OBJECTIVES:We examined the efficacy of a cancer prevention intervention designed to improve health behaviors among working-class, multiethnic populations employed in small manufacturing businesses.METHODS:Worksites were randomly assigned to an intervention or minimal-intervention control condition. The intervention targeted fruit and vegetable consumption, red meat consumption, multivitamin use, and physical activity.RESULTS:Employees in the intervention group showed greater improvements for every outcome compared with employees in the control group. Differences in improvement were statistically significant for multivitamin use and physical activity. Intervention effects were larger among workers than among managers for fruit and vegetable consumption and for physical activity.CONCLUSIONS:The social-context model holds promise for reducing disparities in health behaviors. Further research is needed to improve the effectiveness of the intervention.

Disparities in chronic disease risk by occupation call for new approaches to health promotion. Well Works-2 was a randomized, controlled study comparing the effectiveness of a health promotion/occupational health program (HP/OHS) with a standard intervention (HP). Interventions in both studies were based on the same theoretical foundations. Results from process evaluation revealed that a similar number of activities were offered in both conditions and that in the HP/OHS condition there were higher levels of worker participation using three measures: mean participation per activity (HP: 14.2% vs. HP/OHS: 21.2%), mean minutes of worker exposure to the intervention/site (HP: 14.9 vs. HP/OHS: 33.3), and overall mean participation per site (HP: 34.4% vs. HP/ OHS: 45.8%). There were a greater number of contacts with management (HP: 8.8 vs. HP/OHS: 24.9) in the HP/ OHS condition. Addressing occupational health may have contributed to higher levels of worker and management participation and smoking cessation among blue-collar workers.

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.

In the United States in 1997, the smoking prevalence among blue-collar workers was nearly double that among white-collar workers, underscoring the need for new approaches to reduce social disparities in tobacco use. These inequalities reflect larger structural forces that shape the social context of workers' lives. Drawing from a range of social and behavioral theories and lessons from social epidemiology, we articulate a social-contextual model for understanding ways in which socioeconomic position, particularly occupation, influences smoking patterns. We present applications of this model to worksite-based smoking cessation interventions among blue-collar workers and provide empirical support for this model. We also propose avenues for future research guided by this model.

Background. Worksite initiatives to promote increased consumption of fruits and vegetables include a wide range of programs. Some initiatives focus on the physical and informational environments, with the dual aim of increasing the availability of healthful food options and providing education and support through point-of-choice labeling and signage. Methods. Authors reviewed recent literature on comprehensive worksite health promotion programs that have addressed some type of environmental/organizational intervention to increase fruit/vegetable consumption. Results. This review revealed that environmental/organizational initiatives rely on management commitment, supervisory support, and supportive organizational structures to sustain policy efforts over time. Program effectiveness is enhanced when they are based on social ecological approaches; include worker participation in program planning and implementation (e.g. employee advisory boards and peer-delivered interventions); address multiple (vs. single) risk factors for change; and integrate workers' broader social context (e.g. families, neighborhoods, etc.). Conclusions. Priorities for future worksite-based interventions include identifying and reducing barriers to organizational and environmental change, addressing social disparities in fruit and vegetable consumption, addressing social contextual factors driving behaviors, and building expanded networks of community partnerships. Future research is needed to identify key policy and program components that will yield meaningful increases in fruit and vegetable consumption; barriers/facilitators of organizational and environmental change within worksites; effective community-based participatory methods; and methods to disseminate cost-effective interventions for all worksites.

Worksites represent an untapped resource for reaching teens with tobacco control messages, given that 80% of teens have held at least one job by the time they graduate from high school. This paper presents formative research findings from a methods development study aimed at designing and testing a tobacco control intervention targeting working teens. Formative research included qualitative methods as well as quantitative data from a cross-sectional survey of teens employed in 10 participating grocery stores. Contrary to our a priori hypothesis, smoking rates among employed youth in this study were not higher than statewide averages and most of the teen workers were still in school, indicating that worksite interventions, at least in this setting, represent an alternative or adjunct to school-based programs, but do not necessarily capture a unique population. Employed teen tobacco use patterns and work characteristics that emerged from our formative research are presented in this paper, and may be useful in planning future worksite interventions for employed teens.

The role of fluctuating asymmetry as an indicator of fitness to females in mate choice remains controversial. Previous studies indicated that male medflies with symmetrical supra-fronto-orbital (SFO) bristles achieve relatively high mating success under laboratory conditions. Here we present data from field cage studies of wild collected medflies in Guatemala and Crete, which reveal the same association between fluctuating asymmetry in SFO bristle length and mating success as that seen in the laboratory. The experiments in Crete included males that were missing one or both of their bristles. A comparison of mating success between the three groups indicated that the mere presence of bristles did not exert a major influence. Analysis of attempted courtships suggests that the association between male mating success and FA in bristle length appears to be generated as a result of females being more likely to enter into courtships with symmetrical males, rather than through a rejection of asymmetrical males during or after it. This raises the possibility that the primary stimulus that makes a symmetrical male attractive is acting at too great a distance to depend on symmetry itself Alternatives might include superior pheromone emissions or the occupation of a prime location within the lek. (C) 2004 The Linnean Society of London,

OBJECTIVES:To describe the feasibility of implementing evaluation methods for a worksite tobacco control intervention for teens. Indicators of feasibility included employment stability, response rates to multiple surveys, and self reported 30 day smoking.DESIGN:Grocery stores that were part of a single chain were randomised to four intervention stores and five control stores as part of the SMART project, a phase II methods development study designed to reduce smoking among working adolescents.SUBJECTS:Data on smoking in the last 30 days and employment patterns were collected from working teens aged 15-18 years at seven data points over the 12 month intervention period using cross sectional surveys.RESULTS:Data on employment stability indicate that employee turnover rates averaged 21% over the seven administrations. Response rates for the seven surveys ranged from 43-77% and were slightly greater in the control stores than the interventions stores (71% v 59%, p = 0.06). Mean current smoking at the individual store level ranged from 9-32% and there was a negative correlation between smoking prevalence and response rate by survey and by store (-0.029, p = 0.03). Among smokers who completed at least two surveys, there were no significant differences between intervention and control store on changes in the frequency of smoking.CONCLUSIONS:Evaluating a tobacco control intervention in the grocery store setting requires multiple survey assessments to monitor changes in smoking among adolescents. Strategies are needed to maintain high response rates and increase the number of multiple responses from eligible teens.

Objective: To present feasibility data on SMART, the first teen worksite behavioural tobacco control intervention.Design: This phase II study was designed to estimate the efficacy and feasibility of a small scale, randomised, controlled intervention.Setting and subjects: This study, addressing youths aged 15-18 years, was implemented in four intervention and five control grocery stores that had an average of 44 eligible teens.Interventions: The tobacco use cessation and prevention interventions were based on social influences and peer leader models. Employee break rooms served as centres both for interactive activities including open houses, teen advisory boards, peer leader interviews, games and contests; and non-interactive interventions including bulletin boards and table tents with health messages and home mailings.Main process measures: Project staff collected process data on the extent of implementation of intervention activities, participation rates in activities, and contacts with peer leaders. On the final survey, teens reported on awareness of, participation in, and motivation for participating in project activities.Results: Indicators of feasibility were identified and discussed, including the number of activities implemented, teen participation, management support, cost, and barriers to and facilitators of implementation. During the 12 month intervention, a mean of 24.1 interactive activities and 55.3 non-interactive activities were implemented, and a mean 14.2% participation rate per activity per site was achieved. Eighty four per cent of teens reported being aware of SMART, and 39% reported participating in interactive and 67% in non-interactive activities.Conclusions: Teen smoking cessation rates in worksite programmes might be improved if they are conducted in companies where there is job stability and if teen programmes are part of worksite-wide tobacco control programmes that include both teens and adults.

There is an urgent need to develop and test health promotion strategies that both address health disparities and elucidate the full impact of social, cultural, economic, institutional, and political elements on people's lives. Qualitative research methods, such as life history interviewing, are well suited to exploring these factors. Qualitative methods are also helpful for preparing field staff to implement a social contextual approach to health promotion. This article reports results and application of findings of life history interviews conducted as part of intervention planning for the Harvard Cancer Prevention Program Project, "Cancer Prevention in Working-Class, Multi-Ethnic Populations". The salient themes that emerged from interviews with a multi-ethnic, purposive sample are centered on six construct domains: immigration and social status, social support, stress, food, physical activity, and occupational health. Insights gained from thematic analysis of the interviews were integrated throughout intervention and materials development processes.

Here we present the findings of a laboratory study in which male Mediterranean fruit flies (medflies), Ceratitis capitata, (Wiedemann) had one or both supra-fronto-orbital (SFO) bristles artificially removed, for comparison with unoperated controls. All the flies were weighed and had their wings measured. The time at which a male began pheromone-calling was correlated with its weight, lighter males beginning calling earlier, but there was no effect of weight on mating success. Mated males had significantly longer wings than unmated males although there was no correlation with wing width. Although males missing both bristles were rejected more by females than those with one or two bristles, the loss of a single bristle had no effect on female response. The presence of bristles was not essential for successful mating. This study does not support the idea of females visually assessing males on the basis of their bristle symmetry.

BACKGROUND:We report process data on the feasibility of delivering a clinical preventive nutrition intervention that was effective in increasing participants' consumption of fruits and vegetables. We also examine relationships between process variables and study outcomes.METHODS:We randomly assigned six practice sites in a managed care organization to a dietary intervention or control condition. We invited adults 18 years of age or older scheduled for routine health visits within the subsequent 2 months to participate. Of the 566 patients we contacted from the intervention sites, 230 (41%) enrolled. From the control sites, we contacted 617, and 274 (44%) enrolled. Intervention participants received a tailored letter providing feedback on their consumption of target foods together with recommendations for improvement, stage-matched nutrition education booklets, a diet-health endorsement from their primary care providers (PCPs), and two motivational counseling telephone calls. Of enrollees, 195 (85%) in the intervention group and 252 (92%) in the control group returned the final survey 3 months later.RESULTS:Seventy-one percent of both participants and PCPs reported that the PCPs had discussed the relationship between diet and health at their visit. Fifty-seven percent of participants and 62% of PCPs reported that they discussed the complete diet-health endorsement, which included: (1) acknowledgment of the relationship between diet and health and (2) tailored study recommendations. The inclusion of both parts of the diet-health endorsement, but not the length of time spent, appeared to correlate with healthful outcomes.CONCLUSIONS:These process data suggest that the brief PCP diet-health endorsement contributed to the intervention effect on fruits and vegetables.

BACKGROUND:We evaluated a multifaceted preventive nutrition intervention to improve dietary habits among adult primary care patients.METHODS:We randomized six group practices in a managed care organization. Participants completed baseline and 3-month follow-up surveys. The intervention comprised (1) mailed personalized dietary recommendations and educational booklets focusing on fruits and vegetables, red meat, and dairy foods, tailored to patients' baseline intake and stage of readiness to change eating behaviors; (2) verbal endorsement by the primary care provider of the benefits of these recommendations; and (3) two motivational counseling sessions with telephone counselors to set dietary goals.RESULTS:Among the 230 subjects in the intervention group and 274 in the control group, mean age was 54 years, 70% were female, and 91% were white and 7% African American. Eighty-nine percent of the participants completed the follow-up survey. We measured change in intake of foods using results from the baseline and follow-up food frequency questionnaires. Using an intention-to-treat analysis and adjusting for age, sex, race, and baseline intake, the change in fruit and vegetable intake in the intervention group was 0.6 (95% confidence interval 0.3, 0.8) servings/day higher than in the control group. There was no intervention effect on red meat and dairy products.CONCLUSIONS:Tailored clinical nutrition interventions that combine brief physician endorsement with practice supports may be effective in changing patients' eating behavior.

When work-site health promotion programs incorporate theories of community organization, it is likely that employee ownership and participation are enhanced. This article reports quantitative indicators of involvement of Employee Advisory Board (EAB) members in the Treatwell 5-a-Day work-site study and examines relationships between EAB member time spent on project activities and work-site size, with indicators of the extent of implementation and variables associated with behavior change and work-site support. The results reported here indicate that a greater number of EAB member hours spent on program activities was associated with a greater number of events implemented. Smaller work-site size was associated with greater employee awareness of the program and greater participation in project activities as reported on the employee survey. These results suggest that the number of hours employee representatives devote to project activities might be an important consideration in planning employee involvement in work-site health promotion programming.

Purpose. To report findings from Treatwell 5-a-Day process tracking. Design. Worksites were randomly assigned to a minimal intervention control, worksite-only condition, or worksite-plus-family condition. Setting. Twenty-two small community health centers in Massachusetts. Subjects. Employees of the community health centers. Intervention. Both intervention conditions included the formation of employee advisory boards; activities such as nutrition discussions and taste tests targeting individual behavior change; and point-of-purchase labeling as an environmental strategy. Worksite-plus-family sites incorporated activities such as family contests, campaigns, and picnics. Measures. Documentation of the number and type of activities for extent of implementation; number of participants in activities for reach; program awareness and participation from the follow-up employee survey (n = 1306, representing 76% [range, 56%–100%] of the sample); change in fruit and vegetable consumption from a comparison between the follow-up and baseline surveys (n = 1359, representing 87% [range, 75%–100%] of the sample). Results. A higher number of activities per employee was significantly correlated with greater program awareness (. 68; p = . 006) and greater change in fruit and vegetable consumption (.55; p = .04). Greater participation in activities was significantly correlated with greater awareness (.67; p = .007), higher participation (.61; p = .02), and increase in fruit and vegetable consumption. (.55; p = .04). Conclusions. These results provide quantitative indicators of a dose-response relationship between the number of intervention activities per employee and higher percentage of employee participation and observed increases in fruit and vegetable consumption.

OBJECTIVES: We report on the results of the Treatwell 5-a-Day study, a worksite intervention aimed at increasing consumption of fruits and vegetables. METHODS: Twenty-two worksites were randomly assigned to 3 groups: (1) a minimal intervention control group, (2) a worksite intervention, and (3) a worksite-plus-family intervention. The interventions used community-organizing strategies and were structured to target multiple levels of influence, following a socioecological model. Data were collected by self-administered employee surveys before and after the intervention; the response rate was 87% (n = 1359) at baseline and 76% (n = 1306) at follow-up. A process tracking system was used to document intervention delivery. RESULTS: After control for worksite, gender, education, occupation, race/ethnicity, and living situation, total fruit and vegetable intake increased by 19% in the worksite-plus-family group, 7% in the worksite intervention group and 0% in the control group (P = .05). These changes reflect a one half serving increase among workers in the worksite-plus-family group compared with the control group (P = .018). CONCLUSIONS: The worksite-plus-family intervention was more successful in increasing fruit and vegetable consumption than was the worksite intervention. Worksite interventions involving family members appear to be a promising strategy for influencing workers' dietary habits.

This paper reports a pilot test of the feasibility of implementing an extension of the Expanded Food and Nutrition Education Program (EFNEP) home-based nutrition education intervention in order to maximize involvement of participants' naturally occurring social networks and to target cancer prevention eating patterns. Community residents served as hostesses of a two-session "Nutrition Home Party" and invited at least six family members/friends to attend the sessions, which were held in their homes. Paraprofessionals indigenous to the community facilitated the sessions. Nutrition education sessions were based on the Food Guide Pyramid and the Nutrition Facts label, with emphasis placed on encouraging participants to consume at least five servings of fruits and vegetables a day to reduce their risk of cancer. Preliminary experience with a home-based intervention model indicates that there is considerable potential for working through existing social networks to reach low-income populations.

Although there has been increasing attention to cancer prevention among low-income and minority populations, only a few nutrition interventions have addressed the special needs of people with low literacy skills. To determine the best provider and the most effective format for a nutrition intervention targeting patients with low Literacy skills, we conducted interviews with literacy experts and health care providers and focus groups with members of adult basic education classes. Thirty-five literacy experts and health-center-based physicians, nurses, and nutritionists in Boston, Mass, were interviewed. In addition, 50 volunteer clients from 4 Boston-based adult basic education programs participated in 6 focus groups. Results suggested that health care providers consider nutrition to be a fundamental health education topic, but that its successful inculcation in patients with limited literacy skills is hindered mostly by insufficient provider time. Almost all providers agreed that patients need to be referred to nutritionists for nutrition education. Although most providers and patients acknowledged that patients perceive physicians to be the authorities on health, patients with low literacy skills turned first to family members and friends for health information. These results suggest that effective nutrition interventions must build on patients' social networks; appear in a visually based, interactive format; and be culturally appropriate.