Tailored Worksite Weight Control Programs

描述(由申请人提供)：鉴于超重和肥胖的流行，基于工作场所的健康促进计划因其潜在的覆盖范围和社会支持影响而被推荐。在工作场所的背景下，许多预防和治疗肥胖症的战略都侧重于面对面或向小组提供以获取知识为目标的教育计划，以及针对个人的战略，以改善饮食和活动实践。这些计划一直受到批评，因为它们通常惠及一小部分工人--而且很少有那些可能受益最大、持续时间较短、影响较小的临时计划。它们通常也是在拥有最多资源的大型工作场所进行的。这些项目缺乏成功的原因可能是：1)干预力度不够，2)实施挑战，3)缺乏作为干预发展基础的理论模型。为了克服之前研究的局限性，我们将进行三组随机对照试验，以确定广泛干预的覆盖范围和有效性：a)基于可靠的理论，b)主要通过可扩展的互动技术提供，c)利用工作场所的组织和环境背景。与健康风险评估和压力管理控制(HRA)相比，我们将测试社会生态理论的效用，即基于个人目标的互联网干预和货币激励，以减轻超重和肥胖员工的体重(INCENT)。INCENT的参与者将收到频繁的电子邮件支持，帮助制定目标，定期评估体重，并基于为期12个月的计划中每个季度末原始体重下降的百分比进行激励。电子邮件支持的目标是改善与减肥或保持健康体重相关的自我效能感和结果预期。此外，电子邮件支持将促进参与者解决问题，并在家里、社区和工作地点确定健康饮食和体育活动的资源。考虑到减肥计划后的再犯罪率有很好的记录，第二项研究的目标是确定在最初12个月的干预后提供的体重维持干预的有效性。体重保持干预措施将针对定期的体力活动、健康的食物选择，以及确定当地资源来支持保持健康的体重。它将通过自动交互语音应答(IVR)电话咨询提供，基于社会生态学理论，并支持减肥(即，对于那些体重指数不到25的人)或体重保持(即，对于那些BMI=25的人)。在3组工作地点群随机设计中，48个具有不同种族(即20%拉丁裔)和经济多样性的中小型工作地点将随机接受HRA(n=1Q工作地点)、INCENT(n=19个工作地点)或INCENT+IVR(n=19个工作地点)。

DESCRIPTION (provided by applicant): Given the prevalence of overweight and obesity, worksite-based health promotion programs have been recommended due to their potential reach and social support impact. Within worksite contexts, many strategies to prevent and treat obesity have focused on educational programs delivered in person or to small groups that target knowledge acquisition, and strategies targeted at individuals to improve dietary and activity practices. These programs have been criticized because they typically reach a small percentage of workers-and seldom those that could benefit most, are of short duration, and have small, temporary effects. They have also typically been conducted in large worksites that have the greatest resources. The lack of success of these programs may be due to: 1) inadequate intervention intensity, 2) implementation challenges, and 3) a lack of theoretical models as the bases for intervention development. To overcome the limitations of previous research we will conduct a 3 group RCT to determine the reach and effectiveness of an extensive intervention that: a) is based upon sound theory, b) is delivered primarily through scalable interactive technologies, and c) leverages the organizational and environmental context of the workplace. We will test the utility of a social ecological theory, individually-targeted internet-based intervention with monetary incentives to reduce the weight of overweight and obese employees (INCENT) when compared to a health risk appraisal and stress management control (HRA). Participants in INCENT will receive frequent e-mail supports that facilitate goal setting, regular assessments of body weight, and incentives based on percent of original body weight lost at the end of each quarter over the 12-month program. The e-mail supports will target improving perceptions of self-efficacy and outcome expectations related to weight loss or maintaining a healthy weight in addition e-mail support will facilitate participant problem solving and identification of resources for healthful eating and physical activity at home, in their neighborhoods, and at their worksite. Given the well-documented rate of recidivism following weight loss programs, a secondary study aim, is to determine the effectiveness of a weight maintenance intervention delivered after the original 12-months of intervention. The weight maintenance intervention will target regular physical activity, healthful food choices, and identification of local resources to support maintaining a healthful weight. It will be delivered via automated interactive voice response (IVR) telephone counseling, based on social ecological theory and support weight loss (i.e., for those who are not yet < BMI of 25) or weight maintenance (i.e., for those with a BMI <=25). In a 3 group worksite cluster randomized design, 48 small to medium sized worksites, with a heterogeneous ethnic (i.e., >20 percent Latino) and economic diversity will be randomized to receive HRA (n=1Q worksites), INCENT (n=19 worksites), or INCENT+IVR (n=19 worksites).