Worksite nutrition and physical activity: assessing readiness for change among employees of a large manufacturing facility Sharon Sugerman, MS, RD, FADA, Public Health Institute Cancer Prevention & Nutrition Section October 23, 2001

Worksite - key channel for health promotion for adults On workdays, spend more non-sleeping hours at work than at any other single place Eat 1-2 meals/day in or near the worksite environment Co-worker relationships reinforce social norms

Opportunities Afforded Exposure to worksite environment Provide a baseline –fruit/vegetable consumption –fruit/vegetable attitudes, beliefs/barriers –physical activity Assess fruit/vegetable stage of change Provide direction for possible future intervention

The Survey (Q1) On average, how many servings of fruits and vegetables do you eat each day? That’s a combined total of both fruits and vegetables

The Survey (Q2) About how long have you been eating this number of fruits and vegetables? –Less than 1 month –1-3 months –4-6 months –Longer than 6 months

Intake and Stages of Change (Q3 and Q4) Are you seriously thinking about eating more servings of fruits and vegetables starting sometime in the next six months? YesNo Are you planning to eat more servings of fruits and vegetables during the next month? YesNo

Algorithm for Stages of Change Thompson, Byers, Kohlmeir. J Nutr. 124(11S),

Physical Activity On average, how many times per week do you exercise? or more On average, how many minutes per session do you exercise? or more

Demographics (1) N = 733 (15% of workers) Race/ethnicity –43%White –23%African-American –16%Asian/Pacific Islander –15%Hispanic – 3%Other

Demographics (2) Age/Age Group –Mean age 46 –60% –30% Income Group –18% < $50K –50% $50K-$65K –31% $65K+ Gender –34% Female –66% Male Education Group –26% High school or less –41% Some college –33% 4-year degree+

Self-reported Fruit and Vegetable Consumption and Belief About Amount Needed for Good Health Servings FV Needed for Good Health Percent of Workers California Dept. of Health Services, 2000

Self-reported consumption of fruits and vegetables, by age group Total Age Age Age Mean servings of fruits and vegetables ** **p <.01 California Dept. of Health Services, 2000

Stages of Change Precontemplation Contemplation Preparation Action Maintenance Stage of Change Percent of Workers California Dept. of Health Services, 2000

Belief in Number of Servings Needed Was Associated with Increased Consumption of Fruits and Vegetables

Belief Was Highly Related to Stage of Change

Physical Activity “Adequate” - 8% “Inadequate - 92% AdequateInadequate Age % ** 80% Age %93% Age %93% **p <.01

Relationship Between Adequate Exercise and Fruit/Vegetable Consumption ***p <.001 California Dept. of Health Services, 2000 ***

Most Significant Factors Related to Total Fruit and Vegetable Consumption After controlling for demographics, two factors contributed unique components in terms of predicting the dependent variable –Belief in number of servings for good health –Adequate vs. inadequate exerciser The model accounts for 31.1% of the variance in fruit/vegetable intake

Leading Reasons for Not Eating More Fruits and Vegetables California Dept. of Health Services, 2000

Leading Reasons for Not Eating More Fruits and Vegetables by Amount Reported *** ***p <.001 California Dept. of Health Services, 2000

Preferred source for health information Electronic and Print Media30% Doctor’s office30% At work20% Grocery store10%

Using Stages of Change for Dietary Intervention: Preparation Key strategies –Resolve ambivalence –Develop firm commitment and specific action plan Treatment “do’s” –Encourage clients to set specific, achievable goals –Reinforce small changes client may have already achieved Adapted from Kristal et al. JADA; 99 (6); 684

Using Stages of Change for Dietary Intervention: Preparation Treatment “don’ts” –Not using this as a time to recommend general behavior change, i.e. “eat more fruits and vegetables” –Not downgrading small changes that have already been made Adapted from Kristal et al. JADA; 99 (6); 684

5 a Day Worksite Campaign: Next Steps (1) Formative research Literature search –successful programs –gaps –barriers –potential partners Roundtables & key informant interviews with gatekeepers/employers of large numbers of low and middle-income employees

5 a Day Worksite Campaign: Next Steps (2) Developmental Research Funding an individualized, on-line screening, assessment and delivery of tailored messages for increasing F/V and decreasing fat intake in worksite setting

Sharon B. Sugerman Public Health Institute PO Box , MS-662 Sacramento, CA (phone) (fax)