer than 5 servings of fruits and vegetables a day 69.5% ate more than three servings of red meat a week, 46.8% engaged in less than 2.5 h a week and 72.4% reported that they did not consume a daily multivitamin. CONCLUSIONS: Interventions that address the contextual environment in which health behaviors occur, may provide a method that researchers and practitioners can use to reduce health disparities.

Implementation of a cancer prevention program for working class, multiethnic populations.

BACKGROUND: This paper describes the implementation of the Healthy Directions-Health Centers intervention and examines the characteristics of participants associated with completion of intervention activities. Healthy Directions-Health Centers was designed to address social contextual factors relevant to cancer prevention interventions for working class, multi-ethnic populations. METHODS: Ten community health centers were paired and randomly assigned to intervention or control. Patients who resided in low income, multi-ethnic neighborhoods were approached for participation. This study targeted fruit and vegetable consumption, red meat consumption, multi-vitamin intake, and physical activity. The intervention components consisted of: (1) a brief study endorsement from a clinician; (2) an in-person counseling session with a health advisor; (3) four follow-up telephone counseling sessions; and (4) multiple distributions of tailored materials. RESULTS: Among the 1,088 intervention group participants, 978 participants (90%) completed at least five out of six intervention activities. Participants who missed clinical appointments were less likely to complete all components of the intervention. Participant characteristics that predicted receipt of clinician endorsement differed from characteristics that predicted completion of health advisor activities. Low acculturation did not present a barrier to delivery of the intervention once the participant was enrolled. CONCLUSIONS: Collection and reporting on process evaluation results can help explain variations in program implementation.