Eat 5 for Life Study

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Eat 5 for Life Study

• Shirley A.A. Beresford, PhD
• Sonia J. Bishop
• Yutaka Yasui, PhD
• Dale McLerran
• Jessica A. MacIntyre
• Beti Thompson, PhD
• University of Washington
• Fred Hutchinson Cancer Research Center
• University of Alberta

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Background and Rationale

• Information on long term behavior change is
  sparse
• Few studies have examined long term maintenance
• Worksites are an ideal environment to promote
  dietary change
• they function as small communities
• members can encourage and support increased fruit
  and vegetable consumption as a means of improving
  ones health

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Gaps in knowledge

• Few studies have examined long term maintenance
• Even fewer have proposed well-developed
  theoretical frameworks to explain the maintenance
  of behavior change.
• Theories that include both societal and
  individual components reasonable
  explanations of how behavior can be maintained
  over time

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Theoretical framework
SocialNorms
Awareness Building Maintenance
Resource Availability
WorksiteSocialEnvironment
ParticipatoryStrategies (EAB)
OrganizationalLevel
Regular Cues for Behavior Change
Self-Assessment Feedback
Skill-Building
IndividualLevel
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Eat 5 for Life Research Question

• Will worksites receiving a 5 a Day maintenance
  intervention sustain a greater proportion of the
  initial change in FV consumption than the sites
  in the control group?

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Study Design

• Independent cross-sectional samples
• Seattle 5 a Day randomized 45 worksites (in
  pairs)
• 28 of these agreed were randomized to Eat 5 for
  Life

PRS
PRS
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Description of worksites

• Group I and II only
• 14 Manufacturing
• 4 Transportation
• 9 Service
• 1 Other

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Assessment tools

• Employee surveys
• 7-question FFQ of FV
• Single question of FV
• Stage of readiness to eat more FV
• Key informant interviews
• Blood markers of FV (carotenoids)
• 24-hour recall
• Process evaluation measures

FV Fruits and Vegetables
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Interim Research Questions

• What are the time trends in the 5 a Day
  intervention and comparison groups?
• Did the initial 5 a Day intervention sustain
  change at about 5 years follow-up
• in self-reported vegetable fruit intake?
• in proportion in action or maintenance stage of
  readiness for change?
• What worksite factors are associated with a
  larger intervention effect at 4.5 years?

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Worksite Mean Fruit and Vegetable Intake (single
question)
95 confidence intervals
Seattle 5 a Day
Seattle 5 a Day
Eat 5 for Life ?
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Worksite Proportion in Action or Maintenance
95 confidence intervals
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Analyses

• Adjusted for design effects
• Worksite random effects
• Additional adjustment for seasonal effects and
  gender did not change results
• Used log transformed values

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Long term change in Fruit and Vegetable Intake
(single question)
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Long term change in stage of readiness
(proportion in action or maintenance)
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Long term intervention effect by type of industry
(SIC code)
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Long term intervention effect by worksite average
stage of readiness
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Long term intervention effect by worksite average
stage of readiness
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Long term intervention effect by worksite average
degree of autonomy
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Conclusions

• For both Vegetable and Fruit Intake and Stage of
  Change
• Intervention group increased and then fell off a
  bit over time
• Comparison group crept up over time
• Significant difference at the worksite level
  attributable to the intervention at 4.5 years
• in fruit and vegetable intake
• in proportion in action or maintenance

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Conclusions (continued)

• No worksite factor examined was a significant
  predictor of increased long term intervention
  effect for
• Fruit and vegetable intake
• Stage of readiness for change
• Manufacturing or transportation worksites
  increased the proportion in maintenance or action
  with a significant long term intervention effect
• Worksites with below the median proportion in
  action or maintenance at baseline increased their
  proportion in action or maintenance with a
  significant long term intervention effect
• Worksites with below the median autonomy
  increased their fruit and vegetable intake with a
  significant long term intervention effect

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Acknowledgements

• Eat for Life is supported in part by R01 CA105835
• The project on which it builds (Seattle 5 a Day)
  was supported by R01 CA59731.
• We are additionally grateful for the support of
  the Health Maintenance Consortium 2004 -2009
• And to all the worksites that will have partnered
  with us for more than six years.

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Long term intervention effect by average FV
intake at worksite