OBJECTIVE: This paper describes the design characteristics of the National Heart, Lung, and Blood Institute (NHLBI)-funded studies that are testing innovative environmental interventions for weight control and obesity prevention at worksites. RESEARCH METHODS AND PROCEDURES: Seven separate studies that have a total of 114 worksites ( approximately 48,000 employees) across studies are being conducted. The worksite settings include hotels, hospitals, manufacturing facilities, businesses, schools, and bus garages located across the U.S. Each study uses its own conceptual model drawn from the literature and includes the socio-ecological model for health promotion, the epidemiological triad, and those integrating organizational and social contexts. The interventions, which are offered to all employees, include environmental- and individual-level approaches to improve physical activity and promote healthful eating practices. Environmental strategies include reducing portion sizes, modifying cafeteria recipes to lower their fat contents, and increasing the accessibility of fitness equipment at the workplace. Across all seven studies about 48% (N = 23,000) of the population is randomly selected for measurements. The primary outcome measure is change in BMI or body weight after two years of intervention. Secondary measures include waist circumference, objective, and self-report measures of physical activity, dietary intake, changes in vending machines and cafeteria food offerings, work productivity, healthcare use, and return on investment. DISCUSSION: The results of these studies could have important implications for the design and implementation of worksite overweight and obesity control programs.

Employees are often exposed to and bothered by environmental tobacco smoke (ETS) in the workplace; however, little is known about correlates of workers' perceptions of their exposure. In this study, 20,801 employees in 114 work sites in the United States were surveyed; variables related to perceptions of exposure and being bothered by ETS were entered into regression models. Many of the workplaces had total or partial restrictions on smoking in the workplace; however, over half of the respondents (52.4%) reported they were exposed to ETS at work. Smoking policy, smoking status, age, gender, living with a smoker, and occupation contributed to models for perceived exposure and being bothered by tobacco smoke. Work site smoking restrictions seem to have an impact on employee attitudes concerning exposure to ETS. About 35% of employees were bothered regularly by smokiness at their workplaces, which made their working conditions both uncomfortable and exposed them to an unsafe working environment.

OBJECTIVE: Ecological interventions hold promise for promoting overweight and obesity prevention in worksites. Given the paucity of evaluative research in the hospital worksite setting, considerable formative work is required for successful implementation and evaluation. This paper describes the formative phases of Step Ahead, a site-randomized controlled trial of a multilevel intervention that promotes physical activity and healthy eating in six hospitals in central Massachusetts. The purpose of the formative research phase was to increase the feasibility, effectiveness, and likelihood of sustainability of the intervention. RESEARCH METHODS AND PROCEDURES: The Step Ahead ecological intervention approach targets change at the organization, interpersonal work environment, and individual levels. The intervention was developed using fundamental steps of intervention mapping and important tenets of participatory research. Formative research methods were used to engage leadership support and assistance and to develop an intervention plan that is both theoretically and practically grounded. This report uses observational data, program minutes and reports, and process tracking data. RESULTS: Leadership involvement (key informant interviews and advisory boards), employee focus groups and advisory boards, and quantitative environmental assessments cultivated participation and support. Determining multiple foci of change and designing measurable objectives and generic assessment tools to document progress are complex challenges encountered in planning phases. DISCUSSION: Multilevel trials in diverse organizations require flexibility and balance of theory application and practice-based perspectives to affect impact and outcome objectives. Formative research is an essential component.

According to prior reports, blue-collar workers are less likely to participate in worksite health promotion programs than are white-collar workers. This study examined worker participation in the WellWorks worksite cancer prevention intervention, which integrated health promotion and health protection. Analyses were conducted to assess relationships among participation in health promotion and health protection programs, and workers' perceptions of management changes to reduce potential occupational exposures. Results indicate that blue-collar workers were less likely to report participating in health promotion activities than white-collar workers. A significant association was observed between participation in nutrition- and exposure-related activities, suggesting that participation in programs to reduce exposures to occupational hazards might contribute to blue-collar workers' participation in health promotion activities. Furthermore, when workers were aware of changes their employer had made to reduce exposures to occupational hazards, they were more likely to participate in both smoking control and nutrition activities, even when controlling for job category. These findings have clear implications for future worksite cancer prevention efforts.