Cancer Causes & Control

, Volume 13, Issue 6, pp 493–502 | Cite as

A comprehensive worksite cancer prevention intervention: behavior change results from a randomized controlled trial (United States)

  • Glorian Sorensen
  • Anne M Stoddard
  • Anthony D. LaMontagne
  • Karen Emmons
  • Mary Kay Hunt
  • Richard Youngstrom
  • Deborah McLellan
  • David C Christiani
Article

Abstract

Objective: Workplace cancer prevention initiatives have been least successful with blue-collar workers. This study assesses whether an intervention integrating health promotion with occupational health and safety results in significant and meaningful increases in smoking cessation and consumption of fruits and vegetables, compared to a standard health promotion intervention, for workers overall and for blue-collar workers in particular. Methods: A randomized controlled design was used, with 15 manufacturing worksites assigned to a health promotion (HP) or a health promotion plus occupational health and safety intervention (HP/OHS), and compared from baseline (1997) to final (1999). The response rates to the survey were 80% at baseline (n = 9019) and 65% at final (n = 7327). Both groups targeted smoking and diet; the HP/OHS condition additionally incorporated reduction of occupational exposures. Results: Smoking quit rates among blue-collar workers in the HP/OHS condition more than doubled relative to those in the HP condition (OR = 2.13, p = 0.04), and were comparable to quit rates of white-collar workers. No statistically significant differences between groups were found for mean changes in fruits and vegetables. Conclusions: Integration of occupational health and safety and health promotion may be an essential means of enhancing the effectiveness of worksite tobacco control initiatives with blue-collar workers.

nutrition occupational health tobacco control worksites 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Colditz G, Atwood K, Emmons K, Willett W, Trichopoulos D, Hunter DJ (2000) Harvard report on cancer prevention: Harvard cancer risk index, volume 4. Cancer Causes and Control 11: 477-488.Google Scholar
  2. 2.
    Giovino G, Pederson L, Trosclair A (2000) The prevalence of selected cigarette smoking behaviors by occupation in the United States. Presented at Work, Smoking and Health: A NIOSH Scientific Workshop, Washington, DC.Google Scholar
  3. 3.
    Nelson DE, Emont SL, Brackbill RM, Cameron LL, Peddicord J, Fiore MC (1994) Cigarette smoking prevalence by occupation in the United States. J Occup Environ Med 36: 516-525.Google Scholar
  4. 4.
    Kristal AR, Glanz K, Tilley BC, Li S (2000) Mediating factors in dietary change: understanding the impact of a worksite nutrition intervention. Health Educ Behav 27: 112-125.Google Scholar
  5. 5.
    Abrams D (1991) Conceptual models to integrate individual and public health interventions: the example of the workplace. In: M. Henderson, ed. Proceedings of the International Conference on Promoting Dietary Change in Communities. Seattle, WA: Fred Hutchinson Cancer Research Center, pp. 173-194.Google Scholar
  6. 6.
    Abrams DB, Emmons KM, Linnan L, Biener L (1994) Smoking cessation at the workplace: conceptual and practical considerations. In: R. Richmond, ed. Intervention for Smokers: An International Perspective. New York: Williams & Wilkins, pp. 137-169.Google Scholar
  7. 7.
    Fielding J (1984) Health promotion and disease prevention at the worksite. Annu Rev Public Health 5: 237-265.Google Scholar
  8. 8.
    Heimendinger J, Thompson B, Ockene L, et al. (1990) Reducing the risk of cancer through worksite intervention. In: Occupational Medicine: State of the Art Reviews. Philadelphia, PA: Henley & Belfus, pp. 707-723.Google Scholar
  9. 9.
    Tilley BC, Vernon SW, Myers R, et al. (1999) The Next Step Trial: impact of a worksite colorectal cancer screening promotion program. Prev Med 28: 276-283.Google Scholar
  10. 10.
    Sorensen G, Emmons K, Hunt MK, Johnston D (1998) Implications of the results of community intervention trials. Annu Rev Public Health 19: 379-416.Google Scholar
  11. 11.
    Niknian M, Linnan LA, Lasater TM, Carleton RA (1991) Use of population-based data to assess risk factor profiles of blue-and white-collar workers. J Occup Med 33: 29-36.Google Scholar
  12. 12.
    Grosch J, Alterman T, Petersen M, Murphy L (1998) Worksite health promotion programs in the U.S.: factors associated with availability and participation. Am J Health Prom 13: 36-45.Google Scholar
  13. 13.
    Congress U (1970) Public Law 91-596: The Occupational Safety and Health Act of 1970.Google Scholar
  14. 14.
    Leigh JP, Markowitz SB, Fahs M, Shin C, Landrigan PJ (1997) Occupational injury and illness in the United States: estimates of costs, morbidity, and mortality. Arch Intern Med 157: 1557-1568.Google Scholar
  15. 15.
    NIOSH (1996) National Occupational Research Agenda. US Public Health Service, Centers for Disease Control: National Institute for Occupational Safety and Health. 500 G. Sorensen et al.Google Scholar
  16. 16.
    Walsh DW, Jennings SE, Mangione T, Merrigan DM (1991) Health promotion versus health protection? Employees' perceptions and concerns. J Public Health Policy 12: 148-164.Google Scholar
  17. 17.
    Robins T, Klitzman S (1988) Hazard communication in a large US manufacturing firm: the ecology of health education in the workplace. Health Educ Q 15: 451-472.Google Scholar
  18. 18.
    DeJoy D, Southern D (1993) An integrative perspective on worksite health promotion. J Med 35: 1221-1230.Google Scholar
  19. 19.
    Blewett V, Shawl A (1995) Health promotion, handle with care: issues for health promotion in the workplace. J Occup Health Safety 11: 461-465.Google Scholar
  20. 20.
    Baker E, Israel B, Schurman S (1996) The integrated model: implications for worksite health promotion and occupational health and safety practice. Health Educ Q 23: 175-188.Google Scholar
  21. 21.
    Sorensen G, Himmelstein JS, Hunt MK, et al. (1995) A model for worksite cancer prevention: integration of health protection and health promotion in the WellWorks project. Am J Health Prom 10: 55-62.Google Scholar
  22. 22.
    Chu C, Driscoll T, Dwyer S (1997) The health-promoting workplace: an integrative perspective. Austral NZ J Public Health 21: 377-385.Google Scholar
  23. 23.
    Sorensen G, Stoddard A, Hunt MK (1998) Behavior change in a worksite cancer prevention intervention: the WellWorks Study. Am J Public Health 88: 1685-1690.Google Scholar
  24. 24.
    Marcus AC, Baker DB, Froines J (1986) The ICWU cancer control and evaluation program: research design and needs assessment. J Occup Med 28: 226-236.Google Scholar
  25. 25.
    Schenck A, Thomas R, Hochbaum G, Beliczky L (1987) A labor and industry focus on education: using baseline survey data in program design. Health Educ Res 2: 33-44.Google Scholar
  26. 26.
    Roter DL Rudd RE, Keogh J, Robinson B (1986) Worker produced health education material for the construction trades. Int Q Commun Health Educ 7: 109-117.Google Scholar
  27. 27.
    Maes S, Verhoeven C, Kittel F, Scholten H (1998) Effects of a Dutch worksite wellness-health program: the Brabantia project. Am J Public Health 88: 1037-1041.Google Scholar
  28. 28.
    Bradbury JA (1989) The policy implications of differing concepts of risk. Sci Technol Human Values 14: 381-396.Google Scholar
  29. 29.
    Baker F (1990) Risk communication about environmental hazards. J Public Health Policy 11: 341-359.Google Scholar
  30. 30.
    Fischoff B, Bostrom A, Quadrel MJ (1993) Risk perception and communication. Annu Rev Health 14: 183-200.Google Scholar
  31. 31.
    NIOSH (1979) Adverse Effects of smoking and the Occupational Environment. Bethesda, MD: US Department of Health and Human Services.Google Scholar
  32. 32.
    Lantz PM, House JS, Lepkowski JM, Williams DR, Mero RP, Chen J (1998) Socioeconomic factors, health behaviors, and mortality: results from a nationally representative prospective study of US adults. JAMA 279: 1703-1708.Google Scholar
  33. 33.
    Vernon SW (1997) Participation in colorectal cancer screening: a review. J Natl Cancer Inst 89: 1406-1422.Google Scholar
  34. 34.
    Lee IM, Paffenbarger RS, Hsieh C (1991) Physical activity and risk of developing colorectal cancer among college alumni. J Natl Cancer Inst 83: 1324-1329.Google Scholar
  35. 35.
    Weller DP, Owen N, Hiller JE, Wilson K, Wilson D (1995) Colorectal cancer and its prevention: prevalence of beliefs, attitudes, intentions and behaviour. Austral J Public Health 19: 9-23.Google Scholar
  36. 36.
    Sorensen G, Stoddard A, Hammond SK, Hebert JR, Ocklene JK (1996) Double jeopardy: job and personal risks for craftspersons and laborers. Am J Health Prom 10: 355-363.Google Scholar
  37. 37.
    Green KL (1988) Issues of control and responsibility in worker's health. Health Educ Q 15: 473-486.Google Scholar
  38. 38.
    Rothman J (1970) Three models of community organization practice. In: Cox F, Erlich JL, Rothman J, eds. Strategies of Community Organization. Itasca, IL: Peacock, pp. 86-162.Google Scholar
  39. 39.
    Rothman J, Tropman JE (1987) Models of Community Organization and Macro Practice. Itasca, I.L.: Peacock.Google Scholar
  40. 40.
    Hancock L, Sanson-Fisher R, Redman S, et al. (1997) Community action for health promotion: a review of methods and outcomes 1990-1995. Am J Prev Med 13: 229-239.Google Scholar
  41. 41.
    Minkler M, Wallerstein N (1997) Improving health through community organization and community building. In: Glanz K, Lewis FM, Rimer BK, eds. Health Behavior and Health Education: Theory, Research, and Practice. San Francisco, CA: Jossey-Bass, pp. 241-289.Google Scholar
  42. 42.
    Bronfenbrenner U (1979) The Ecology of Human Development. Cambridge, MA: Harvard University Press.Google Scholar
  43. 43.
    McLeroy K, Bibeau D, Steckler A, Glanz K (1988) An ecological perspective on health promotion programs. Health Educ Q 15: 351-377.Google Scholar
  44. 44.
    Stokols D, Allen J, Bellingham RL (1996) The social ecology of health promotion: implications for research and practice. Am J Health Prom 10: 247-251.Google Scholar
  45. 45.
    Green LW, Richard L, Potrin L (1996) Ecological foundations of health promotion. Am J Health Prom 10: 270-281.Google Scholar
  46. 46.
    Sorensen G, Hunt MK, Emmons K, McLellan D (2001) A worksite intervention cancer prevention model for blue-collar workers: process tracking results. (In preparation).Google Scholar
  47. 47.
    Office of Technology Assessment (1985) Preventing Illness and Injury in the Workplace. Washington, DC: Office of Technology Assessment, Congressional Board of the 99th Congress, US Government Printing Office.Google Scholar
  48. 48.
    Bandura A (1986) Social Foundations of Thought and Action: a social cognitive theory. Englewood Cliffs, NJ: Prentice Hall.Google Scholar
  49. 49.
    Glanz K, Patterson RE, Kristal AR, et al. (1994) Stages of change in adopting healthy diets: fat, fiber, and correlates of nutrient intake. Health Educ Q 21: 499-519.Google Scholar
  50. 50.
    Prochaska JO, DiClemente CC (1983) Stages and processes of selfchange of smoking: toward an integrative model of change. J Consult Clin Psychol 51: 390-395.Google Scholar
  51. 51.
    Subar AS, Heimdinger J, Krebs-Smith SM, Patterson BH, Kessler R, Pivonka E (1995) Fruit and vegetable intake in the United States: the baseline survey of the Five a Day for Better Health Program. Am J Health Prom 9: 352-360.Google Scholar
  52. 52.
    Serdula MK, Coates RJ, Byers T, et al. (1995) Fruit and vegetable intake among adults in 16 states: results of a brief telephone survey. Am J Public Health 85: 236-239.Google Scholar
  53. 53.
    Krebs Smith SM, Cook A, Subar AF, Cleveland L, Friday J (1995) US adults' fruit and vegetable intakes, 1989 to 1991: a revised baseline for the Healthy People 2000 objective. Am J Public Health 85: 1623-1629.Google Scholar
  54. 54.
    Serdula M, Coates R, Byers T, et al. (1993) Evaluation of a brief telephone questionnaire to estimate fruit and vegetable consumption in diverse study populations. Epidemiology 4: 455-463.Google Scholar
  55. 55.
    Murray DM (1998) Design and Analysis of Group Randomized Trials. New York: Oxford University Press.Google Scholar
  56. 56.
    Wolfinger R, O'Connel lM(1993) Generalized linear models: a pseudo-likelihood approach. J Stat Comput Simul 48: 233-243.Google Scholar
  57. 57.
    SAS Institute Inc. (1999-2000) SAS For Windows, Release 8.01. Cary, NC: SAS Institute Inc. Worksite cancer prevention 501Google Scholar
  58. 58.
    Conrad P (1987) Wellness in the work place: potentials and pitfalls of work-site health promotion. Milbank Q 65: 255-275.Google Scholar
  59. 59.
    Gebhardt DL, Crump C (1990) Employee fitness and wellness programs in the workplace. Am Psychol 45: 262-272.Google Scholar
  60. 60.
    Glasgow RE, Mullooly JP, Vogt TM, et al. (1993) Biochemical validation of smoking status: pros, cons, and data from four lowintensity intervention trials. Addict Behav 18: 511-527.Google Scholar
  61. 61.
    Erfurt J (1995) The Wellness Outreach at Work Program: a step-by-step guide. Washington, DC: National Institutes of Health.Google Scholar
  62. 62.
    Morris W, Conrad K, Marcantonio R, Marks B, Ribisl K (1999) Do blue-collar workers perceive the worksite health climate differently than white-collar workers? J Health Prom 13: 319-324.Google Scholar
  63. 63.
    Abrams DB, Boutwell WB, Grizzle J, Heimendinger J, Sorensen G, Varnes J (1994) Cancer control at the workplace: the Working Well Trial. Prevent Med 23: 1-13.Google Scholar
  64. 64.
    Sorensen G, Thompson B, Glanz K, et al. (1996) Worksite-based cancer prevention: Primary results from the Working Well Trial Am J Public Health 86: 939-947.Google Scholar
  65. 65.
    NIOSH (2000) Smoking cessation at the worksite: what works and what is the role of occupational health? Prepared for the National Institute for Occupational Safety and Health, Centers for Disease Control, Workshop on Work, Smoking, and Health, 15-16 June 2000, Washington, DC.Google Scholar
  66. 66.
    Velicer WF, Fava JL, Prochaska JO, Abrams DB, Emmons KM, Pierce JP (1995) Distribution of smokers in three representative samples. Prevent Med 24: 401-411.Google Scholar

Copyright information

© Kluwer Academic Publishers 2002

Authors and Affiliations

  • Glorian Sorensen
    • 1
    • 2
  • Anne M Stoddard
    • 3
  • Anthony D. LaMontagne
    • 4
    • 5
  • Karen Emmons
    • 4
    • 2
  • Mary Kay Hunt
    • 4
  • Richard Youngstrom
    • 4
  • Deborah McLellan
    • 4
  • David C Christiani
    • 2
  1. 1.Center for Community-Based ResearchDana-Farber Cancer InstituteBostonUSA
  2. 2.Australia
  3. 3.University of Massachusetts at AmherstAustralia
  4. 4.Center for Community-Based ResearchDana-Farber Cancer InstituteBostonUSA
  5. 5.Monash Medical SchoolPrahranAustralia

Personalised recommendations