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由于其潜在的影响范围和社会支持影响而被推荐。在工作场所环境中，许多预防和治疗肥胖的策略都集中在亲自或向小团体提供的针对知识获取的教育计划，以及针对个人改善饮食和活动实践的策略。这些计划一直受到批评，因为它们通常只惠及一小部分工人，而很少惠及那些受益最大的工人，而且持续时间短，效果小，暂时的。它们通常也在拥有最多资源的大型工地进行。这些方案不成功的原因可能是：1）干预强度不足，2）实施挑战，3）缺乏理论模型作为干预发展的基础。为了克服之前研究的局限性，我们将进行3组随机对照试验，以确定广泛干预的范围和有效性，这些干预措施：a）基于可靠的理论，B）主要通过可扩展的交互技术提供，以及c）利用工作场所的组织和环境背景。我们将测试社会生态理论的效用，与健康风险评估和压力管理控制（HRA）相比，以金钱激励为基础的个性化针对性互联网干预，以减轻超重和肥胖员工的体重（INCENT）。INCENT的参与者将经常收到电子邮件支持，以促进目标设定，定期评估体重，并根据12个月计划中每个季度末的原始体重下降百分比进行奖励。电子邮件支持的目标将是提高自我效能感和与减肥或保持健康体重相关的结果预期，此外，电子邮件支持将促进参与者解决问题，并确定在家中、社区和工作场所进行健康饮食和体育活动的资源。鉴于减肥计划后的累犯率有据可查，次要研究目的是确定在最初的12个月干预后提供的体重维持干预的有效性。体重维持干预将针对定期的身体活动，健康的食物选择，并确定当地资源，以支持维持健康的体重。它将通过自动交互式语音应答（IVR）电话咨询提供，基于社会生态理论和支持减肥（即，对于那些尚未< BMI 25的人）或体重维持（即，对于BMI <=25的人）。在3组工作地点集群随机设计中，48个中小型工作地点，具有异质种族（即，> 20%拉丁裔）和经济多样性将被随机分配到HRA（n= 10个工作地点），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).