1. 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

2. 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

3. 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

4. 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. 0 1 2 3 4 5 6 7 8 9 10+

5. 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

6. 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

7. Algorithm for Stages of Change Thompson, Byers, Kohlmeir. J Nutr. 124(11S), 2306-2308

8. Physical Activity On average, how many times per week do you exercise? 012345 or more On average, how many minutes per session do you exercise? 0-910-1920-29 30-3940-4950 or more

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

10. Demographics (2) Age/Age Group –Mean age 46 –60% 35-50 –30% 51-64 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+

11. Self-reported Fruit and Vegetable Consumption and Belief About Amount Needed for Good Health 11 37 52 0-23-45+ Servings FV Needed for Good Health 0 10 20 30 40 50 60 Percent of Workers California Dept. of Health Services, 2000

12. Self-reported consumption of fruits and vegetables, by age group 3.1 4.1 3.1 Total Age 25-34 Age 35-50 Age 51-64 0 0.5 1 1.5 2 2.5 3 3.5 4 4.5 5 5.5 Mean servings of fruits and vegetables ** **p <.01 California Dept. of Health Services, 2000

13. Stages of Change 11 2 68 3 15 Precontemplation Contemplation Preparation Action Maintenance Stage of Change 0 10 20 30 40 50 60 70 80 90 100 Percent of Workers California Dept. of Health Services, 2000

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

15. Belief Was Highly Related to Stage of Change

16. Physical Activity “Adequate” - 8% “Inadequate - 92% AdequateInadequate Age 25-34-20% ** 80% Age 35-50- 7%93% Age 51-64- 7%93% **p <.01

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

18. 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

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

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

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

22. 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

23. 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

24. 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

25. 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

26. Sharon B. Sugerman Public Health Institute PO Box 942732, MS-662 Sacramento, CA 94234-7320 916-324-3059 (phone) 916-322-1532 (fax) ssugerma@dhs.ca.gov