Does worksite social capital enhance retention into a worksite weight-loss programme?

OBJECTIVE: To determine if worksite social capital predicted retention in a worksite-based weight-loss programme using structural equation modelling. A secondary aim was to determine if worksite social capital was related to changes in weight at 6 months. METHODS: Overweight or obese employees from 28 worksites enrolled in a larger 12-month worksite weight-loss trial. Workplace social capital was assessed using an eight-item scale specific to the workplace. Weight was measured using a HealthSpottm, and change in weight was computed from weigh-ins at baseline and 6 months and reported as pounds (lbs) lost. Retention was defined as those employees who completed a weigh-in at 6 months. RESULTS: Across the trial, N = 1,790; age = 46.6 ± 11; 73% women; 73% White overweight or obese employees participated. The odds of participant attrition were 1.12 times greater with each unit decrease in social capital score at baseline (p < 0.05), and while the model testing the direct effect of social capital at baseline on weight loss at 6 months demonstrated acceptable fit, social capital was not a significant predictor of weight loss (p > 0.05). CONCLUSIONS: Increased worksite social capital was predictive of retention in a worksite weight-loss programme. To maximize return on investments for employee wellness and weight-loss programmes, employers may benefit from understanding the facets of the 'social' environment such as social capital that may increase the likelihood of sustained participation.

Workplace policies and prevalence of knee osteoarthritis: the Johnston County Osteoarthritis Project.

OBJECTIVE: Previous studies on work and knee osteoarthritis (KOA) have been primarily focused on physical demands; very little is known about work-related organisational policies and KOA risks and outcomes. We examined the associations between workplace policies and KOA in a community-based population in the USA. METHODS: The associations between employment offering accommodations (switch to physically less demanding jobs; part-time work for people needing reduced time) and benefits policies (paid sick leave; disability payment) with KOA outcomes (knee symptoms; symptomatic KOA [sKOA]; asymptomatic radiographic KOA [rKOA]) were analysed in participants (n = 1639) aged <65 years old and with completed employment histories and knee radiographs at baseline examination of the Johnston County Osteoarthritis Project. Multiple logistic regression models were used to estimate the prevalence odds ratios (ORs) of KOA associated with each workplace policy, adjusting for sociodemographic features, lifestyle factors, knee injuries, body mass index and other workplace characteristics. We used propensity score models to evaluate the differential selection in employment offering favourable policies and adjust for this potential bias accordingly. RESULTS: Individuals employed in workplaces offering better policies had significantly less knee symptoms. Lower sKOA prevalence was noted in workplaces offering job-switch accommodation (8% vs. 13%), paid sick leave (9% vs. 16%) and disability payment (8% vs. 16%) than their counterparts. In multivariable models, the difference in sKOA prevalence was statistically significant for paid sick leave (adjusted OR 0.58, 95% CI 0.37 to 0.91) and disability payment policies (adjusted OR 0.54, 95% CI 0.35 to 0.85). Even among those without overt knee-related symptoms, a similar pattern of negative association between workplace policies and rKOA was present and remained robust after propensity score adjustment. CONCLUSION: The negative associations between KOA and workplace policies raise concerns about possible employment discrimination or beneficial effects of workplace policies. Longitudinal studies are needed to clarify the dynamic complexities of KOA risks and outcomes in relation to workplace policies.

Beauty salons: a promising health promotion setting for reaching and promoting health among African American women

African American women suffer disproportionately from a wide range of health disparities. This article clarifies how beauty salons can be mobilized at all levels of the social-ecological framework to address disparities in health among African American women. The North Carolina BEAUTY and Health Project is a randomized, controlled intervention trial that takes into account the unique and multilevel features of the beauty salon setting with interventions that address owners, customers, stylists; interactions between customers and stylists; and the salon environment. The authors make explicit the role of the political economy of health theoretical perspective for understanding important factors (social, political, historical, and economic) that should be considered if the goal is to create successful, beauty-salon-based interventions. Despite some important challenges, the authors contend that beauty salons represent a promising setting for maximizing reach, reinforcement, and the impact of public health interventions aimed at addressing health disparities among African American women. (AU)

Working with licensed cosmetologists to promote health: results from the North Carolina BEAUTY and Health Pilot Study.

BACKGROUND: Beauty salons are located in all communities and represent a promising channel for delivering health promotion programs. No previous salon-based health promotion program has assessed the needs, interests, and preferences of licensed cosmetologists about sharing health information with their clients. METHODS: Licensed cosmetologists in one town completed a mailed survey assessing (1) health topics typically discussed with clients, (2) interest in delivering messages about beauty and health, and (3) preferred methods for learning about and sharing health information with their clients. RESULTS: The average cosmetologist sees 47 clients per week and spends 30-60 min per appointment. Eighty-two percent report that they are interested in talking about health with their clients. Most cosmetologists already discuss a wide range of health topics with their clients and are most comfortable discussing healthy eating (65.3%), physical activity (63.3%), and dieting (63.3%). Cosmetologists preferred reading pamphlets (55.1%) and watching educational videos (46.9%) to learn about beauty and health. Distributing pamphlets (69.4%), talking with clients (61.2%), and placing posters/mirror stickers in the salons (59.2%) were the methods cosmetologists most preferred for sharing health information with their clients. CONCLUSIONS: Licensed cosmetologists are in a unique position to serve as "natural helpers" by delivering health messages to their clients and reinforcing those messages over time. Partnerships with licensed cosmetologists should be developed to deliver salon-based health promotion programs.

Using theory to understand the multiple determinants of low participation in worksite health promotion programs.

Low participation at the employee or worksite level limits the potential public health impact of worksite-based interventions. Ecological models suggest that multiple levels of influence operate to determine participation patterns in worksite health promotion programs. Most investigations into the determinants of low participation study the intrapersonal, interpersonal, and institutional influences on employee participation. Community- and policy-level influences have not received attention, nor has consideration been given to worksite-level participation issues. The purpose of this article is to discuss one macrosocial theoretical perspective--political economy of health--that may guide practitioners and researchers interested in addressing the community- and policy-level determinants of participation in worksite health promotion programs. The authors argue that using theory to investigate the full spectrum of determinants offers a more complete range of intervention and research options for maximizing employee and worksite levels of participation.

Stages of change versus addiction: a replication and extension.

Data from the Working Well trial (n = 2379) were used to test the capacity of 19 variables to predict smoking cessation at 1- and 2-year follow-ups. Among the core constructs of transtheoretical model (TTM), stage of change was the best predictor. The processes of change and the pros and cons of smoking were relatively ineffective predictors. Among other variables, self-efficacy, cigarettes per day, duration of longest quit attempt during the previous year, and the contemplation ladder were the most effective stand-alone predictors. A composite of cigarettes per day and quit duration was particularly effective for predicting cessation. Consistent with Farkas et al. (Farkas AJ, Pierce JP, Zhu SH, Rosbrook B, Gilpin EA, Berry C, Kaplan RM, Addiction 91:1271-1280, 1996), multivariate analyses including the composite variable (cigarettes per day and quit duration) and the stages of change revealed the composite variable to be the better predictor of cessation.

The relationship between organizational characteristics and the adoption of workplace smoking policies.

Organizational-level variables that are hypothesized to influence the level of smoking policy restrictions and the prevalence of smoking control activities were tested in a sample of 1 14 worksites that participated in the Working Well Trial, a national trial of worksite health promotion. Predictors related to more restrictive policies included smaller size, larger percentage of white-collar workers, larger number of complaints about environmental tobacco smoke, less complexity, more formalization, and having a CEO who valued health and employees' well-being. The number of smoking control activities offered in a worksite was predicted by having a larger blue-collar workforce, a higher percentage of female employees, higher levels of workforce stability, and a CEO who valued health and employees' well-being. Efforts to identify predictors of companies' adoption and implementation of workplace-based policies and interventions are an important part of tobacco control efforts and will enhance future intervention and research efforts.

Measuring participatory strategies: instrument development for worksite populations.

A participatory strategies approach which involves employees in the planning and delivery of worksite health promotion programs was utilized in the 55 experimental worksites included in the national, NCI-funded Working Well Trial. According to study protocol, Employee Advisory Boards (EABs) were organized in each experimental worksite. This paper describes two substudies designed to develop and measure participatory strategies associated with the EABs in the Working Well Trial. Study 1 determined characteristics of the EABs, developed subscales and assessed the internal consistency of the scales. Study 2 used a confirmatory factor analysis to examine the structure of the developed questionnaire. The four subscales include: Autonomy/Independence, Management Involvement, Institutionalization/Commitment and Others Involvement. Results from Study 1 indicate that the four subscales of the 24-item instrument demonstrated strong internal consistency and three were sensitive enough to register differences by Study Center at the baseline. Study 2 results found that the EAB subscales again demonstrated good internal consistency, structural stability and acceptable sensitivity. An initial validity analysis was performed and yielded results which supported some but not all of the hypothesized associations. Implications for further refinement and application of this new instrument in worksite settings are explored.

Impact of the Working Well Trial on the worksite smoking and nutrition environment.

This article reports the effect of a worksite cancer control intervention on aspects of the physical and social environment related to dietary and smoking behaviors of employees. Data are from 111 intervention and control worksites that participated in the Working Well Trial. Employee surveys and interviews with key organizational informants assessed environmental and normative changes relevant to nutrition and tobacco use. Results indicated significant effects of the intervention on all nutrition outcomes: access to healthy food, nutritional information at work, and social norms regarding dietary choice. Significant benefits were not found for smoking norms or smoking policies. However, changes occurred in both the control and intervention sites on these variables. This first large analysis of environmental and normative effects of a worksite intervention is consistent with the employee behavior change findings for the trial and serves as a model for future analyses of multilevel worksite health promotion programs.

Do processes of change predict smoking stage movements? A prospective analysis of the transtheoretical model.

The transtheoretical model (TTM) posits that processes of change and the pros and cons of smoking predict progressive movement through the stages of change. This study provides both a cross-sectional replication and a prospective test of this hypothesis. As part of a larger study of worksite cancer prevention (the Working Well Trial), employees of 26 manufacturing worksites completed a baseline and 2 annual follow-up surveys. Of the 63% of employees completing baseline surveys, 27.7% were smokers (N = 1,535), and a cohort of these smokers completed the 2-year follow-up. Cross-sectional results replicated previous studies with virtually all the processes of change and the cons of smoking increasing in linear fashion from precontemplation to preparation (all ps < .00001), and the pros of smoking decreasing (p < .01). However, contrary to the hypothesis, the baseline processes of change and the pros and cons of smoking failed to predict progressive stage movements at either the 1- or the 2-year follow-ups. Possible explanations for these findings and concerns about the conceptual internal consistency of the TTM are discussed.

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

Worksites are a key channel for delivery of interventions designed to reduce chronic disease among adult populations. Although some evaluations of worksite physical-activity interventions have been conducted, to date very few randomized trials of worksite health promotion have included the goal of increasing physical-activity levels as part of a comprehensive multiple risk factor approach to worksite health promotion. This article presents the results regarding behavior change found among the cohort of 2055 individuals who completed three health-behavior assessments as part of their worksites' participation in The Working Healthy Project (WHP), a multiple risk factor intervention implemented in 26 manufacturing worksites. In this study, a randomized matched-pair design was used. Fifty-one percent (n = 2,761) of the employees who completed the baseline assessment also completed the interim survey. Eighty-three percent of those who completed the interim assessment also completed the final survey. The WHP intervention targeted smoking, nutrition, and physical activity. At baseline, 38% of the sample reported engaging in regular exercise, and subjects reported consuming an average of 2.7 servings of fruits and vegetables per day, 7.9 grams of fiber per 1000 kilocalories, and 35.4% calories from fat per day; 28% of the sample were smokers. By the time of both the interim (intervention midpoint) and final (end of intervention) assessments, participants in the intervention condition had significantly increased their exercise behavior, compared with the control condition. There was also increased consumption of fruits and vegetables and fiber in the intervention condition by the time of the final assessment, compared with the control condition. No differences by condition were found with regard to percentage of calories from fat consumed or smoking cessation. These results suggest that among a cohort of participants in a worksite health promotion study, there were significant health behavior changes across two risk factors over time. These data suggest that further investigation of multiple risk factor worksite health promotion is warranted, particularly with a focus on ways to increase participation in these programs and to diffuse intervention effects throughout the entire workforce.

Impact of work site health promotion on stages of dietary change: the Working Well Trial.

The stages of change construct has been applied to healthful dietary behavior in cross-sectional studies. This report examines associations of stages of change with diet prospectively and addresses whether (1) baseline stage of change predicts participation, (2) forward changes in stage movement were greater in treatment work sites, and (3) change in stage was associated with adoption of healthful diets, using data from a cohort of 11,237 employees. Findings indicate that persons in later stages of change reported higher participation levels. Employees from intervention work sites who were in preaction stages at baseline were much more likely to shift into action and maintenance stages than controls. Changes in dietary stage of change were associated with decreases in fat intake and increases in fiber, fruit and vegetable intake. Net change in diet due to the intervention was modest. Stage of change appears to be useful for understanding mediators of health promotion intervention effectiveness.

Evaluation of motivationally tailored vs. standard self-help physical activity interventions at the workplace.

PURPOSE: This study compares the efficacy of a self-help intervention tailored to the individual's stage of motivational readiness for exercise adoption with a standard self-help exercise promotion intervention. DESIGN: Interventions were delivered at baseline and 1 month; assessments were collected at baseline and 3 months. SETTING: Eleven worksites participating in the Working Healthy Research Trial. SUBJECTS: Participants (n = 1559) were a subsample of employees at participating worksites, individually randomized to one of two treatment conditions. INTERVENTION: Printed self-help exercise promotion materials either (1) matched to the individual's stage of motivational readiness for exercise adoption (motivationally tailored), or (2) standard materials (standard). MEASURES: Measures of stage of motivational readiness for exercise and items from the 7-Day Physical Activity Recall. RESULTS: Among intervention completers (n = 903), chi-square analyses showed that, compared to the standard intervention, those receiving the motivationally tailored intervention were significantly more likely to show increases (37% vs. 27%) and less likely to show either no change (52% vs. 58%) or regression (11% vs. 15%) in stage of motivational readiness. Multivariate analyses of variance showed that changes in stage of motivational readiness were significantly associated with changes in self-reported time spent in exercise. CONCLUSIONS: This is the first prospective, randomized, controlled trial demonstrating the efficacy of a brief motivationally tailored intervention compared to a standard self-help intervention for exercise adoption. These findings appear to support treatment approaches that tailor interventions to the individual's stage of motivational readiness for exercise adoption.

Components of the working well trial intervention associated with adoption of healthful diets.

INTRODUCTION: This report examines whether variability in the type and amount of the nutrition intervention in a worksite-based intervention could explain dietary outcomes. METHODS: Data are from 55 intervention worksites in the Working Well Trial, a randomized controlled trial of worksite-based health promotion. The components of the nutrition intervention were kickoff event, direct education, interactive activities (e.g., food sampling), contests, printed information picked up by employees, and materials distributed to employees. We measured delivery of the nutrition intervention (i.e., dose) by determining the amount of workforce participation in each intervention component. Diet outcomes were changes in intakes of fat, fiber, and servings of fruits and vegetables (reported on food frequency questionnaires). All variables were aggregated to the worksite level. We correlated the dose variables with indices of receipt of the intervention and with the dietary outcomes. RESULTS: Contests were associated with employee awareness of and participation in the nutrition intervention (r = 0.49 and 0.28, respectively), and interactive activities were associated with intervention participation (r = 0.43). Contests were associated with increased fiber intake and fruit and vegetable consumption (r = 0.36 and 0.31, respectively), and direct education was associated with fruit and vegetable consumption (r = 0.38). All the above correlation coefficients were statistically significant (P < .05). Intervention dose was not associated with changes in fat intake. CONCLUSIONS: It appears that longer, interactive intervention efforts (contests and classes) resulted in more positive outcomes than did one-time activities (such as the kickoffs) or more passive efforts (use of printed materials). There is a need for studies designed to test worksite- and community-based nutrition intervention methods.

Dietary intake and exposure to environmental tobacco smoke in a worksite population.

OBJECTIVES: Nonsmokers who live with smokers have poorer dietary habits than those who live in nonsmoking households. This relationship may be due to shared lifestyle patterns by spouses and family members. However, in order to fully understand the nature of this relationship, it is also important to examine the association between diet and exposure to environmental tobacco smoke (ETS) at the workplace. Further, blue collar workers' patterns of exposure to ETS both at work and at home have not been studied. The goal of this study is to examine the dietary intake of manufacturing workers as it relates to exposure to ETS at work and at home. METHODS: The Working Well Trial surveyed 10,833 nonsmokers about a variety of health behaviors, including smoking, dietary behaviors, and ETS exposure. RESULTS: Nonsmokers who had ETS exposure in their household had significantly lower intake of all target micronutrients, compared to those without household exposure. Exposure to ETS at the workplace was associated with lower intakes of vitamin C and fruits and vegetables, but not the other micronutrients examined. CONCLUSIONS: Exposure to ETS was associated with poorer dietary habits. Household exposure was a stronger predictor of intake than was workplace exposure. Because of the antagonistic effects of many components of a healthful diet in relation to the harmful effects of tobacco smoke, these findings have relevance larger than either ETS exposure or diet considered singly.

Mechanisms in multiple risk factor interventions: smoking, physical activity, and dietary fat intake among manufacturing workers. Working Well Research Group.

BACKGROUND: Individuals who have multiple poor health behaviors account for a disproportionately large percentage of the preventable U.S. health care cost burden. Understanding the relationships between multiple risk factors is important for the design of both individual and public health interventions. There have been few efforts to examine the co-occurrence of psychosocial and motivational mechanisms that mediate smoking, dietary fat intake, and physical activity in a defined population of blue collar workers. METHODS: The sample comprised 1,559 manufacturing workers who participated in a self-help physical activity intervention and who completed a computerized assessment battery about their smoking, dietary fat intake, physical activity, and demographic characteristics. RESULTS: Twenty-six percent of the sample were smokers, 51% did not exercise regularly, and 35% consumed more than an estimated 40% of calories per day from fat. Almost half of the sample was in the later stages of readiness for physical activity and dietary fat intake, compared with only 3% for smoking. Only 12% of the smokers had smoking as their only risk factor. Smokers were significantly more likely to engage in poor dietary and physical activity behaviors, compared with nonsmokers. The relationship among smoking status and the other risk factors was apparent both in terms of dietary fat and physical activity behaviors, as well as mediators such as motivation for change. Lower dietary fat intake was associated with an absence of the other two risk factors. CONCLUSIONS: The results suggest that there are important mediating mechanisms both within and among workers with one or more risk factors. Smokers are a particularly important target for health promotion interventions, and it may be possible to make initial contact with them through other health programs at the worksite. The role of other lifestyle changes as a gateway to smoking cessation has not yet been explored, but may have potential for reaching smokers who are very low in their motivational readiness to change. The implications of these findings for research and the design of multiple risk factor interventions are discussed.

Recruitment of work sites to a health promotion research trial. Implications for generalizability.

The characteristics of companies that either accepted or declined participation in a 5-year randomized trial of a multirisk factor health promotion intervention were compared to investigate potential limitations on the generalizability of research findings. A representative sample of 151 manufacturing work sites in the northeast was recruited to participate. Sixty-four of the companies were determined to be eligible and 10 others, which refused to have an administrator interviewed, were presumed to be eligible. Of this group, 27 companies agreed to participate. Work force demographics, shift structure, and prior history of health promotion offerings were not significantly different in the two groups. However, participating companies employed fewer workers and had a more favorable financial outlook than did companies that declined to participate. Implications of these findings for research on work site health promotion are discussed.

Stages of change in adopting healthy diets: fat, fiber, and correlates of nutrient intake.

The stages of change construct, which addresses the readiness to change, has only recently been applied to dietary behavior, such as fat consumption. This article describes the application of the stages of change construct to dietary fat and fiber consumption and examines the association of dietary stages to eating practices and related demographic and psychosocial factors in a large, geographically diverse population of workers. We present results from the baseline survey of 17,121 employees in the Working Well Trial. We assessed stage from an algorithm based on seven items and measured dietary intake with an 88-item food frequency questionnaire. Findings indicated that a greater proportion of the population has actively tried to reduce fat intake than to consume more fiber. Stage of change was associated with fat, fiber, and fruit and vegetable intake in a stepwise manner, as predicted. In multivariate analyses that controlled for demographic characteristics, stage of change predicted between 8 and 13% of the variance in dietary intake, and more than demographic variables. These findings have implications for the design of nutrition interventions and for the evaluation of intermediate outcomes.