Email-Based Diet & Activity Promotion in Worksites

描述（由申请人提供）：美国每年约有40万人死于不良饮食和缺乏身体活动。尽管有充分的证据表明，定期的身体活动和高水果和蔬菜以及低脂肪的饮食对健康有益，但这些行为的流行率在整个人口中仍然相对较低，在少数民族和社会经济弱势群体中甚至更低。本提案的总体目的是评估在工作场所环境中通过电子邮件提供的具有成本效益的4个月计算机化饮食和体力活动干预计划的有效性。该干预计划将建立在现有原型的基础上，该原型在为期12周的试点研究中显示了技术可行性和潜在的科学价值。在目前研究的第一阶段，我们将在内容和技术能力方面进一步发展这一原型。具体来说，我们将增加身体活动部分（旨在增加步行和减少久坐行为），并将进一步根据参与者的变化准备阶段，自我效能和生活方式特征定制信息。我们还将增强交互功能，例如模拟饮食或体育活动特定变化的整体影响的工具。在研究的第二阶段，我们将在北方加州Kaiser Permanente（KP）的员工中进行干预计划的双臂随机试验。将邀请来自20个区域KP部门的约2，000名员工参加试验，方法是KP领导人发送电子邮件描述研究，然后研究工作人员发送电子邮件，其中包含基线评估、说明和知情同意书。有兴趣参与的员工将通过电子邮件直接将表格返回给研究工作人员。员工将被随机分配，大致相等的数量，部门作为随机化的单位，干预组，谁将接受完整的干预计划，或等待名单控制组，谁将接受标准的饮食和体育活动的建议和信息。对照组可以选择在研究期结束时接受干预。为了确定短期效果和长期效果的可持续性，两组都将在试验开始时、4个月干预后以及基线后8个月完成饮食和体力活动评估以及其他问卷（自我效能、社会支持、健康相关生活质量和人口统计学特征）。除了身体活动和饮食行为外，研究结果还包括与健康相关的生活质量、缺勤率和医疗保健利用率。对干预组和对照组之间差异的主要分析将基于“意向治疗”，并将解释群集随机化设计。这种以电子邮件为基础的干预措施，如果证明是成功的，可以广泛和具有成本效益的传播，从而大大有助于实现2010年健康人的饮食和身体活动目标。

DESCRIPTION (provided by applicant): Approximately 400,000 deaths in the United States each year are attributable to poor diet and physical inactivity. Despite the well-documented health benefits of regular physical activity and diets high in fruits and vegetables and low in fat, the prevalence of these behaviors remains relatively low in the population as a whole, and even lower in minority and socioeconomically disadvantaged subgroups. The overall purpose of this proposal is to evaluate the efficacy of a cost-effective, 4-month computerized diet and physical activity intervention program, delivered by e-mail, within the worksite environment. The intervention program will be built on an existing prototype that showed both technical feasibility and potential scientific merit in a 12-week pilot study. In the first stage of the current study, we will develop that prototype further both in terms of content and technical capabilities. Specifically, we will add a physical activity component (designed to increase walking and decrease sedentary behavior), and will further tailor messages to participants' stage of readiness for change, self efficacy and lifestyle characteristics. We will also enhance the interactive features, such as a tool that simulates the overall effects of a specific change in diet or physical activity. In the second stage of the study, we will conduct a 2-arm randomized trial of the intervention program in employees of Northern California Kaiser Permanente (KP). Approximately 2,000 employees from 20 regional KP departments will be invited to participate in the trial through an e-mail from KP leaadership that describes the study, followed by an e-mail from the study staff containing baseline assessments, instructions, and informed consent. Employees who are interested in participating will return the forms by e-mail directly to study staff. Employees will be randomly assigned, in roughly equal numbers, with the department as the unit of randomization, to the intervention group, who will receive the full intervention program, or the wait-list control group, who will receive standard diet and physical activity recommendations and information. The control group may choose to receive the intervention at the end of the study period. To determine both shortterm effects and longer-term sustainability of effects, both groups will complete dietary and physical activity assessments and other questionnaires (self efficacy, social support, health-related quality of life, and demographic characteristics) at the beginning of the trial, after the 4-month intervention, and then again 8 months from baseline. In addition to physical activity and dietary behaviors, study outcomes will include health-related quality of life, absenteeism, and health care utilization. Primary analyses of differences between the intervention and control groups will be based on "intent to treat," and will account for the cluster randomization design. This e-mail-based intervention, if proven successful, could be widely and cost-effectively disseminated and, thereby contribute significantly to achieving the dietary and physical activity goals for Healthy People 2010.